Saturday, April 30, 2011
Protect With Iodine
Question: I am worried about the radiation fallout from the Japan nuclear plant disaster. How much iodine should I take to protect myself?
Dr. Brownstein's Answer:
My clinical experience has shown that more than 95 percent of patients who come to my office are iodine deficient. Furthermore, over the last 30 years, iodine levels have fallen by 50 percent across the United States. Practitioners from across the country have informed me that they are seeing similar numbers in their practice.
Therefore, I believe that most Americans are suffering from iodine deficiency. What are the consequences? The tissues affected by iodine deficiency include the thyroid (autoimmune disease, hypothyroidism, and thyroid cancer), breast (fibrocystic breast disease, breast cancer), ovary (cysts, cancer), uterus (fibroids, cancer), and prostate (enlargement, cancer). Iodine therapy may help all of these conditions.
It is estimated that the Japanese ingest around 12 mg of iodine per day. This amount of iodine has been shown to decrease the absorption of radioactive iodine by the thyroid gland by more than 95 percent.
My experience has shown that most adults require 6 to 50 mg per day of a combination of iodine and iodide. Lugol’s solution, Iodoral, and Iodizime HP are all examples of the optimal form of iodine for supplementation.
The best results with iodine supplementation occur as part of a holistic treatment regimen. I wrote about iodine in the July, 2008 issue of my "Natural Way to Health" newsletter. More information about iodine also can be found in my book, "Iodine: Why You Need It, Why You Can’t Live Without It."
Dr. Brownstein's Answer:
My clinical experience has shown that more than 95 percent of patients who come to my office are iodine deficient. Furthermore, over the last 30 years, iodine levels have fallen by 50 percent across the United States. Practitioners from across the country have informed me that they are seeing similar numbers in their practice.
Therefore, I believe that most Americans are suffering from iodine deficiency. What are the consequences? The tissues affected by iodine deficiency include the thyroid (autoimmune disease, hypothyroidism, and thyroid cancer), breast (fibrocystic breast disease, breast cancer), ovary (cysts, cancer), uterus (fibroids, cancer), and prostate (enlargement, cancer). Iodine therapy may help all of these conditions.
It is estimated that the Japanese ingest around 12 mg of iodine per day. This amount of iodine has been shown to decrease the absorption of radioactive iodine by the thyroid gland by more than 95 percent.
My experience has shown that most adults require 6 to 50 mg per day of a combination of iodine and iodide. Lugol’s solution, Iodoral, and Iodizime HP are all examples of the optimal form of iodine for supplementation.
The best results with iodine supplementation occur as part of a holistic treatment regimen. I wrote about iodine in the July, 2008 issue of my "Natural Way to Health" newsletter. More information about iodine also can be found in my book, "Iodine: Why You Need It, Why You Can’t Live Without It."
FUN FACTS
* If electrodes are inserted at opposite ends of a pickle, and electricity is passed through, the pickle will glow. *
* Disney`s Donald Duck was originally called Donald Drake. *
* A single sheeps fleece might well contain as many as 26 million fibers *
* The sunbeams that shine down through the clouds are called crespucular rays. *
* 0.3% of all road accidents in Canada involve a moose. *
* Disney`s Donald Duck was originally called Donald Drake. *
* A single sheeps fleece might well contain as many as 26 million fibers *
* The sunbeams that shine down through the clouds are called crespucular rays. *
* 0.3% of all road accidents in Canada involve a moose. *
Doctor-Recommended Remedies to Relieve Back Pain
Bending over your desk, twisting in the car seat, walking down stairs – all make you feel as if gnomes are beating tiny hammers on your back. Whatever its source, backaches are bad news, putting you out of sorts – and out of sync. Discover the common causes and how to relieve back pain. Plus, how bad is your back pain? Take our quiz to find out…
With all those years of toting tots, groceries, laundry, computer bags – even oversized purses with everything but the kitchen sink – it’s no wonder that women are no strangers to back pain.
But heavy loads aren’t the only culprits. Posture, arthritis and pregnancy are other triggers.
Women are particularly vulnerable “because they may develop osteoporosis, which is a weakening of the vertebrae,” says Reza Ghorbani, M.D., a pain management specialist at Suburban Hospital in Bethesda, Md. “And then they don’t have stability in their spines.”
But that doesn’t mean you have to live with the misery. Here’s a guide to 7 common culprits of backaches, plus doctor-recommended remedies to relieve back pain:
1. Back strain
Many activities women do daily – hoisting shopping bags, climbing in and out of cars, bending to pick up dirty clothes or kids – strain muscles and ligaments around the spine.
“The muscles start stretching and that can irritate the nerve ending in the muscles,” Ghorbani says.
What you can do: For starters, lift things correctly.
“Many people bend straight down to pick something up instead of squatting before lifting,” Ghorbani says.
The right way? Lift from the knees, using muscles in your legs and arms – not your back (see right).
Doctor’s fix: For minor, occasional back pain, “the first line of treatment is over-the-counter anti-inflammatory drugs, such as Advil or Motrin,” Ghorbani says. “Use as directed on the package.”
He also recommends topical pain relief creams because they act only where it hurts, not on your whole body.
Also, treat a sore back with a warm bath, he advises. “Heat increases the blood flow to the muscles, which helps ease the pain.”
To make a heating pad, fill a sock with rice, tie off the end and heat it in a microwave for a minute. Wrap this – or any heating pad – in a cloth to prevent burns and hold against your back for 15-20 minutes.
2. Slouching
Poor posture hurts your back, says rheumatologist Harris McIlwain, M.D., author of The Pain-Free Back (Henry Holt & Co). Sitting or standing with shoulders slouched forward strains muscles.
“If you sit leaning forward, the pressure on the spine is much greater than if you're sitting straight,” McIlwain says.
Normally, your lower back has a slight inward curve, adds Sheeraz Qureshi, M.D., assistant professor of orthopedic surgery at Mount Sinai School of Medicine in New York City.
“Poor posture causes your back to come out of that curve, which puts more pressure on your spinal discs and back muscles,” he says.
What you can do: “Get a comfortable desk chair that has arms and allows you to put your feet on the floor,” McIlwain says (see right).
Then elevate your feet with a stool or something similar, which relieves pressure on your back, Qureshi says.
Don’t have an aerodynamic office chair? Then you’ll need lumbar, or lower back, support. So tuck a pillow behind your lower back and keep your shoulders back, with head aligned over your shoulders.
Also, don’t sit in the same position all day, McIlwain says: Get up and walk around the desk or do a few stretches every half-hour.
When standing, lift your breastbone, straighten your shoulders, keep your chin level and spine neutral, with buttocks neither too far out (a swayback) nor too tucked under.
And try the following exercise in your chair several times a day, McIlwain advises:
Tighten your buttocks' muscles and count to 10, then relax them. Do two more times. This strengthens the gluteus muscles, the large muscles in the buttocks that help support the hips.
When they aren’t strong, back muscles jump in to do their work. The result? Lower-back pain.
Doctor’s fix: “One of the first lines of treatment is physical therapy,” Qureshi says. “The therapist can focus on strengthening the muscles around the spine.”
Many physical therapists can evaluate your work station, checking where the computer and keyboard location and the type and height of your chair.
“Then they can put you in the best position for your back,” Qureshi says.
In some cases, the doctor may recommend wearing a back brace, which will help correct your posture and relieve pain – but only temporarily.
“Don’t wear one indefinitely,” Qureshi warns. “Braces do the job of the muscles, so in the long run the muscles can weaken.”
When you have severe back pain, use a brace, such as a support belt, for around three days, allowing the back “to calm down,” he says.
3. Too much couch time
Out-of-shape muscles are the enemy here.
“You can’t stop aging,” Ghorbani says. “But by strengthening your lower back muscles with exercise and stretching, you can avoid back pain.”
What you can do: Try a low-impact aerobic exercise that gets your heart pumping – such as walking or swimming – every day, building to at least 20 minutes at a time, Qureshi says.
“Stretching and range of motion exercises, like Pilates and yoga, are also very good,” he says. (Check out our easy yoga exercises slideshow.)
Don’t have time? “Even simple things like stretching for 10 minutes a day can protect your back by improving your posture and muscle [strength].”
Doctor’s fix: Ask your doc to recommend exercises that strengthen back and abdominal muscles (which support the back). You may also be referred to a physical therapist to learn proper form for exercises and help you set up a back-boosting fitness routine.
4. Pregnancy
At least half of pregnant women have some back pain, from general lower back aches to sciatica – a searing pain from the buttocks that shoots down the leg.
Why? Blame the bundle of joy you’re carrying.
During pregnancy, “the uterus enlarges and that shifts the center of gravity forward,” says Robert Goldfarb, M.D., an obstetrician/gynecologist at Henry Ford West Bloomfield Hospital in West Bloomfield, Mich. “So you’re tilted a little backward to maintain posture and your back muscles have to work harder.”
Plus, in the third trimester, hormones relax your pelvic ligaments, loosening joints and intensifying back pain, Goldfarb says.
What you can do: The better shape you’re in physically, the less likely you are to have back pain, Goldfarb says.
“It’s hard to do sit-ups when you’re pregnant,” he says. “But get regular exercise, like walking or water aerobics.”
He also recommends stretching and flexibility exercises, like yoga.
“And make sure you have a solid mattress,” Goldfarb says. Soft mattresses don’t support the natural position of the spine, throwing it out of alignment, he says. In turn, that places stress on back muscles, ligaments and joints.
“If it’s more than 5 years old, stick a piece of plywood beneath it to make it firmer,” he suggests.
That’s a helpful tip for any back pain – pregnancy or not.
Doctor’s fix: Don’t take non-steroidal anti-inflammatories drugs (NSAID), such as Advil and Motrin. They aren’t safe for pregnant women because they can affect the baby’s circulatory system, Goldfarb says.
But Tylenol gets the doctor’s nod, and for severe back pain, you may be prescribed a narcotic pain reliever such as Vicodyn or Tylenol with codeine – both are safe during pregnancy, he says.
5. Excess weight
The more you weigh, the harder it is for the spine to support your body. Add weak muscles to excess weight and you’ll soon be reaching for Advil.
What you can do: “You want to be as close to your ideal weight as [possible],” Qureshi says. Find out what it is by using our BMI calculator – or ask your doctor.
Even a loss of few pounds’ can help with back pain, doctors agree.
“If calories in are less than calories out, you’re going to lose weight,” he says.
Eating more lean meats, fruits, veggies and whole grains instead of high-fat, sugar-laden fast foods will also help you feel full on fewer calories.
And, of course, exercise more.
Doctor’s fix: If you need help to lose weight, see a nutritionist, McIlwain says.
“A nutritionist can give you personal instruction in basic diet choices,” and develop a weight-loss plan for you, he says.
But even if weight loss is difficult, you can still relieve back pain by doing exercises for the back and hamstrings to strengthen those weight-bearing muscles.
Weak hamstrings – the muscles at the back of the legs that connect to the pelvis – can make it tilt forward, which then causes muscle tightness in your lower back.
Here’s McIlwain’s exercise to strengthen hamstrings: Sitting in a desk chair, push one foot down into the floor (using your muscles) until you feel the hamstring tighten. Hold for 10 seconds, then release. Repeat with the other side. To start, perform 1-2 reps of the exercise twice a day, building up to 20 reps twice a day.
6. Stress
The refrigerator’s broken, the babysitter didn’t show up and you were late to work. Now you’re feeling an angry twinge in your back. Why today?
Blame stress. It triggers the release of cortisol, adrenaline and other hormones that rev up your body to fight or flee whatever’s agitating you. That makes muscles tighten, irritating the nerves and increasing inflammation, which causes back pain, Qureshi says.
What you can do: Simply realizing when you’re experiencing stress and trying to control its triggers can help relieve back pain, he says.
Then take steps to de-stress: Cut out unnecessary events in your schedule. Instead, go for a walk (which both relaxes you and improves fitness) or take a warm bath mixed with a couple cups of Epsom salts. The magnesium in the salts helps relax aching muscles.
Also try deep breathing exercises, which can help relieve back pain and stress, says Loren Gelberg-Goff, a clinical social worker in River Edge, N.J.
“Pain generally makes people tense up, causing more pain and tension,” Gelberg-Goff says. “Deep breathing changes that pattern.”
Breathe in through your nose to the count of four, feeling your stomach push out, then release slowly through your mouth to the count of four.
“Do it for at least a full minute every hour,” Gelberg-Goff recommends.
Doctor’s fix: If anxiety lies behind your back aches, you may be referred to a psychotherapist, who can help identify stressors, work to eliminate them and teach you to react less strongly to those you can’t avoid.
7. Degenerative disc disease
Around age 30, we begin to lose some of the cushioning from the discs between the bones in our spines, due to aging, wear and tear or trauma.
“Degeneration can be a normal part of the aging process,” says Scott L. Blumenthal, M.D., an orthopedic spine surgeon at the Texas Back Institute in Plano, Texas.
The joints between vertebrae – facet joints – also begin to deteriorate, adding to the ache. Both conditions can cause a bulging (herniated) disc, Ghorbani says, which occurs when the discs shift, touching the nerves in the spine. The result is severe back pain shooting to the toes.
What you can do: “Some of the pain comes from inflammation,” Qureshi says, “so you can take over-the-counter anti-inflammatories like Advil or Aleve.”
Also apply ice for about 10 minutes every 1-1/2 hours, he says. Make sure the ice is wrapped in a cloth so you don’t get ice burn.
If you smoke, stop.
“Smoking shrinks blood vessels and without blood flow, discs become dehydrated and don’t get the nutrients they need,” Ghorbani says.
And avoid standing for long periods, he says. “When you stand, it compresses the discs further,” which is why we’re taller in the morning than in the evening. When the discs compress, “that causes pain.”
Doctor’s fix: Your doctor may prescribe anti-inflammatories, physical therapy or cortisone injections – the latter relieves inflammation at the site for many.
“But if the bulging disc is causing a lot of nerve pressure and you have numbness or tingling going down the leg, you need to see a back specialist to remove the disc,” Qureshi says.
That could involve spinal fusion surgery, in which the damaged disc is removed and the vertebrae above and below are fused together.
“It’s the tried-and-true method,” Qureshi says.
The downside is that you lose some spinal mobility in the area, which places more stress on the parts of the spine that still move.
“But once you have disc and arthritic changes, you’ve already lost movement,” Qureshi says. “So the amount of movement you lose with fusion is small.”
Another option: replacing the damaged disc with an artificial one. Disc replacement, a procedure available only in the last decade, “can treat the disc problem and preserve motion,” Blumenthal says. “It’s the greatest advance in spinal surgery in 20 years.”
Still, the life span of artificial discs isn’t clear. And, says Qureshi, if you have pain and arthritis in other areas of the spine, your pain may not diminish as much as you hoped.
With all those years of toting tots, groceries, laundry, computer bags – even oversized purses with everything but the kitchen sink – it’s no wonder that women are no strangers to back pain.
But heavy loads aren’t the only culprits. Posture, arthritis and pregnancy are other triggers.
Women are particularly vulnerable “because they may develop osteoporosis, which is a weakening of the vertebrae,” says Reza Ghorbani, M.D., a pain management specialist at Suburban Hospital in Bethesda, Md. “And then they don’t have stability in their spines.”
But that doesn’t mean you have to live with the misery. Here’s a guide to 7 common culprits of backaches, plus doctor-recommended remedies to relieve back pain:
1. Back strain
Many activities women do daily – hoisting shopping bags, climbing in and out of cars, bending to pick up dirty clothes or kids – strain muscles and ligaments around the spine.
“The muscles start stretching and that can irritate the nerve ending in the muscles,” Ghorbani says.
What you can do: For starters, lift things correctly.
“Many people bend straight down to pick something up instead of squatting before lifting,” Ghorbani says.
The right way? Lift from the knees, using muscles in your legs and arms – not your back (see right).
Doctor’s fix: For minor, occasional back pain, “the first line of treatment is over-the-counter anti-inflammatory drugs, such as Advil or Motrin,” Ghorbani says. “Use as directed on the package.”
He also recommends topical pain relief creams because they act only where it hurts, not on your whole body.
Also, treat a sore back with a warm bath, he advises. “Heat increases the blood flow to the muscles, which helps ease the pain.”
To make a heating pad, fill a sock with rice, tie off the end and heat it in a microwave for a minute. Wrap this – or any heating pad – in a cloth to prevent burns and hold against your back for 15-20 minutes.
2. Slouching
Poor posture hurts your back, says rheumatologist Harris McIlwain, M.D., author of The Pain-Free Back (Henry Holt & Co). Sitting or standing with shoulders slouched forward strains muscles.
“If you sit leaning forward, the pressure on the spine is much greater than if you're sitting straight,” McIlwain says.
Normally, your lower back has a slight inward curve, adds Sheeraz Qureshi, M.D., assistant professor of orthopedic surgery at Mount Sinai School of Medicine in New York City.
“Poor posture causes your back to come out of that curve, which puts more pressure on your spinal discs and back muscles,” he says.
What you can do: “Get a comfortable desk chair that has arms and allows you to put your feet on the floor,” McIlwain says (see right).
Then elevate your feet with a stool or something similar, which relieves pressure on your back, Qureshi says.
Don’t have an aerodynamic office chair? Then you’ll need lumbar, or lower back, support. So tuck a pillow behind your lower back and keep your shoulders back, with head aligned over your shoulders.
Also, don’t sit in the same position all day, McIlwain says: Get up and walk around the desk or do a few stretches every half-hour.
When standing, lift your breastbone, straighten your shoulders, keep your chin level and spine neutral, with buttocks neither too far out (a swayback) nor too tucked under.
And try the following exercise in your chair several times a day, McIlwain advises:
Tighten your buttocks' muscles and count to 10, then relax them. Do two more times. This strengthens the gluteus muscles, the large muscles in the buttocks that help support the hips.
When they aren’t strong, back muscles jump in to do their work. The result? Lower-back pain.
Doctor’s fix: “One of the first lines of treatment is physical therapy,” Qureshi says. “The therapist can focus on strengthening the muscles around the spine.”
Many physical therapists can evaluate your work station, checking where the computer and keyboard location and the type and height of your chair.
“Then they can put you in the best position for your back,” Qureshi says.
In some cases, the doctor may recommend wearing a back brace, which will help correct your posture and relieve pain – but only temporarily.
“Don’t wear one indefinitely,” Qureshi warns. “Braces do the job of the muscles, so in the long run the muscles can weaken.”
When you have severe back pain, use a brace, such as a support belt, for around three days, allowing the back “to calm down,” he says.
3. Too much couch time
Out-of-shape muscles are the enemy here.
“You can’t stop aging,” Ghorbani says. “But by strengthening your lower back muscles with exercise and stretching, you can avoid back pain.”
What you can do: Try a low-impact aerobic exercise that gets your heart pumping – such as walking or swimming – every day, building to at least 20 minutes at a time, Qureshi says.
