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Vol. 2 Issue 4 $4.

99
Don't Let Your Allergies
Bloom This Spring
Winning
the War on
Breast Cancer
Does My Child
Have Athlete's Foot?
HIV Cure?
CS223139-E
Older kids (adolescents,
preteens, tweens, and teens)
need vaccinations too, including
Tdap, Meningococcal, HPV, and fu.
Ask your childs doctor or nurse if
your child needs immunizations to
protect against serious diseases.
http://www.cdc.gov/vaccines/teens
whatdoctorsknow.com
On Call with Dr. Porter
Steve Porter, MD
Publisher and Chairman
Theres nothing more I can do.
Perhaps the most difficult words
a doctor can say. If it werent for
the passion we have as healers,
those five words would cause a
lot of good doctors to change
their profession. So often we are
told to not get too close or dont
get too personal. But we have
no choice. Our passion comes
from being able to heal and to
continue fighting for lives.
As a gastroenterologist,
I see colon cancer and
its related issues every
day. Colon cancer is the third leading killer in America. This year, nearly
50,000 men and women will die from colon cancer. And as far as Im concerned,
thats 50,000 to many. We have to fight every day to find a cure.
As physicians, we can only use the knowledge we have available, but that
doesnt mean we are allowed to give up. Our ultimate goal is telling
a patient to go home and enjoy life. Everything is fine.
Fortunately, I dont deal with breast cancer. But breast cancer is the leading cancer among
women and nearly 40,000 will die this year from the disease. And, thats 40,000 too many. Are
we making progress? Im happy to report that we are doing better. In the article Winning
the War on Breast Cancer, Dr. Mariana Chavez-MacGregor talks about the progress being
made in Stage IV or metastatic cancer. One of the nations leading cancer researchers
Dr. Chavez-MacGregor gives us hope in the war on breast cancer and hope to finding a
cure. But as a word of caution, Dr. Chavez-MacGregor notes, We need to do better.
Join us in the quest to find a cure because every day a life is snuffed out by cancer. I
couldnt agree more with Dr. Chavez-MacGregor. We need to do better.
whatdoctorsknow.com
WHAT DOCTORS KNOW
And you should, too!
P32
Health Hints
34 STIs: Adolescents and Young Adults
36 Helping Heal Little Hearts
40 Get the Facts: Organ Donation
42 Do You Have Dental Jitters?
44 Birth Control: Whats Best?
46 Myth 3: Cancer is a Death Sentence
P12
Taking Control
12 Meningitis
15 New Smartphone App
21 Therafit
26 Gut Feelings About Gastritis
31 Allergies? Or Something More?
whatdoctorsknow.com
Vol. 2 Issue 4
01 On Call With Dr. Porter
04 Meet Our Doctors
06 Medicine in the News
27 CDC Vital Signs: Making
Health Care Safer
32 HealthWatchMD: Dont Let
Foot Pain Cramp Your Style
52 Know Your Specialist:
Reproductive Endocrinologist
In Every Issue
Contents
16 Winning the War
on Breast Cancer
22 Dont Let Your Allergies
Bloom This Spring
41 Does My Child Have
Athletes Foot?
56 HIV Cure?
On The Cover
Inquiring Minds
48 Traumatic Brain Injury, Dementia and Genetic Testing
50 Esophageal Cancer
54 New Approach to Care for Inflammatory Bowel Disease Patients
55 Can Ethnic Background Increase Risk?
58 Whats the Rush?
60 Helping Epilepsy in Children
P52
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Meet Our Doctors
Copyright 2013 by What Doctors Know, LLC. All rights reserved. Reproduction of this magazine,
in whole, or in part is prohibited unless authorized by the publisher or its advertisers. The
Advertising space provided in What Doctors Know is purchased and paid for by the advertisers.
Products and services are not necessarily endorsed by What Doctors Know,LLC.
Calling All Doctors. Our readers want to hear from you. What healthcare
issues do you want to address? What do you want to tell patients all
over the country? Whats new in your practice, in your specialty?
Drop us a line and let us know about any healthcare topic you want
to address in What Doctors Know. Remember, we want to inform and
educate our readers. We know, an informed reader has the opportunity
to live longer and happier. You can be part of that healing process.
Our readers look forward to hearing from you.
Send story ideas to: submit@whatdoctorsknow.com
Steven Porter, MD
Founder and
publisher of What
Doctors Know, Dr.
Porter is recognized
as one of the top
gastroenterologists in the country.
He is the medical director of the
endoscopy lab at a leading hospital in
Ogden, Utah and has been practicing
for more than 25 years. Contact
Dr. Porter at (801)387-2550.
Timothy J. Sullivan, MD
Contributing editorial
advisory board
member of What
Doctors Know, Dr.
Sullivan spent 25 years
in full-time academic medicine at
Washington University, University
of Texas Southwestern Medical
School, and Emory University. He
currently has a full-time allergy and
immunology practice in Atlanta,
Georgia and is a clinical professor at
the Medical College of Georgia.
Vicki Lyons, MD
Founding member
and chairman of the
editorial advisory
board of What Doctors
Know, Dr. Lyons is
a board certified and fellowship
trained allergist and immunologist
practicing in Ogden, Utah. She
has been practicing for 20 years.
Contact Dr. Lyons at (801)387-4850
or www.vicki-lyonsmd.com.
Ronald Mito, DDS,
FDS, RCSEd
Associate dean for
academic programs and
personnel and a professor
of clinic dentistry at
the UCLA School of
Dentistry. Dr. Mito has been a practicing
dentist and UCLA faculty member since
1977. Dr. Mito credits Dr. Kenneth
Mazey, clinical psychologist, for his
significant contributions to protocols
for the management of dental fear.
Mariana Chavez-
MacGregor, MD, MSc
Assistant Professor,
Department of Breast
Medical Oncology,
Division of Cancer
Medicine, The University
of Texas MD Anderson Cancer Center,
Houston, TX. Dr. Chavez-MacGregor
earned an M.D. from the Universidad
Nacional Autnoma de Mxico and a
masters in clinical epidemiology from the
Netherlands Institute of Health and Sciences.
She completed her internal medicine
residency at Barnes-Jewish Hospital at
Washington University in St. Louis and her
medical oncology training at the University
of Texas MD Anderson Cancer Center.
Hannah B. Gay, MD
Associate professor of
pediatrics at the University
of Mississippi Medical
Center. Dr. Gay is a
pediatric HIV specialist
working with the infectious
diseases program at Batson Children's
Hospital which provides a number of
clinical services, including outpatient and
inpatient evaluation and treatment, for
neonatal, pediatric and adolescent patients.
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WHAT DOCTORS KNOW
And you should, too!
Published by
What Doctors Know, LLC
Publisher and Chairman
Steve Porter, MD
Editorial Advisory Board
Vicki J. Lyons, MD, Chairman
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Bonnie Jean Thomas
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E-cigarettes Long Term Health Affects Unclear
ATLANTA, Ga. About one in five U.S. adult cigarette smokers have tried an electronic
cigarette to quit smoking. But the long-term health affects need more studies.
In 2011, about 21 percent of adults who smoke traditional cigarettes had used electronic cigarettes, also known as
e-cigarettes, up from about 10 percent in 2010, according to a report released by the Centers for Disease Control
and Prevention. Overall, about six percent of all adults have tried e-cigarettes, with estimates nearly doubling
from 2010. This study is the first to report changes in awareness and use of e-cigarettes between 2010 and 2011.
During 20102011, adults who have used e-cigarettes increased among both sexes, non-Hispanic
Whites, those aged 4554 years, those living in the South, and current and former smokers
and current and former smokers. In both 2010 and 2011, e-cigarette use was significantly
higher among current smokers compared to both former and never smokers. Awareness of
e-cigarettes rose from about four in 10 adults in 2010 to six in 10 adults in 2011.
E-cigarette use is growing rapidly, said
CDC Director Tom Frieden, MD, MPH.
There is still a lot we dont know about these
products, including whether they will decrease
or increase use of traditional cigarettes.
Although e-cigarettes appear to have far fewer
of the toxins found in smoke compared to
traditional cigarettes, the impact of e-cigarettes
on long-term health must be studied. Research
is needed to assess how e-cigarette marketing
could impact initiation and use of traditional
cigarettes, particularly among young people.
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ST. LOUIS, Mo. Researchers at Washington University
School of Medicine in St. Louis have found that
Nanoparticles carrying a toxin found in bee venom can
destroy human immunodeficiency virus (HIV) while
leaving surrounding cells unharmed. The finding is an
important step toward developing a vaginal gel that may
prevent the spread of HIV, the virus that causes AIDS.
Our hope is that in places where HIV is running
rampant, people could use this gel as a preventive
measure to stop the initial infection, says Joshua L.
Hood, MD, PhD, a research instructor in medicine
at Washington University School of Medicine.
Bee venom contains a potent toxin called melittin
that can poke holes in the protective envelope that
surrounds HIV, and other viruses. Large amounts of
free melittin can cause a lot of damage. In addition to
anti-viral therapy, the researchers found melittin-loaded
nanoparticles to be effective in killing tumor cells.
The new study shows melittin loaded onto these
nanoparticles does not harm normal cells. Thats because
Hood added protective bumpers to the nanoparticle
surface. When the nanoparticles come into contact
with normal cells, which are much larger in size, the
particles simply bounce off. HIV, on the other hand,
is even smaller than the nanoparticle, so HIV fits
between the bumpers and makes contact with the
surface of the nanoparticle, where the bee toxin awaits.
Melittin on the nanoparticles fuses with the
viral envelope, Hood says. The melittin forms
little pore-like attack complexes and ruptures
the envelope, stripping it off the virus.
According to Hood, an advantage of this approach
is that the nanoparticle attacks an essential part of
the virus structure. In contrast, most anti-HIV
drugs inhibit the viruss ability to replicate. But this
anti-replication strategy does nothing to stop initial
infection, and some strains of the virus have found
ways around these drugs and reproduce anyway.
We are attacking an inherent physical
property of HIV, Hood says.
Theoretically, there isnt any way for the
virus to adapt to that. The virus has to
have a protective coat, a double-layered
membrane that covers the virus.
Beyond prevention in the form of a vaginal gel, Hood
also sees potential for using nanoparticles with melittin
as therapy for existing HIV infections, especially
those that are drug-resistant. The nanoparticles
could be injected intravenously and, in theory, would
be able to clear HIV from the blood stream.
The basic particle that we are using in these
experiments was developed many years ago as an
artificial blood product, Hood says. It didnt work
very well for delivering oxygen, but it circulates safely
in the body and gives us a nice platform that we
can adapt to fight different kinds of infections.
Since melittin attacks double-layered membranes
indiscriminately, this concept is not limited to HIV.
Many viruses, including hepatitis B and C, rely on
the same kind of protective envelope and would
be vulnerable to melittin-loaded nanoparticles.
While this particular paper does not address
contraception, Hood says the gel easily could be
adapted to target sperm as well as HIV. But in some
cases people may only want the HIV protection.
We also are looking at this for couples where
only one of the partners has HIV, and they want
to have a baby, Hood says. These particles by
themselves are actually very safe for sperm, for
the same reason they are safe for vaginal cells.
While this work was done in cells in a laboratory
environment, Hood and his colleagues say the
nanoparticles are easy to manufacture in large enough
quantities to supply them for future clinical trials.
Toxin Found
In Bee Venom
Kills HIV Virus
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Lethal, Drug-resistant Bacteria
Spreading in U.S. Healthcare Facilities
ATLANTA, Ga. A family of bacteria has become
increasingly resistant to last-resort antibiotics during the
past decade, and more hospitalized patients are getting
lethal infections that, in some cases, are impossible to
cure. The findings, published in the Centers for Disease
Control (CDC) and Preventions Vital Signs report, are
a call to action for the entire health care community to
work urgently individually, regionally and nationally
to protect patients. During just the first half of 2012,
almost 200 hospitals and long-term acute care facilities
treated at least one patient infected with these bacteria.
The bacteria, Carbapenem-Resistant Enterobacteriaceae
(CRE), kill up to half of patients who get bloodstream
infections from them. In addition to spreading among
patients, often on the hands of health care personnel,
CRE bacteria can transfer their resistance to other
bacteria within their family. This type of spread can
create additional life-threatening infections for patients
in hospitals and potentially for otherwise healthy
people. Currently, almost all CRE infections occur in
people receiving significant medical care in hospitals,
long-term acute care facilities, or nursing homes.
CRE are nightmare bacteria. Our strongest antibiotics
dont work and patients are left with potentially untreatable
infections, said CDC Director Tom Frieden, M.D., M.P.H.
Doctors, hospital leaders, and public health, must work
together now to implement CDCs detect and protect
strategy and stop these infections from spreading.
Enterobacteriaceae are a family of
more than 70 bacteria including
Klebsiella pneumoniae and E. coli
that normally live in the digestive
system. Over time, some of these
bacteria have become resistant to
a group of antibiotics known as
carbapenems, often referred to as
last-resort antibiotics. During the
last decade, CDC has tracked one
type of CRE from a single health
care facility to health care facilities
in at least 42 states. In some
medical facilities, these bacteria
already pose a routine challenge
to health care professionals.
The Vital Signs report describes
that although CRE bacteria are
not yet common nationally, the
percentage of Enterobacteriaceae
that are CRE increased by
fourfold in the past decade. One type of CRE, a
resistant form of Klebsiella pneumoniae, has shown a
sevenfold increase in the last decade. In the U.S.,
northeastern states report the most cases of CRE.
According to the report, during the first half of
2012, four percent of hospitals treated a patient
with a CRE infection. About 18 percent of
long-term acute care facilities treated a patient
with a CRE infection during that time.
In 2012, CDC released a concise, practical CRE
prevention toolkit with in-depth recommendations for
hospitals, long-term acute care facilities, nursing homes
and health departments. Key recommendations include:
enforcing use of infection control precautions
(standard and contact precautions)
grouping patients with CRE together
dedicating staff, rooms and equipment to the
care of patients with CRE, whenever possible
having facilities alert each other when
patients with CRE transfer back and forth
asking patients whether they have recently received
care somewhere else (including another country)
using antibiotics wisely
In addition, CDC recommends screening patients
in certain scenarios to determine if they are carrying
CRE. Because of the way CRE can be carried by
patients from one health care setting to another,
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iPad Users Can Solve Public Health Outbreaks
facilities are encouraged to work together regionally
to implement CRE prevention programs.
These core prevention measures are critical and can
significantly reduce the problem today and for the
future. In addition, continued investment into research
and technology, such as a testing approach called
Advanced Molecular Detection (AMD), is critical to
further prevent and more quickly identify CRE.
In some parts of the world, CRE appear to be
more common, and evidence shows they can be
controlled. Israel recently employed a coordinated
effort in its 27 hospitals and dropped CRE rates by
more than 70 percent. Several facilities and states
in the U.S. have also seen similar reductions.
We have seen in outbreak after outbreak that when
facilities and regions follow CDCs prevention
guidelines, CRE can be controlled and even stopped,
said Michael Bell, M.D., acting director of CDCs
Division of Healthcare Quality Promotion. As
trusted health care providers, it is our responsibility
to prevent further spread of these deadly bacteria.
For more information, visit the CDC website to get
details on CRE and the prevention toolkit (http://www.
cdc.gov/hai/organisms/cre/cre-toolkit/index.html).
ATLANTA, Ga. Scientists and gamers
alike can now play disease detective,
through Solve the Outbreak, a new
iPad app from the Centers for Disease
Control and Prevention. The app
lets users assume the role of a disease
outbreak investigator in the agencys
Epidemic Intelligence Service (EIS)
by navigating three fictional outbreaks
based on real-life events. Users get
clues, review data, and make decisions
to determine the cause of the outbreak.
The goal is to use new technology
to provide an engaging, interactive
way for users to learn how CDC solves
outbreaks, thereby increasing general
knowledge about real-life public
health issues, said CDC Director
Dr. Tom Frieden. This application
allows us to illustrate the challenges of
solving outbreaks and how our disease
detectives work on the front lines to
save lives and protect people 24/7.
In the game, participants also become
familiar with health tips, definitions
and information about epidemiology,
which is a science used to investigate
outbreaks and to monitor patterns,
causes and effects of diseases on
the public. Users advance in rank as
they earn points and can post their
results on Facebook and Twitter
to challenge other participants.
This is a great learning tool for
science teachers, teens, young adults,
public health enthusiasts and mystery
lovers, said Carol Crawford, branch
chief, CDCs Electronic Media
Branch. The three introductory
scenarios are based on actual events
EIS officers have solved. We also
plan to add new outbreak cases.
Established in the early 1950s, the EIS
program recruits some of the most
gifted physicians, scientists, health
professionals and veterinarians into a
two year on the job training program
in epidemiology. In addition to their
scientific, research, and surveillance
work in public health, EIS officers, also
known as disease detectives, are
ready at a moments
notice to fly
anywhere in United States and
around the world to investigate
mysterious disease outbreaks,
natural and man-made disasters, and
other public health emergencies.
The public no longer have to
experience an outbreak investigation
through fictional Hollywood films
like Contagion, Dr. Frieden said.
Users can now get their own first-
hand experience of being a disease
detective through this new application.
Solve the Outbreak application
is available in the iTunes store
at: https://tunes.apple.com/
US/app/id592485067.
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One In Four Physicians Uses Social Media Daily
comfortable with that type of social media instead
of a more public space like Twitter or Facebook.
In March 2011, Miller and colleagues e-mailed the
survey, about attitudes and usage of social media, to
a random sample of 1,695 practicing oncologists and
primary care physicians found among the American
Medical Associations Physician Masterfile. Social
media was defined as Internet-based applications that
allow for the creation and exchange of user-generated
content, including social networking, professional
online communities, wikis, blogs and microblogging.
Of 485 practicing physicians who responded,
nearly sixty percent said social media is beneficial,
engaging and good way to get current, high-quality
information (279 respondents); enables them to care
for patients more efficiently (281 respondents); and
improves the quality of patient care they deliver (291
respondents). What influenced a physicians usage
of social media most were perceived ease of use and
usefulness. Physicians who had positive attitudes
toward social media were more likely to use it.
Neither age nor gender affected use of social media.
More studies are needed to determine how social
media impacts physicians knowledge, attitudes,
skills and behaviors, and its usage among other
populations of health care professionals, Miller says.
For more information go to: http://
www.hopkinsmedicine.org/news
BALTIMORE, Md. A survey from an oncologist
at Johns Hopkins Kimmel Cancer Center shows
that about one in four physicians uses social media
daily or multiple times a day to scan or explore
medical information, and 14 percent use social
media each day to contribute new information.
The survey of 485 oncologists and primary care
physicians, also found that on a weekly basis or more,
61 percent of physicians scan for information and 46
percent contribute new information. More than half said
they use online physician-only communities but only 7
percent said they use Twitter. The work was published
recently in the Journal of Medical Internet Research.
Oncologists are more likely to use social media to keep
up with innovation, while primary care physicians
are more likely to use social media to get in touch
with peers and learn from them, the survey found.
Since the survey was conducted, its likely that more
physicians are using social media now, says Robert S.
Miller, M.D., an assistant professor of oncology and
oncology medical information officer at the Johns
Hopkins Kimmel Cancer Center. The amount of
information required for medical practice is growing
exponentially, he says, and social media provides a
very valid construct for physicians to keep current.
What did surprise us was the heavy use of
online physician-only communities, Miller says.
Its possible that many physicians feel more
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UCLA Researchers Find Signs of Alzheimers
Decades Before Illness Strikes
LOS ANGELES, Calif.
Scientists at UCLA have
discovered a new genetic
risk factor for Alzheimers
disease by screening peoples
DNA, then using an advanced
kind of brain scan to visualize
the brains connections.
Alzheimers disease the commonest
cause of dementia in the elderly
erodes those connections, which we
rely on to support thinking, emotion,
and memory. With no known cure,
the 20 million Alzheimers sufferers
worldwide lack an effective treatment,
and we are all at risk - our risk of developing
Alzheimer's doubles every five years after age 65.
The researchers discovered a common abnormality
in our genetic code that increases our risk for
Alzheimers. To find the gene, they used a new
method that screens the brains connections, the
wiring or circuitry that communicates information in
the brain. Switching off these Alzheimer risk genes
first discovered 20 years ago could stop the disorder
in its tracks, or delay its onset by many years.
The research appears in the March 4
th
online edition
of the Proceedings of the National Academy of Sciences.
We found a change in our genetic code that boosts
our risk for Alzheimers disease, said Paul Thompson,
senior author of the study, a UCLA professor of
neurology, and a member of the UCLA Laboratory of
Neuro Imaging. If you have this variant in your DNA,
your brain connections are weaker. As you get older,
faulty brain connections increase your risk of dementia.
The researchers screened over a thousand peoples DNA,
to find, said Thompson, the common spelling errors
in the genetic code that might heighten risk for disease
later in life. In another first, each person received a
connectome scan as wella special type of brain scan
that measures water diffusion in the brain, which allows
it to map the strength of the brains connections.
Hundreds of computers, calculating for months, sifted
through more than 4,000 brain connections and the
entire genetic code, comparing connection patterns
in people with different genetic variations. In people
whose genetic code differed in one specific gene
called SPON1, weaker brain connections were found
between brain centers controlling
reasoning and emotion. The rogue
gene also affects how senile plaques
build up in the brain one of the
main causes of Alzheimers.
The new study is the first of its
kind to use connectome
scans, which reveal
the brains circuitry
and how information
is routed around the
brain, to discover risk
factors for disease. It
combines these connectivity
scans with extensive genomic screening, to
pinpoint what causes faulty wiring in the brain.
Much of your risk for disease is written in your DNA,
so the genome is a good place to look for new drug
targets, said Thompson, who founded a research
network in 2009 known as Project ENIGMA to pool
brain scans and DNA from 26,000 people worldwide.
If we scan your brain and DNA today, we can discover
dangerous genes that will undermine your ability to
think and plan, and make you ill in the future. If we
find these genes now, there is a better chance of new
drugs that can switch them off before you or your family
get ill. Developing new therapeutics for Alzheimers
is a hot area for pharmaceutical research, he said.
The researchers also found that the SPON1 gene can
also be manipulated to develop new treatments for the
devastating disease. When the rogue gene was altered in
mice, it led to cognitive improvements and fewer plaques
built up in the brain. Alzheimers patients show an
accumulation of these senile plaques made of a sticky
substance called amyloid which kills brain cells, causing
irreversible memory loss and personality changes.
Screening genomes has led to many new drug targets
in the treatment of cancer, heart disease, arthritis,
and brain disorders such as epilepsy. But the UCLA
teams approach screening genomes and brain scans
from the same people promises a faster and more
efficient search. With a brain scan that takes half an
hour and a DNA scan from a saliva sample, we can
search your genes for factors that help or harm your
brains connections, said Thompson. This opens up
a new landscape of discovery in medical science.
For more information, see http://
www.neurology.ucla.edu/
Meningitis
Understanding the Panic
T
his past summer created widespread
panic when contaminated steroid
injections exposed 14,000 people across
23 states to viral meningitis. The
medicine was responsible for 720 viral
meningitis cases and 48 deaths.
If there is any comfort, the meningitis in this case was the
Fungal variety and unless you were unfortunate enough
to receive the contaminated medicine, you werent at risk.
That doesnt make meningitis any less dangerous because
there are five type of the disease it can be contagious
and deadly. There is a great deal of confusion about
meningitis and meningococcal meningitis disease. There
is a difference a deadly difference. Perhaps the greatest
mistake made by people today is confusing meningitis
with the flu and not getting medical help fast enough to
avoid potentially serious complications from the disease.
According to the National Meningitis Association:
1. IntheUnitedStates,approximately1,500
peoplewillbediagnosedwithMeningococcal
Meningitisand11percentwilldie.
2. Adolescentsandyoungadultsareatgreater
riskformeningococcaldiseasethanmost,
accountingfor15percentofallcases.One
outofsevenwhogetthediseasewilldie.
3. Amongthosewhosurvive,approximately
20percentlivewithpermanentdisabilities,
suchasbraindamage,hearingloss,lossof
kidneyfunctionorlimbamputations.
4. Meningococcaldiseaseisoftenmisdiagnosedbecause
itsearlysymptomsaremuchlikethoseoftheflu.
whatdoctorsknow.com
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Types of Meningitis
Viral meningitis, also called aseptic meningitis, is
the most common type. It is rarely fatal and usually
resolves with treatment. Meningitis develops in
fewer than 1 in 1000 people who are infected with
one of the viruses associated with the condition.
Bacterial meningitis is often severe and is considered
a potential medical emergency. If left untreated,
bacterial meningitis may be fatal or cause serious long-
term complications. Because bacterial meningitis can
progress rapidly, it is important to identify the bacteria
and begin antibiotic treatment as soon as possible.
Bacterial infection in the ears, mouth, or sinuses can
spread directly to the brain and spinal cord. Some
types of bacteria are transmitted from person to
person through secretions from the mouth and nose.
Bacterial meningitis is usually severe. While
most people with meningitis recover, it can cause
serious complications, such as brain damage,
hearing loss, or learning disabilities.
What is Meningitis?
Meningitis is inflammation of the meninges that
results in swelling of brain tissue and sometimes
spinal tissue (spinal meningitis). Swelling inhibits
the flow of blood and oxygen to brain tissue.
The characteristic symptoms of meningitis
are stiff neck, severe headache, and fever.
The meninges are three ultrathin membranes
that surround and protect the brain and
a portion of the spinal cord: the outer
membrane (dura mater), middle membrane
(arachnoid), and inner membrane (pia mater).
Meningitis is either infectious (contagious) or
noninfectious. Infectious meningitis is classified
as viral, bacterial, fungal, or parasitic, depending
on the type of organism causing the infection.
There are several pathogens (types of germs) that can
cause bacterial meningitis. Some of the leading causes
of bacterial meningitis in the United States include
Haemophilus influenzae (most often caused by type b,
Hib), Streptococcus pneumoniae, group B Streptococcus,
Listeria monocytogenes, and Neisseria meningitidis.
Fungal meningitis develops in patients with conditions
that compromise the effectiveness of their immune
systems (e.g., HIV/AIDS, lupus, diabetes). Fungal
meningitis occurs in 10% of patients with AIDS.
Crytococcus neoformans and Candida albicans
are commonly involved in fungal meningitis.
Parasitic meningitis is more common in underdeveloped
countries and usually is caused by parasites
found in contaminated water, food, and soil.
Noninfectious meningitis may develop as a complication
of another illness (e.g., mumps, tuberculosis,
syphilis). A break in the skin and/or bones in the
face or skull (caused by birth defect, brain surgery,
head injury) can allow bacteria to enter the body.
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What Causes Meningitis?
Viruses and bacteria that spread to or directly
infect the central nervous system cause
most cases of infectious meningitis.
About 90% of cases of viral meningitis are caused by
one of the enteroviruses (e.g., coxsackievirus, echovirus,
poliovirus). Mumps, herpesvirus, and arboviruses
(transmitted by insect bites) also may cause viral
meningitis. About 30% of mumps cases in people
not vaccinated for the disease develop meningitis.
Common causes of bacterial meningitis include
Streptococcus pneumoniae, Neisseria meningitides,
Staphylococcus aureus, Escherichia coli, and
Staphylococcus epidermidis. Prior to the 1990s,
Haemophilus influenzae type b was the primary
cause, but widespread vaccination (Hib vaccine) has
greatly reduced the incidence of this infection.
Noninfectious Meningitis Causes
There are other, noninfectious ways to
get meningitis. These include:
* Carcinomatosis (widespread metastatic cancer)
* Contaminated water (may contain parasites)
* Head injury, birth defect of the skull, brain surgery (may
result in infection of the meninges or cerebrospinal fluid)
* Medications such as nonsteroidal anti-inflammatories
(e.g., ibuprofen, naproxen) and antibiotics.
Know the Signs and Symptoms of Meningitis
Symptoms of bacterial meningitis are usually
acute, developing within a few hours and last 2 to
3 weeks. It is important to get medical attention
as soon as the symptoms occur, because acute
bacterial meningitis can be fatal within hours.
Viral meningitis can develop suddenly or
within days or weeks, depending on the virus
and the overall health of the patient.
The most common symptoms of both viral and
bacterial meningitis are stiff neck, headache, and
fever. The symptoms can develop over the course of a
few hours (acute bacterial meningitis) or a few days.
Some patients experience cough, runny nose, and
congestion prior to developing other symptoms.
Other signs and symptoms of meningitis can include:
* Confusion
* Drowsiness
* Joint pain
* Lethargy
* Nausea and vomiting
* Seizures
* Sensitivity to light (photophobia)
* Skin rash (commonly near the armpits
and on the hands and feet)
Symptoms in Infants.
Meningitis symptoms in infants can be
difficult to detect and include:
* Bulging of the soft spots (fontanels) in the head
caused by increased intracranial pressure
* Decreased activity
* Difficulty nursing or eating
* Excessive sleeping
* High-pitched cry
* Increased crying and irritability
* Vomiting
Treatment for Meningitis
Treatment for meningitis is determined by the type
of meningitis and the organism causing the disease.
Viral meningitis usually requires bed rest, increased fluid
intake to prevent dehydration, and analgesics (e.g., aspirin,
acetaminophen) to reduce fever and relieve body aches.
Meningitis caused by herpesvirus can be
treated using antiviral medication
Bacterial meningitis requires prompt intravenous
(IV) antibiotic treatment in the hospital to prevent
serious complications and neurological damage. If
symptoms are severe, IV treatment may be initiated
before the lumbar puncture is performed.
Severely ill patients are treated immediately with
a combination of antibiotics. Penicillin combined
with other medications is commonly used.
There are specific medications that are effective against fungal
meningitis and Parasitic meningitis usually is treated with a
benzimidazole derivative or other antihelminthic agent.
Meningitis can strike quickly. When in doubt, seek medical
advice. It could be more than the flu. -This information
provided courtesy of the National Meningitis Association
A smartphone application that has potential to
help children with autism communicate more
effectively is now available for download.
Developed by Keith Allen, Ph.D., professor of psychology
at the University of Nebraska Medical Centers Munroe-
Meyer Institute, the app uses evidence-based naturalistic
teaching procedures to foster communication.
We wanted to help parents do more to help their
children learn basic communication skills. We wanted
to develop something that could assist parents right
in their homes, and we wanted something that was
supported by research, Dr. Allen said. Naturalistic
teaching that provides pictures of objects and
prompts for parents fit all of these requirements.
We is Dr. Allen and BehaviorApp, LLC -- a Lincoln, Neb.-
based smartphone app development company.
This will allow us to put the
experience of a professional
like Dr. Allen into the hands
of many families of children
with autism, said Evelyn
Bartlett, BehaviorApp CEO.
Dr. Allen emphasized that
the app is designed to supplement, not substitute trained
professionals who specialize in treating speech and
communication problems in children with autism.
A limited number of apps, which retail for $24.99, are
being offered free of charge to families of children with
autism. For more information, contact Craig Lutz-Prefect at
BehaviorApp, LLC at craig@sectornow.com or 402-423-2444.
The CDCs most recent figures reported that 1 in 88
children are diagnosed with an autism spectrum disorder.
M
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Helping Children With
Autism Communicate Better
A smartphone application that has potential to
help children with autism communicate more
effectively is now available for download.
Developed by Keith Allen, Ph.D., professor of psychology
at the University of Nebraska Medical Centers Munroe-
Meyer Institute, the app uses evidence-based naturalistic
teaching procedures to foster communication.
We wanted to help parents do more to help their
children learn basic communication skills. We wanted
to develop something that could assist parents right
in their homes, and we wanted something that was
supported by research, Dr. Allen said. Naturalistic
teaching that provides pictures of objects and
prompts for parents fit all of these requirements.
We is Dr. Allen and BehaviorApp, LLC -- a Lincoln, Neb.-
based smartphone app development company.
This will allow us to put the
experience of a professional
like Dr. Allen into the hands
of many families of children
with autism, said Evelyn
Bartlett, BehaviorApp CEO.
Dr. Allen emphasized that
the app is designed to supplement, not substitute trained
professionals who specialize in treating speech and
communication problems in children with autism.
A limited number of apps, which retail for $24.99, are
being offered free of charge to families of children with
autism. For more information, contact Craig Lutz-Prefect at
BehaviorApp, LLC at craig@sectornow.com or 402-423-2444.
The CDCs most recent figures reported that 1 in 88
children are diagnosed with an autism spectrum disorder.
M
y
S
o
c
iu
s
a
p
p