“Stretching and range of motion exercises, like Pilates and yoga, are also very good,” he says. (Check out our easy yoga exercises slideshow.)
Don’t have time? “Even simple things like stretching for 10 minutes a day can protect your back by improving your posture and muscle [strength].”
Doctor’s fix: Ask your doc to recommend exercises that strengthen back and abdominal muscles (which support the back). You may also be referred to a physical therapist to learn proper form for exercises and help you set up a back-boosting fitness routine.
4. Pregnancy
At least half of pregnant women have some back pain, from general lower back aches to sciatica – a searing pain from the buttocks that shoots down the leg.
Why? Blame the bundle of joy you’re carrying.
During pregnancy, “the uterus enlarges and that shifts the center of gravity forward,” says Robert Goldfarb, M.D., an obstetrician/gynecologist at Henry Ford West Bloomfield Hospital in West Bloomfield, Mich. “So you’re tilted a little backward to maintain posture and your back muscles have to work harder.”
Plus, in the third trimester, hormones relax your pelvic ligaments, loosening joints and intensifying back pain, Goldfarb says.
What you can do: The better shape you’re in physically, the less likely you are to have back pain, Goldfarb says.
“It’s hard to do sit-ups when you’re pregnant,” he says. “But get regular exercise, like walking or water aerobics.”
He also recommends stretching and flexibility exercises, like yoga.
“And make sure you have a solid mattress,” Goldfarb says. Soft mattresses don’t support the natural position of the spine, throwing it out of alignment, he says. In turn, that places stress on back muscles, ligaments and joints.
“If it’s more than 5 years old, stick a piece of plywood beneath it to make it firmer,” he suggests.
That’s a helpful tip for any back pain – pregnancy or not.
Doctor’s fix: Don’t take non-steroidal anti-inflammatories drugs (NSAID), such as Advil and Motrin. They aren’t safe for pregnant women because they can affect the baby’s circulatory system, Goldfarb says.
But Tylenol gets the doctor’s nod, and for severe back pain, you may be prescribed a narcotic pain reliever such as Vicodyn or Tylenol with codeine – both are safe during pregnancy, he says.
5. Excess weight
The more you weigh, the harder it is for the spine to support your body. Add weak muscles to excess weight and you’ll soon be reaching for Advil.
What you can do: “You want to be as close to your ideal weight as [possible],” Qureshi says. Find out what it is by using our BMI calculator – or ask your doctor.
Even a loss of few pounds’ can help with back pain, doctors agree.
“If calories in are less than calories out, you’re going to lose weight,” he says.
Eating more lean meats, fruits, veggies and whole grains instead of high-fat, sugar-laden fast foods will also help you feel full on fewer calories.
And, of course, exercise more.
Doctor’s fix: If you need help to lose weight, see a nutritionist, McIlwain says.
“A nutritionist can give you personal instruction in basic diet choices,” and develop a weight-loss plan for you, he says.
But even if weight loss is difficult, you can still relieve back pain by doing exercises for the back and hamstrings to strengthen those weight-bearing muscles.
Weak hamstrings – the muscles at the back of the legs that connect to the pelvis – can make it tilt forward, which then causes muscle tightness in your lower back.
Here’s McIlwain’s exercise to strengthen hamstrings: Sitting in a desk chair, push one foot down into the floor (using your muscles) until you feel the hamstring tighten. Hold for 10 seconds, then release. Repeat with the other side. To start, perform 1-2 reps of the exercise twice a day, building up to 20 reps twice a day.
6. Stress
The refrigerator’s broken, the babysitter didn’t show up and you were late to work. Now you’re feeling an angry twinge in your back. Why today?
Blame stress. It triggers the release of cortisol, adrenaline and other hormones that rev up your body to fight or flee whatever’s agitating you. That makes muscles tighten, irritating the nerves and increasing inflammation, which causes back pain, Qureshi says.
What you can do: Simply realizing when you’re experiencing stress and trying to control its triggers can help relieve back pain, he says.
Then take steps to de-stress: Cut out unnecessary events in your schedule. Instead, go for a walk (which both relaxes you and improves fitness) or take a warm bath mixed with a couple cups of Epsom salts. The magnesium in the salts helps relax aching muscles.
Also try deep breathing exercises, which can help relieve back pain and stress, says Loren Gelberg-Goff, a clinical social worker in River Edge, N.J.
“Pain generally makes people tense up, causing more pain and tension,” Gelberg-Goff says. “Deep breathing changes that pattern.”
Breathe in through your nose to the count of four, feeling your stomach push out, then release slowly through your mouth to the count of four.
“Do it for at least a full minute every hour,” Gelberg-Goff recommends.
Doctor’s fix: If anxiety lies behind your back aches, you may be referred to a psychotherapist, who can help identify stressors, work to eliminate them and teach you to react less strongly to those you can’t avoid.
7. Degenerative disc disease
Around age 30, we begin to lose some of the cushioning from the discs between the bones in our spines, due to aging, wear and tear or trauma.
“Degeneration can be a normal part of the aging process,” says Scott L. Blumenthal, M.D., an orthopedic spine surgeon at the Texas Back Institute in Plano, Texas.
The joints between vertebrae – facet joints – also begin to deteriorate, adding to the ache. Both conditions can cause a bulging (herniated) disc, Ghorbani says, which occurs when the discs shift, touching the nerves in the spine. The result is severe back pain shooting to the toes.
What you can do: “Some of the pain comes from inflammation,” Qureshi says, “so you can take over-the-counter anti-inflammatories like Advil or Aleve.”
Also apply ice for about 10 minutes every 1-1/2 hours, he says. Make sure the ice is wrapped in a cloth so you don’t get ice burn.
If you smoke, stop.
“Smoking shrinks blood vessels and without blood flow, discs become dehydrated and don’t get the nutrients they need,” Ghorbani says.
And avoid standing for long periods, he says. “When you stand, it compresses the discs further,” which is why we’re taller in the morning than in the evening. When the discs compress, “that causes pain.”
Doctor’s fix: Your doctor may prescribe anti-inflammatories, physical therapy or cortisone injections – the latter relieves inflammation at the site for many.
“But if the bulging disc is causing a lot of nerve pressure and you have numbness or tingling going down the leg, you need to see a back specialist to remove the disc,” Qureshi says.
That could involve spinal fusion surgery, in which the damaged disc is removed and the vertebrae above and below are fused together.
“It’s the tried-and-true method,” Qureshi says.
The downside is that you lose some spinal mobility in the area, which places more stress on the parts of the spine that still move.
“But once you have disc and arthritic changes, you’ve already lost movement,” Qureshi says. “So the amount of movement you lose with fusion is small.”
Another option: replacing the damaged disc with an artificial one. Disc replacement, a procedure available only in the last decade, “can treat the disc problem and preserve motion,” Blumenthal says. “It’s the greatest advance in spinal surgery in 20 years.”
Still, the life span of artificial discs isn’t clear. And, says Qureshi, if you have pain and arthritis in other areas of the spine, your pain may not diminish as much as you hoped.
Low vitamin D levels linked to diabetes risk
NEW YORK (Reuters Health) - Lower levels of vitamin D circulating in the bloodstream are tied to a higher risk of developing diabetes in a new study of Australian adults.
After following more than 5,000 people for 5 years, the researchers found those with lower than average vitamin D levels had a 57 percent increased risk of developing type 2 diabetes compared to people with levels in the recommended range.
"Studies like ours have suggested that blood levels of vitamin D higher than what is recommended for bone health may be necessary to reduce the risk of developing type 2 diabetes," said lead author Dr. Claudia Gagnon, a fellow at the Western Hospital at the University of Melbourne in Australia when the study was done.
Vitamin D is manufactured by the body in response to sunlight and also occurs naturally in some foods, like eggs, cod and salmon. The vitamin is best known for its role in working with calcium to build bones.
The Institute of Medicine recommends that adults get about 600 IU of vitamin D a day to maintain circulating levels in the desirable range.
Past studies have shown that vitamin D may also help keep blood sugar levels under control (see Reuters Health story of February 23, 2011).
In type 2 diabetes, the most common form of the disease, the body can't use insulin it produces efficiently to control blood sugar levels. Vitamin D may play a role by increasing the release of insulin, Gagnon said.
To see whether circulating D levels and calcium consumption influenced insulin sensitivity and diabetes risk, Gagnon's team measured the vitamin D blood levels of 5,200 people without diabetes. After 5 years, about 200 of them had developed diabetes, and the researchers measured everyone's vitamin D levels again.
The researchers found that twice as many people (6 in 100) with low blood levels of vitamin D later developed diabetes, compared to those with blood levels in the normal range (3 in 100).
When the researchers took into consideration risk factors for diabetes such as age, waist circumference, and a family history of the disease, the increased risk from low D levels translated to 57 percent, relative to those with higher levels.
Calcium is also thought to participate in insulin release, but the researchers found no link between the mineral and risk of developing diabetes later.
"Lower levels of vitamin D in the blood were associated with an increased risk of developing type 2 diabetes," Gagnon told Reuters Health by e-mail. "However, our findings do not prove cause and effect."
Further studies are needed, Gagnon's group writes in the journal Diabetes Care, both to directly test whether vitamin D supplements make a difference in diabetes risk, and if so, to determine the optimal circulating D levels to minimize that risk.
It's hard to know what exactly the link between vitamin D and diabetes is, Dr. Ian de Boer, assistant professor of medicine at the University of Washington in Seattle, told Reuters Health.
But obesity and inactivity, the highest risk factors for type 2 diabetes, may be the cause of low vitamin D levels, said de Boer, who did not work on the Australian study.
Vitamin D has also been linked to lower risks of asthma, heart disease, and certain cancers. However, there hasn't been much evidence showing that taking supplements helps these conditions.
Vitamin D is widely available for less than $10 for a 2-month supply.
The sun is the major vitamin D source for most people, but salmon and fortified dairy products also contain a lot, de Boer added.
The best ways to reduce diabetes risk are still to exercise and eat a healthy diet, he said.
"I don't think there's conclusive information that supplementing with vitamin D reduces diabetes risk," de Boer said.
SOURCE: http://bit.ly/gblGJj Diabetes Care, online March 23, 2011.
After following more than 5,000 people for 5 years, the researchers found those with lower than average vitamin D levels had a 57 percent increased risk of developing type 2 diabetes compared to people with levels in the recommended range.
"Studies like ours have suggested that blood levels of vitamin D higher than what is recommended for bone health may be necessary to reduce the risk of developing type 2 diabetes," said lead author Dr. Claudia Gagnon, a fellow at the Western Hospital at the University of Melbourne in Australia when the study was done.
Vitamin D is manufactured by the body in response to sunlight and also occurs naturally in some foods, like eggs, cod and salmon. The vitamin is best known for its role in working with calcium to build bones.
The Institute of Medicine recommends that adults get about 600 IU of vitamin D a day to maintain circulating levels in the desirable range.
Past studies have shown that vitamin D may also help keep blood sugar levels under control (see Reuters Health story of February 23, 2011).
In type 2 diabetes, the most common form of the disease, the body can't use insulin it produces efficiently to control blood sugar levels. Vitamin D may play a role by increasing the release of insulin, Gagnon said.
To see whether circulating D levels and calcium consumption influenced insulin sensitivity and diabetes risk, Gagnon's team measured the vitamin D blood levels of 5,200 people without diabetes. After 5 years, about 200 of them had developed diabetes, and the researchers measured everyone's vitamin D levels again.
The researchers found that twice as many people (6 in 100) with low blood levels of vitamin D later developed diabetes, compared to those with blood levels in the normal range (3 in 100).
When the researchers took into consideration risk factors for diabetes such as age, waist circumference, and a family history of the disease, the increased risk from low D levels translated to 57 percent, relative to those with higher levels.
Calcium is also thought to participate in insulin release, but the researchers found no link between the mineral and risk of developing diabetes later.
"Lower levels of vitamin D in the blood were associated with an increased risk of developing type 2 diabetes," Gagnon told Reuters Health by e-mail. "However, our findings do not prove cause and effect."
Further studies are needed, Gagnon's group writes in the journal Diabetes Care, both to directly test whether vitamin D supplements make a difference in diabetes risk, and if so, to determine the optimal circulating D levels to minimize that risk.
It's hard to know what exactly the link between vitamin D and diabetes is, Dr. Ian de Boer, assistant professor of medicine at the University of Washington in Seattle, told Reuters Health.
But obesity and inactivity, the highest risk factors for type 2 diabetes, may be the cause of low vitamin D levels, said de Boer, who did not work on the Australian study.
Vitamin D has also been linked to lower risks of asthma, heart disease, and certain cancers. However, there hasn't been much evidence showing that taking supplements helps these conditions.
Vitamin D is widely available for less than $10 for a 2-month supply.
The sun is the major vitamin D source for most people, but salmon and fortified dairy products also contain a lot, de Boer added.
The best ways to reduce diabetes risk are still to exercise and eat a healthy diet, he said.
"I don't think there's conclusive information that supplementing with vitamin D reduces diabetes risk," de Boer said.
SOURCE: http://bit.ly/gblGJj Diabetes Care, online March 23, 2011.
US Appeals Court Lifts Stem-Cell Research Ban
WASHINGTON — Opponents of taxpayer-funded embryonic stem-cell research lost a key round in a U.S. appeals court Friday.
In a 2-1 decision, a panel of the court of appeals in Washington overturned a judge's order that would have blocked federal financing of stem-cell research. The judges ruled that opponents are not likely to succeed in their lawsuit to stop the government funding.
The panel reversed an opinion in August from U.S. District Judge Royce Lamberth, who said the research likely violates the law against federal funding of embryo destruction.
The White House praised the ruling. "Responsible stem-cell research has the potential to treat some of our most devastating diseases and conditions and offers hope to families across the country and around the world," said spokesman Nick Papas. He said the ruling was a victory for scientists and patients.
Researchers hope one day to use stem cells in ways that cure spinal cord injuries, Parkinson's disease and other ailments. Opponents say the research is a form of abortion because human embryos must be destroyed to obtain the stem cells.
The 1996 law prohibits the use of taxpayer dollars in work that harms an embryo, so private money has been used to cull batches of the cells. Those batches can reproduce in lab dishes indefinitely, and the Obama administration issued rules permitting taxpayer dollars to be used in work on them.
The lawsuit was filed in 2009 by two scientists who argued that Obama's expansion jeopardized their ability to win government funding for research using adult stem cells — ones that have already matured to create specific types of tissues — because it will mean extra competition.
Lamberth, the chief judge of the U.S. District Court in Washington, issued a preliminary injunction in August to block the research while the case continued.
The Obama administration immediately appealed and requested the order be stopped. The appeals court quickly ruled that the research could continue at the National Institutes of Health while the judges took up the case.
The appeals court ruled Friday that Lamberth's injunction would impose a substantial hardship on stem cell researchers at NIH, particularly because it would stop multi-year projects already underway. The appellate judges also noted that Congress has re-enacted the 1996 embryo-protection law, called the Dickey-Wicker amendment, year after year with the knowledge that the government has been funding embryonic stem cell research since 2001 — evidence that Congress considers funding of such research permissible.
The majority opinion was written by Judge Douglas Ginsburg, nominated to the court by President Ronald Reagan, and supported by Judge Thomas Griffith, a nominee of President George W. Bush. The dissent came from Judge Karen LeCraft Henderson, a nominee of President George H.W. Bush.
Henderson said she agreed with the lower court judge that the lawsuit was likely to succeed and said her colleagues "perform linguistic jujitsu" by taking a straightforward case and issuing an unnecessarily complicated 21-page ruling "that would make Rube Goldberg tip his hat."
As a result of the appellate ruling Friday, the original lawsuit can continue before Judge Lamberth, but the taxpayer-funded research also will go on. Lamberth has not thus far either held a trial or issued a final ruling, which he could do based on court filings without taking testimony.
"We're thrilled with this decision and look forward to allowing federally funded scientists to continue with their work without political constraints," said Sean Tipton, a spokesman for the American Society for Reproductive Medicine.
Once the cells are culled, they can reproduce in lab dishes indefinitely. So government policies said using taxpayer dollars to work with the already-created batches of cells is allowed.
The Obama administration has expanded the number of stem cell lines created with private money that federally funded scientists could research, up from the 21 that President George W. Bush had allowed to at least 75 so far. To qualify, parents who donate the original embryo must be told of other options, such as donating to another infertile woman.
In a 2-1 decision, a panel of the court of appeals in Washington overturned a judge's order that would have blocked federal financing of stem-cell research. The judges ruled that opponents are not likely to succeed in their lawsuit to stop the government funding.
The panel reversed an opinion in August from U.S. District Judge Royce Lamberth, who said the research likely violates the law against federal funding of embryo destruction.
The White House praised the ruling. "Responsible stem-cell research has the potential to treat some of our most devastating diseases and conditions and offers hope to families across the country and around the world," said spokesman Nick Papas. He said the ruling was a victory for scientists and patients.
Researchers hope one day to use stem cells in ways that cure spinal cord injuries, Parkinson's disease and other ailments. Opponents say the research is a form of abortion because human embryos must be destroyed to obtain the stem cells.
The 1996 law prohibits the use of taxpayer dollars in work that harms an embryo, so private money has been used to cull batches of the cells. Those batches can reproduce in lab dishes indefinitely, and the Obama administration issued rules permitting taxpayer dollars to be used in work on them.
The lawsuit was filed in 2009 by two scientists who argued that Obama's expansion jeopardized their ability to win government funding for research using adult stem cells — ones that have already matured to create specific types of tissues — because it will mean extra competition.
Lamberth, the chief judge of the U.S. District Court in Washington, issued a preliminary injunction in August to block the research while the case continued.
The Obama administration immediately appealed and requested the order be stopped. The appeals court quickly ruled that the research could continue at the National Institutes of Health while the judges took up the case.
The appeals court ruled Friday that Lamberth's injunction would impose a substantial hardship on stem cell researchers at NIH, particularly because it would stop multi-year projects already underway. The appellate judges also noted that Congress has re-enacted the 1996 embryo-protection law, called the Dickey-Wicker amendment, year after year with the knowledge that the government has been funding embryonic stem cell research since 2001 — evidence that Congress considers funding of such research permissible.
The majority opinion was written by Judge Douglas Ginsburg, nominated to the court by President Ronald Reagan, and supported by Judge Thomas Griffith, a nominee of President George W. Bush. The dissent came from Judge Karen LeCraft Henderson, a nominee of President George H.W. Bush.
Henderson said she agreed with the lower court judge that the lawsuit was likely to succeed and said her colleagues "perform linguistic jujitsu" by taking a straightforward case and issuing an unnecessarily complicated 21-page ruling "that would make Rube Goldberg tip his hat."
As a result of the appellate ruling Friday, the original lawsuit can continue before Judge Lamberth, but the taxpayer-funded research also will go on. Lamberth has not thus far either held a trial or issued a final ruling, which he could do based on court filings without taking testimony.