u
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Helping Children With
Autism Communicate Better
...a progress report
O
ver the past 30 years, the pink ribbon has become synonymous with breast
cancer and the fight to find a cure. Finding a cure means prevention,
early detection and treatment of breast cancer and more survivors.
In spite of approximately 39,520 breast cancer deaths in 2012,
second only to lung cancer, there is great progress being made,
especially in the later and more deadly stages of the disease.
Awareness efforts have certainly led to an earlier diagnosis for many,
but we havent been able to reach the ultimate goala cure.
For patients in the advanced stages of breast cancer such as Stage IV or metastatic, they too
often feel abandoned or left out of the fight. But according to physicians like Dr. Mariana
Chavez-MacGregor, Assistant Professor at the Breast Medical Oncology Department at
The University of Texas MD Anderson Cancer Center, the fight for advanced stage cancer
patients is becoming more aggressive than ever with more wins seemingly every day.
whatdoctorsknow.com
Winning
the
War
on
Breast
Cancer
whatdoctorsknow.com
cell with a specific targeted
therapy directed to revert
the course in that highway.
The key to survival or even
extended life expectancy for
advanced cancer is to find
effective drugs that can target
the pathways and stop the
spread. Its surprising and
refreshing to realize how
much effort is going into
research. At MD Anderson
Cancer Center alone, Dr.
Chavez-MacGregor said,
more than 100 drugs (or
compounds) are under
research as part of clinical
trials for different tumor
types at any given time.
Happily, the research some
times (I wish it more often)
turns out a little more hope.
Metastatic cancer patients
can be on medications for the
rest of their life. Once the
cancer has spread to other
parts of the body, treatments
can slow down or stop the
spread. But as a general rule,
it cant be totally cured. It
can only be controlled.
In the United States, approximately 40,000 women
and 500 men die every year from Metastatic Breast
Cancer (MBC). Metastatic, or Stage IV is when
breast cancer has spread to other parts of the body,
including organs like the liver, lung, bones and others.
The challenge is to stop the spread and extend the
life expectancy of the patient. That means finding a
drug that targets the cancer. Easier said than done.
According to the National Foundation for Cancer
Research (NFCR), breast cancer is most likely to become
fatal when cancerous cells metastasize, or spread, to other
parts of the body. In fact, more than 90% of cancer
mortalities are due to cancer that has metastasized. Even
after successful removal of a primary tumor, cancer patients
still live under the constant fear that a few cancer cells
have escaped the surgery, and these cells may eventually
become secondary tumors in other locations of the body.
We are looking at new drugs that act differently than
standard chemotherapy we know them as targeted
therapies and they usually act in a specific pathway. We
are trying to understand and identify those targets. We
are trying to identify the highway inside the cell that has
been identified as a problem so we can treat that cancer
As cancer doctors, every day, we get reminded that we
need to do better. There is no way to give up when you have
to tell a 40 year-old woman with two kids at home she has
metastatic breast cancer and thats it, there is no cure. We
cant do that. It is a constant reminder that we have to do
better. There is no way to give up. Its too hard. There are
too many people effected by it. Dr. Chavez-MacGregor.
The University of Texas, MD Anderson Cancer Center.
When I was first diagnosed with metastatic breast
cancer, the first thought was my children. Im a
mother of three daughters, and it was a fear that I
have to fight this for my daughters, and this was the
first diagnosis. My daughters immediately became
my caregivers. So, that was important for us, and we
bonded as a family, my three daughters and I, through
this journey. Kim Parker, Baltimore, Maryland
A typical treatment plan for a metastatic cancer patient
involves finding the right drug. We may find one to
work for a while and it may stop working. That means
we have to go back to our arsenal of options and find
something else that works, said Dr. Chavez-MacGregor.
I often tell my patients, Im like a plumber and I have
a belt with a number of tools those are my therapeutic
options. I keep using them until I find the right tool for
the situation. As physicians, we dont ever want to run
out of options. We know there has been a lot of progress
in the development of tools, but we want more.
whatdoctorsknow.com
The FDA recently approved three new drugs that
Dr. Chavez-MacGregor says are a welcomed addition
to the fight against advanced stages of breast
cancer. The three include: Afinitor

(Everolimus),
Perjeta (Pertuzumab) and Kadcyla (TDM1).
The greatest breakthrough in these new drugs is
their ability to hitchhike or latch onto the cancer
cells and slow down or even stop their progression.
Everolimus
According to Novartis, makers of Afinitor


(everolimus), the FDA approval for the drug marks
a significant milestone for women battling advanced
breast cancer. The approval of Afinitor

:
* Represents the first major advance for US patients
with advanced HR+ breast cancer since aromatase
inhibitors were introduced more than 15 years ago
InaPhaseIIItrial,Afinitorplusexemestanemore
thandoubledthetimewomenlivedbeforethe
cancerworsenedcomparedtoexemestanealone
Afinitor

(everolimus) is approved for the


treatment of postmenopausal women with
advanced hormone receptor-positive, HER2-
negative breast cancer (advanced HR+ breast
cancer) in combination with exemestane after failure
of treatment with letrozole or anastrozole .
While endocrine therapy remains the cornerstone of
treatment for these women, most will eventually develop
treatment resistance. Therapeutic resistance has been
associated with overactivation of the PI3K/AKT/mTOR
pathway. Afinitor

targets the mTOR pathway, which


is hyperactivated in many types of cancer cells. mTOR
is a protein that acts as an important regulator of tumor
cell division, blood vessel growth and cell metabolism.
Afinitor