"We're thrilled with this decision and look forward to allowing federally funded scientists to continue with their work without political constraints," said Sean Tipton, a spokesman for the American Society for Reproductive Medicine.
Once the cells are culled, they can reproduce in lab dishes indefinitely. So government policies said using taxpayer dollars to work with the already-created batches of cells is allowed.
The Obama administration has expanded the number of stem cell lines created with private money that federally funded scientists could research, up from the 21 that President George W. Bush had allowed to at least 75 so far. To qualify, parents who donate the original embryo must be told of other options, such as donating to another infertile woman.
Is Weight-Loss Surgery the Answer to Diabetes?
Weight-loss surgery appears to change the body's metabolism in a way that dieting alone cannot, helping to explain why diabetes often disappears after the surgery even before much weight is lost, U.S. researchers said on Wednesday.
Understanding how gastric bypass affects metabolism could shed light on treatments for Type-2 diabetes, which has become a global epidemic and is strongly linked with obesity and too little exercise.
Weight-loss surgery is becoming increasingly popular as obese people struggle to lose weight and avoid the health complications that accompany the extra pounds — including diabetes, heart disease, joint pain, and some cancers.
In research conducted at Columbia University in New York and Duke University in North Carolina, scientists studied two small groups of severely obese diabetic patients who either had gastric bypass surgery or went on strict diets.
Both groups lost about 20 pounds.
For the study, the teams measured metabolites — chemical byproducts of foods in the body.
They found that unlike dieting, gastric bypass changes a person's metabolism by significantly reducing levels of circulating amino acids — compounds linked with obesity, diabetes, and insulin resistance.
"What we were trying to do is cast a very wide net," said Christopher Newgard of Duke, who worked on the study published in Science Translational Medicine.
"What we caught is a very clear difference between bariatric surgery and dietary intervention."
He said patients in the surgery group had lower levels of molecules known as branch chain amino acids.
"These dropped much more precipitously in people having bariatric surgery than people having the dietary intervention," he said.
People in the gastric bypass arm of the study underwent a surgery known as Roux-en-Y, in which doctors surgically reduce the size of the stomach to prevent people from eating too much.
Newgard said it is not clear why reducing stomach size might have this effect, but it is clear that bariatric surgery results in significant metabolic changes.
The team is now looking to discover ways to develop drugs that could replicate this effect.
Newgard said the results might not apply to Allergan's Lap-Band weight-loss device, in which doctors insert an adjustable silicone band around the upper part of the stomach but do not surgically reduce the size of the stomach.
Up to one-third of U.S. adults could suffer from diabetes by 2050, according to the Centers for Disease Control and Prevention.
Understanding how gastric bypass affects metabolism could shed light on treatments for Type-2 diabetes, which has become a global epidemic and is strongly linked with obesity and too little exercise.
Weight-loss surgery is becoming increasingly popular as obese people struggle to lose weight and avoid the health complications that accompany the extra pounds — including diabetes, heart disease, joint pain, and some cancers.
In research conducted at Columbia University in New York and Duke University in North Carolina, scientists studied two small groups of severely obese diabetic patients who either had gastric bypass surgery or went on strict diets.
Both groups lost about 20 pounds.
For the study, the teams measured metabolites — chemical byproducts of foods in the body.
They found that unlike dieting, gastric bypass changes a person's metabolism by significantly reducing levels of circulating amino acids — compounds linked with obesity, diabetes, and insulin resistance.
"What we were trying to do is cast a very wide net," said Christopher Newgard of Duke, who worked on the study published in Science Translational Medicine.
"What we caught is a very clear difference between bariatric surgery and dietary intervention."
He said patients in the surgery group had lower levels of molecules known as branch chain amino acids.
"These dropped much more precipitously in people having bariatric surgery than people having the dietary intervention," he said.
People in the gastric bypass arm of the study underwent a surgery known as Roux-en-Y, in which doctors surgically reduce the size of the stomach to prevent people from eating too much.
Newgard said it is not clear why reducing stomach size might have this effect, but it is clear that bariatric surgery results in significant metabolic changes.
The team is now looking to discover ways to develop drugs that could replicate this effect.
Newgard said the results might not apply to Allergan's Lap-Band weight-loss device, in which doctors insert an adjustable silicone band around the upper part of the stomach but do not surgically reduce the size of the stomach.
Up to one-third of U.S. adults could suffer from diabetes by 2050, according to the Centers for Disease Control and Prevention.
Friday, April 29, 2011
THOUGHT FOR THE DAY ....
Trees will clear a path for the presence of you / Flowers will bow to the greatness of you / And all the world is enhanced by you...still
Childhood stimulation may reduce adult violence
NEW YORK (Reuters Health) -Toddlers in a program to encourage interaction and play with their mothers grew into adults with higher IQs, greater educational attainment and less involvement in violence than kids who did not receive the early stimulation, a new study finds.
These latest results are the fourth follow-up in a series of studies since the early-childhood program ended, about 20 years ago.
"The most exciting finding this time was the reduction in violent behavior, because that's something we haven't shown before," said Dr. Susan Walker, the lead researcher and a professor at the University of the West Indies in Jamaica.
Beginning in the 1980s, Walker and her colleagues tracked 129 Jamaican toddlers who all had stunted growth and lived in an impoverished area.
One group of children was part of the stimulation program, another was given supplemental baby formula, a third group received both interventions, and a fourth group did not get either.
The stimulation involved a weekly visit from a woman who taught the mothers how to play with their toddlers and engage them in everyday activities, and who also left toys and books each week.
Children who received food every week were given 1 kg of milk-based formula, which makes a little less than two gallons.
Each intervention lasted two years.
As in previous follow-ups, Walker found that children who received the stimulation from their mother had higher IQs. In this study of the participants at age 22, there was a six-point difference between those who had received the interaction and those who did not.
"It's a substantial improvement for something that took place in early childhood," Walker told Reuters Health.
Children who were stimulated were also 65 percent less likely to be involved in fights and violent crime as adults, and they performed better in math and reading tests.
The group of toddlers who received formula had no improvements in these measurements two decades later, compared to kids who did not get the extra food.
None of the interventions were tied to any differences in alcohol or cigarette use, teenage births, or education past secondary school. And the participants remained small compared to their peers - likely the result of poor nutrition as babies, Walker said.
The study did not examine the cause of the benefits to children whose mothers received the play training. But Walker said that the interactions might have improved the children's self esteem, which could have resulted in better school performance.
Dr. Benard Dreyer, a pediatrics professor at New York University School of Medicine, who was not involved in the study, said the results show that the benefits of early childhood stimulation can ripple for years - increasing the likelihood of excelling in school and avoiding violence.
In an editorial he wrote in the journal Pediatrics, where the study is published, Dreyer said such programs should be offered to poor children in the United States and the developing world.
"It's not that we don't know what to do, it's that we haven't decided to implement this on a large scale," he told Reuters Health.
The study did not estimate how much such an intervention program would cost.
Dreyer said weekly at-home interventions would be less expensive than full-time daycare, which is another experience shown to help the development of disadvantaged children.
He added that Walker's study is one of the few well-planned interventions followed-up for so many years.
Walker suggests that early-childhood intervention for children who are deprived of nutrition and stimulation should become part of regular pediatric services, just like immunizations.
"In this context, where there are virtually no toys in the home and maybe not much language interaction, what you do to improve the quality of that mother-child interaction and the engagement in play can be tremendously important," Walker said.
SOURCE: http://bit.ly/gduuJn Pediatrics, online April 25, 2011.
These latest results are the fourth follow-up in a series of studies since the early-childhood program ended, about 20 years ago.
"The most exciting finding this time was the reduction in violent behavior, because that's something we haven't shown before," said Dr. Susan Walker, the lead researcher and a professor at the University of the West Indies in Jamaica.
Beginning in the 1980s, Walker and her colleagues tracked 129 Jamaican toddlers who all had stunted growth and lived in an impoverished area.
One group of children was part of the stimulation program, another was given supplemental baby formula, a third group received both interventions, and a fourth group did not get either.
The stimulation involved a weekly visit from a woman who taught the mothers how to play with their toddlers and engage them in everyday activities, and who also left toys and books each week.
Children who received food every week were given 1 kg of milk-based formula, which makes a little less than two gallons.
Each intervention lasted two years.
As in previous follow-ups, Walker found that children who received the stimulation from their mother had higher IQs. In this study of the participants at age 22, there was a six-point difference between those who had received the interaction and those who did not.
"It's a substantial improvement for something that took place in early childhood," Walker told Reuters Health.
Children who were stimulated were also 65 percent less likely to be involved in fights and violent crime as adults, and they performed better in math and reading tests.
The group of toddlers who received formula had no improvements in these measurements two decades later, compared to kids who did not get the extra food.
None of the interventions were tied to any differences in alcohol or cigarette use, teenage births, or education past secondary school. And the participants remained small compared to their peers - likely the result of poor nutrition as babies, Walker said.
The study did not examine the cause of the benefits to children whose mothers received the play training. But Walker said that the interactions might have improved the children's self esteem, which could have resulted in better school performance.
Dr. Benard Dreyer, a pediatrics professor at New York University School of Medicine, who was not involved in the study, said the results show that the benefits of early childhood stimulation can ripple for years - increasing the likelihood of excelling in school and avoiding violence.
In an editorial he wrote in the journal Pediatrics, where the study is published, Dreyer said such programs should be offered to poor children in the United States and the developing world.
"It's not that we don't know what to do, it's that we haven't decided to implement this on a large scale," he told Reuters Health.
The study did not estimate how much such an intervention program would cost.
Dreyer said weekly at-home interventions would be less expensive than full-time daycare, which is another experience shown to help the development of disadvantaged children.
He added that Walker's study is one of the few well-planned interventions followed-up for so many years.
Walker suggests that early-childhood intervention for children who are deprived of nutrition and stimulation should become part of regular pediatric services, just like immunizations.
"In this context, where there are virtually no toys in the home and maybe not much language interaction, what you do to improve the quality of that mother-child interaction and the engagement in play can be tremendously important," Walker said.
SOURCE: http://bit.ly/gduuJn Pediatrics, online April 25, 2011.
Chronic-Pain Help: Finding Relief with Treatment and Management
Long-lasting, debilitating pain can result from everyday tasks or health conditions – and sometimes for no apparent reason. Magdalena Anitescu, M.D., Ph.D, explains how to treat the most common chronic pain conditions and how to manage pain’s fellow passenger, depression. Plus, how bad is your back pain? Take our quiz to find out…
Picking up the kids, doing laundry, even driving carpool can lead to the most common type of chronic pain – an aching back.
Osteoarthritis, chronic fatigue syndrome, endometriosis and fibromyalgia top women’s lists of chronic-pain complaints, according to expert Magdalena Anitescu, M.D., Ph.D., and assistant professor of anesthesia and critical care at the University of Chicago Medical Center.
In fact, about 50 million Americans are affected. And the financial toll — from loss of income, lost productivity, lawsuit expenses and workman’s compensation cases — is significant. Chronic pain costs the U.S. about $100 billion annually, according to the American Pain Foundation (APA).
But the personal impact is even greater. Here, Anitescu explains how to treat the most frequent chronic-pain conditions.
Why do so many of us have back pain?
Women often work on their feet all day. With lifting, twisting, and toting children, there’s a lot of loading and unloading of weight on the spine. As a result, discs between the spine’s vertebrae lose their cushionability and degenerate earlier.
I see patients as young as 35 or 40 lose joint cartilage [osteoarthritis] for various reasons, including poor posture that doesn’t properly support their weight.
Additionally, constant driving vibrates and jolts everything, including the vertebrae, muscles, ligaments or discs of the spine, which erodes joints. That arthritic condition causes bone-to-bone friction in the back, contributing to pain.
How does chronic pain start?
When you injure skin, muscles or joints — say you cut your hand with a knife — that injury information is transmitted to the brain, which signals the spine and hand to drop the knife.
The brain determines whether pain messages require immediate action to reduce the pain. With chronic pain, your brain can get many messages about that same spot. Unless your brain blocks that pain message, your spine starts to sense that injury without actually experiencing it. You feel damage, but none is actually there.
Is that phenomenon connected to fibromyalgia, a source of pain for a lot of women?
Fibromyalgia usually is not treated right away because the triggers are not easily identifiable. It may be hard for primary care physicians to identify and treat ‘constant pain’ when they can’t pinpoint the origin. While waiting to get treated, the spine continues sending pain messages to the brain and the pain becomes chronic.
When a patient sees her doctor for chronic pain, what happens?
First, we try to identify the cause, not just treat symptoms. [For example,] is it coming from nerve injury related to diabetes? Or osteoarthritis triggers?
Can chronic pain be diagnosed with a medical test, such as magnetic resonance imaging (MRI)?
That’s the problem with chronic-pain. With some conditions, such as fibromyalgia, the injury is invisible. Even a MRI might not show where pain originates, so finding an appropriate treatment is difficult.
MRI is most successful at locating arthritic changes in the back. It can identify disc herniation [bulging] and stenosis [narrowing of the spinal canal, causing compression of the spinal nerve cord]. Once pinpointed, pain from nerve inflammation can be helped with steroid injections.
Functional MRI (fMRI) — a specialized scan that maps brain function — identifies spots in the brain where sensory and emotional components of the pain are processed, resulting in a specific pain sensation. This procedure is expected to be widely used for diagnosing a variety of pain syndromes and pinpointing appropriate treatments.
Once you determine the cause, what’s next?
We treat pain with medication. There are several options: steroid injections in the back and knees, or infusion therapies [medication delivered through a needle or catheter] such as lidocaine [Xylocaine] and ketamine HCI [Ketalar]. At low doses these therapies retrain the brain and spinal cord to lower pain thresholds.
Prescription anti-seizure medications are also useful for pain.
Should sufferers start with aspirin and ibuprofen (non-steroidal anti-inflammatory drugs) and work their way up the medication ladder?
NSAIDs are good to start with, but they can cause side effects, such as gastric ulcers and bleeding intestines. I prefer a combination of muscle relaxers and NSAIDs. It depends on the source of pain and symptoms.
Can you give an example?
For back pain, the first step is physical therapy. Many patients have bad posture, such as slouching with shoulders hunched forward or having too large an inward curve in the lower back. Physical therapy can improve adjacent muscles and keep the spine straight.
Next would be medications — NSAIDs and muscle relaxants. If pain runs down the leg, such as sciatica, we prescribe an oral anti-epileptic drug, which calms nerves everywhere in the body, including the spine.
Then we use steroid injections in the space surrounding nerve roots in the spine. The medication helps reduce inflammation and allows patients to build spine strength with physical therapy. Opioids [like Vicodin] come much later. The very last resort is ketamine HCI. Patients get daily treatments of the anesthetic on an outpatient basis for two weeks, then are weaned from the drug over time. Most patients sleep during the infusion procedure. The FDA recently released warnings about combination painkillers such as Vicodin.
Why are Vicodin and ketamine harmful?
We try to avoid Vicodin [a combination of hydrocodone, a narcotic, and acetaminophen, an over-the-counter pain and fever reducer] as a first-line pain treatment.
It has lots of acetaminophen and is liver toxic. If you take three a day today, and 20 per day in two months, then in four months you could have liver failure. That’s a problem.
Ketamine is good for chronic pain management; low doses can reduce pain by 60%. But it has a lot of side effects, such as hallucinations (we use anti-anxiety medications for that) and nausea. It’s used as a last resort for pain.
Do you recommend a combination of treatments, like medication and lifestyle changes, for pain management?
Absolutely. Pain physicians prefer a multipronged approach that includes physical therapy, exercise, losing weight, improved posture, aqua therapy, medication management, steroid injections and minimally invasive surgeries.
Psychotherapy and learning coping mechanisms are important. We also recommend biofeedback and group therapy.
Why does depression often accompany chronic pain? Should sufferers take medication for it?
There’s a definite connection between depression and pain. As many as one-third of chronic-pain patients may also suffer from depression.
Depression is a depletion of neurotransmitters in the brain. It’s exacerbated by lack of sleep. If you’re in pain, you can’t sleep, so you’re always depressed because the neurotransmitters can’t rejuvenate or pump themselves up.
In this pain cycle, patients would benefit from psychotherapy and antidepressants. Seeing a psychiatrist for depression may help you elevate mood, sleep better and ease pain.
Is chronic pain ever curable, or just managed?
The reality is, we can make pain manageable. But we can’t get rid of it completely. Patients learn to deal with pain once we establish an allowable level for them. It sounds very grim, but we see happy results.
Who should be on the pain-treatment team?
Start with a primary care physician, add a psychotherapist, physical therapist and rheumatologist for undiagnosed connective-tissue disease.
The primary care physician can establish a diagnosis and arrange follow-up exams and any necessary interventions. These might include a trip to a psychiatrist for sleep solutions or anxiety remedies.
Are there new tools in the treatment arsenal?
The types of tools are increasing rapidly. For example, we can now insert pumps under the patient’s skin to deliver medicine continuously to the spine for several months. It’s beneficial for patients with relentless pain and has fewer side effects than oral medications.
Spinal cord stimulators are now more widely used. Small electrodes placed near the spine vibrate and trick the brain and spinal cord into thinking the sensations aren’t pain. Since the brain can’t process pain, patients don’t feel any.
This is a last-resort treatment when nothing else works. It’s effective with certain back syndromes, when patients have had 4-5 back surgeries and still feel pain. Unfortunately, they have to undergo surgery again to insert the device, then replace the battery or alter the prescription. Other risks include infection, hardware breakage and allergic reactions.
What else?
Kyphoplasty – a minimally invasive surgery in which cement, similar to that used in knee replacement, is injected into a patient’s vertebrae. It reshapes the vertebrae’s form and alleviates pain. This treatment is effective with osteoporosis patients and those with cancer metastases to the spine.
Similarly, minimally invasive lumbar decompression, a new technology, uses instruments to remove small portions of calcified ligaments in patients with severe back pain due to arthritic changes.
On the horizon are nerve-pain medications. It’s a very dynamic field, always changing.
Let’s talk about chronic-pain help from non-medical treatments. What if someone is in too much pain to exercise?
You do the best you can. [Patients undergoing] aggressive physical therapy may benefit from a catheter in the epidural space near the spine. That provides local anesthesia before physical therapy.
Do certain foods have healing properties?
Not for pain, but for weight loss. It’s recommended that overweight patients lose weight to decrease weight on the spine. Low-back pain is often caused by excess weight, especially around the midsection.
A Body Mass Index (BMI) of greater than 25 makes you more prone to osteoarthritis of the spine. The BMI is a mathematical formula that calculates a person’s weight in kilograms and height in meters to determine amount of body fat. [Use our Body Mass Calculator to find out yours.]
Which alternative therapies offer chronic-pain help?
Muscular pain can benefit from acupuncture, a practice of inserting needles into the body to stimulate certain locations on or in the skin.
Physicians also may recommend electrical stimulation, which uses electrodes to invigorate the skin. They sometimes help.
Does insurance cover those therapies?
Acupuncture may be covered, depending on your health plan.
Services provided at pain clinics usually require pre-approval by the insurance carrier. Ketamine, pumps and spinal therapies are very expensive, so insurance companies typically want proof of medical necessity and whether other treatments have failed. Your doctor’s office may help you get approvals for these types of treatment options.
Physical therapy usually is covered, but for a limited time. After 15 visits or so, insurance companies figure you know how to do the exercises on your own.
What about support groups? Some patients find them depressing.
It’s important to join a support group with those who share your problems. For some cancer patients, the prognosis is grim. Looking at others and seeing themselves six months from now is hard. If you have back pain, though, it’s important to talk to others.
It may prevent you from feeling alone and getting more depressed, which could exacerbate pain.
What’s the bottom line on chronic-pain help?
It’s easier to treat pain earlier rather than later. Take ownership of your treatment: If your doctor recommends something that doesn’t work, tell her and change it.
Picking up the kids, doing laundry, even driving carpool can lead to the most common type of chronic pain – an aching back.
Osteoarthritis, chronic fatigue syndrome, endometriosis and fibromyalgia top women’s lists of chronic-pain complaints, according to expert Magdalena Anitescu, M.D., Ph.D., and assistant professor of anesthesia and critical care at the University of Chicago Medical Center.
In fact, about 50 million Americans are affected. And the financial toll — from loss of income, lost productivity, lawsuit expenses and workman’s compensation cases — is significant. Chronic pain costs the U.S. about $100 billion annually, according to the American Pain Foundation (APA).
But the personal impact is even greater. Here, Anitescu explains how to treat the most frequent chronic-pain conditions.
Why do so many of us have back pain?
Women often work on their feet all day. With lifting, twisting, and toting children, there’s a lot of loading and unloading of weight on the spine. As a result, discs between the spine’s vertebrae lose their cushionability and degenerate earlier.
I see patients as young as 35 or 40 lose joint cartilage [osteoarthritis] for various reasons, including poor posture that doesn’t properly support their weight.
Additionally, constant driving vibrates and jolts everything, including the vertebrae, muscles, ligaments or discs of the spine, which erodes joints. That arthritic condition causes bone-to-bone friction in the back, contributing to pain.
How does chronic pain start?
When you injure skin, muscles or joints — say you cut your hand with a knife — that injury information is transmitted to the brain, which signals the spine and hand to drop the knife.
The brain determines whether pain messages require immediate action to reduce the pain. With chronic pain, your brain can get many messages about that same spot. Unless your brain blocks that pain message, your spine starts to sense that injury without actually experiencing it. You feel damage, but none is actually there.
Is that phenomenon connected to fibromyalgia, a source of pain for a lot of women?
Fibromyalgia usually is not treated right away because the triggers are not easily identifiable. It may be hard for primary care physicians to identify and treat ‘constant pain’ when they can’t pinpoint the origin. While waiting to get treated, the spine continues sending pain messages to the brain and the pain becomes chronic.
When a patient sees her doctor for chronic pain, what happens?
First, we try to identify the cause, not just treat symptoms. [For example,] is it coming from nerve injury related to diabetes? Or osteoarthritis triggers?
Can chronic pain be diagnosed with a medical test, such as magnetic resonance imaging (MRI)?
That’s the problem with chronic-pain. With some conditions, such as fibromyalgia, the injury is invisible. Even a MRI might not show where pain originates, so finding an appropriate treatment is difficult.
MRI is most successful at locating arthritic changes in the back. It can identify disc herniation [bulging] and stenosis [narrowing of the spinal canal, causing compression of the spinal nerve cord]. Once pinpointed, pain from nerve inflammation can be helped with steroid injections.
Functional MRI (fMRI) — a specialized scan that maps brain function — identifies spots in the brain where sensory and emotional components of the pain are processed, resulting in a specific pain sensation. This procedure is expected to be widely used for diagnosing a variety of pain syndromes and pinpointing appropriate treatments.
Once you determine the cause, what’s next?
We treat pain with medication. There are several options: steroid injections in the back and knees, or infusion therapies [medication delivered through a needle or catheter] such as lidocaine [Xylocaine] and ketamine HCI [Ketalar]. At low doses these therapies retrain the brain and spinal cord to lower pain thresholds.
Prescription anti-seizure medications are also useful for pain.
Should sufferers start with aspirin and ibuprofen (non-steroidal anti-inflammatory drugs) and work their way up the medication ladder?
NSAIDs are good to start with, but they can cause side effects, such as gastric ulcers and bleeding intestines. I prefer a combination of muscle relaxers and NSAIDs. It depends on the source of pain and symptoms.
Can you give an example?
For back pain, the first step is physical therapy. Many patients have bad posture, such as slouching with shoulders hunched forward or having too large an inward curve in the lower back. Physical therapy can improve adjacent muscles and keep the spine straight.
Next would be medications — NSAIDs and muscle relaxants. If pain runs down the leg, such as sciatica, we prescribe an oral anti-epileptic drug, which calms nerves everywhere in the body, including the spine.
Then we use steroid injections in the space surrounding nerve roots in the spine. The medication helps reduce inflammation and allows patients to build spine strength with physical therapy. Opioids [like Vicodin] come much later. The very last resort is ketamine HCI. Patients get daily treatments of the anesthetic on an outpatient basis for two weeks, then are weaned from the drug over time. Most patients sleep during the infusion procedure. The FDA recently released warnings about combination painkillers such as Vicodin.
Why are Vicodin and ketamine harmful?
We try to avoid Vicodin [a combination of hydrocodone, a narcotic, and acetaminophen, an over-the-counter pain and fever reducer] as a first-line pain treatment.
It has lots of acetaminophen and is liver toxic. If you take three a day today, and 20 per day in two months, then in four months you could have liver failure. That’s a problem.
Ketamine is good for chronic pain management; low doses can reduce pain by 60%. But it has a lot of side effects, such as hallucinations (we use anti-anxiety medications for that) and nausea. It’s used as a last resort for pain.
Do you recommend a combination of treatments, like medication and lifestyle changes, for pain management?
Absolutely. Pain physicians prefer a multipronged approach that includes physical therapy, exercise, losing weight, improved posture, aqua therapy, medication management, steroid injections and minimally invasive surgeries.
Psychotherapy and learning coping mechanisms are important. We also recommend biofeedback and group therapy.
Why does depression often accompany chronic pain? Should sufferers take medication for it?
There’s a definite connection between depression and pain. As many as one-third of chronic-pain patients may also suffer from depression.
Depression is a depletion of neurotransmitters in the brain. It’s exacerbated by lack of sleep. If you’re in pain, you can’t sleep, so you’re always depressed because the neurotransmitters can’t rejuvenate or pump themselves up.
In this pain cycle, patients would benefit from psychotherapy and antidepressants. Seeing a psychiatrist for depression may help you elevate mood, sleep better and ease pain.
Is chronic pain ever curable, or just managed?
The reality is, we can make pain manageable. But we can’t get rid of it completely. Patients learn to deal with pain once we establish an allowable level for them. It sounds very grim, but we see happy results.
Who should be on the pain-treatment team?
Start with a primary care physician, add a psychotherapist, physical therapist and rheumatologist for undiagnosed connective-tissue disease.
The primary care physician can establish a diagnosis and arrange follow-up exams and any necessary interventions. These might include a trip to a psychiatrist for sleep solutions or anxiety remedies.
Are there new tools in the treatment arsenal?
The types of tools are increasing rapidly. For example, we can now insert pumps under the patient’s skin to deliver medicine continuously to the spine for several months. It’s beneficial for patients with relentless pain and has fewer side effects than oral medications.
Spinal cord stimulators are now more widely used. Small electrodes placed near the spine vibrate and trick the brain and spinal cord into thinking the sensations aren’t pain. Since the brain can’t process pain, patients don’t feel any.
This is a last-resort treatment when nothing else works. It’s effective with certain back syndromes, when patients have had 4-5 back surgeries and still feel pain. Unfortunately, they have to undergo surgery again to insert the device, then replace the battery or alter the prescription. Other risks include infection, hardware breakage and allergic reactions.
What else?
Kyphoplasty – a minimally invasive surgery in which cement, similar to that used in knee replacement, is injected into a patient’s vertebrae. It reshapes the vertebrae’s form and alleviates pain. This treatment is effective with osteoporosis patients and those with cancer metastases to the spine.
Similarly, minimally invasive lumbar decompression, a new technology, uses instruments to remove small portions of calcified ligaments in patients with severe back pain due to arthritic changes.
On the horizon are nerve-pain medications. It’s a very dynamic field, always changing.
Let’s talk about chronic-pain help from non-medical treatments. What if someone is in too much pain to exercise?
You do the best you can. [Patients undergoing] aggressive physical therapy may benefit from a catheter in the epidural space near the spine. That provides local anesthesia before physical therapy.
Do certain foods have healing properties?
Not for pain, but for weight loss. It’s recommended that overweight patients lose weight to decrease weight on the spine. Low-back pain is often caused by excess weight, especially around the midsection.
A Body Mass Index (BMI) of greater than 25 makes you more prone to osteoarthritis of the spine. The BMI is a mathematical formula that calculates a person’s weight in kilograms and height in meters to determine amount of body fat. [Use our Body Mass Calculator to find out yours.]
Which alternative therapies offer chronic-pain help?
Muscular pain can benefit from acupuncture, a practice of inserting needles into the body to stimulate certain locations on or in the skin.
Physicians also may recommend electrical stimulation, which uses electrodes to invigorate the skin. They sometimes help.
Does insurance cover those therapies?
Acupuncture may be covered, depending on your health plan.
Services provided at pain clinics usually require pre-approval by the insurance carrier. Ketamine, pumps and spinal therapies are very expensive, so insurance companies typically want proof of medical necessity and whether other treatments have failed. Your doctor’s office may help you get approvals for these types of treatment options.
Physical therapy usually is covered, but for a limited time. After 15 visits or so, insurance companies figure you know how to do the exercises on your own.
What about support groups? Some patients find them depressing.
It’s important to join a support group with those who share your problems. For some cancer patients, the prognosis is grim. Looking at others and seeing themselves six months from now is hard. If you have back pain, though, it’s important to talk to others.
It may prevent you from feeling alone and getting more depressed, which could exacerbate pain.
What’s the bottom line on chronic-pain help?
It’s easier to treat pain earlier rather than later. Take ownership of your treatment: If your doctor recommends something that doesn’t work, tell her and change it.
What Is Iritis, and How Is It Treated?
Question: I’ve had iritis now for the past two years. Is it a form of arthritis? I have been using a steroid drop (prednisolone) in my eyes as much as six drops two as low as two a day in one eye.
Every time my doctor reduces the dosage, I have a flare up. Is there any other form of treatment? Can it be cured? And most importantly, what causes this condition and is there any research being done?
Dr. Hibberd's Answer:
Iritis is the medical term for inflammation of the iris, the pigmented tissue that gives our eyes their color. It is in front of the lens and behind the clear cornea at the front of our eye and serves as a type of shutter mechanism to adjust the amount of light that enters the eye.
Inflammation produces pain, decreased vision, redness and intense sensitivity to light (photophobia).
Many cases have no known cause. When an infectious or autoimmune cause is evident, it is important to treat the underlying disorder to prevent the recurrence or persistence of iritis. Iritis may be associated with joint inflammation (arthritis) and is often seen in conjunction with various disorders that cause arthritis.
While the iritis itself does not cause arthritis, an underlying disorder is often found that triggers both conditions.
Left untreated, iritis can be serious and can cause scar tissue that is difficult to treat and can result in permanent complications including loss of vision. Initial treatment is often topical medications (steroids and drops to dilate the eye), and treatment of the underlying disorder. Immune suppressants are often needed in recurrent cases, since many of these are caused by an autoimmune disorder.
Iritis can be caused by trauma, and should be treated without delay. Untreated trauma to the iris of one eye can actually set up an immune reaction that may stimulate attack on the iris of the unaffected eye resulting in permanent vision loss in both eyes!
If you think you may have iritis, see your opthamologist without delay or go to the emergency department of your nearby hospital.
Recurring iritis suggests there is underlying disorder that should be investigated. I am not happy to see your therapy consists of only steroid eye drops. See your opthamologist and your primary care physician to begin your workup, but if no cause is found, request a referral to a rheumatologist and an infectious disease specialist for further consultation.
Recurrent iritis usually has an identifiable precipitating condition that can be treated to reduce recurrent attacks.
Every time my doctor reduces the dosage, I have a flare up. Is there any other form of treatment? Can it be cured? And most importantly, what causes this condition and is there any research being done?
Dr. Hibberd's Answer:
Iritis is the medical term for inflammation of the iris, the pigmented tissue that gives our eyes their color. It is in front of the lens and behind the clear cornea at the front of our eye and serves as a type of shutter mechanism to adjust the amount of light that enters the eye.
Inflammation produces pain, decreased vision, redness and intense sensitivity to light (photophobia).
Many cases have no known cause. When an infectious or autoimmune cause is evident, it is important to treat the underlying disorder to prevent the recurrence or persistence of iritis. Iritis may be associated with joint inflammation (arthritis) and is often seen in conjunction with various disorders that cause arthritis.
While the iritis itself does not cause arthritis, an underlying disorder is often found that triggers both conditions.
Left untreated, iritis can be serious and can cause scar tissue that is difficult to treat and can result in permanent complications including loss of vision. Initial treatment is often topical medications (steroids and drops to dilate the eye), and treatment of the underlying disorder. Immune suppressants are often needed in recurrent cases, since many of these are caused by an autoimmune disorder.
Iritis can be caused by trauma, and should be treated without delay. Untreated trauma to the iris of one eye can actually set up an immune reaction that may stimulate attack on the iris of the unaffected eye resulting in permanent vision loss in both eyes!
If you think you may have iritis, see your opthamologist without delay or go to the emergency department of your nearby hospital.
Recurring iritis suggests there is underlying disorder that should be investigated. I am not happy to see your therapy consists of only steroid eye drops. See your opthamologist and your primary care physician to begin your workup, but if no cause is found, request a referral to a rheumatologist and an infectious disease specialist for further consultation.
Recurrent iritis usually has an identifiable precipitating condition that can be treated to reduce recurrent attacks.
What Is Causing My Partner's Swollen Ankles and Feet?
Question: My 78-year-old partner has suddenly developed swollen ankles and feet. He's reduced his salt intake and started drinking more water. He is a little overweight. Any suggestions? I'm afraid I have little faith in American medicine.
Dr. Hibberd's Answer:
Vascular (blood vessel) disease will very often cause swollen ankles and feet, but they can also be caused by other problems including arthritis, infections, and nutritional deficiencies. An evaluation of the feet with attention to the nerves and the blood vessels supplying these nerves is required.
Once the problem is isolated by a health professional, a search for its cause is advised. Do not wait for things to worsen or go away, they usually do not leave until the underlying problem is properly addressed.
My advice is to seek out a doctor you can trust. Swelling of both ankles and feet requires a physical exam and assessment to properly address and treat the cause. Do not delay consultation as some of the causes of this are quite serious.
Dr. Hibberd's Answer:
Vascular (blood vessel) disease will very often cause swollen ankles and feet, but they can also be caused by other problems including arthritis, infections, and nutritional deficiencies. An evaluation of the feet with attention to the nerves and the blood vessels supplying these nerves is required.
Once the problem is isolated by a health professional, a search for its cause is advised. Do not wait for things to worsen or go away, they usually do not leave until the underlying problem is properly addressed.
My advice is to seek out a doctor you can trust. Swelling of both ankles and feet requires a physical exam and assessment to properly address and treat the cause. Do not delay consultation as some of the causes of this are quite serious.
Is Cipro Damaging My Tendons?
Question: My doctor recently prescribed Cipro for an infection. A friend told me that it's bad for your tendons. How can a medicine hurt tendons?
Dr. Hibberd's Answer:
Your friend is quite correct. I have been prescribing Cipro and related agents for many years and have yet to see a single case of tendon rupture or damage (yet!).
This family of antibiotics (quinolones) is very potent. The drug levels in tissues are many times the levels found in the bloodstream.
The animal studies published have demonstrated the potential for significant weight-bearing joint and soft tissue injury in juvenile animals. The mechanism of tendon injury is unknown, however, reports of spontaneous shoulder, hand, and Achilles tendon rupture and tendonitis have been well documented to occur both during and after therapy. The risks of tendon injury appear more pronounced in the elderly and those on corticosteroid therapy.
Generally these agents are not intended for use in children and used with caution in those under the age of 18. These agents have extended warnings and precautions that should be heeded by professionals using them. They should generally not be used as first line agents.
Dr. Hibberd's Answer:
Your friend is quite correct. I have been prescribing Cipro and related agents for many years and have yet to see a single case of tendon rupture or damage (yet!).
This family of antibiotics (quinolones) is very potent. The drug levels in tissues are many times the levels found in the bloodstream.
The animal studies published have demonstrated the potential for significant weight-bearing joint and soft tissue injury in juvenile animals. The mechanism of tendon injury is unknown, however, reports of spontaneous shoulder, hand, and Achilles tendon rupture and tendonitis have been well documented to occur both during and after therapy. The risks of tendon injury appear more pronounced in the elderly and those on corticosteroid therapy.
Generally these agents are not intended for use in children and used with caution in those under the age of 18. These agents have extended warnings and precautions that should be heeded by professionals using them. They should generally not be used as first line agents.
FUN FACTS
* On the stone temples of Madura in southern India, there are more than 30 million carved images of gods and goddesses. *
* If you're going to eat fast food, the odds are 2 out of 5 you will buy it at McDonald's. The odds are 1 out of 5 you will choose Burger King, and 1 out of 10 for Hardee's and for Wendy's. *
* According to a market research survey done some time ago, 68% of consumers receiving junk mail actually open the envelopes. *
* Head injuries occur about every 15 seconds in the United States. *
*Flying once around the moon is the equivalent with a round trip from New York to London. (Earth is about four times the size of the moon.) *
* If you're going to eat fast food, the odds are 2 out of 5 you will buy it at McDonald's. The odds are 1 out of 5 you will choose Burger King, and 1 out of 10 for Hardee's and for Wendy's. *
* According to a market research survey done some time ago, 68% of consumers receiving junk mail actually open the envelopes. *
* Head injuries occur about every 15 seconds in the United States. *
*Flying once around the moon is the equivalent with a round trip from New York to London. (Earth is about four times the size of the moon.) *
Thursday, April 28, 2011
THOUGHT FOR THE DAY ....
Be who you are and say what you feel because those who mind don't matter and those who matter don't mind.
An Apple a Day Keeps Calories Away
How did celebrity chef Nikki Cascone, a Top Chef veteran and owner of Octavia’s Porch in New York City, drop 42 pounds of baby weight?