is the first
and only treatment that
boosts the effectiveness
of endocrine therapy,
significantly extending
the time women with
advanced breast cancer
live without tumor
progression, said
Gabriel Hortobagyi,
MD, former Chair
of Breast Medical
Oncology, University
of Texas MD Anderson
Cancer Center. This
approval redefines
the treatment and
management of advanced
hormone receptor-
positive breast cancer,
offering a critical new
option for physicians
and patients.
TDM1
The second new drug
approved recently by
the FDA is Kadcyla
(ado-trastuzumab) from Genentech. The U.S.
Food and Drug Administration (FDA) approved
Kadcyla (ado-trastuzumab emtansine or T-DM1)
for the treatment of people with HER2-positive
metastatic breast cancer. Kadcyla is the first FDA-
approved Antibody Drug Conjugate for treating
HER2-positive, an aggressive form of the disease.
In a recent study, people who received Kadcyla
lived a median of 5.8 months longer (overall
survival) than those who received the combination
of lapatinib and Xeloda, the standard of care in
this setting (median overall survival: 30.9 months
vs. 25.1 months). Also, those receiving Kadcyla
experienced a 32 percent reduction in the risk of dying
compared to people who received other medications.
Pertuzumab
The U. S. Food and Drug Administration approved
Perjeta (pertuzumab), also from Genentech, injection
for use in combination with trastuzumab and docetaxel
for the treatment of patients with HER2-positive
metastatic breast cancer who have not received prior anti-
HER2 therapy or chemotherapy for metastatic disease.
Pertuzumab targets the cellular domain of HER2.
Pertuzumab is being studied in early and advanced
stages of HER2-positive breast cancer and advanced
HER2-positive gastric cancer. Pertuzumab is unique
in that it is designed specifically to prevent the HER2
whatdoctorsknow.com
receptor from pairing with other HER receptors, a
process believed to play a critical role in the growth
and formation of several different cancer types. By
preventing receptor pairing, pertuzumab is thought
to block cell signaling, which may inhibit cancer
cell growth or lead to the death of the cancer cell.
Binding of pertuzumab to HER2 may also signal the
body's immune system to destroy the cancer cells.
The mechanisms of action of pertuzumab and
Herceptin are believed to complement each other,
as both bind to the HER2 receptor but on different
regions. The goal of combining pertuzumab with
Herceptin and chemotherapy is to determine if the
combination may provide a more comprehensive
blockade of HER signaling pathways.
A Massive Challenge
We have done a lot better, especially with these new
advanced therapies. We categorize advanced breast
cancer into three groups: Horomone receptor positive,
HER2 positive and Triple Negative, Dr. Chavez-
MacGregor noted. Of the three, we have made the least
progress with Triple Negative subtype because it is the
most complex. For these tumors we dont have targeted
therapies, chemotherapy is our only option and many
times the tumors become resistant to chemotherapy.
We are desperately trying to find answers. Triple
negative breast cancer is our greatest challenge.
The drugs above represent only three approvals for
virtually hundreds of other drugs under study for the
fight against cancer. The first question for many,
particularly those fighting for their lives, is why arent
we seeing more medications becoming available,
particularly when time is not on the side of an advanced
cancer patient? Why, with so many in clinical trials,
are so few drugs being approved by the FDA?
Dr. Chavez-MacGregor explains that while everyone
involved in the process from the patient to the
doctors to the pharmaceutical companies to the
government want nothing more than more and
better medications, and while the process seems to be
painfully drawn out, it can only be accelerated so much.
We have to be careful, she pointed out. We have
to be certain the drug is effective and that it has been
thoroughly tested. It could be disastrous to introduce
a drug that hasnt been properly and thoroughly tested.
If a drug has gone through the proper processes, and
clinical trials, as physicians, we can be confident in
prescribing a medication as part of a treatment plan.
In addition to time and money, testing a drug requires
clinic trials and patients for these trials. According to
Dr. Chavez-MacGregor, clinical trials include thousands
of patients to obtain the necessary results to safely
add a new tool to the battle against breast cancer.
Adequate Funding?
Medical research is expensive with never a promise of
a positive outcome. There is a fear from the medical
community that recent government spending cuts
may affect research. However, a great deal of drug
research comes from pharmaceutical companies looking
for effective products to bring to market. Other
funding comes from non-profit organizations such as
the Susan G, Komen Foundation, the Breast Cancer
Research Foundation and the Avon Breast Cancer
Foundation. The process will still require federal
government funding through such organizations
as the National Cancer Institute. Time will tell if
the budget cuts will slow down the governments
most important role approving the drugs.
Perhaps the greatest question on the mind
of any advanced stage breast cancer patient
and their doctor is: Are we winning the war?
-Mariana Chavez-MacGregor, MD, MSC
whatdoctorsknow.com 0
STAGE 0
E
A
R
L
Y
A
D
V
A
N
C
E
D
Abnormal cells that are
not invasive cancer
(non-invasive is often
referred to as in situ).
There are 2 types of
breast cancer in situ.
Ductal carcinoma in situ (DCIS): Abnormal cells are found in the lining of a breast duct.
In some cases, DCIS may become invasive cancer and spread to other tissues.
Lobular carcinoma in situ (LCIS): Abnormal cells are found in the lobules of the breast. This condition
seldom becomevs invasive cancer, but having lobular carcinoma in situ in one breast increases the risk of
developing breast cancer in either breast.
STAGE IV
Metastatic cancer; the cancer has spread to other parts of the body, such as the lungs, bones or liver.
STAGE I
An early stage of
invasive breast cancer,
and includes two
subcategories.
Stage IA: The tumor is 2 cm (about 3/4 of an inch) or less across (T1), and has not spread to lymph nodes (N0).
Stage IB: The tumor is 2 cm or less across, or is not found (T0 or T1). There are micrometastases in 1
to 3 lymph nodes under the arm (axillary) (the cancer in the lymph nodes is greater than 0.2 mm across
and/or more than 200 cells but is not larger than 2 mm [N1mi]).
STAGE II
Includes two
subcategories
Stage IIA: One of the following applies:
1He tumor |s Z cm or |ess across |or |s not lound |1 or 1 and one ol tHe lo||ow|n app||es:
o It has spread to 1 to 3 axillary lymph nodes, with the cancer in the lymph nodes larger than 2 mm
across (N1a).
o Tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy
(N1b).
o It has spread to 1 to 3 axillary and internal mammary lymph nodes (found on sentinel lymph node
biopsy) (N1c).
1He tumor |s |arer tHan Z cm across and |ess tHan b cm |1Z, but Hasn't spread to tHe |ympH nodes |N.
Stage IIB: One of the following applies:
1He tumor |s |arer tHan Z cm and |ess tHan b cm across |1Z, and Has spread to to 3 ax|||ary |ympH
nodes and/or tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph
node biopsy (N1), OR
1He tumor |s |arer tHan b cm across but does not row |nto tHe cHest wa|| or sk|n and Has not spread to
|ympH nodes |13, N. 1He cancer Hasn't spread to d|stant s|tes |l.
STAGE III
Includes three
subcategories
Stage IIIA: One of the following applies:
1He tumor |s not more tHan b cm across |or cannot be lound |1 to 1Z, Has spread to 4 to 9 ax|||ary
lymph nodes or it has enlarged the internal mammary lymph nodes (N2), OR
1He tumor |s |arer tHan b cm across but does not row |nto tHe cHest wa|| or sk|n |13. lt Has spread to
to 9 ax|||ary nodes or to |nterna| mammary nodes |N or NZ.
Stage IIIB: The tumor has grown into the chest wall or skin (T4), and one of the following applies:
It has not spread to the lymph nodes (N0).
It has spread to 1 to 3 axillary lymph nodes and/or tiny amounts of cancer are found in internal mammary
lymph nodes on sentinel lymph node biopsy (N1).
lt Has spread to 4 to 9 ax|||ary |ympH nodes or |t Has en|ared tHe |nterna| mammary |ympH nodes |NZ.
Note: Inammatory breast cancer, a rare type of cancer, is diagnosed as Stage IIIB unless it has spread to
distant lymph nodes or organs, in which case it would be Stage IV. With inammatory breast cancer, the
breast looks red and swollen because cancer cells block the lymph vessels in the skin.
Stage IIIC: Which is a tumor of any size or cannot be found, and one of the following applies:
Cancer has spread to 10 or more axillary lymph nodes (N3).
Cancer has spread to the lymph nodes under the clavicle (collar bone) (N3).
Cancer has spread to the lymph nodes above the clavicle (N3).
Cancer involves axillary lymph nodes and has enlarged the internal mammary lymph nodes (N3).
Breast Cancer Staging
C
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Equal Parts Comfort & Style:
Therat by Dr. Lisa
The comfort shoe trend has a strong new contender
Therat by Dr. Lisa. Co-developed by Dr. Lisa Masterson
of the Emmy Award-winning television series, The
Doctors, these shoes are designed specically for
women, and provide cushioning, comfort, style and
support and are accredited by the National Posture
Institute. The 12-hour shoe for the 12- hour day, as we
like to call it, completely transforms lives lled with
errands, household activities, long days at the job,
workouts and more.
The wrong shoes can plague the body with insuerable
aches, pains and stress. Therat By Dr. Lisa shoes feature
multiple layers and densities that distribute the shock of
each step downward and outward providing cushioning
and support. Theres no need to worry about rough
landings leading to dicult body aches in the mornings.
Women are constantly moving. Were always on the go
and we want comfortable shoes that move with us, but we
want them stylish enough so we can wear them wherever
were going, says Dr. Masterson. Thats why Therat By Dr.
Lisa shoes were designed to be extra comfortable and to
relieve pain in the back, hips, legs and feet.
Thanks to the cushioning and supportive layers, Therat
By Dr. Lisa oers extra comfort for the active woman with
their patented, innovative technology. The Therat By Dr.
Lisa Personal Comfort System (PCS) Technology allows
the outsole of the shoe to be adjusted to increase or
decrease levels of impact resistance. There are three
special dual-density Adapters inside the shock-
absorbing wedge that may be removed to adjust the
resistance and the cushioning.
I know what it is to be a working mom, says Dr.
Masterson. Juggling it all and maintaining good health is
a challenge. This shoe is a realistic solution for women to
encourage exercise, and bring overall wellness into their
lifestyle. Depending on each womans unique physical
conditions on a particular day or even hour they may
remove the Personal Comfort Adapters to comfort tired,
aching feet.
Therat By Dr. Lisa shoes make women look good and feel
good in their active lifestyles constantly on the go. The
Deborah model is for athletic or walking purposes and
comes in ve great colors: pink, black/pink, red, silver/blue
and black/white. The work shoe and a great
uniform-appropriate style is the Renee model available in
black or white. Prices for both models start at $95 and they
can be shopped online exclusively via Theratshoe.com.
More styles will launch in the near future as well!
The Therat By Dr. Lisa shoes are a smart choice for active
women in various styles of living to maintain a balance of
comfort, support and style.
whatdoctorsknow.com
Don't Let Your
Allergies
Bloom This Spring
T
he term allergic rhinitis
means allergic reactions
occurring in the nose and
surrounding tissues. These
reactions are caused by
airborne substances such
as seasonal pollen, mold spores, house
dust mites, dust from animals, and dust
from cockroaches. Everyone breathes
these materials, but some people make
IgE antibodies (allergic antibodies) and
become allergic to these substances.
An estimated 60,000,000 people in
the United States have allergic rhinitis,
approximately 19 percent of the
population. The symptoms of allergic
rhinitis are nasal itching, sneezing, runny
nose, nasal congestion, obstruction of the
nose at night resulting in poor quality
sleep (allergic inflammation becomes
much more intense during the night),
snoring, postnasal drainage, dry throat
in the morning, popping and ringing
and pressure sensations in the ears, and
sinus pressure headaches. Some people
with allergic rhinitis also have allergic
conjunctivitis and experience intense
itching and burning of the eyes, excessive
tearing, swelling around the eyes, and
dark discoloration beneath the eyes
(allergic shiners). Some allergy sufferers
develop a crease across the bridge of
the nose (where the cartilage joins the
nasal bones) because of constant rubbing
of the nose to relieve the itching.
Seasonal allergic rhinitis causes fatigue
in approximately 80 percent of patients,
and depression in 30 percent. Seasonal
allergic rhinitis, caused by tree and
grass pollen in the spring and weed and
ragweed pollen in the fall causes several
other problems to flare. Active seasonal
rhinitis nearly doubles patients needs
for doctor visits and new medications
for anxiety, depression, asthma, sinus
infections, middle ear infections, and
tonsil infections (Crystal-Peters, et.al.
Annals of Allergy, Asthma & Immunol.
2002;89:457-462). Migraine headaches
are more frequent when allergies are
active. Embarrassing symptoms occur
in at least 25 percent of patients.
whatdoctorsknow.com
whatdoctorsknow.com
The economic impact of allergic
rhinitis includes 3,500,000 workdays
lost each year and approximately
2,000,000 days of school lost because
of allergic rhinitis. When allergic
rhinitis is active, productivity at work
or school is impaired by fatigue,
distraction by allergic symptoms, and
sometimes by the sedating properties
of over-the-counter allergy remedies.
How to control of allergic rhinitis
We have gained a detailed
understanding of the mechanisms
of allergic rhinitis. This has led to
the development of a broad range
of powerful interventions can
provide nearly complete control
of allergic rhinitis symptoms and
methods to eliminate these allergic
reactions, with mild or no adverse
reactions from medications.
Reasonable expectations
of these interventions:
No symptoms. Symptoms of allergic
rhinitis usually can be suppressed
to the point that they are of little
consequence in most patients.
No sleep disturbance. Aggressive
interventions can eliminate nocturnal
nasal obstruction which leads to
poor quality sleep. This seems to
be the main reason for fatigue and
other allergic rhinitis complications.
No complications. Aggressive
management of allergic rhinitis
should minimize the chance of
complications such as bacterial
sinusitis or flares of asthma.
Three levels of care for allergic
rhinitis: Self-care, physician care,
and specialist physician care
Self-care: Approximately 80 percent
of people with allergic rhinitis either
endure the problems or use over-
the-counter medications. Keeping
the windows in the home and car
closed helps. HEPA air filters in the
bedroom may help. Oral antihistamines
can be helpful for itching, sneezing,
runny nose, and itching and burning
of the eyes, reducing symptoms
25% better than a placebo. Older
sedating antihistamines such as
diphenhydramine can be helpful, but
also have been shown to impair our
ability to drive and learn. Newer, non-
sedating antihistamines are available
over-the-counter that provide relief
and are much safer. Antihistamines
have little effect on nasal or sinus
congestion. Oral decongestants
can provide some relief from the
congestion, but they also disrupt
normal sleep architecture, and can
cause heart rhythm problems,
dizziness, anxiety and tremors.
Nasal spray decongestants can
be effective for congestion,
but many people quickly
become dependent upon the
decongestant sprays. Once
the effect of the decongestant
spray wears off, the nose
swells shut and is very
uncomfortable unless the
spray is used again. Intranasal
cromolyn and intranasal
saline also help some individuals.
Is self-care effective? For some
individuals, self-care provides
acceptable relief from symptoms,
protection against sleep
disturbance, and protection against
complications such as sinusitis.
Physician care: Approximately
20 percent of patients with allergic
rhinitis see a physician for more
powerful interventions. Prescription
medications proven to be effective
for allergic rhinitis include intranasal
steroids, intranasal antihistamines,
intranasal nerve blocking agents, oral
medications that block leukotrienes
(allergy mediators that along with
histamine account for most of the
allergic manifestations), and in extreme
cases, oral or injected steroids.
If the allergic rhinitis symptoms are
suppressed, sleep isn't disturbed, and
there are no complications, the goals
reasonably expected have been achieved.
whatdoctorsknow.com
whatdoctorsknow.com
Expert care: When symptoms are not
well controlled, and sleep is disturbed
by nocturnal nasal obstruction, or when
complications of allergic rhinitis such as
asthma or sinusitis are present despite
these interventions, an Allergy and
Immunology specialist is able to provide
effective relief. Accurate diagnosis is
necessary to establish that the problem
really is allergic rhinitis, to guide
specific measures to avoid exposure to
the causes and aggravating factors, and
to identify patients whose problems
can be minimized or eradicated by
immunotherapy (allergy shots). The
evaluation also includes searching for
complications or concurrent problems
such as nasal polyps, nasal septal
deviation, other anatomical problems
in the nasal passages, bacterial sinusitis,
medication effects on the nose, and
multiple other factors that modify or
mimic allergic rhinitis. Concurrent
problems such as asthma, sensitivity
to non-steroidal anti-inflammatory
drugs, Vitamin D deficiency,
and antibody immunodeficiency
should be identified and corrected.
Interventions selected and adjusted