She stocked her fridge with veggies ready for stir-fries and salads, and made sure to have plenty of low-cal, protein-rich toppings like hard-boiled eggs, chickpeas and smoked salmon on hand.
Another trick? She committed to eating two pieces of fruit a day and wouldn’t give in to a craving for ice cream or other sweets without munching an apple first, which often eliminated her craving. When it didn’t, it helped her feel satisfied with a much smaller portion than she would have had on an empty stomach.
She stocked her fridge with veggies ready for stir-fries and salads, and made sure to have plenty of low-cal, protein-rich toppings like hard-boiled eggs, chickpeas and smoked salmon on hand.
Another trick? She committed to eating two pieces of fruit a day and wouldn’t give in to a craving for ice cream or other sweets without munching an apple first, which often eliminated her craving. When it didn’t, it helped her feel satisfied with a much smaller portion than she would have had on an empty stomach.
7 Ways to Ease Fibromyalgia Pain
If you have fibromyalgia, you know that life is 10 times harder. The complex chronic pain disorder affects every part of your day. You’re tired, achy and can’t think straight. So how can you cope? From exercising to herbs and supplements, here are 7 ways to tame symptoms. Plus, how much do you know about fibromyalgia? Take our quiz to find out...
It’s bad enough that you have fibromyalgia, a painful, puzzling disorder. What’s worse is that every symptom – from brain fog to pain, fatigue and depression – hurts not only yourself but also your relationships, work life and physical, emotional and mental health.
There's no cure, which means you just have to learn to live with fibromyalgia pain and take steps to ease its symptoms.
“Effectively treating fibromyalgia requires a combination of medication and lifestyle skills,” says Daniel Clauw, M.D., fibromyalgia expert and professor of anesthesiology and medicine at the University of Michigan. He’s also director of the Chronic Pain and Fatigue Research Center there.
Here are 7 expert tips to ease fibromyalgia pain:
1. Start exercising.
Working out is great for everyone, but it can especially help fibromyalgia sufferers, who often feel stiffness (especially after waking in the morning) and restless leg syndrome.
Exercising regularly – whatever you can manage on a routine basis – can boost mood, ease pain, improve sleep, reduce fatigue, improve circulation and strengthen your heart. Among recommended activities for fibromyalgia patients: stretching, walking, yoga, cycling, swimming, water aerobics and strength training.
“Take small steps toward becoming more active as your symptoms begin to improve,” Clauw advises.
But be careful: Sometimes exercise can be counterproductive, says Stephen MacPherson, N.D., a naturopathic doctor at the Fibromyalgia and Fatigue Center in Seattle, Wash. Many are so fatigued, that it makes it difficult to exercise.
Know your limit, he advises, and consult your doctor before starting or changing an exercise program.
2. Try various therapies.
Fibromyalgia patients suffer pain more intensely than other people do. They may feel it all over their body or in multiple tender points.
Water therapy, light aerobics, application of heat or cold, acupuncture, and osteopathic or chiropractic manipulation have helped fibromyalgia patients, say the experts at the National Fibromyalgia Association. So has physical therapy.
It can increase mobility, improve physical function and ease pain. Experts at the National Pain Foundation believe that physical therapy can help people regain their muscle tone and flexibility.
Massage may help some people, but not everyone should have one because even light pressure could worsen the pain, MacPherson advises. “A medium-pressure massage can make a person feel like they’ve been hit by a truck the next day.”
Like exercise, all therapies must be gradually implemented, he says.
3. Eat a healthy diet.
Eating lots of vegetables, fruits, whole grains, lean meats and dairy also will energize you, lower weight and improve overall health as you battle fibromyalgia.
Janet Horn, M.D., Lifescript’s women’s health expert and a practicing physician in Baltimore, suggests eliminating the following foods, which appear to bother some people with fibromyalgia:
Food additives like MSG and nitrates (the preservative in hot dogs and bacon)
Aspartame (NutraSweet)
Sugar
4. Get enough sleep.
Pain, stress and anxiety can rob you of the ability to sleep. But that’s exactly what you need to manage one of fibromyalgia’s major symptoms: fatigue.
Many of MacPherson’s patients have sleep apnea. “We sometimes recommend that people go to a sleep study and get checked out,” he says.
Talk to your doctor to see whether sleep meds are appropriate for you. And try to implement good sleep habits. Here are some suggestions from the University of Maryland's Sleep Disorder Center:
Make your bedroom comfortable by reducing noises and extreme temperatures.
Use light and comfortable bed linens and garments.
Begin rituals to help you relax at bedtime, such as taking a soothing bath or enjoying a light snack.
Go to bed and get up at the same time every day, including weekends and holidays.
If you nap, keep it to less than one hour and take it before 3 p.m.
Avoid caffeine, alcohol and cigarettes.
Stay away from fatty, spicy foods that may upset your stomach or cause heartburn.
Set aside time during the day to get all your worries out of your system.
Go to bed only when you're sleepy and reserve the bed only for sleeping and sex.
5. Pay attention to your sex life.
Women with fibromyalgia commonly experience pain with their menstrual cycles and during intercourse. Pain or joint/muscle stiffness may interfere with their ability to enjoy intimacy.
On top of the physical challenges, negative changes in self-perception, such as feeling unattractive, uncomfortable or simply not feeling sexy, may lead to a loss of desire.
Plus, stress and anxiety can get in the way of good sex.
If you’ve fallen into a habit of avoiding sex for these or any other reasons, talk to your doctor.
Your sexual health is as important as your physical, mental and emotional health. A physician will not only help you troubleshoot the problem, but recommend ways to boost your libido and self-esteem and help you manage the pain or discomfort.
6. Reduce stress.
Fibromyalgia can affect memory and cause “fibro fog,” an inability to think clearly, which can be particularly frustrating when you’re trying to perform simple tasks.
“Constant stress can drain the endocrine system and alter hormone levels,” which may be a cause of fibromyalgia, MacPherson says.
Try these tips to manage your stress load:
Pace your daily activities. Fibromyalgia patients sometimes unknowingly exacerbate pain and fatigue by overdoing it when they’re feeling well, Clauw says.
Try relaxation techniques. Methods that help reduce stress and pain include breathing and relaxation exercises, meditation, aromatherapy and biofeedback. The latter uses a machine to help patients read their body’s signals to reduce anxiety and pain.
Set boundaries. You may want to speak to your supervisor at work about modifying your schedule, reducing your workload or simply identifying and communicating your needs to your boss and coworkers, according to the KnowFibro guide.
See a behavioral cognitive therapist. This form of psychotherapy examines how our thinking influences how we feel and what we do. Fibromyalgia sufferers can have a lot of emotional distress, MacPherson says, and therapy may help to manage it.
7. Try herbs and supplements.
Magnesium and acetyl-L-carnitine may help ease symptoms, says Suzy Cohen, R. Ph., Lifescript’s Pharmacist and author of The 24-Hour Pharmacist.
“Magnesium reduces nerve pain and muscle pain,” she says. “When the mineral runs low, the body experiences more pain.”
It's also used to make ATP, an energy molecule, which may help with fatigue, she says.
“And the body uses acetyl-L-carnitine to make another hormone, acetylcholine, which is used in the brain to improve mood, memory and concentration difficulties, which often coincide with fibromyalgia.”
Always check with your doctor about any supplements, herbs, or other therapies you’re considering.
It’s bad enough that you have fibromyalgia, a painful, puzzling disorder. What’s worse is that every symptom – from brain fog to pain, fatigue and depression – hurts not only yourself but also your relationships, work life and physical, emotional and mental health.
There's no cure, which means you just have to learn to live with fibromyalgia pain and take steps to ease its symptoms.
“Effectively treating fibromyalgia requires a combination of medication and lifestyle skills,” says Daniel Clauw, M.D., fibromyalgia expert and professor of anesthesiology and medicine at the University of Michigan. He’s also director of the Chronic Pain and Fatigue Research Center there.
Here are 7 expert tips to ease fibromyalgia pain:
1. Start exercising.
Working out is great for everyone, but it can especially help fibromyalgia sufferers, who often feel stiffness (especially after waking in the morning) and restless leg syndrome.
Exercising regularly – whatever you can manage on a routine basis – can boost mood, ease pain, improve sleep, reduce fatigue, improve circulation and strengthen your heart. Among recommended activities for fibromyalgia patients: stretching, walking, yoga, cycling, swimming, water aerobics and strength training.
“Take small steps toward becoming more active as your symptoms begin to improve,” Clauw advises.
But be careful: Sometimes exercise can be counterproductive, says Stephen MacPherson, N.D., a naturopathic doctor at the Fibromyalgia and Fatigue Center in Seattle, Wash. Many are so fatigued, that it makes it difficult to exercise.
Know your limit, he advises, and consult your doctor before starting or changing an exercise program.
2. Try various therapies.
Fibromyalgia patients suffer pain more intensely than other people do. They may feel it all over their body or in multiple tender points.
Water therapy, light aerobics, application of heat or cold, acupuncture, and osteopathic or chiropractic manipulation have helped fibromyalgia patients, say the experts at the National Fibromyalgia Association. So has physical therapy.
It can increase mobility, improve physical function and ease pain. Experts at the National Pain Foundation believe that physical therapy can help people regain their muscle tone and flexibility.
Massage may help some people, but not everyone should have one because even light pressure could worsen the pain, MacPherson advises. “A medium-pressure massage can make a person feel like they’ve been hit by a truck the next day.”
Like exercise, all therapies must be gradually implemented, he says.
3. Eat a healthy diet.
Eating lots of vegetables, fruits, whole grains, lean meats and dairy also will energize you, lower weight and improve overall health as you battle fibromyalgia.
Janet Horn, M.D., Lifescript’s women’s health expert and a practicing physician in Baltimore, suggests eliminating the following foods, which appear to bother some people with fibromyalgia:
Food additives like MSG and nitrates (the preservative in hot dogs and bacon)
Aspartame (NutraSweet)
Sugar
4. Get enough sleep.
Pain, stress and anxiety can rob you of the ability to sleep. But that’s exactly what you need to manage one of fibromyalgia’s major symptoms: fatigue.
Many of MacPherson’s patients have sleep apnea. “We sometimes recommend that people go to a sleep study and get checked out,” he says.
Talk to your doctor to see whether sleep meds are appropriate for you. And try to implement good sleep habits. Here are some suggestions from the University of Maryland's Sleep Disorder Center:
Make your bedroom comfortable by reducing noises and extreme temperatures.
Use light and comfortable bed linens and garments.
Begin rituals to help you relax at bedtime, such as taking a soothing bath or enjoying a light snack.
Go to bed and get up at the same time every day, including weekends and holidays.
If you nap, keep it to less than one hour and take it before 3 p.m.
Avoid caffeine, alcohol and cigarettes.
Stay away from fatty, spicy foods that may upset your stomach or cause heartburn.
Set aside time during the day to get all your worries out of your system.
Go to bed only when you're sleepy and reserve the bed only for sleeping and sex.
5. Pay attention to your sex life.
Women with fibromyalgia commonly experience pain with their menstrual cycles and during intercourse. Pain or joint/muscle stiffness may interfere with their ability to enjoy intimacy.
On top of the physical challenges, negative changes in self-perception, such as feeling unattractive, uncomfortable or simply not feeling sexy, may lead to a loss of desire.
Plus, stress and anxiety can get in the way of good sex.
If you’ve fallen into a habit of avoiding sex for these or any other reasons, talk to your doctor.
Your sexual health is as important as your physical, mental and emotional health. A physician will not only help you troubleshoot the problem, but recommend ways to boost your libido and self-esteem and help you manage the pain or discomfort.
6. Reduce stress.
Fibromyalgia can affect memory and cause “fibro fog,” an inability to think clearly, which can be particularly frustrating when you’re trying to perform simple tasks.
“Constant stress can drain the endocrine system and alter hormone levels,” which may be a cause of fibromyalgia, MacPherson says.
Try these tips to manage your stress load:
Pace your daily activities. Fibromyalgia patients sometimes unknowingly exacerbate pain and fatigue by overdoing it when they’re feeling well, Clauw says.
Try relaxation techniques. Methods that help reduce stress and pain include breathing and relaxation exercises, meditation, aromatherapy and biofeedback. The latter uses a machine to help patients read their body’s signals to reduce anxiety and pain.
Set boundaries. You may want to speak to your supervisor at work about modifying your schedule, reducing your workload or simply identifying and communicating your needs to your boss and coworkers, according to the KnowFibro guide.
See a behavioral cognitive therapist. This form of psychotherapy examines how our thinking influences how we feel and what we do. Fibromyalgia sufferers can have a lot of emotional distress, MacPherson says, and therapy may help to manage it.
7. Try herbs and supplements.
Magnesium and acetyl-L-carnitine may help ease symptoms, says Suzy Cohen, R. Ph., Lifescript’s Pharmacist and author of The 24-Hour Pharmacist.
“Magnesium reduces nerve pain and muscle pain,” she says. “When the mineral runs low, the body experiences more pain.”
It's also used to make ATP, an energy molecule, which may help with fatigue, she says.
“And the body uses acetyl-L-carnitine to make another hormone, acetylcholine, which is used in the brain to improve mood, memory and concentration difficulties, which often coincide with fibromyalgia.”
Always check with your doctor about any supplements, herbs, or other therapies you’re considering.
Poor Cardio Health Linked to Fat, Not BMI
Researchers found that fat around the heart and aorta, as well as within the liver, were associated with poor cardio health and reduced cardiac pumping function in people who were obese and had high blood pressure and/or type 2 diabetes, according to Boston University School of Medicine (BUSM) studies. In those studied, high fat collections in these two areas weren’t predicted by the body mass index (BMI) of the individual.
“Our study found that fat collection around the heart, the aorta and within the liver is clearly associated with decreased heart functions, and that an MRI can quickly and noninvasively measure fat volume in these areas,” said James Hamilton, Ph.D, senior author and project leader and professor of biophysics, physiology and biomedical engineering at BUSM.
This noninvasive scan may provide a basis for future individualized treatment, said the researchers.
“Our study found that fat collection around the heart, the aorta and within the liver is clearly associated with decreased heart functions, and that an MRI can quickly and noninvasively measure fat volume in these areas,” said James Hamilton, Ph.D, senior author and project leader and professor of biophysics, physiology and biomedical engineering at BUSM.
This noninvasive scan may provide a basis for future individualized treatment, said the researchers.
Say Goodbye to Pain
Common, but Treatable
If the mere thought of running out of ibuprofen sends you into a panic, you’re far from alone. One in four Americans—the majority of them women—get sidelined by an achy back, neck, head or joints. In a 2006 government survey, more than half of them reported their agony lasted three months or longer.
Chronic pain can affect our relationships and our job performance. But experts say there is no reason to wince through your days needlessly. “There are options available,” says Scott Glaser, M.D. of the American Society of Interventional Pain Physicians. “We are now able to find the source of the pain, treat it and control it, and give individuals back their quality of life.” Find out how to treat the most common pain complaints.
Fibromyalgia
People with fibromyalgia (mostly women) suffer fatigue, stiffness, joint tenderness, muscle pain and so-called “fibro fog” or memory problems. No one knows for sure what causes fibromyalgia, but some theories include traumatic events and repetitive injuries, as well as genetic factors.
Over-the-counter painkillers can help, as can antidepressants and drugs used to treat restless legs syndrome. Dr. Teitelbaum, who had fibromyalgia himself, recommends getting at least eight hours of sleep nightly; hormonal support to regulate thyroid, adrenal and reproductive hormones; treating infections, including anti-fungal treatments for infections such as Candida; proper nutrition and exercise.
Back Pain
There are two main causes. The sponge-like discs and joints between spinal vertebrae become injured or degenerated with daily wear and tear. Or the spinal nerves become compressed and inflamed from injury or conditions like arthritis. Dr. Glaser says “ice and heat applications are time-honored therapies” for chronic pain.
Other options include chiropractic treatments, physical therapy, massage and biofeedback. Jacob Teitelbaum, M.D., author of Pain Free 1-2-3, recommends boswellia, willow bark and curcumin-based supplements, which have anti-inflammatory properties. If those methods don’t work, a pain specialist may suggest patches that deliver painkillers directly to area or medication injected into the joints between the vertebrae or the nerves. Heat treatments or electrical stimulation can also help. Back surgery should be a last resort because of long-term risks and the possibility of creating more pain.
Chronic Headaches
Everyone gets a headache now and then, but 15 percent of Americans get severe headaches, and they occur twice as often in women than men. Migraine, cluster and tension headaches are the three most common types, and they can be triggered by anxiety, stress or hormonal changes.
If you suffer from migraines, over-the-counter remedies such as Excedrin Migraine can help, says Dr. Teitelbaum, and daily doses of magnesium and vitamins B6 and B2 may help prevent them. Stronger drugs to treat migraine pain and relieve tension and cluster headaches are available by prescription. Inhaling pure oxygen, available in small canisters by prescription, can also relieve cluster headaches. And antidepressants can help prevent tension headaches.
A Sore Neck
The same factors that cause back pain contribute to neck pain—bulging spinal discs touch nerve endings, and suddenly shaking your head is next to impossible. Worse, upper neck pain can also trigger headaches, Dr. Glaser says. “The spine is simply a series of bones sitting on top of each other protecting the spinal cord and nerves,” Dr. Glaser says, “Every joint where these bones touch is capable of being a source of pain.”
If neck pain is associated with headache, chiropractic care can help release the muscles that cause most tension headaches. Medications used to treat the headache can also offer relief. As with lower back pain, minimally invasive procedures to deaden nerve endings or deliver medications are an option.
Facial Pain
Facial pain has many causes, from a toothache to more serious conditions like trigeminal neuralgia, when inflamed nerves cause shooting, stabbing pain in the face.
For simple tooth pain, over-the-counter pain killers can help until you can see your dentist. If the problem is in your jaw’s temporomandibular joint (TMJ), you can use ice packs and a bite guard at night that helps position the jaw correctly, relieving chronic pain. For trigeminal neuralgia, anticonvulsants and muscle relaxants are typically prescribed. In extreme cases, surgery to damage the nerve so it stops delivering pain messages may help, but often results in some facial numbness.
Arthritis
The cartilage between joints erodes over time, causing pain that is the hallmark symptom of arthritis. There are two main forms of arthritis: Osteoarthritis, caused by aging and repetitive injury, and rheumatoid arthritis, an autoimmune condition that causes the body to attack its own healthy joints.
There’s no cure for arthritis, but anti-inflammatory painkillers like ibuprofen can help. Rheumatoid arthritis responds to anti-rheumatic drugs and corticosteroids. Exercise can also ease arthritis pain as it strengthens the muscles surrounding the joints and keeps the joints limber. Steroid injections into the joint or replacing the normal joint fluid with injections of medication also provide relief. Joint replacement surgery is also a popular treatment for severe arthritis in the hip and knee.
Seeking Treatment for Pain
All too often, people grin and bear it when it comes to pain, says Dr. Glaser, which can make it worse. “We tend to see patients a year after they’ve injured their back,” he says. “That makes it much harder to treat. Patients that come to me a month after they start hurting have a much higher success rate.”
If you’re in pain, talk to your primary care doctor. If conservative treatments aren’t working, Dr. Teitelbaum recommends seeking a pain specialist through the American Academy of Pain Management. “Pain is like the flashing red oil light on your dashboard,” he says. “It’s your body’s way of saying something needs attention.”
If the mere thought of running out of ibuprofen sends you into a panic, you’re far from alone. One in four Americans—the majority of them women—get sidelined by an achy back, neck, head or joints. In a 2006 government survey, more than half of them reported their agony lasted three months or longer.
Chronic pain can affect our relationships and our job performance. But experts say there is no reason to wince through your days needlessly. “There are options available,” says Scott Glaser, M.D. of the American Society of Interventional Pain Physicians. “We are now able to find the source of the pain, treat it and control it, and give individuals back their quality of life.” Find out how to treat the most common pain complaints.
Fibromyalgia
People with fibromyalgia (mostly women) suffer fatigue, stiffness, joint tenderness, muscle pain and so-called “fibro fog” or memory problems. No one knows for sure what causes fibromyalgia, but some theories include traumatic events and repetitive injuries, as well as genetic factors.
Over-the-counter painkillers can help, as can antidepressants and drugs used to treat restless legs syndrome. Dr. Teitelbaum, who had fibromyalgia himself, recommends getting at least eight hours of sleep nightly; hormonal support to regulate thyroid, adrenal and reproductive hormones; treating infections, including anti-fungal treatments for infections such as Candida; proper nutrition and exercise.
Back Pain
There are two main causes. The sponge-like discs and joints between spinal vertebrae become injured or degenerated with daily wear and tear. Or the spinal nerves become compressed and inflamed from injury or conditions like arthritis. Dr. Glaser says “ice and heat applications are time-honored therapies” for chronic pain.
Other options include chiropractic treatments, physical therapy, massage and biofeedback. Jacob Teitelbaum, M.D., author of Pain Free 1-2-3, recommends boswellia, willow bark and curcumin-based supplements, which have anti-inflammatory properties. If those methods don’t work, a pain specialist may suggest patches that deliver painkillers directly to area or medication injected into the joints between the vertebrae or the nerves. Heat treatments or electrical stimulation can also help. Back surgery should be a last resort because of long-term risks and the possibility of creating more pain.
Chronic Headaches
Everyone gets a headache now and then, but 15 percent of Americans get severe headaches, and they occur twice as often in women than men. Migraine, cluster and tension headaches are the three most common types, and they can be triggered by anxiety, stress or hormonal changes.
If you suffer from migraines, over-the-counter remedies such as Excedrin Migraine can help, says Dr. Teitelbaum, and daily doses of magnesium and vitamins B6 and B2 may help prevent them. Stronger drugs to treat migraine pain and relieve tension and cluster headaches are available by prescription. Inhaling pure oxygen, available in small canisters by prescription, can also relieve cluster headaches. And antidepressants can help prevent tension headaches.
A Sore Neck
The same factors that cause back pain contribute to neck pain—bulging spinal discs touch nerve endings, and suddenly shaking your head is next to impossible. Worse, upper neck pain can also trigger headaches, Dr. Glaser says. “The spine is simply a series of bones sitting on top of each other protecting the spinal cord and nerves,” Dr. Glaser says, “Every joint where these bones touch is capable of being a source of pain.”
If neck pain is associated with headache, chiropractic care can help release the muscles that cause most tension headaches. Medications used to treat the headache can also offer relief. As with lower back pain, minimally invasive procedures to deaden nerve endings or deliver medications are an option.
Facial Pain
Facial pain has many causes, from a toothache to more serious conditions like trigeminal neuralgia, when inflamed nerves cause shooting, stabbing pain in the face.
For simple tooth pain, over-the-counter pain killers can help until you can see your dentist. If the problem is in your jaw’s temporomandibular joint (TMJ), you can use ice packs and a bite guard at night that helps position the jaw correctly, relieving chronic pain. For trigeminal neuralgia, anticonvulsants and muscle relaxants are typically prescribed. In extreme cases, surgery to damage the nerve so it stops delivering pain messages may help, but often results in some facial numbness.
Arthritis
The cartilage between joints erodes over time, causing pain that is the hallmark symptom of arthritis. There are two main forms of arthritis: Osteoarthritis, caused by aging and repetitive injury, and rheumatoid arthritis, an autoimmune condition that causes the body to attack its own healthy joints.
There’s no cure for arthritis, but anti-inflammatory painkillers like ibuprofen can help. Rheumatoid arthritis responds to anti-rheumatic drugs and corticosteroids. Exercise can also ease arthritis pain as it strengthens the muscles surrounding the joints and keeps the joints limber. Steroid injections into the joint or replacing the normal joint fluid with injections of medication also provide relief. Joint replacement surgery is also a popular treatment for severe arthritis in the hip and knee.
Seeking Treatment for Pain
All too often, people grin and bear it when it comes to pain, says Dr. Glaser, which can make it worse. “We tend to see patients a year after they’ve injured their back,” he says. “That makes it much harder to treat. Patients that come to me a month after they start hurting have a much higher success rate.”
If you’re in pain, talk to your primary care doctor. If conservative treatments aren’t working, Dr. Teitelbaum recommends seeking a pain specialist through the American Academy of Pain Management. “Pain is like the flashing red oil light on your dashboard,” he says. “It’s your body’s way of saying something needs attention.”
Do painkillers interfere with antidepressants?
NEW YORK (Reuters Health) - Certain types of antidepressants may not work as well in people that take painkillers such as ibuprofen and aspirin, suggests a new study.
The findings can't prove that the painkillers, called non-steroidal anti-inflammatory drugs, or NSAIDs, stop antidepressants from working, the authors said. But the possible link is something for patients with depression - and the doctors treating them - to think about when treating pain and inflammation, researchers report in Proceedings of the National Academy of Sciences, or PNAS.
"This is certainly something that clinicians and individuals should be keeping in mind," Jennifer Warner-Schmidt, the study's lead author from The Rockefeller University in New York City, told Reuters Health.
"If you're taking an SSRI antidepressant and it's not working so well for you, one possibility could be that the anti-inflammatory drugs are having an effect there," she said.
By analyzing the brains and behavior of mice treated with Celexa, a drug from the class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs, Warner-Schmidt and her colleagues found that mice treated with Celexa and an NSAID had lower levels of the antidepressant in their blood than those that were only given Celexa.
Mice that were given a painkiller and antidepressant also did worse on tests measuring their stress and depression than those who just took the antidepressant.
The effect wasn't limited to rodents. The same researchers analyzed data from a previous study done on about 1,500 people treated with Celexa for 12 weeks. Those participants also reported if they took an anti-inflammatory drug such as aspirin or ibuprofen during antidepressant treatment.
After those 12 weeks, 55% of patients who never took an NSAID during the study period got better and were no longer depressed. That compared to 45% of participants who said they took an NSAID at least once and stop being depressed.
The researchers note that they couldn't separate people who took an NSAID only once or twice during the 12 weeks from those who regularly took NSAIDs, which are used to treat arthritis and are often given to people who have recently had a heart attack.
Warner-Schmidt and her colleagues also didn't find that NSAIDs interfered with other, non-SSRI antidepressants, which include Wellbutrin and Cymbalta.
Dr. Solomon Snyder, a neuroscientist at Johns Hopkins Medical School in Baltimore who will have a commentary coming out with the print study, said in an email that the findings show that "if someone is receiving SSRIs, he/she should avoid NSAIDs."
However, Snyder told Reuters Health, "Such a recommendation may well be controversial and cause difficulties for patients with arthritis and other conditions which benefit from NSAIDs."
The authors said that based on the data they used, it was impossible to prove that NSAIDs stop SSRIs from working. It's possible, for example, that people who have underlying conditions that require drugs such as aspirin and ibuprofen have more trouble recovering from depression.
However, Warner-Schmidt said, "The animal studies suggest there's a direct interaction between these two drugs."
Dr. Michael Thase, a psychiatrist from the University of Pennsylvania School of Medicine who was involved in the original research on humans used by the authors, told Reuters Health that the new analysis is "intriguing," but that his data don't definitively support the animal studies.
However, Thase said, "Given how commonly the NSAIDs are used, this finding certainly needs to be followed up."
Warner-Schmidt added that it wasn't clear how the interaction between NSAIDs and SSRIs might be happening, and that future studies will need look more closely at that question.
Source: http://bit.ly/S1eCH Proceedings of the National Academy of Sciences, online April 25, 2011.
The findings can't prove that the painkillers, called non-steroidal anti-inflammatory drugs, or NSAIDs, stop antidepressants from working, the authors said. But the possible link is something for patients with depression - and the doctors treating them - to think about when treating pain and inflammation, researchers report in Proceedings of the National Academy of Sciences, or PNAS.
"This is certainly something that clinicians and individuals should be keeping in mind," Jennifer Warner-Schmidt, the study's lead author from The Rockefeller University in New York City, told Reuters Health.
"If you're taking an SSRI antidepressant and it's not working so well for you, one possibility could be that the anti-inflammatory drugs are having an effect there," she said.
By analyzing the brains and behavior of mice treated with Celexa, a drug from the class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs, Warner-Schmidt and her colleagues found that mice treated with Celexa and an NSAID had lower levels of the antidepressant in their blood than those that were only given Celexa.
Mice that were given a painkiller and antidepressant also did worse on tests measuring their stress and depression than those who just took the antidepressant.
The effect wasn't limited to rodents. The same researchers analyzed data from a previous study done on about 1,500 people treated with Celexa for 12 weeks. Those participants also reported if they took an anti-inflammatory drug such as aspirin or ibuprofen during antidepressant treatment.
After those 12 weeks, 55% of patients who never took an NSAID during the study period got better and were no longer depressed. That compared to 45% of participants who said they took an NSAID at least once and stop being depressed.
The researchers note that they couldn't separate people who took an NSAID only once or twice during the 12 weeks from those who regularly took NSAIDs, which are used to treat arthritis and are often given to people who have recently had a heart attack.
Warner-Schmidt and her colleagues also didn't find that NSAIDs interfered with other, non-SSRI antidepressants, which include Wellbutrin and Cymbalta.
Dr. Solomon Snyder, a neuroscientist at Johns Hopkins Medical School in Baltimore who will have a commentary coming out with the print study, said in an email that the findings show that "if someone is receiving SSRIs, he/she should avoid NSAIDs."
However, Snyder told Reuters Health, "Such a recommendation may well be controversial and cause difficulties for patients with arthritis and other conditions which benefit from NSAIDs."
The authors said that based on the data they used, it was impossible to prove that NSAIDs stop SSRIs from working. It's possible, for example, that people who have underlying conditions that require drugs such as aspirin and ibuprofen have more trouble recovering from depression.
However, Warner-Schmidt said, "The animal studies suggest there's a direct interaction between these two drugs."
Dr. Michael Thase, a psychiatrist from the University of Pennsylvania School of Medicine who was involved in the original research on humans used by the authors, told Reuters Health that the new analysis is "intriguing," but that his data don't definitively support the animal studies.
However, Thase said, "Given how commonly the NSAIDs are used, this finding certainly needs to be followed up."
Warner-Schmidt added that it wasn't clear how the interaction between NSAIDs and SSRIs might be happening, and that future studies will need look more closely at that question.
Source: http://bit.ly/S1eCH Proceedings of the National Academy of Sciences, online April 25, 2011.
Pediatricians call for stricter laws for chemicals
NEW YORK (Reuters Health) - The U.S. is not doing enough to protect kids from exposure to potentially dangerous chemicals, pediatricians said in a new statement released today.
The policy paper from the American Academy of Pediatrics explains that a law meant to inform the public about the risks of different chemicals, and to give the government the right to intervene to keep dangerous chemicals off the market, has largely failed to achieve those goals.
And, writes Dr. Jerome Paulson, part of the AAP's Council on Environmental Health, the consequences of that may hit kids the hardest, and in unpredictable ways.
"Children are not little adults," Paulson, of Children's National Medical Center in Washington, D.C., told Reuters Health. "Their bodies are different and their behaviors are different. That means that their exposures to chemicals in the environment are different, and the way their bodies (break down) those chemicals are different."
Kids may be especially vulnerable to chemicals during important periods in development, when their brains and bodies are changing quickly, Paulson added.
He said the goal of the report is to include the voice of pediatricians in current discussions about the need to update the Toxic Substances Control Act, passed in 1976 with the intention of protecting the public against exposure to hazardous chemicals.
That law has only been used to regulate five chemicals or types of chemicals, Paulson writes.
That's because it gives the companies that make chemicals an easy out, according to the report, not requiring them to research chemicals for safety before those chemicals go on the market.
And without safety data, the Environmental Protection Agency can't prove that any of the 80,000 chemicals used in the U.S. are risky enough to require regulation.
Paulson said that even without more stringent laws on chemical use, the lack of information about just how risky different chemicals are makes it hard for people to avoid those potential risks.
"The reality is, we live in a chemical world, and some of them are benign and some of them aren't, and we don't know" which are and which aren't, Paulson said.
"It makes it impossible for us to understand what people should do to try to protect themselves or their children."
Noting recent surges of concern about bisphenol A in baby bottles and flame retardants, Paulson said that "we can't really deal with these kinds of issues one chemical at a time. We need a better system for screening chemicals before they're introduced into the marketplace, trying as best we can to identify ones that could be problematic ... while at the same time monitoring those that do come on the market."
Michael Wilson, who studies chemical policy at the University of California, Berkeley, said he was "thrilled" to see the new policy paper and that "it's a powerful statement, it's overdue and also timely."
Two weeks ago, New Jersey senator Frank Lautenberg introduced for the second time a bill that would reform the Toxic Substances Control Act.
"The problems that we're experiencing today that are very concrete problems ... all of those problems are going to broaden and deepen in coming years," Wilson, who is not connected to the AAP's council, told Reuters Health.
A spokesperson from the American Chemistry Council told Reuters Health in an email that the chemical company representative agrees that the Toxic Substances Control Act needs to be updated, and that the chemical industry is also working with the government to protect kids' health through other means.
Reform of chemical laws would "send a whole new signal to the industry" that the health impacts of its products, especially the impacts on vulnerable babies and kids, are just important as their function and price, Wilson said.
Then, the council pointed out, companies would have incentives to produce safer products, instead of having incentives not to measure health and safety risks at all.
SOURCE: http://bit.ly/c7DozH Pediatrics, online April 25, 2011.
The policy paper from the American Academy of Pediatrics explains that a law meant to inform the public about the risks of different chemicals, and to give the government the right to intervene to keep dangerous chemicals off the market, has largely failed to achieve those goals.
And, writes Dr. Jerome Paulson, part of the AAP's Council on Environmental Health, the consequences of that may hit kids the hardest, and in unpredictable ways.
"Children are not little adults," Paulson, of Children's National Medical Center in Washington, D.C., told Reuters Health. "Their bodies are different and their behaviors are different. That means that their exposures to chemicals in the environment are different, and the way their bodies (break down) those chemicals are different."
Kids may be especially vulnerable to chemicals during important periods in development, when their brains and bodies are changing quickly, Paulson added.
He said the goal of the report is to include the voice of pediatricians in current discussions about the need to update the Toxic Substances Control Act, passed in 1976 with the intention of protecting the public against exposure to hazardous chemicals.
That law has only been used to regulate five chemicals or types of chemicals, Paulson writes.
That's because it gives the companies that make chemicals an easy out, according to the report, not requiring them to research chemicals for safety before those chemicals go on the market.
And without safety data, the Environmental Protection Agency can't prove that any of the 80,000 chemicals used in the U.S. are risky enough to require regulation.
Paulson said that even without more stringent laws on chemical use, the lack of information about just how risky different chemicals are makes it hard for people to avoid those potential risks.
"The reality is, we live in a chemical world, and some of them are benign and some of them aren't, and we don't know" which are and which aren't, Paulson said.
"It makes it impossible for us to understand what people should do to try to protect themselves or their children."
Noting recent surges of concern about bisphenol A in baby bottles and flame retardants, Paulson said that "we can't really deal with these kinds of issues one chemical at a time. We need a better system for screening chemicals before they're introduced into the marketplace, trying as best we can to identify ones that could be problematic ... while at the same time monitoring those that do come on the market."
Michael Wilson, who studies chemical policy at the University of California, Berkeley, said he was "thrilled" to see the new policy paper and that "it's a powerful statement, it's overdue and also timely."
Two weeks ago, New Jersey senator Frank Lautenberg introduced for the second time a bill that would reform the Toxic Substances Control Act.
"The problems that we're experiencing today that are very concrete problems ... all of those problems are going to broaden and deepen in coming years," Wilson, who is not connected to the AAP's council, told Reuters Health.
A spokesperson from the American Chemistry Council told Reuters Health in an email that the chemical company representative agrees that the Toxic Substances Control Act needs to be updated, and that the chemical industry is also working with the government to protect kids' health through other means.
Reform of chemical laws would "send a whole new signal to the industry" that the health impacts of its products, especially the impacts on vulnerable babies and kids, are just important as their function and price, Wilson said.
Then, the council pointed out, companies would have incentives to produce safer products, instead of having incentives not to measure health and safety risks at all.
SOURCE: http://bit.ly/c7DozH Pediatrics, online April 25, 2011.
Wednesday, April 27, 2011
THOUGHT FOR THE DAY ....
The mystery of life is not a problem to be solved but a reality to be experienced.
Wider Use of Stents Drives Health Costs
Heart devices known as drug-eluting stents have added as much as $1.57 billion to U.S. health costs since their introduction in 2003, researchers said on Monday.
The study offers an illustration of how new technology can drive health costs, the researchers said in the Archives of Internal Medicine.
Stents, made by companies such as Boston Scientific, Abbott Laboratories, Medtronic Inc., and Johnson & Johnson, are wire-mesh coils used to prop open arteries narrowed by fatty deposits called plaque.
Many models release drugs over time that help prevent scar tissue from building up and blocking the artery.
When they were first introduced to the U.S. market, they were approved mostly for use in previously untreated blood vessels, but their use quickly expanded.
Now, according to some estimates, more than half of all drug-eluting stents are used in so-called off-label indications — uses beyond the scope of their original approval.
Dr. Peter Groeneveld of the University of Pennsylvania School of Medicine and colleagues wanted to see what kind of impact the introduction of a new medical technology such as drug-eluting stents could have on health spending.
They studied data from more than 2,000 people covered by the federal Medicare insurance program for the elderly between 2002 and 2006. The team looked at both direct procedure costs and indirect costs associated with the treatment.
They found that drug-eluting stents may have added $1.57 billion in annual Medicare expenditures.