for individualized care usually provide
excellent control of allergic rhinitis.
Symptoms of Seasonal Allergic
Rhinitis and Conjunctivitis
Nasalitching
Sneezing
Clearnasalsecretions(runnynose)
Poorqualitysleep
Snoring
Sinuspressureheadaches
Earsymptoms-popping,ringing,
congestion,variablehearingchanges
Eyesymptomsitching,burning,
tearing,swellingaroundtheeyes
Complications of Seasonal Allergic Rhinitis
Fatigue(80%)
Depression(30%)
Anxiety
Sinus
Sinusinfection
Middleearinfection
Migraineheadaches
Publicembarrassmentbecause
ofobvioussymptoms(25%)
The likelihood allergic rhinitis will
spontaneously go away is approximately
1-2 percent per year. Seasonal
allergies usually return and being
prepared is essential to the long-
term management of this problem.
Starting intranasal steroids before the
pollen season can markedly reduce or
eliminate the flare in some patients.
Immunotherapy (allergy shots), especially
rush immunotherapy, may be useful to
greatly reduce the severity or completely
eliminate seasonal allergic rhinitis.
Patients with allergic rhinitis severe
enough to require the help of an allergist
are usually excellent candidates for
therapy aimed at cure, rather than relief.
Dont accept disrupted quality of
life because of allergic rhinitis.
We now have a large array of over-
the-counter, prescription, and
specialist interventions to
suppress, and even, eliminate
seasonal allergic rhinitis.
You do not have to put
up with seasonal allergies
anymore. Dont let your
allergies bloom this spring. -Timothy J.
Sullivan, MD and Vicki J. Lyons, MD
For Robbie, a
lung transplant
could
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I just want to be a regular mom:
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Robbie is among the tens of
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To find out how, go today to www.donatelife.net
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whatdoctorsknow.com
Gut Feelings About Gastritis
When Your Stomach's Sick
Y
our stomach lining has an
important job. It makes
acid and enzymes that help
break down food so you
can extract the nutrients
you need. The lining also
protects itself from acid damage by
secreting mucus. But sometimes the
lining gets inflamed and starts making
less acid, enzymes and mucus. This
type of inflammation is called gastritis,
and it can cause long-term problems.
Some people think they have gastritis
when they have pain or an uncomfortable
feeling in their upper stomach. But
many other conditions can cause these
symptoms. Gastritis can sometimes
lead to pain, nausea and vomiting.
But it often has no symptoms at all. If
left untreated, though, some types of
gastritis can lead to ulcers (sores in the
stomach lining) or even stomach cancer.
People used to think gastritis and
ulcers were caused by stress and spicy
foods. But research studies show that
bacteria called Helicobacter pylori are
often to blame. Usually, these bacteria
cause no symptoms. In the United
States, 20% to 50% of the population
may be infected with H. pylori.
H. pylori breaks down the inner protective
coating in some peoples stomachs and
immune cells mistakenly attack
healthy cells in the stomach lining.
Gastritis can be diagnosed with an
endoscope, a thin tube with a tiny
camera on the end, which is inserted
through the patients mouth or nose
and into the stomach. The doctor
will look at the stomach lining and
may also remove some tissue samples
for testing. Treatment will depend
on the type of gastritis you have.
Although stress and spicy foods
dont cause gastritis and ulcers, they
can make symptoms worse. Milk
might provide brief relief, but it also
increases stomach acid, which can
worsen symptoms. Your doctor may
recommend taking antacids or other
drugs to reduce acid in the stomach.
Talk with a health care provider if
youre concerned about ongoing pain
or discomfort in your stomach. These
symptoms can have many causes.
Your doctor can help determine
the best course of action for you.
-Source: NIH News in Health,
November 2012, published by the
National Institutes of Health and the
Department of Health and Human
Services. For more information go
to www.newsinhealth.nih.gov
Watch for Ulcers
Gastritis can lead to ulcers over time.
Symptoms of ulcers include pain between
the belly button and breastbone that:
starts between meals or during the night
briefly stops if you eat or take antacids
lasts for minutes to hours
comes and goes for several days or weeks
Contact your doctor right away if you have:
sudden sharp stomach pain that doesnt go away
black or bloody stools
vomit that is bloody or looks like coffee grounds
causes inflammation. I
tell people H. pylori is
like having termites in
your stomach, says
Dr. David Graham,
an expert in digestive
diseases at Baylor
College of Medicine in
Texas. You usually dont
know you have termites until
someone tells you, and you
ignore it at your own risk. H.
pylori can spread by passing
from person to person or
through contaminated food or
water. Infections can be treated with
bacteria-killing drugs called antibiotics.
One type of gastritis, called erosive
gastritis, wears away the stomach
lining. The most common cause of
erosive gastritis is long-term use of
medications called non-steroidal anti-
inflammatory drugs. These include
aspirin and ibuprofen. When you
stop taking the drugs, the condition
usually goes away, says Graham.
Doctors might also recommend
reducing the dose or switching to
another class of pain medication.
Less common causes of gastritis include
certain digestive disorders (such as
Crohns disease) and autoimmune
disorders, in which the bodys protective
1
Making Health Care Safer
About 4% of US hospitals had
at least one patient with a
CRE (carbapenem-resistant
Enterobacteriaceae) infection
About 18% of long-termacute
care hospitals* had one.
4
%
&18
%
Stop Infections from Lethal CRE Germs Now
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
www http://www.cdc.gov/vitalsigns
Untreatable and hard-to-treat infections from CRE
germs are on the rise among patients in medical facilities.
CRE germs have become resistant to all or nearly all the
antibiotics we have today. Types of CRE include KPC
and NDM. By following CDC guidelines, we can halt CRE
infections before they become widespread in hospitals
and other medical facilities and potentially spread to
otherwise healthy people outside of medical facilities.
Health Care Providers can
Know if patients in your facility have CRE.
es CRE.
Alert the receiving facility when a patient with CRE
transfers into your facility.
Protect your patients from CRE.
Follow contact precautions and hand hygiene
recommendations when treating patients with CRE.
Dedicate rooms, staff, and equipment to patients with CRE.
Prescribe antibiotics wisely.
Remove temporary medical devices such as catheters
and ventilators from patients as soon as possible.
*Long-term acute care hospitals provide complex medical care,
such as ventilation or wound care, for long periods of time.
One type of CRE infection
has been reported in medical
facilities in 42 states during the
last 10 years.
CRE germs kill up to half of
patients who get bloodstream
infections from them.
1in2
Problem
Action is needed now to stop
these deadly infections.
CRE germs have found ways to
beat antibiotics.
CRE infections are caused by a family of germs that
are a normal part of a persons healthy digestive
sysLem. TIese germs cun cuuse InIecLIons wIen
LIey geL InLo LIe bIudder, bIood, or oLIer ureus
wIere germs don`L beIong.
Some of these germs have become resistant to
uII or uImosL uII unLIbIoLIcs, IncIudIng IusL-resorL
drugs cuIIed curbupenems. TIese resIsLunL germs
ure cuIIed CRE.
Almost all CRE infections happen to patients
receIvIng serIous medIcuI cure. CRE InIecLIons
ure Iurd Lo LreuL, und In some cuses, unLreuLubIe.
CRE kill up to half of patients who get
bIoodsLreum InIecLIons Irom LIem.
n uddILIon Lo spreudIng umong peopIe,
CRE easily spread their antibiotic resistance to
oLIer kInds oI germs, mukIng LIose poLenLIuIIy
unLreuLubIe us weII.
CRE infections are spreading, and urgent
action is needed to stop them.
AILIougI CRE germs ure noL very common, LIey
Iuve Increused Irom 1% Lo q% In LIe pusL decude.
One Lype oI CRE Ius Increused Irom z% Lo 1o%.
CRE ure more common In some US regIons, sucI
us LIe NorLIeusL, buL qz sLuLes reporL IuvIng Iud uL
IeusL one puLIenL LesL posILIve Ior one Lype oI CRE.
About 18% of long-term acute care hospitals and
about 4% of short-stay hospitals in the US had at
IeusL one CRE InIecLIon durIng LIe hrsL IuII oI zo1z.
CREs ability to spread themselves and their
resistance raises the concern that potentially
untreatable infections could appear in otherwise
IeuILIy peopIe.
CRE infections can be prevented.
Medical facilities in several states have reduced
CRE infection rates by following CDCs prevention
guIdeIInes (see box).
srueI decreused CRE InIecLIon ruLes In uII z; oI
ILs IospILuIs by more LIun ;o% In one yeur wILI u
coordInuLed prevenLIon progrum.
TIe US Is uL u crILIcuI LIme In wIIcI CRE
infections could be controlled if addressed in a
rupId, coordInuLed, und consIsLenL eIIorL by
docLors, nurses, Iub sLuII, medIcuI IucIIILy
IeudersIIp, IeuILI depurLmenLsJsLuLes, poIIcy
mukers, und LIe IederuI governmenL.
CDCs 2012 CRE Toolkit provides CRE
prevention guidelines for doctors and
nurses, hospitals, long-term acute care
hospitals, nursing homes, and health
departments. It gives step-by-step
instructions for facilities treating patients
with CRE infections and for those not yet
affected by them. (http://www.cdc.gov/
hai/organisms/cre/cre-toolkit/index.html)
3
Colorado Department of Public
Health and Environment
Florida Department of Health
CO
Colorado requires laboratories to report CRE
and actively tracks the germs presence.
CDC, Colorado, and several facilities
implemented CDC recommendations to control
an outbreak of CRE.
Result: The outbreak was stopped.
CDC worked with Florida to stop a year-long
CRE outbreak in a long-term acute care hospital.
Improved use of CDC recommendations such
as educating staff; dedicating staff, rooms, and
equipment to patients with CRE; and improving
use of gloves and gowns.
Result: The percentage of patients who got
CRE at the facility dropped from 44% to 0.
FL
3. Local Short-Stay Hospital
2. Long-Term
Acute Care Hospital
Other patients in this facility have CRE.
A nurse doesnt wash his hands, and
CRE are spread to Jan. She develops a
fever and is put on antibiotics without
proper testing.
1. Lots of germs,
1 or 2 are CRE
2. Antibiotics kill off
good germs
3. CRE grow
4. CRE share genetic defenses to
make other bacteria resistant
How CRE Take Over
Risk of CRE Infections
1. Local Short-Stay Hospital
Jan has a stroke and is in the hospital.
She is stable but needs long-term critical care
at another facility.
Jan becomes unstable and goes back to the
hospital, but her new doctors dont know she
has CRE. A doctor doesnt wash her hands after
treating Jan. CRE are spread to other patients.
SOURCE: CDC Vital Signs, 2013
or more InIormuLIon, pIeuse conLucL
Telephone: 1-800-CDC-INFO (232-4636)
TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov
Web: www.cdc.gov
CenLers Ior DIseuse ConLroI und PrevenLIon
16oo CIIILon Roud NE, ALIunLu, GA o
PubIIcuLIon duLe: JJzo1
What Can Be Done
CS238189B
Federal Government is
Monitoring the presence of and risk factors
for CRE infections through the National
Healthcare Safety Network (NHSN) and
EmergIng nIecLIons Progrum (EP).
ProvIdIng CRE ouLbreuk supporL sucI us sLuII
experLIse, prevenLIon guIdeIInes, LooIs, und Iub
LesLIng Lo sLuLes und IucIIILIes.
Developing detection methods and prevention
progrums Lo conLroI CRE. CDC`s DeLecL und
ProLecL eIIorL supporLs regIonuI CRE progrums.
Helping medical facilities improve antibiotic
prescrIbIng prucLIces.
States and Communities can
Know CRE Lrends In your regIon.
Coordinate regional CRE tracking and control
eIIorLs In ureus wILI CRE. Areus noL yeL or
rarely affected by CRE infections can be
proucLIve In CRE prevenLIon eIIorLs.
Require facilities to alert each other when
LrunsIerrIng puLIenLs wILI uny InIecLIon.
Consider including CRE infections on your
sLuLe`s NoLIhubIe DIseuses IIsL.
Health Care CEOs/Medical Offcers can
Require and strictly enforce CDC guidance
Ior CRE deLecLIon, prevenLIon, LruckIng,
und reporLIng.
Make sure your lab can accurately identify CRE
and alert clinical and infection prevention staff
wIen LIese germs ure presenL.
Know CRE Lrends In your IucIIILy und In LIe
IucIIILIes uround you.
WIen LrunsIerrIng u puLIenL, requIre sLuII
Lo noLIIy LIe oLIer IucIIILy ubouL InIecLIons,
IncIudIng CRE.
JoIn or sLurL regIonuI CRE prevenLIon eIIorLs,
und promoLe wIse unLIbIoLIc use.
Health Care Providers can
Know II puLIenLs wILI CRE ure IospILuIIzed uL
your IucIIILy, und sLuy uwure oI CRE InIecLIon
ruLes. Ask II your puLIenLs Iuve receIved
medIcuI cure somewIere eIse, IncIudIng unoLIer
counLry.
Follow infection control recommendations with
every puLIenL, usIng conLucL precuuLIons Ior
puLIenLs wILI CRE. WIenever possIbIe, dedIcuLe
rooms, equIpmenL, und sLuII Lo CRE puLIenLs.
PrescrIbe unLIbIoLIcs wIseIy (ILLp:JJwww.cdc.
govJgeLsmurLJIeuILIcure). Use cuILure resuILs
Lo modIIy prescrIpLIons II needed.
Remove temporary medical devices as soon
us possIbIe.
Patients can
TeII your docLor II you Iuve been IospILuIIzed
In unoLIer IucIIILy or counLry.
Tuke unLIbIoLIcs onIy us prescrIbed.
Insist that everyone wash their hands before
LoucIIng you.
www http://www.cdc.gov/vitalsigns
whatdoctorsknow.com
Allergies?
Or
Something More?
Surgery through the nose stops a
brain fluid leak in a Tucson mom
F
or more than four months,
Aundrea Aragon struggled
with what doctors told her
were allergies. Whenever
she bent over, clear liquid
which turned out to be
brain fluid streamed out her nose.
It took several trips to different
doctors before the cause of the
leaking fluid was determined. Two
small cracks in the back wall of
Aragons sphenoid sinus allowed
cerebral spinal fluid (CSF) to leak.
Most often, surgeons repair such
cracks, which are caused by cerebral
pressure, through craniotomies,
resulting in painful recoveries, extensive
scarring and possible side effects.
But a team of UA surgeons were
able to fix Aragons leaks with an
endoscopic procedure through the
nose, requiring no incisions on
her head and resulting in a shorter
hospital stay and faster recovery.
Alexander G. Chiu, MD, chief of the
Division of Otolaryngology, and G.
Michael Lemole, MD, chief of the
Division of Neurosurgery, in the UA
Department of Surgery, used image-
guided neuronavigation and fluorescein
dye to help find the cracks. They then
used tissue from inside Aragons nose,
as well as a small piece of belly fat, to
repair the cracks and stop the leak.
This case is a nice example where the
otolaryngology and neurosurgery team
approach really helps, Dr. Chiu said.
Our ability to refine our technique
and our synergy with one another
allowed for our patient to go
home sooner, Dr. Lemole said.
Aragon was referred to Drs. Chiu
and Lemole from a community
otolaryngologist based on their national
reputation in skull-base and minimally
invasive surgery. The two pair up to
perform as many as 80 sinonasal and
skull-base cases a year, commonly
treating tumors of the sinuses and
skull base, head trauma and CSF
leaks in patients from throughout
Arizona and neighboring states.
This type of interdisciplinary
teamwork has resulted in UAMC
becoming a referral center for the
best surgical treatment options for
patients with complex neurological
and otolaryngological disorders,
said Rainer W.G. Gruessner, MD,
chairman, UA Department of Surgery.
Before her diagnosis, Aragon said she
was terrified she might not survive.
I was scared to death and
desperate, Aragon said. I knew
it could not be allergies. The fluid
would come out like a puddle.
Steroids and antibiotics did nothing.
I was walking around with toilet
paper shoved up my nose and changing
it every 10 minutes, she recalled.
Aragon and her husband, Anthony,
said they knew they were in good
hands with Drs. Chiu and Lemole.
They were very patient and answered
all of our questions, Anthony
Aragon said. Both were relieved that
minimally invasive surgery could
be performed, accessing the cracks
through Aragons nasal cavity.
They also were relieved to hear the
statistics: Performed endoscopically,
the procedure is successful in 95
to 99 percent of cases; it is only 60
percent successful when performed
via craniotomy, Dr. Chiu said.
While the human body replaces
brain fluid, Aragon was at risk for
developing a lethal infection.
If you are leaking brain fluid out your
nose then you have the potential for
catastrophic meningitis, the kind where
bacteria crawls into your brain and 24
hours later you are essentially in a coma
or dead, Dr. Lemole said. That is
what we worry about in these cases.
Aragon is recovering well, and
is happy to be home with her
husband and children Art,
16, Marc, 10, and Reina, 9.
Aragon posted about the success
of her Oct. 1, 2012 surgery
recently on Facebook.
I am so grateful to them for
everything they have done for us, said
Aragon. I had great care from a great
staff, she said. Im here, and I am
grateful I can take care of my kids.
-This information provided courtesy
of Arizona Health Sciences Center
whatdoctorsknow.com
HealthWatchMD
with Dr. Randy Martin
Provided courtesy of Piedmont Healthcare
Dr. Randy Martin: In our modern society, we are
constantly on our feet, meaning soreness at the end
of the day, particularly if you wear certain types of
shoes. I met with Dr. Charles Haendel, a podiatrist
at Piedmont Mountainside Hospital, to learn more
about how to keep feet healthy and pain-free.
Don't Let Foot
Pain Cramp
Your Style
whatdoctorsknow.com
Dr. Randy Martin: Given that our feet carry
our entire body weight and make up a large
portion of our osteo-structure, it is crucial to
wear proper shoes. Remember Dr. Haendels
tips next time you are shoe shopping and
if you are struggling with persistent foot
pain, it may be time to see your doctor.
D
id you know that 25 percent
of the bones in your body
can be found in your feet?
The foot is comprised of
26 bones, 38 muscles and
108 ligaments. Given that
they support our entire body weight, it is
imperative to take good care of our feet.
Before the days of modern society,
human feet were adapted to walking
on softer, uneven surfaces with a
ball-of-the-foot strike pattern.
Evolutionarily, our feet were not made
to walk on hard, flat surfaces, says
Charles Haendel, M.D., a podiatrist at
Piedmont Mountainside Hospital. Now
we are on concrete, asphalt or terrazzo
floors, so we have adaptively changed
our gait to a prominent heel strike.
In our modern society, Dr. Haendel
sees more women with foot problems.
When women go through their child-
bearing years, the pregnancy hormone
progesterone relaxes ligaments and
the longitudinal arches. As a result,
[womens] shoe sizes change, he says.
Dr. Haendel adds that many women
are wearing the wrong size shoe
and choosing fashion over comfort,
which can lead to foot pain now and
bigger problems down the road.
The Choice Between Fashion
and Foot Health
High heels create not only foot problems
and demand an unnatural position
of the foot, but they create structural
problems as well, says Dr. Haendel.
Rheumatologists and orthopedists have
multiple papers to show that high heels
can destroy the knee progressively.
So how can we make stylish and safe
footwear choices? Dr.Haendel says to
remember the following criteria:
The shoe should properly fit to your
foot and support your arch.
Buy moderately high heels not
sky-high stilettos. Pick heels that
do not cause your toes to contract
or Achilles tendon to tighten.
Shoes should be comfortable when
you try them on. Dont believe
that you can break them in.
whatdoctorsknow.com 34
STI's: Adolescents
and Young Adults
Young People aged 15-24 Responsible
for Nearly Half of STI Cases
S
exually active adults and young people in the
United States account for nearly half of the
STI (sexually transmitted infections) cases
reported. According to the CDC (Center for
Disease Control) an estimated 20 million new
sexually transmitted infections occur every
year while many cases of chlamydia, gonorrhea, and
syphilis continue to go undiagnosed and unreported.
It seems sexually active adolescents aged 1519
years and young adults aged 2024 years are at
higher risk of acquiring STDs due to a combination
of behavioral, biological, and cultural reasons.
In addition to increasing a persons risk for HIV
infection, sexually transmitted disease (STDs) can lead
to severe reproductive health complications, such as
infertility. Theres also the health cost. STDs are a
serious drain on the U.S. health care system, costing the
nation almost $16 billion in health care costs every year.
Sexually transmitted infections are diseases spread by
having sex with someone who has an STI. You can
get a sexually transmitted disease from sexual activity
that involves the mouth, anus, vagina, or penis.
STIs are serious illnesses that require treatment. Some
STIs, like HIV, cannot be cured and are deadly. By
learning more about STIs, you can learn ways to
protect yourself from these diseases. STIs include:
Genitalherpes
HIV/AIDS
Genitalwarts
HepatitisB
Chlamydia
Syphilis
Gonorrhea("Clap")
Vaginitis
Trichomonias("Trick")
What are the symptoms of STIs?
Sometimes, there are no symptoms. If
symptoms are present, they may include:
Bumps,sores,orwartsnearthe
mouth,anus,penis,orvagina
Swellingorrednessnearthepenisorvagina
Skinrash
Painfulurination
whatdoctorsknow.com 35
Weightloss,loosestools,nightsweats
Aches,pains,fever,andchills
Yellowingoftheskin(jaundice)
Dischargefromthepenisorvagina
(Vaginaldischargemaysmellbad.)
Bleedingfromthevaginaotherthan
duringamonthlyperiod
Painfulsex
Severeitchingnearthepenisorvagina
How can I know if I have an STI?
Talk to your health care provider. He or she can
examine you and perform tests to determine if
you have a sexually transmitted disease. If you
think that you have an STI, its important to see
your health care provider. Treatment can:
CuremanySTIs
LessenthesymptomsofSTIs
Makeitlesslikelyyouwillspreadthedisease
Helpyoutogethealthyandstayhealthy
Provideyouwithinformationonhowyou
canpreventgettingandspreadingSTDs
How are STIs treated?
Many STIs are treated with antibiotics. Antibiotics are
medicines that are given as a shot or taken by mouth.
If you are given an antibiotic to treat an STI, its
important that you take all of your medicine, even if
the symptoms go away. Also, never take someone else's
medicine to treat your illness. By doing so, you may
make it more difficult to treat the infection. Likewise,
you should not share your medicine with others.
How can I protect myself from STIs?
Here are some basic steps you can take
to help protect yourself from STIs:
Consider that not having sex is the
only sure way to prevent STIs.
Use a latex condom every time you have sex. (If
you use a lubricant, make sure it is water-based.)
Limit your number of sexual partners.
The more partners you have, the more
likely you are to catch an STI.
Practice monogamy. This means having sex
with only one person. That person must also
have sex with only you to reduce your risk.
Choose your sex partners with care. Dont have sex
with someone whom you suspect may have an STI.
Get checked for STIs. Dont risk giving
the infection to someone else.
If you have more than one sex
partner, always use a condom.
Dont use alcohol or drugs before you
have sex. You may be less likely to practice
safe sex if you are drunk or high.
Know the signs and symptoms of STIs. Look
for them in yourself and your sex partners.
Learn about STIs. The more you know about
STIs, the better you can protect yourself.
How can I prevent spreading a
sexually transmitted infection?
Stop having sex until you see a health
care provider and are treated.
Follow your health care providers
instructions for treatment.
Use condoms whenever you have sex,
especially with new partners.
Dont resume having sex unless your
health care provider says its okay.
Return to your health care
provider to get rechecked.
Be sure your sex partner or partners also are treated.
The Centers for Diseases Control (CDC) recommends
that a screening test for HIV infection be performed
routinely in all individuals age 13 to 64. Additionally,
if you visit your doctor for treatment of STIs, the CDC
recommends routine screening for HIV during each
visit for a new complaint, regardless if you do or do not
practice behaviors that put you at risk for HIV infection.
What is HIV?
Human immunodeficiency virus (HIV) is the virus,
or germ, that causes acquired immune deficiency
syndrome (AIDS). The virus weakens a person's ability
to fight infections and cancer. People with HIV are
said to have AIDS when the virus makes them very
sick and they develop certain infections or cancers.
Having HIV does not always mean you have AIDS. It
can take many years for people with the virus to develop
AIDS. HIV and AIDS cannot be cured. Although
people with AIDS will one day die from an AIDS-related
illness, there are ways to help people stay healthy longer.
How do people get HIV?
A person gets HIV when an infected person's body
fluids (blood, semen, fluids from the vagina, or breast
milk) enter his or her bloodstream. The virus can enter
the blood through linings in the mouth, anus, or sex
organs (the penis and vagina), or through broken skin.
Both men and women can spread HIV. A person with HIV
can feel okay and still give the virus to others. Pregnant
women with HIV can also give the virus to their babies.
Common ways people get HIV:
Sharinganeedletotakedrugs
Havingsexwithaninfectedperson
You cannot get HIV from:
TouchingorhuggingsomeonewhohasHIV/AIDS
Publicbathroomsorswimmingpools
Sharingcups,utensils,ortelephones
withsomeonewhohasHIV/AIDS
Bugbites
Where can I learn more?
CDC Hotline: 800.232.4636 www.cdc.gov/
std/default.htm or www.myclevelandclinic.org
-This information provided courtesy of Cleveland
Clinic and the Center for Disease Control
whatdoctorsknow.com
Helping Heal
Little Hearts
W
aiting on the arrival of your bundle
of joy is an exciting time and,
as days tick by, the prospect of a
healthy bouncing baby becomes
a reality. Yet most families dont
know the risks of congenital heart
defects (CHD), what they are and how they are treated
until they are diagnosed just before, or after, the baby
is born. Thats why the American Heart Association
is working to educate parents and their loved ones
during pregnancy on things they should know.
Before Blake was born, I wish I had known how common
CHDs are in children and that, as a mother there was
nothing that I did to cause his condition, commented
Tiffany Galligan, mom and caregiver to Blake, 4. It
would have been great to know that they are treatable
and, if detected early, children can live full, happy lives.
In fact, about 32,000 infants are diagnosed with a
congenital heart defect each year and 1.3 million
Americans are living today with a CHD.
Blake was diagnosed with Hypoplastic
Left Heart Syndrome, or HLHS. He
had his first open-heart surgery at seven
days old, the second at five months old
and his third when he was three years- old. No
one in our family had a similar condition this was
new to us, Tiffany continued. We were in shock
and disbelief when he was diagnosed at a day old and
felt like our world was crashing down around us.
Parents need credible information and peer support
during this time. In an effort to help provide families
the tools and information parents need to help
prepare them, or offer support and information
during diagnosis and treatment, the American Heart
Association has a web portal that breaks down the
meaning of a CHD, most common types of CHDs,
treatment, and what caregivers can do when their
little one is diagnosed with a CHD and personal
stories that help offer support and motivation.
The diagnosis of a congenital heart defect can be
devastating and frightening for parents. Medical care
teams are able to educate families about congenital
heart disease, whether the diagnosis is made prenatally
American Heart Association offers
tools and resources for families of
children with congenital heart defects
and big
ones, too!
whatdoctorsknow.com
or after birth. With the knowledge and support given
by health care providers, parents as well as extended
families are better equipped to tackle the medical and
surgical treatment, which may be difficult, as they help
their child along the road to recovery. Commented
Catherine L. Webb, M.D., M.S, Pediatric Cardiologist,
Professor of Pediatrics and Communicable Diseases
at the University of Michigan Medical School and
spokesperson for the American Heart Association. I
often find myself reassuring parents that there is nothing
they could have done to prevent their child's congenital
heart defect. Its not anyone's fault. Although
congenital heart disease is the leading cause of death
in children with birth defects, the prognosis is quite
hopeful, as there are more than 1.3 million Americans
living today with some form of a congenital heart
defect. Parents should also know that the American
Heart Associations tools and resources are focused on
preventing as well as improving diagnosis and outcomes
in congenital heart disease. The prognosis for patients
with CHD is far superior today compared to even 10
years ago. Research supported by organizations, such
as the AHA, will continue to improve outcomes and
quality of life for patients with congenital heart disease.
As for Blake whats his prognosis? He is living
life as a normal kid. He plays soccer, swims, goes to
gymnastics and attends preschool. We dont know
what the future has in store for our little guy. He may
need more surgeries later down the road, or even a
transplant, but we are enjoying every day, every smile
and every accomplishment, Tiffany concluded. I
just hope the parents of kids with CHDs take care of
themselves so they can take care of their little ones.
For more information on congenital heart
defects and support for caregivers visit www.
heart.org/congenitalheartdefects and www.
heart.org/caregivers. -This information provided
courtesy of the American Heart Association
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Sklice Lotion should be used in the context of an overall lice management program:
wash (in hot water) or dry-clean all recently worn clothing, hats, used bedding and towels
wash personal care items such as combs, brushes and hair clips in hot water
IMPORTANT SAFETY INFORMATION FOR SKLICE LOTION:
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Avoid contact with eyes. The most common side effects from Sklice Lotion include eye
redness or soreness, eye irritation, dandruff, dry skin, burning sensation of the skin.
Please see Brief Summary of full prescribing information on the next page.
Talk with your doctor if you have any side effect that bothers you or that does not go
away. You may report side effects to the FDA at 1-800-FDA-1088.
When your child comes home with lice, you want to take action. Prescription Sklice Lotion
is FDA approved to treat head lice for children 6 months of age and older, without the need
to nit comb. A ne tooth comb or special nit comb may be used to remove dead lice and nits.
SKLICE Lotion is approved
as a 10-minute treatment for head lice.
sklice.com 1-855-5SKLICE
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whatdoctorsknow.com 0
Get the Facts:
Organ Donation
whatdoctorsknow.com 0
D
espite continuing efforts at public
education, misconceptions and
inaccuracies about donation
persist. Learn these facts to help
you better understand organ,
eye and tissue donation:
Fact: Anyone can be a potential donor regardless
of age, race, or medical history.
Fact: All major religions in the United States support
organ, eye and tissue donation and see it as the
final act of love and generosity toward others.
Fact: If you are sick or injured and admitted to the
hospital, the number one priority is to save
your life. Organ, eye and tissue donation can
only be considered after you are deceased.
Fact: When you are on the waiting list for an organ,
what really counts is the severity of your
illness, time spent waiting, blood type, and
other important medical information, not
your financial status or celebrity status.
Fact: An open casket funeral is possible for
organ, eye and tissue donors. Through
the entire donation process the body is
treated with care, respect and dignity.
Fact: There is no cost to the donor or their
family for organ or tissue donation.
whatdoctorsknow.com
Does my child have
athletes foot?
A
thletes are not the
only ones who get
the itchy skin rash
known as athletes
foot. Anyone can get
athletes foot if their
bare feet are exposed to a fungus in
the right environment such as wet
public/school gym and shower floors.
Athletes foot is rare in pre-teens.
Athletes foot is a very common rash on
the skin of the foot. The fungus that
causes athletes foot grows on warm,
damp surfaces such as around pools,
public showers and locker rooms.
The fungus can cause infection
when it comes in contact with
conditions that allow it thrive; for
example, on bare damp feet. Most
people, especially teenage boys, are
likely to contract athletes foot at
some point in their lives, observes
Robert Morris, M.D., pediatrician at
Mattel Childrens Hospital UCLA.
Symptoms include:
itching; burning; cracked, blistered
or peeling areas between the toes
redness and scaling on
the soles of the feet
rash that spreads to the
instep, and raw skin.
Occasionally the open skin can
become infected with bacteria that
will cause pain and spreading redness.
The fungus that causes athletes foot
can spread to other parts of the foot,
including toenails. It can also infect
other parts of the bodysuch as the
groin, inner thighs and underarms.
Diagnosis and Treatment
Physicians can generally diagnose athletes
foot just by looking at the infected feet.
An over-the-counter, topical antifungal
cream will kill the fungus. Athletes foot
can also be diagnosed by scraping the
affected skin and looking at it under a
microscope to see if the fungus is present.
For infections that involve the sole of
the foot, prescription oral medication
may be prescribed, Dr. Morris notes.
Its also helpful to wash feet and
keep them dry and in the open air
to inhibit the fungus from growing.
Maintaining a disinfected environment
to discourage fungal infection is
ideal, but not always feasible.
Not all foot skin problems are athletes
foot. Parents should talk to their children
about how common these infections are
to get them to recognize symptoms and
seek treatment before the rash becomes
more bothersome and uncomfortable,
If you suspect your child (especially a
preteen) has athletes foot, it is a good
idea to have a doctor take a look in
order to make a correct diagnosis.
Ways to avoid athletes foot:
Wash your feet every day
and dry them thoroughly,
especially between the toes
Wear footwear that allows
your feet to breathe
Wear shower sandals or shoes in pool
areas, public showers and gyms
Use antifungal powder in
your sneakers or shoes
Keep home bathroom surfaces clean
especially showers and tubs
-This information provided courtesy
of Mattel Children's Hospital UCLA
whatdoctorsknow.com
whatdoctorsknow.com
Do You Have
Dental Jitters?
Exploring the causes and ways to get over it
D
ental phobia or dental fear affects an estimated 30 to 40 million Americans, thats
roughly 9 to 13 percent of the population. Thats a lot of people who avoid regular dental
check-ups and needed treatment for several years or even decades because of a deep-
seeded fear of the dentist. Only when an individual is faced with a dental emergency
or unbearable pain will they break down and with great trepidation visit a dentist.
For more than 30 years, I have observed and worked with people who fear
the dentist. I have found that most people fear the dentist because of misperceptions about
treatment, fear of pain, and fear of the unknown. Naturally, people will do everything
in their power to avoid a fearful situation, even if it compromises their health.
However, there are several coping mechanisms and methods to control anxiety and
fear associated with going to the dentist. With patience, trust, and behavioral therapy,
dental phobic individuals will reach a point where they will be able to control their
fear and get on track with restoring and maintaining good oral health.
whatdoctorsknow.com
The following methods are
what I recommend to people
who have dental phobia
and want to get over it:
1