Dr. Rita Redberg, editor of the journal, called the increase "staggering."
"It is time to clearly define what the value of this extraordinary investment has been in terms of patient benefits and study the harms and determine if we are getting good value for this outlay," she wrote.
Several studies have shown that adding the drug coating to stents helps reduce the need for repeat procedures that were common with earlier, bare metal stents.
The study did not account for increased drug costs, which may have added to the overall increase. Sanofi-Aventis' anti-clotting drug clopidogrel or Plavix is typically prescribed after a stent is implanted to keep patients from developing blood clots.
"This analysis contributes to understanding the cost-increasing effects of technology because the cost effects of drug-eluting stents were measured beyond the price of the new technology itself," the researchers wrote.
The study offers an illustration of how new technology can drive health costs, the researchers said in the Archives of Internal Medicine.
Stents, made by companies such as Boston Scientific, Abbott Laboratories, Medtronic Inc., and Johnson & Johnson, are wire-mesh coils used to prop open arteries narrowed by fatty deposits called plaque.
Many models release drugs over time that help prevent scar tissue from building up and blocking the artery.
When they were first introduced to the U.S. market, they were approved mostly for use in previously untreated blood vessels, but their use quickly expanded.
Now, according to some estimates, more than half of all drug-eluting stents are used in so-called off-label indications — uses beyond the scope of their original approval.
Dr. Peter Groeneveld of the University of Pennsylvania School of Medicine and colleagues wanted to see what kind of impact the introduction of a new medical technology such as drug-eluting stents could have on health spending.
They studied data from more than 2,000 people covered by the federal Medicare insurance program for the elderly between 2002 and 2006. The team looked at both direct procedure costs and indirect costs associated with the treatment.
They found that drug-eluting stents may have added $1.57 billion in annual Medicare expenditures.
Dr. Rita Redberg, editor of the journal, called the increase "staggering."
"It is time to clearly define what the value of this extraordinary investment has been in terms of patient benefits and study the harms and determine if we are getting good value for this outlay," she wrote.
Several studies have shown that adding the drug coating to stents helps reduce the need for repeat procedures that were common with earlier, bare metal stents.
The study did not account for increased drug costs, which may have added to the overall increase. Sanofi-Aventis' anti-clotting drug clopidogrel or Plavix is typically prescribed after a stent is implanted to keep patients from developing blood clots.
"This analysis contributes to understanding the cost-increasing effects of technology because the cost effects of drug-eluting stents were measured beyond the price of the new technology itself," the researchers wrote.
Exercise for Eternal Youth
When Meredith* came to see me, she was 45 and the blush of youth in her face had morphed into the beauty of an adult woman with a significantly pear-shaped figure.
In her teens, Meredith had won many beauty pageants. Her crowning glory came at 20 when she almost won Miss Universe. She then retired from the beauty pageant world and became a lawyer, having decided to make better use of her brain.
The following 25 years proved a mixed bag for Meredith. Work was hard and success in the business world required her to place much of her true self on the back burner. Still, she was among those lucky women able to juggle career and family successfully. Three wonderful children, gloriously successful husband, a mansion in Westchester — all in all, a life to envy.
Despite her many blessings, Meredith’s focus became her oversized body. The erstwhile fashion plate found herself relegated to extra-large couture sizes, and her image in the mirror often made her cry.
Initially convinced her problem could be solved with a serious dietary makeover, she visited with the best and most famous nutritionists in town. She followed rigid diets, acquiesced to weekly IVs of mysterious potions, and swallowed dozens of supplements at all times of day. Spas became her sole vacation destinations and weight loss her Waterloo.
Yes, she did lose weight, hundreds of pounds she lost, but somehow it never stayed off. And while the glow of hope made her run out and buy entire new wardrobes every time she lost 10 pounds, the aftermath was always a disappointing gain of yet another 10 pounds.
Conscious of her options, she saw endocrinologists and bariatric surgeons. She wanted the weight gone before her 45th birthday and every time she ate a morsel of chocolate or a sliver of cake, she secretly swore to herself this was the last time. But alas, it never was. Her will power seemed to betray her along with her body.
As she turned 45 she thought her future held decades of physical decline and more weight gain. Not so.
When she came to see me on an early March morning five years ago, her future changed. Together we took over the task of restoring the puzzle of her life to its perfect and whole beauty.
Each piece fell into its proper place: the beauty queen career, legal feats, child rearing and marriage, sleep and exercise, diet and lifestyles, friends, and the largest piece of all — the wisdom women share.
As her last-resort doctor, I made it my mission to be the final doctor who would help her find her peace, lose the weight obsession, and drop the pounds for good.
Checking her hormones, I found her thyroid a bit underactive, her estrogens, testosterone and progesterone a tad low, her adrenal glands tender and drained. With the proper hormones and supplements balance was quickly restored.
Meredith just celebrated her 50th birthday last month. And she weighs 45 pounds less than when she turned 45.
She is gorgeous! Not just inside as we all are, but now outside as well. And with her hormones in balance we pushed the door ajar for Meredith’s most important transformation that helped her shed the pounds permanently; she started working out consistently five days a week.
Exercise, both Meredith and I agree, is one major key to eternal youth.
Making exercise part of your life, like brushing your teeth, is more important for your wellbeing than getting your hair done or getting a manicure. Believe me, I do them all!
If you take exercise seriously and look at it with passion and gratitude, not as a chore, your mood will improve, your heart will benefit, your skin won’t age, and your brain will stay sharp.
The results of exercising are all pervasive and, if done in balance and not to extremes, will literally keep you forever young. Just ask Meredith!
*Name changed to protect her identity.
In her teens, Meredith had won many beauty pageants. Her crowning glory came at 20 when she almost won Miss Universe. She then retired from the beauty pageant world and became a lawyer, having decided to make better use of her brain.
The following 25 years proved a mixed bag for Meredith. Work was hard and success in the business world required her to place much of her true self on the back burner. Still, she was among those lucky women able to juggle career and family successfully. Three wonderful children, gloriously successful husband, a mansion in Westchester — all in all, a life to envy.
Despite her many blessings, Meredith’s focus became her oversized body. The erstwhile fashion plate found herself relegated to extra-large couture sizes, and her image in the mirror often made her cry.
Initially convinced her problem could be solved with a serious dietary makeover, she visited with the best and most famous nutritionists in town. She followed rigid diets, acquiesced to weekly IVs of mysterious potions, and swallowed dozens of supplements at all times of day. Spas became her sole vacation destinations and weight loss her Waterloo.
Yes, she did lose weight, hundreds of pounds she lost, but somehow it never stayed off. And while the glow of hope made her run out and buy entire new wardrobes every time she lost 10 pounds, the aftermath was always a disappointing gain of yet another 10 pounds.
Conscious of her options, she saw endocrinologists and bariatric surgeons. She wanted the weight gone before her 45th birthday and every time she ate a morsel of chocolate or a sliver of cake, she secretly swore to herself this was the last time. But alas, it never was. Her will power seemed to betray her along with her body.
As she turned 45 she thought her future held decades of physical decline and more weight gain. Not so.
When she came to see me on an early March morning five years ago, her future changed. Together we took over the task of restoring the puzzle of her life to its perfect and whole beauty.
Each piece fell into its proper place: the beauty queen career, legal feats, child rearing and marriage, sleep and exercise, diet and lifestyles, friends, and the largest piece of all — the wisdom women share.
As her last-resort doctor, I made it my mission to be the final doctor who would help her find her peace, lose the weight obsession, and drop the pounds for good.
Checking her hormones, I found her thyroid a bit underactive, her estrogens, testosterone and progesterone a tad low, her adrenal glands tender and drained. With the proper hormones and supplements balance was quickly restored.
Meredith just celebrated her 50th birthday last month. And she weighs 45 pounds less than when she turned 45.
She is gorgeous! Not just inside as we all are, but now outside as well. And with her hormones in balance we pushed the door ajar for Meredith’s most important transformation that helped her shed the pounds permanently; she started working out consistently five days a week.
Exercise, both Meredith and I agree, is one major key to eternal youth.
Making exercise part of your life, like brushing your teeth, is more important for your wellbeing than getting your hair done or getting a manicure. Believe me, I do them all!
If you take exercise seriously and look at it with passion and gratitude, not as a chore, your mood will improve, your heart will benefit, your skin won’t age, and your brain will stay sharp.
The results of exercising are all pervasive and, if done in balance and not to extremes, will literally keep you forever young. Just ask Meredith!
*Name changed to protect her identity.
Painkillers May Hamper Antidepressants
Certain types of antidepressants may not work as well in people who take painkillers such as ibuprofen and aspirin, suggests a new study.
The findings can't prove that the painkillers, called non-steroidal anti-inflammatory drugs, or NSAIDs, stop antidepressants from working, the authors said. But the possible link is something for patients with depression — and the doctors treating them — to think about when treating pain and inflammation, researchers report in Proceedings of the National Academy of Sciences, or PNAS.
"This is certainly something that clinicians and individuals should be keeping in mind," Jennifer Warner-Schmidt, the study's lead author from The Rockefeller University in New York City, told Reuters Health.
"If you're taking an SSRI antidepressant and it's not working so well for you, one possibility could be that the anti-inflammatory drugs are having an effect there," she said.
By analyzing the brains and behavior of mice treated with Celexa, a drug from the class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs, Warner-Schmidt and her colleagues found that mice treated with Celexa and an NSAID had lower levels of the antidepressant in their blood than those that were only given Celexa.
Mice that were given a painkiller and antidepressant also did worse on tests measuring their stress and depression than those who just took the antidepressant.
The effect wasn't limited to rodents. The same researchers analyzed data from a previous study done on about 1,500 people treated with Celexa for 12 weeks. Those participants also reported if they took an anti-inflammatory drug such as aspirin or ibuprofen during antidepressant treatment.
After those 12 weeks, 55 percent of patients who never took an NSAID during the study period got better and were no longer depressed. That compared to 45 percent of participants who said they took an NSAID at least once and stopped being depressed.
The researchers note that they couldn't separate people who took an NSAID only once or twice during the 12 weeks from those who regularly took NSAIDs, which are used to treat arthritis and are often given to people who have recently had a heart attack.
Warner-Schmidt and her colleagues also didn't find that NSAIDs interfered with other, non-SSRI antidepressants, which include Wellbutrin and Cymbalta.
Dr. Solomon Snyder, a neuroscientist at Johns Hopkins Medical School in Baltimore who will have a commentary published with the print study, said in an e-mail that the findings show that "if someone is receiving SSRIs, he/she should avoid NSAIDs."
However, Snyder told Reuters Health, "Such a recommendation may well be controversial and cause difficulties for patients with arthritis and other conditions which benefit from NSAIDs."
The authors said that based on the data they used, it was impossible to prove that NSAIDs stop SSRIs from working. It's possible, for example, that people who have underlying conditions that require drugs such as aspirin and ibuprofen have more trouble recovering from depression.
However, Warner-Schmidt said, "The animal studies suggest there's a direct interaction between these two drugs."
Dr. Michael Thase, a psychiatrist from the University of Pennsylvania School of Medicine who was involved in the original research on humans used by the authors, told Reuters Health that the new analysis is "intriguing," but that his data don't definitively support the animal studies.
However, Thase said, "Given how commonly the NSAIDs are used, this finding certainly needs to be followed up."
Warner-Schmidt added that it wasn't clear how the interaction between NSAIDs and SSRIs might be happening, and that future studies will need look more closely at that question.
The findings can't prove that the painkillers, called non-steroidal anti-inflammatory drugs, or NSAIDs, stop antidepressants from working, the authors said. But the possible link is something for patients with depression — and the doctors treating them — to think about when treating pain and inflammation, researchers report in Proceedings of the National Academy of Sciences, or PNAS.
"This is certainly something that clinicians and individuals should be keeping in mind," Jennifer Warner-Schmidt, the study's lead author from The Rockefeller University in New York City, told Reuters Health.
"If you're taking an SSRI antidepressant and it's not working so well for you, one possibility could be that the anti-inflammatory drugs are having an effect there," she said.
By analyzing the brains and behavior of mice treated with Celexa, a drug from the class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs, Warner-Schmidt and her colleagues found that mice treated with Celexa and an NSAID had lower levels of the antidepressant in their blood than those that were only given Celexa.
Mice that were given a painkiller and antidepressant also did worse on tests measuring their stress and depression than those who just took the antidepressant.
The effect wasn't limited to rodents. The same researchers analyzed data from a previous study done on about 1,500 people treated with Celexa for 12 weeks. Those participants also reported if they took an anti-inflammatory drug such as aspirin or ibuprofen during antidepressant treatment.
After those 12 weeks, 55 percent of patients who never took an NSAID during the study period got better and were no longer depressed. That compared to 45 percent of participants who said they took an NSAID at least once and stopped being depressed.
The researchers note that they couldn't separate people who took an NSAID only once or twice during the 12 weeks from those who regularly took NSAIDs, which are used to treat arthritis and are often given to people who have recently had a heart attack.
Warner-Schmidt and her colleagues also didn't find that NSAIDs interfered with other, non-SSRI antidepressants, which include Wellbutrin and Cymbalta.
Dr. Solomon Snyder, a neuroscientist at Johns Hopkins Medical School in Baltimore who will have a commentary published with the print study, said in an e-mail that the findings show that "if someone is receiving SSRIs, he/she should avoid NSAIDs."
However, Snyder told Reuters Health, "Such a recommendation may well be controversial and cause difficulties for patients with arthritis and other conditions which benefit from NSAIDs."
The authors said that based on the data they used, it was impossible to prove that NSAIDs stop SSRIs from working. It's possible, for example, that people who have underlying conditions that require drugs such as aspirin and ibuprofen have more trouble recovering from depression.
However, Warner-Schmidt said, "The animal studies suggest there's a direct interaction between these two drugs."
Dr. Michael Thase, a psychiatrist from the University of Pennsylvania School of Medicine who was involved in the original research on humans used by the authors, told Reuters Health that the new analysis is "intriguing," but that his data don't definitively support the animal studies.
However, Thase said, "Given how commonly the NSAIDs are used, this finding certainly needs to be followed up."
Warner-Schmidt added that it wasn't clear how the interaction between NSAIDs and SSRIs might be happening, and that future studies will need look more closely at that question.
So Many Reasons to Eat Mangoes
If you’ve had your fill of citrus fruits this past winter, now is the time to go a little tropical with mangoes, which are in season now through September. With their sweet and juicy taste, versatility, and abundance of nutrients, mangoes make a great addition to your diet and cooking. Throw them in a blender for smoothies or slice them into a salad — you’ll be treating your body to much-needed vitamins, minerals, and cancer-fighting compounds.
Versatile
Sweet and slightly tart, mangoes are a welcome addition to the spring and early summer fruit season. They taste great alone or in salads, salsas, smoothies, chutneys, cakes, and tarts. Grown on trees and cultivated in India, mangoes are now raised in temperate climates throughout the world, including in Florida and California, says the American Institute of Cancer Research.
Salsas made with mangoes are fabulous for topping off fish or lean chicken, or rolling into a sandwich wrap. For a terrific tasting and heart-healthy salsa, try this recipe for Avocado and Mango Salsa from the AICR.
Rich in vitamins
Mangoes supply lots of nutrients, according to the American Institute for Cancer Research. They are especially high in vitamins A and C and beta-carotene, as well as potassium. One cup of sliced, raw mango has 25 percent of the recommended daily intake of vitamin A and 76 percent of recommended daily intake of vitamin C. As a good source of potassium, mangoes are considered a great post-workout snack because the mineral helps keep electrolyte levels steady. Potassium also helps with blood pressure regulation.
Cancer fighter
Vitamin A in mangoes is known for promoting vision health, but it also helps cells reproduce normally and may cut the risk of certain cancers. What’s more, Runner’s World magazine reports that the antioxidant compounds known as tannins, which are found in mangoes, discourage the growth of breast- and colon-cancer cells.
Mangoes also pack in dietary fiber — 3 grams in one cup of raw mango — adding to their title as a champ in the battle against certain cancers as well as heart disease.
Pick them carefully
To choose the best fruit, give the nose a squeeze and take those with some give — mangoes soften as they ripen. The peel is tough and inedible and its color ranges from yellow to red to green. The flesh is typically golden colored.
Eat the mango by slicing it top to bottom along the long, flat pit. Then, with the skin side down, use a knife to crosshatch each half without cutting into the skin and spoon out the flesh, advises Runner’s World magazine.
Versatile
Sweet and slightly tart, mangoes are a welcome addition to the spring and early summer fruit season. They taste great alone or in salads, salsas, smoothies, chutneys, cakes, and tarts. Grown on trees and cultivated in India, mangoes are now raised in temperate climates throughout the world, including in Florida and California, says the American Institute of Cancer Research.
Salsas made with mangoes are fabulous for topping off fish or lean chicken, or rolling into a sandwich wrap. For a terrific tasting and heart-healthy salsa, try this recipe for Avocado and Mango Salsa from the AICR.
Rich in vitamins
Mangoes supply lots of nutrients, according to the American Institute for Cancer Research. They are especially high in vitamins A and C and beta-carotene, as well as potassium. One cup of sliced, raw mango has 25 percent of the recommended daily intake of vitamin A and 76 percent of recommended daily intake of vitamin C. As a good source of potassium, mangoes are considered a great post-workout snack because the mineral helps keep electrolyte levels steady. Potassium also helps with blood pressure regulation.
Cancer fighter
Vitamin A in mangoes is known for promoting vision health, but it also helps cells reproduce normally and may cut the risk of certain cancers. What’s more, Runner’s World magazine reports that the antioxidant compounds known as tannins, which are found in mangoes, discourage the growth of breast- and colon-cancer cells.
Mangoes also pack in dietary fiber — 3 grams in one cup of raw mango — adding to their title as a champ in the battle against certain cancers as well as heart disease.
Pick them carefully
To choose the best fruit, give the nose a squeeze and take those with some give — mangoes soften as they ripen. The peel is tough and inedible and its color ranges from yellow to red to green. The flesh is typically golden colored.
Eat the mango by slicing it top to bottom along the long, flat pit. Then, with the skin side down, use a knife to crosshatch each half without cutting into the skin and spoon out the flesh, advises Runner’s World magazine.
Many kids with diabetes have other immune diseases
NEW YORK (Reuters Health) - A third of children with type 1 diabetes have signs of other immune system disorders when they get diagnosed with diabetes, according to a new study.
The findings, researchers say, underscore the importance of keeping an eye out for symptoms of those diseases in diabetic children.
Type 1 diabetes is what's known as an autoimmune disease, where the immune system launches a misguided attack on the body's own tissue. In the case of diabetes, the assault kills off cells in the pancreas that make the blood-sugar-regulating hormone insulin.
Doctors have known for some time that people with type 1 diabetes also have higher-than-average rates of other autoimmune disorders, including autoimmune thyroid disease, the digestive disorder celiac disease, and Addison's disease, a disorder of the adrenal glands.