Its very important
that you talk to your
dentist or potential
dentist to make sure they
are aware of your phobia
and they have the time and
desire to work with you
on overcoming your fear.
If necessary, you may even
ask your dentist if he or she
would be willing to meet
in a non-clinical/neutral
setting to discuss your
fears, such as the reception
room or business office.
2

Avoiding stimulants
such as caffeine
is an effective
way to minimize jitters
and agitation. I advise
people to avoid caffeine
at least six hours prior
to dental treatment.
3

When you go in for
your treatment, you
may want to create
a signal to indicate to
your dentist to temporarily
stop treatment. This will
help you feel more in
control of the situation.
4

Folding your
hands over your
stomach can help you feel reassurance if
you are anxious while in the dental chair.
5

Try eating protein prior to going to a
dental appointment. This will help reduce any
feelings of hunger while in the dental chair.
6

A really good technique to calm
yourself down before and during a dental
appointment is to focus on calm steady
breathing. Fear can sometimes lead people to
either hold their breath or breathe too rapidly.
7

Another effective method of reducing dental
phobia is oral and intravenous sedation while
undergoing treatment. However, this is only
a temporary method and avoids the issue of long-
term fear. It can be a method to allow the dentist
to get your urgent dental needs under control while
you work on developing your coping skills.
8

For children, the key is have their first dental
appointment by six months of age so they begin
to become accustomed to the dental office. Their
first visit should not be for an emergency as this could
traumatize them and set the stage for future fears.
If none of these techniques work to help relieve dental
phobia, I encourage people to seek out fear reduction
therapy with a clinical psychologist or other mental
health professional. I have found that many patients
who have mastered coping skills, either on their own
or with the guidance of a psychologist have built the
confidence they needed to start seeing their dentist
regularly without the aid of sedative agents. -Ronald S.
Mito, DDS, FDS, RCSEd, UCLA School of Dentistry
whatdoctorsknow.com
Birth Control: What's Best?
A

study to evaluate birth-control methods
has found dramatic differences in their
effectiveness. Women who used short-
term methods like birth-control pills,
the patch or vaginal ring were 20 times
more likely to have an unintended
pregnancy than those who used longer-acting forms
such as an intrauterine device (IUD) or implant.
Results of the study, by researchers at Washington
University School of Medicine in St. Louis, are reported
May 24, 2012 in the New England Journal of Medicine.
Birth-control pills are the most commonly used
reversible contraceptive in the United States, but their
effectiveness hinges on women remembering to take
a pill every day and having easy access to refills.
In the study, birth-control pills and other short-term
contraceptive methods, such as the contraceptive patch
or ring, were especially unreliable among younger
women. For those under 21 who used birth-control
pills, the patch or ring, the risk of unplanned pregnancy
was almost twice as high as the risk among older
women. This finding suggests that increased adolescent
use of longer acting contraceptive methods could
prevent substantially more unplanned pregnancies.
This study is the best evidence we have that long-
acting reversible methods are far superior to the
birth-control pill, patch and ring, says senior author
Jeffrey Peipert, MD, the Robert J. Terry Professor
of Obstetrics and Gynecology. IUDs and implants
are more effective because women can forget about
them after clinicians put the devices in place.
Unintended pregnancy is a major problem in the
United States. About 3 million pregnancies per year
50 percent of all pregnancies are unplanned.
The rate of unintended pregnancy in the United
States is much higher than in other developed nations,
and past studies have shown that about half of these
pregnancies result from contraceptive failure.
whatdoctorsknow.com
IUDs are inserted into the uterus by a health-care
provider. The hormonal IUD is approved for five
years, and the copper IUD can be used for as long as
10 years. Hormonal implants are inserted under the
skin of the upper arm and are effective for three years.
Many women, however, cannot afford the upfront costs
of these methods, which can be more than $500.
We know that IUDs and implants have very low failure
rates less than 1 percent, says Brooke Winner,
MD, a fourth-year resident at Barnes-Jewish Hospital
and the studys lead author. But although IUDs are
very effective and have been proven safe in women
and adolescents, they only are chosen by 5.5 percent of
women in the United States who use contraception.
Earlier contraceptive studies asked women to recall
the birth-control method they used and number of
pregnancies. For this study, the investigators wanted
to determine whether educating women about the
effectiveness of various birth-control options and
having them choose a method without considering
cost would reduce the rate of unintended pregnancy.
Birth control was provided to women at no cost.
The study involved more than 7,500 women enrolled in
the Contraceptive CHOICE project. Participants were
ages 14-45 and at high risk of unintended pregnancy.
The women were sexually active or planned to become
sexually active in the next six months. They either
were not currently using contraception or wanted to
switch birth-control methods.
The women also said they did
not want to become pregnant
for the next 12 months.
Participants in this report could
choose among the following
birth-control methods: IUD,
implant, birth-control pills,
patch, ring and contraceptive
injection. The women were
counseled about the contraceptive
methods, including their
effectiveness, side effects, risks
and benefits. Participants were
permitted to discontinue or
switch methods as many times
as desired during the study.
Investigators interviewed
participants by telephone at
three and six months and every
six months thereafter for the
remainder of the study. During
each interview, participants
were asked about missed periods
and possible pregnancy. Any
participant who thought she
might be pregnant was asked to come in for a urine
pregnancy test. Those who were pregnant were asked
if it was intended and what contraceptive method,
if any, they were using at time of conception.
Over the three-year study, 334 women became
pregnant. Of these, 156 pregnancies were due to
contraceptive failure. Overall, 133 (4.55 percent)
of women using pills, the patch or ring had
contraceptive failure, compared with 21 (0.27
percent) of women using IUDs and implants.
This study also is important because it showed
that when IUDs and implants are provided at
no cost, about 75 percent of women chose these
methods for birth control, Winner says.
Women who chose an IUD or implant were more
likely to be older, to have public health insurance and
to have more children than women who chose other
contraceptive methods. Women who chose pills, the
patch or ring were more likely to have private health
insurance and to not have had children previously.
If there were a drug for cancer, heart disease
or diabetes that was 20 times more effective, we
would recommend it first, he says. Unintended
pregnancies can have negative effects on womens
health and education and the health of newborns.
-This information provided courtesy of Washington
University in St. Louis School of Medicine
MYTH 3:
CANCER
IS A DEATH
SENTENCE
ADVANCES IN CANCER PREVENTION AND
TREATMENT
Advances in understanding risk and prevention, early detection and
treatment have revolutionised the management of cancer leading to
improved outcomes for patients.
EVIDENCE
WiIh !ew excepIiohs, early sIage cahcers are less leIhal ahd more IreaIable
Ihah laIe sIage cahcers.
Ih Ihe UhiIed SIaIes alohe, Ihere are 12 millioh Americahs livihg wiIh cahcer
Ioday.
Ih couhIries wiIh more Ihah a decade o! experiehce wiIh orgahised breasI
cahcer screehihg programmes, Ihe reducIioh ih morIaliIy !rom breasI
cahcer is sighi!cahI, wiIh !or example, AusIralia's mammographic screehihg
programme esIablished ih 1991, ihIegral Io achievihg ah almosI 30%
reducIioh ih morIaliIy !rom breasI cahcer over Ihe lasI Iwo decades.
Cervical cahcer raIes ih wealIhier haIiohs plummeIed ohce Pap IesIihg was
ihIroduced broadly - ahd raIes cohIihue Io lower, wiIh recehI !gures showihg
IhaI ih some couhIries such as Ihe UK, morIaliIy has halved beIweeh 1990
ahd 2010.
GLOBAL ADVOCACY
MESSAGE
Cost-effective strategies
!or cahcer cohIrol such
as breasI ahd cervical
cahcer screehihg as well
as early deIecIioh exist
for all resource settings
ahd cah be Iailored Io Ihe
populaIioh-based heed.
TRUTH:
Many cancers that
were once considered
a death sentence
CAN NOW
BE CURED
AND FOR
MANY MORE
PEOPLE,
THEIR CANCER
CAN NOW
BE TREATED
EFFECTIVELY.
ACCESS TO CANCER SERVICES
Sadly, access to comprehensive cancer services, including access
to essential medicines, is largely restricted to wealthy countries
and individuals.
EVIDENCE
Clobally, closihg Ihe gap ih cahcer ouIcomes beIweeh rich ahd poor couhIries
is ah equiIy imperaIive.
We khow iI is possible, Ihere are proveh examples o! low resource seIIihgs
providihg e!!ecIive cahcer services IhaI spah Ihe specIrum o! cahcer cohIrol
ahd care !rom prevehIioh Ihrough Io palliaIioh, dispellihg Ihe myIh IhaI Ihis
approach is ohly !easible ih high resource seIIihgs.
DELIVERY OF CANCER SERVICES IN ALL
RESOURCE SETTINGS
Increasing public and political awareness that solutions exist and can
be implemented and integrated in all resource settings is essential to
achieving equity in cancer prevention and care.
EVIDENCE
II is a commoh miscohcepIioh IhaI cahcer soluIiohs are Ioo complex ahd
expehsive !or developihg couhIries.
1he cosI o! ihIervehIiohs does hoI have Io be prohibiIively expehsive. A
recehI reporI esIimaIes IhaI mosI o! Ihe o!!-paIehI geheric cahcer medicihes
required !or developihg couhIries are available !or less Ihah $US 100 per
course o! IreaImehI, ahd hearly all !or uhder $US 1000. For li!e-savihg
vaccihes, such as Ihe humah papillomavirus (HPV) vaccihe, progress Iowards
a!!ordable pricihg is beihg driveh by Ihe CAVI Alliahce, wiIh CAVI recehIly
opehihg a wihdow o! supporI !or eligible couhIries !or Ihe ihIroducIioh o!
Ihe HPV vaccihe aI eiIher Ihe haIiohal level or as a demohsIraIioh pro|ecI.
GLOBAL ADVOCACY MESSAGE
1he core elemehIs o! a cancer control
and care continuum must be decided
wiIhih each couhIry based on existing
health resources and infrastructure,
Ihe burden o! cahcer based oh
ih!ormaIioh !rom populaIioh-based
cahcer regisIries, country-specifc
cancer risks, poliIical ahd social
cohdiIiohs, ahd culIural belie!s ahd
pracIices. NaIiohal cahcer cohIrol
plahs (NCCPs) should cohsider Ihe !ull
specIrum o! mulIidisciplihary cahcer
services ahd ih!rasIrucIure across Ihe
cohIihuum o! cahcer cohIrol ahd care.
GLOBAL ADVOCACY MESSAGE
1eam-based, multidisciplinary
treatment programmes IhaI ihclude
access Io qualiIy, a!!ordable ahd
e!!ecIive cahcer medicihes ahd
screehihg should also incorporate
other cost-effective treatment
solutions including radiotherapy
which should be seeh as ah essehIial
compohehI o! every couhIry's haIiohal
cahcer cohIrol plah.
All people should have access Io
proveh e!!ecIive mulIidisciplihary
cancer services on equal terms,
ehsurihg IhaI cahcer is diaghosed early
wheh Ihe chahce o! cure is greaIesI.
worldcancerday.org
UNION FOR INTERNATIONAL CANCER CONTROL
UNION INTERNATIONALE CONTRE LE CANCER
62 route de Frontenex t 1207 Geneva t Switzerland
Tel. +41 (0)22 809 1811 t Fax +41 (0)22 809 1810 t info@uicc.org tuicc.org
whatdoctorsknow.com
Traumatic Brain Injury,
Dementia and Genetic Testing

In the wake of NFL suicides, a call to consider
genetic testing for young athletes
S
hould high school athletes
and prospective military
personnel be genetically
tested to determine if
they are at increased
risk for dementia caused
by repeated head injuries? The
dean of the University of Virginia
School of Medicine and the director
of Mount Sinais NFL Neurological
Program are asking that question and
offering recommendations to clarify
the ethical issues that accompany it.
The long-term effects of traumatic brain
injury [TBI] have been spotlighted
by the high-profile suicides of former
NFL players Junior Seau and Dave
Duerson. Increasing evidence suggests
that repeated head injuries, whether
from sports or the battlefield, can
lead to dementia in later life. But
genetics play an important role as well,
potentially increasing the risk for late-
life dementia more than 10 fold.
That has prompted Steven T. DeKosky,
MD, vice president and dean of UVAs
School of Medicine, and Sam Gandy,
MD, the chair in Alzheimers research at
the Mount Sinai School of Medicine, to
examine whether genetic testing could
help avert dementia and reduce the costs
of dementia care a figure estimated
to top $1 trillion annually by 2050.
Key information missing
In a new editorial in the journal
Science Translational Medicine,
DeKosky and Gandy note there is a
lack of vital information on which to
base a decision on the value of such
genetic testing. They conducted an
informal poll of experts in Alzheimers
disease, TBI and related areas, and
they found a significant majority of
the 45 respondents agreed that it
was premature to introduce genetic
testing into schools or the military.
What is needed, DeKosky and Gandy
conclude, is additional information to
evaluate the usefulness of such testing.
Finding solutions
One approach to collecting the
necessary data, they suggest, would be
to set up a network of research centers.
This would allow for the collection
of data from an array of subjects,
including high-risk adolescents exposed
to brain injuries through sports. The
information could then be used to
create predictive mathematical models.
DeKosky and Gandy also suggest
that valuable data could be drawn
from studies now being assembled,
such as the National Institute of
Child Health and Development
Vanguard Study, which plans to
track major life events of 100,000
children until their 21st birthdays.
Ethical and psychological issues
DeKosky and Gandy note that there
are both ethical and psychological
complexities to the question of
genetic testing. There is a very real
concern about the effect of genotype
information on family members
and on personal employability and
insurability, they write. In addition,
recruiting high school-age subjects
for genotyping and follow-up
could be controversial as parental
informed consent would be required,
necessitating pre-test genetic counseling
for adolescents and their parents.
Conclusion: An idea
worth considering
Despite such concerns, DeKosky and
Gandy conclude that considering
genetic testing for high school
athletes and the military is, without
a doubt, a worthwhile challenge.
If lifestyle modifications for [those
at genetic risk] such as avoiding
high-impact sports or opting for
military careers that do not put the
brain at risk can reduce dementia
prevalence in 2050 by even 1%, they
write, we would gain an annual
savings of $10 billion in costs of
care and immeasurable savings in
terms of human suffering. -This
information provided courtesy of the
University of Virginia Health System

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Sheyla wants a different
set of wheels.
St. Jude patient Sheyla:
Skating Queen
But at this moment, shes fighting cancer.
Thats why St. Jude Childrens Research Hospital spends every moment changing
the way the world treats children with pioneering research and exceptional care.
And no family ever pays St. Jude for anything. Dont wait. Join St. Jude in finding cures
and saving children like Sheyla. Because at this moment, she should be putting on
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Help them live. Visit stjude.org.
whatdoctorsknow.com 0
Esophageal