In the new study, researchers wanted to find out how common it is for children to have signs of those three diseases at the time of their type 1 diabetes diagnosis.
They did that by measuring blood levels of certain "autoantibodies" that serve as markers of the conditions. Autoantibodies are immune system proteins directed against the body's own cells.
Of the 491 children in the study, one-quarter had autoantibodies related to thyroid disease, and one in eight of those children had the disease itself.
Meanwhile, nearly one in eight had antibodies related to celiac disease, and a quarter of those kids had the disease. Five children (or 1 percent of the whole group) had Addison's autoantibodies, and the disease was confirmed in one of them.
The fact that a third of the kids had signs of other autoimmune diseases means parents and doctors should be on the lookout for the three disorders in diabetic children, according to researcher Dr. Jennifer M. Barker of the University of Colorado Denver, who led the new work.
Autoimmune thyroid disease arises when an immune system reaction causes the thyroid gland to produce either too much or too little thyroid hormone. An overactive thyroid can cause symptoms like nervousness, weight loss, sleep problems and intolerance to heat; an underactive one can cause fatigue, dry skin, hair loss and slow growth in height.
Celiac disease is a digestive disorder in which the immune system reacts to foods with gluten (a protein in wheat, barley and rye), damaging the small intestine. In Addison's disease, the adrenal glands cannot produce enough of the hormones cortisol or aldosterone, leading to problems like weakness and fatigue, appetite and weight loss, and irritability.
But while the current study used autoantibody testing to screen for the diseases, there are questions about using the tests in actual practice, according to Barker.
Right now, she told Reuters Health in an email, the American Diabetes Association recommends that children with type 1 diabetes be tested for thyroid disease and celiac disease at the time of their diabetes diagnosis. (After that, thyroid screening should be done yearly, and celiac testing if there are potential symptoms.)
Celiac screening has to be done with an antibody test. But doctors can screen for thyroid disease by measuring blood levels of thyroid-stimulating hormone. And there is debate, Barker said, about whether testing for thyroid antibodies would be useful.
"The presence of autoantibodies does not necessarily mean the child will develop the disease," Barker said.
As for Addison's disease, there are no guidelines on screening children with type 1 diabetes. But Barker said that parents and doctors should at least keep an eye out for symptoms of the disease -- as well as signs of celiac disease and thyroid problems.
In particular, she said, parents should pay attention to their children's growth and physical development, and keep track of any problems they are having with episodes of low blood sugar, abdominal pain, constipation or diarrhea.
It's estimated that anywhere from 15 percent to 30 percent of people with type 1 diabetes have autoimmune thyroid disease, while 4 percent to 9 percent have celiac disease, and less than 1 percent have Addison's.
SOURCE: http://bit.ly/e9SG59 Diabetes Care, online March 23, 2011.
The findings, researchers say, underscore the importance of keeping an eye out for symptoms of those diseases in diabetic children.
Type 1 diabetes is what's known as an autoimmune disease, where the immune system launches a misguided attack on the body's own tissue. In the case of diabetes, the assault kills off cells in the pancreas that make the blood-sugar-regulating hormone insulin.
Doctors have known for some time that people with type 1 diabetes also have higher-than-average rates of other autoimmune disorders, including autoimmune thyroid disease, the digestive disorder celiac disease, and Addison's disease, a disorder of the adrenal glands.
In the new study, researchers wanted to find out how common it is for children to have signs of those three diseases at the time of their type 1 diabetes diagnosis.
They did that by measuring blood levels of certain "autoantibodies" that serve as markers of the conditions. Autoantibodies are immune system proteins directed against the body's own cells.
Of the 491 children in the study, one-quarter had autoantibodies related to thyroid disease, and one in eight of those children had the disease itself.
Meanwhile, nearly one in eight had antibodies related to celiac disease, and a quarter of those kids had the disease. Five children (or 1 percent of the whole group) had Addison's autoantibodies, and the disease was confirmed in one of them.
The fact that a third of the kids had signs of other autoimmune diseases means parents and doctors should be on the lookout for the three disorders in diabetic children, according to researcher Dr. Jennifer M. Barker of the University of Colorado Denver, who led the new work.
Autoimmune thyroid disease arises when an immune system reaction causes the thyroid gland to produce either too much or too little thyroid hormone. An overactive thyroid can cause symptoms like nervousness, weight loss, sleep problems and intolerance to heat; an underactive one can cause fatigue, dry skin, hair loss and slow growth in height.
Celiac disease is a digestive disorder in which the immune system reacts to foods with gluten (a protein in wheat, barley and rye), damaging the small intestine. In Addison's disease, the adrenal glands cannot produce enough of the hormones cortisol or aldosterone, leading to problems like weakness and fatigue, appetite and weight loss, and irritability.
But while the current study used autoantibody testing to screen for the diseases, there are questions about using the tests in actual practice, according to Barker.
Right now, she told Reuters Health in an email, the American Diabetes Association recommends that children with type 1 diabetes be tested for thyroid disease and celiac disease at the time of their diabetes diagnosis. (After that, thyroid screening should be done yearly, and celiac testing if there are potential symptoms.)
Celiac screening has to be done with an antibody test. But doctors can screen for thyroid disease by measuring blood levels of thyroid-stimulating hormone. And there is debate, Barker said, about whether testing for thyroid antibodies would be useful.
"The presence of autoantibodies does not necessarily mean the child will develop the disease," Barker said.
As for Addison's disease, there are no guidelines on screening children with type 1 diabetes. But Barker said that parents and doctors should at least keep an eye out for symptoms of the disease -- as well as signs of celiac disease and thyroid problems.
In particular, she said, parents should pay attention to their children's growth and physical development, and keep track of any problems they are having with episodes of low blood sugar, abdominal pain, constipation or diarrhea.
It's estimated that anywhere from 15 percent to 30 percent of people with type 1 diabetes have autoimmune thyroid disease, while 4 percent to 9 percent have celiac disease, and less than 1 percent have Addison's.
SOURCE: http://bit.ly/e9SG59 Diabetes Care, online March 23, 2011.
FUN FACTS
* Each day some forty-five thousand thunderstorms occur worldwide, resulting in as many as one hundred lightning strikes every second. *
* If Benjamin Franklin had had his way, the Eagle would not be the symbol of the United States. In 1789 he proposed that it be replaced by the Turkey. *
* Thyroid imbalance and iron deficiency are reversible causes for hair loss. *
* All dogs, from the German Shepherd to the tiny Poodle, are direct descendants of wolves. *
* How far can an eagle see?... A lot further than the human eye can see. An eagle can see a rabbit about 1 mile or 1760 yards away. Now the average person needs to be about 550 yards away to see the same rabbit. *
* If Benjamin Franklin had had his way, the Eagle would not be the symbol of the United States. In 1789 he proposed that it be replaced by the Turkey. *
* Thyroid imbalance and iron deficiency are reversible causes for hair loss. *
* All dogs, from the German Shepherd to the tiny Poodle, are direct descendants of wolves. *
* How far can an eagle see?... A lot further than the human eye can see. An eagle can see a rabbit about 1 mile or 1760 yards away. Now the average person needs to be about 550 yards away to see the same rabbit. *
Tuesday, April 26, 2011
THOUGHT FOR THE DAY ....
When one door closes, another opens; but we often look so long and so regretfully upon the closed door that we do not see the one which has opened for us.
Hot Bath on Cold Day May Harm Heart
Taking a hot bath on a cold day could spell trouble for the heart, a Japanese study hints.
Researchers found the rate of cardiac arrests during bathing rose 10-fold from summer to winter, although it was still very low overall, at 54 events per 10 million people bathing for an hour.
During cardiac arrest the heart stops beating, with fatal consequences in the majority of cases. Some 50,000 cardiac arrests occur in Japan every year, compared to 300,000 in the United States.
And new findings may be extra important in Japan, according to the new report, which is published in the journal Resuscitation.
"In Japan, most people take a deep hot bath, since traditional Japanese homes are not well-insulated as in the west, and central heating is quite uncommon," Chika Nishiyama, of Kyoto Prefectural University of Medicine School of Nursing, and colleagues write.
The researchers tapped into data from nearly 11,000 cardiac arrests occurring in Osaka Prefecture between 2005 and 2007.
Before their heart stopped, 22 percent of people had been sleeping, 9 percent had been bathing, 3 percent had been working and one-half percent had been exercising. The rest had been doing "non-specific" or unknown activities.
When looking at the cardiac arrest rates per hour of each activity, bathing was at the top of the list at 54 arrests per 10 million people, followed by 10 per 10 million people exercising.
For bathers, the risk was tied to outside temperatures, with more cardiac arrests on colder days.
While it's still unclear how to explain the link, jumping into the hot tub on a frigid day causes a rapid blood pressure drop, which stresses the heart.
As a consequence, the researchers say, "preventive approaches such as warming a bathroom and a hallway or refraining from taking a deep hot bath could be important for high-risk people."
Researchers found the rate of cardiac arrests during bathing rose 10-fold from summer to winter, although it was still very low overall, at 54 events per 10 million people bathing for an hour.
During cardiac arrest the heart stops beating, with fatal consequences in the majority of cases. Some 50,000 cardiac arrests occur in Japan every year, compared to 300,000 in the United States.
And new findings may be extra important in Japan, according to the new report, which is published in the journal Resuscitation.
"In Japan, most people take a deep hot bath, since traditional Japanese homes are not well-insulated as in the west, and central heating is quite uncommon," Chika Nishiyama, of Kyoto Prefectural University of Medicine School of Nursing, and colleagues write.
The researchers tapped into data from nearly 11,000 cardiac arrests occurring in Osaka Prefecture between 2005 and 2007.
Before their heart stopped, 22 percent of people had been sleeping, 9 percent had been bathing, 3 percent had been working and one-half percent had been exercising. The rest had been doing "non-specific" or unknown activities.
When looking at the cardiac arrest rates per hour of each activity, bathing was at the top of the list at 54 arrests per 10 million people, followed by 10 per 10 million people exercising.
For bathers, the risk was tied to outside temperatures, with more cardiac arrests on colder days.
While it's still unclear how to explain the link, jumping into the hot tub on a frigid day causes a rapid blood pressure drop, which stresses the heart.
As a consequence, the researchers say, "preventive approaches such as warming a bathroom and a hallway or refraining from taking a deep hot bath could be important for high-risk people."
Treatment for Depression Boosts Health of Diabetics
Diabetics with depression take better care of their health when they receive cognitive behavioral therapy, according to a new study.
Depression and diabetes often occur together, and depression often hinders the ability of diabetics to follow their medicine schedule and exercise regularly, according to researchers.
The yearlong study, conducted by scientists at the VA Ann Arbor Healthcare System and the University of Michigan Health System, looked at 145 people diagnosed with Type-2 diabetes and depression who underwent 12 weeks of cognitive behavioral therapy via phone, then monthly booster sessions for nine months, reports Health Day. Cogntive behavioral therapy is a form of talk therapy that helps patients replace negative, distorted thinking patterns with healthier, more realistic ways of thinking.
A control group of 146 diabetics with depression receiving regular diabetes care were used as a comparison.
For 58 percent of those in the intervention group, symptoms of depression had subsided by the end of the year compared with 39 percent of those in the control group, according to researchers. Those in the intervention group also reported lower blood pressure, an increase in the amount of exercise they got, and an upgrade in their overall quality of life.
Depression and diabetes often occur together, and depression often hinders the ability of diabetics to follow their medicine schedule and exercise regularly, according to researchers.
The yearlong study, conducted by scientists at the VA Ann Arbor Healthcare System and the University of Michigan Health System, looked at 145 people diagnosed with Type-2 diabetes and depression who underwent 12 weeks of cognitive behavioral therapy via phone, then monthly booster sessions for nine months, reports Health Day. Cogntive behavioral therapy is a form of talk therapy that helps patients replace negative, distorted thinking patterns with healthier, more realistic ways of thinking.
A control group of 146 diabetics with depression receiving regular diabetes care were used as a comparison.
For 58 percent of those in the intervention group, symptoms of depression had subsided by the end of the year compared with 39 percent of those in the control group, according to researchers. Those in the intervention group also reported lower blood pressure, an increase in the amount of exercise they got, and an upgrade in their overall quality of life.
500-year-old book surfaces in Utah
SALT LAKE CITY – Book dealer Ken Sanders has seen a lot of nothing in his decades appraising "rare" finds pulled from attics and basements, storage sheds and closets.
Sanders, who occasionally appraises items for PBS's Antiques Roadshow, often employs "the fine art of letting people down gently."
But on a recent Saturday while volunteering at a fundraiser for the small town museum in Sandy, Utah, just south of Salt Lake, Sanders got the surprise of a lifetime.
"Late in the afternoon, a man sat down and started unwrapping a book from a big plastic sack, informing me he had a really, really old book and he thought it might be worth some money," he said. "I kinda start, oh boy, I've heard this before."
Then he produced a tattered, partial copy of the 500-year-old Nuremberg Chronicle.
The German language edition printed by Anton Koberger and published in 1493 is a world history beginning in biblical times. It's considered to be one of the earliest and most lavishly illustrated books produced after Johannes Gutenberg invented the printing press and revolutionized publishing.
"I was just absolutely astounded. I was flabbergasted, particularly here in the interior West," Sanders said. "We might see a lot of rare Mormon books and other treasures, but you don't expect to see a five centuries old book, you don't expect to see one of the oldest printed books in the world pop up in Sandy, Utah."
The book's owner has declined to be identified, but Sanders said it was passed down to the man by his great uncle and had been just gathering dust in his attic for decades.
Because of the cotton bond paper it was printed on, not wood pulp paper like most present-day works, Sanders said the remaining pages have been well-preserved albeit literally coming apart at the seams
"Barring further calamity or disaster, it will last another 500 years," he said.
And Sanders is certain it's not a fake.
"It passes the smell test," he said. "I'm not sure there's ever been a forger born who is ambitious enough to hand-create a five centuries old book in a manner sufficient enough to fool people."
But what's it actually worth? Turns out, not much.
It is believed there are several hundred copies in circulation worldwide, making it not-so-rare of a find, and about two-thirds of its pages are missing.
Still, it's not the monetary value that excites Sanders.
"Just the opportunity to handle something from the very beginning of the printed word and the book itself, especially, ironically, in the 21st century with all this talk of the death of the book, and here we have a book that's survived 500-plus years," he said. "It's just exciting ... The value of an artifact like this to me is the least interesting part of it all."
Sanders is displaying the copy at his rare book shop in Salt Lake City.
San Francisco-based antiquities book dealer John Windle said if this copy of the Nuremberg Chronicle were in mint condition and fully intact, it could be worth up to a million dollars.
One in such shape sold last year at a London auction for about $850,000, Windle said, but not so much because it's such a rare find.
"The rarity of the book has almost nothing to do with its value," he said. "If you're collecting monuments of printing history, monuments of human history, if you're collecting achievements of the human spirit through the printed word, this is one of the foundation books ... Every book collector wants a copy of that book or at least some pages from it."
Windle noted that while its worth to collectors is priceless, it is "probably the most common book from the 15th century making its way onto the market these days."
"We have a saying in the book trade: there's nothing as common as a rare book," he added.
Because of this book's tattered state, Windle said it's likely worth less than $50,000.
"It basically kills the value," he said. "If it turned up in perfect condition in Salt Lake City, now that would be amazing. That would be astounding." Luise Poulton, curator and head of rare books at the University of Utah's J. Willard Marriott Library, called it "an exciting find," but largely just because of the way it surfaced.
"It's that classic story," said Poulton, who has several pages from another copy of a Nuremberg Chronicle on display. "You really never know what's in your attic."
Sanders, who occasionally appraises items for PBS's Antiques Roadshow, often employs "the fine art of letting people down gently."
But on a recent Saturday while volunteering at a fundraiser for the small town museum in Sandy, Utah, just south of Salt Lake, Sanders got the surprise of a lifetime.
"Late in the afternoon, a man sat down and started unwrapping a book from a big plastic sack, informing me he had a really, really old book and he thought it might be worth some money," he said. "I kinda start, oh boy, I've heard this before."
Then he produced a tattered, partial copy of the 500-year-old Nuremberg Chronicle.
The German language edition printed by Anton Koberger and published in 1493 is a world history beginning in biblical times. It's considered to be one of the earliest and most lavishly illustrated books produced after Johannes Gutenberg invented the printing press and revolutionized publishing.
"I was just absolutely astounded. I was flabbergasted, particularly here in the interior West," Sanders said. "We might see a lot of rare Mormon books and other treasures, but you don't expect to see a five centuries old book, you don't expect to see one of the oldest printed books in the world pop up in Sandy, Utah."
The book's owner has declined to be identified, but Sanders said it was passed down to the man by his great uncle and had been just gathering dust in his attic for decades.
Because of the cotton bond paper it was printed on, not wood pulp paper like most present-day works, Sanders said the remaining pages have been well-preserved albeit literally coming apart at the seams
"Barring further calamity or disaster, it will last another 500 years," he said.
And Sanders is certain it's not a fake.
"It passes the smell test," he said. "I'm not sure there's ever been a forger born who is ambitious enough to hand-create a five centuries old book in a manner sufficient enough to fool people."
But what's it actually worth? Turns out, not much.
It is believed there are several hundred copies in circulation worldwide, making it not-so-rare of a find, and about two-thirds of its pages are missing.
Still, it's not the monetary value that excites Sanders.
"Just the opportunity to handle something from the very beginning of the printed word and the book itself, especially, ironically, in the 21st century with all this talk of the death of the book, and here we have a book that's survived 500-plus years," he said. "It's just exciting ... The value of an artifact like this to me is the least interesting part of it all."
Sanders is displaying the copy at his rare book shop in Salt Lake City.
San Francisco-based antiquities book dealer John Windle said if this copy of the Nuremberg Chronicle were in mint condition and fully intact, it could be worth up to a million dollars.
One in such shape sold last year at a London auction for about $850,000, Windle said, but not so much because it's such a rare find.
"The rarity of the book has almost nothing to do with its value," he said. "If you're collecting monuments of printing history, monuments of human history, if you're collecting achievements of the human spirit through the printed word, this is one of the foundation books ... Every book collector wants a copy of that book or at least some pages from it."
Windle noted that while its worth to collectors is priceless, it is "probably the most common book from the 15th century making its way onto the market these days."
"We have a saying in the book trade: there's nothing as common as a rare book," he added.
Because of this book's tattered state, Windle said it's likely worth less than $50,000.
"It basically kills the value," he said. "If it turned up in perfect condition in Salt Lake City, now that would be amazing. That would be astounding." Luise Poulton, curator and head of rare books at the University of Utah's J. Willard Marriott Library, called it "an exciting find," but largely just because of the way it surfaced.
"It's that classic story," said Poulton, who has several pages from another copy of a Nuremberg Chronicle on display. "You really never know what's in your attic."
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