Cancer
New Understanding
of Fastest-Rising
Solid Tumor in U.S.
whatdoctorsknow.com 0
whatdoctorsknow.com
R
esearchers at Columbia University Medical
Center (CUMC) have identified the critical
early cellular and molecular events that
give rise to a type of esophageal cancer
called esophageal adenocarcinoma, the
fastest-rising solid tumor in the United
States. The findings, published online in Cancer Cell
(21(1) 3651 (2012), challenge conventional wisdom
regarding the origin and development of this deadly
cancer and its precursor lesion, Barretts esophagus, and
highlight possible targets for new clinical therapies.
Lacking a good animal model of esophageal
adenocarcinoma (EAC), researchers have been hard
pressed to explain exactly where and how this cancer
arises. What is known is that EAC is usually triggered
by gastroesophageal reflux disease (GERD), in which
bile acid and other stomach contents leak backwards
from the stomach to the esophagus, the muscular tube
that moves food from the mouth to the stomach. Over
time, acid reflux can irritate and inflame the esophagus,
leading to Barretts esophagus, an asymptomatic
precancerous condition in which the tissue lining the
esophagus is replaced by tissue similar to the lining of
the intestine. A small number of people with Barretts
esophagus eventually go on to develop EAC.
Using a new genetically engineered mouse model
of esophagitis, the CUMC researchers have clarified
critical cellular and molecular changes that occur
during the development of Barretts esophagus and
EAC. In human patients, acid reflux often leads to
overexpression of a molecule called interleukin-1
beta, an important mediator of the inflammatory
response, reported study leader Timothy C. Wang,
MD, the Dorothy L. and Daniel H. Silberberg
Professor of Medicine at CUMC. Thus, Wang and
his colleagues created a transgenic mouse in which
interleukin-1 beta was overexpressed in the esophagus.
Overexpression of interleukin-1 beta in the mouse
esophagus resulted in chronic esophageal inflammation
(esophagitis) and expansion of progenitor cells that
were sustained by the notch signaling pathway. Notch
is a fundamental signaling system used by neighboring
cells to communicate with each other in order to
assume their proper developmental role. When we
inhibited notch signaling, that blocked proliferation
and survival of the pre-malignant cells, so thats a new
possible clinical strategy to use in Barretts patients at
high risk for cancer development, noted Dr. Wang.
For decades, investigators thought that the physiological
changes associated with Barretts esophagus originate
in the lower esophagus. However, our study shows
that Barretts esophagus actually arises in the gastric
cardia, a small region between the lower part of the
esophagus and the upper, acid-secreting portion
of the stomach, said Dr. Wang. What happens
is that the bile acid and inflammatory cytokines
activate stem cells at this transition zone, and they
begin migrating up toward the esophagus, where
they take on this intestinal-like appearance.
The researchers also demonstrated that these changes
occur primarily in columnar-like epithelial cells, rather
than in goblet cells, as was previously thought.
All told, the findings present a new model for
the pathogenesis of Barretts esophagus and
esophageal adenocarcinoma, said Dr. Wang.
Barretts esophagus affects about 1 percent of adults
in the United States. Men are affected by Barretts
esophagus twice as frequently as women, and Caucasian
men are affected more frequently than men of other
races. The average age at diagnosis is 50. At present,
there is no way to determine which patients with
the condition will develop EAC. EAC is increasing
in incidence about 7 to 8 percent a year, making it
the most rapidly rising solid tumor in the U.S.
Treatment with acid-reducing drugs can lessen
symptoms of GERD and lower the chances of
developing Barretts esophagus and EAC. Low-grade
EAC is highly treatable with endoscopic radiofrequency
ablation, photodynamic therapy, or surgical resection.
Patients with severe disease may require open surgery,
in which most of the esophagus is removed. The
overall five-year survival rate with advanced disease
is about 25 percent. -This information provided
courtesy of Columbia University Medical Center
whatdoctorsknow.com
KNOW YOUR SPECIALIST
Reproductive Endocrinologist
N
ot being able to conceive can be an
emotional drain on a couple. Reaching out
to an infertility specialist is an important
step in growing a family. Taking that
step should include the help of a medically
trained and qualified Infertility Specialist.
What To Look For In An Infertility Specialist.
A medical specialist who treats patients with infertility
is known professionally as a reproductive endocrinologist.
Training in reproductive endocrinology requires four
years of college followed by four years of medical school.
The physician must then complete a four-year residency
in obstetrics and gynecology (OB/GYN), during which
the physician receives broad training in general Obstetrics
and Gynecology. The final course of training is a two
or three-year fellowship in reproductive endocrinology.
Fellowship training focuses on the diagnosis and
treatment of infertility and related disorders. This training
includes experience in microsurgery, laparoscopic and
hysteroscopic surgery, in vitro fertilization-embryo
transfer, sonography, and ovulation induction. In
addition, the physician spends a significant amount
of time performing clinical or laboratory research.
Upon completion of a fellowship in reproductive
endocrinology, a specialist seeks board certification-a
multi-step process. To become board certified in
reproductive endocrinology, the physician must first
obtain board certification in obstetrics and gynecology.
This requires successful completion of both a written and
an oral examination. Board certification in reproductive
endocrinology requires successful completion of
additional written and oral examinations. The entire
certification process takes several years to complete. Only
a physician who has successfully completed a fellowship in
reproductive endocrinology and passed the examinations
can become board certified as an infertility specialist.
It can be difficult for a patient to determine whether or not
her physician is an infertility specialist. Some physicians
have gained skills through experience outside fellowship
training, and some physicians successfully complete
fellowship training and do not obtain board certification.
whatdoctorsknow.com whatdoctorsknow.com
However, board certification is the only
objective criteria by which patients can
measure a physician's qualifications.
Female Infertility
In couples, about 50% of infertility
issues are because of the female.
Female age is a very important
component of natural fertility. Apart
from this, female infertility can be
caused by ovulatory dysfunction
(anovulation), tubal/uterine and peritoneal factors
and other unusual or unexplained factors.
Male Infertility
About 30% of infertility in couples may be due to the
male while another 20 percent of couples inability to
conceive may be due to combined male and female factors.
A fertility doctor usually collaborates with urologists
to ensure fast-track evaluation and management of the
male partner, which increase treatment success rates.
Fertility Promoting Surgery
Many of the fertility promoting surgeries performed
by Infertility Specialists are minimally invasive
surgery techniques allowing the discharge of patients
on the same day without requiring an overnight
hospital stay. These techniques include laparoscopy,
hysteroscopy and mini-laparotomy. Some surgeries,
such as multiple myomectomies, are performed
through a larger abdominal incision require a 24 to
48 hour hospital admission to allow the physician an
opportunity to observe and support initial recovery
Laparoscopy:
Laparoscopy has become one of the most common
procedures performed by surgical specialists. Physicians use
laparoscopy for removal of ectopic pregnancies, treatment of
endometriosis, assessment and removal of abnormal ovarian
masses, ovarian drilling to induce ovulation in clomiphene
resistant patients with polycystic ovary syndrome, evaluation
and treatment of tubal diseases, treatment of scars, removal
of small uterine myomas and more. It involves creation
of pneumoperitoneum with CO2 gas to distend the
abdominal cavity to ease exploration and placement of a
specific telescope (a lens and a light system) connected to
a video camera into the abdomen, mostly through the
belly button. This site usually requires 5-12 mm incision.
The surgeon may need one to three 5 mm incision sites in
the lower abdomen to introduce laparoscopic instruments
to explore or to perform relevant surgical procedures.
Hysteroscopy:
This is a minimally invasive procedure for evaluating
uterine cavity and treating various abnormalities. It
involves a speculum placement to expose the cervix for
transcervical placement of telescope (a light and a lens
system) attached to a video camera system into the uterus.
To see the walls of the endometrial
cavity and its covering cellular tissue
(endometrium), a distention media,
mostly normal saline, is used. Although
there are hysteroscopic systems, which
can be used at an office setting, many
operative hysteroscopies may require
ambulatory surgery center facilities.
Hysteroscopy is an excellent diagnostic
technique for potential abnormalities
detected in screening tests like saline infusion sonography
or hysterosalpingography. In addition to its diagnostic
value, it serves as an effective minimally invasive treatment
for abnormal uterine bleeding, endometrial polyps
and fibroids, proximal tubal occlusion, some uterine
abnormalities like uterine septum and intra-uterine scars.
Tubal Reversal:
Tubal reversals are performed as an outpatient procedure.
The procedure is done through a mini bikini incision
under loop magnification utilizing microsurgical
techniques. The patient may start trying to conceive
within 2-3 weeks of surgery following the patients
complete surgical recover. If the couple cannot become
pregnant in 4-6 months, a hysterosalpingography (HSG)
may be necessary. After a successful tubal reversal,
cumulative pregnancy rates in the year following tubal
reversal procedure are in the 50-80 percent range.
Several clinical characteristics are associated with
the high success rates for tubal reversal:
Patient under 40 years of age
Tubal length after tubal reversal greater than 4 cm
Previous sterilization by Fallope ring, clip or Pomeroy type
(most postpartum tubal sterilizations) tubal sterilization
Absence of associated pelvic pathology such
as endometriosis, severe pelvic scarring
Absence of male factor infertility
Absence of other factors like anovulation
Myomectomy:
Fertility may be compromised by the presence of
myomas (fibroids) distorting or pressing or growing
into, the uterine cavity. These mostly benign
tumors may need to be resected while minimizing
additional harm to the uterus by laparoscopy or
hysteroscopy or via an open abdominal incision.
whatdoctorsknow.com
New Approach
to Care for
Inflammatory
Bowel Disease
Patients
A
pproximately 1.4-million
people in the United
States are affected by
inflammatory bowel
disease (IBD), a group
of chronic diseases
of the colon and small intestine
generally falling into the categories of
ulcerative colitis and Crohn's disease.
The illnesses tend to be diagnosed
in childhood or young adulthood,
and are characterized by periods of
remission followed by flare-ups of
symptoms that can include abdominal
pain and cramping, diarrhea, rectal
bleeding, vomiting and weight loss.
"On the outside, you wouldn't know
that someone has IBD," says Daniel
Hommes, M.D., Ph.D., head of
UCLA's Center for Inflammatory
Bowel Diseases. "But on the inside, it's
very destructive. A significant number
of patients require frequent toilet visits
and have problems with pain. Careers
and relationships can be affected. The
drugs that are available come with side
effects and are ineffective in about 20
percent of patients, who end up needing
experimental therapy or surgery."
Dr. Hommes believes the traditional
approach to assisting patients with
IBD has left much to be desired,
and so the Center is implementing
a new approach to chronic-disease
management. Playing off the concepts of
intelligence quotient (IQ) and emotional
intelligence quotient (EQ), the center
is tracking each patient's value quotient
(VQ), a measure that incorporates the
annual burden of the patient's disease
(including factors such as disease activity,
complications, medication side effects
and hospitalizations); quality of life;
and work productivity. Each year, an
individual patient's VQ will be analyzed
by the center's professional staff to
determine factors that influence the score
and to devise a plan for the year ahead.
"It is our mission to annually improve
each individual VQ," Dr. Hommes says.
The center's approach to controlling
patients' disease is two-pronged. The
first involves the development of
new treatments. Patients who don't
improve with standard medications
can participate in state-of-the-art IBD
research through a clinical-trials program
and a stem-cell-treatment program.
Dr. Hommes has been a leader in both
autologous hematopoietic stem-cell
transplantation (using patients' own
stem cells, drawn from blood) and
mesenchymal-stem-cell therapy - using
cells with the capability of differentiating
into a variety of cell types as a strategy
for controlling inflammation.
The other part of the approach centers
around the active role patients play
in their care. An online-education
program empowers patients by teaching
them about the disease, treatments,
home care and their individual case.
The center is also developing home-
care devices, including biochips
for clinical testing. To ensure close
monitoring of their disease, patients
are invited to periodically transmit
results of self-administered tests as well
as information on their symptoms,
quality of life, and work productivity.
Dr. Hommes believes the center's
approach can serve as a model for
other chronic diseases.David Ziring,
M.D., director of the UCLA Pediatric
IBD Center - part of the Center for
Inflammatory Bowel Diseases - says
the value-based approach is also
beneficial for children with IBD. "They
will enjoy a seamless transition from
adolescent to adult care, will be able to
participate in groundbreaking clinical
trials of new drugs, and for those in
whom conventional therapies have
failed, will be given the opportunity
to participate in new stem-cell-therapy
regimens," Dr. Ziring says. "Like Dr.
Hommes, I strive to provide holistic
care to my patients and their families,
including not only maintaining disease
remission, but also optimizing quality
of life and school performance."
For more information go to:
www.gastro.ucla.edu/ibd
-This information provided courtesy
of UCLA Health Systems
whatdoctorsknow.com
CanEthnicBackground
IncreaseRisk?
Study reveals Blacks and Hispanics are at a higher
risk for precancerous colorectal polyps.
B
lacks and Hispanics have a
significantly higher risk of
developing precancerous
colorectal polyps compared
with whites, according
to a study by researchers
at NewYork Presbyterian Hospital/
Columbia University Medical
Center. The findings appeared in
the online edition of Alimentary
Pharmacology and Therapeutics.
Our data suggest that we need
to redouble our efforts to increase
colon cancer screening in areas with
large numbers of racial and ethnic
minorities, said lead author Benjamin
Lebwohl, MD, MS, assistant professor
of clinical medicine and epidemiology
at NewYork Presbyterian Hospital/
Columbia University Medical
Center and Columbia Universitys
Mailman School of Public Health.
The study also found that blacks
and Hispanics have a higher risk
of developing polyps in the upper
portion of the colon, compared with
whites. These lesions would have
been missed had these
patients undergone
sigmoidoscopy,
which examines only
the lower half of
the colon, said Dr.
Lebwohl. Therefore,
colonoscopy, which
examines the entire
colon, may be preferable
to sigmoidoscopy as
a screening test for
blacks and Hispanics.
Colorectal cancer
caused an estimated
51,370 deaths in 2010 the last year
for which data are available. This
type of cancer is largely preventable
if caught early, in the form of
precancerous polyps, or adenomas.
Such polyps are effectively treated
with removal during colonoscopy.
The researchers looked at rates of
advanced adenomas polyps 10 mm or
larger that exhibited aggressive features
under microscopic examination. These
are the kinds of polyps that we are
most concerned may eventually develop
into cancer, said Fay Kastrinos, MD,
MPH, assistant professor of clinical
medicine at NewYork Presbyterian
Hospital/Columbia University Medical
Center and senior author of the study.
We found that blacks and Hispanics
were roughly twice as likely to have
advanced adenomas, compared with
whites, after adjusting for factors
such as age and family history.
Previous studies had shown that
colorectal cancer incidence and
mortality are higher in blacks than in
whites, and that blacks are typically
younger at the time of diagnosis than
are whites. Little was known about the
risk of adenomas among Hispanics.
In the current study, the first to
compare adenomas in white, blacks,
and Hispanics, the investigators
analyzed data from 5,075 men and
women age 50 or older who underwent
first-time colonoscopy at NewYork
Presbyterian Hospital/Columbia
University Medical Center from 2006
to 2010. The study population was 70
percent white, 18 percent Hispanic, and
12 percent black, with a mean age of
62. None of the subjects had signs or
symptoms of colon cancer at the time
of screening. At least one adenoma was
detected in 19 percent of whites, 22
percent of Hispanics, and 26 percent
of blacks, the researchers reported.
The findings run counter to existing
statistics showing that Hispanics have
a lower rate of colon cancer compared
with whites. Surprisingly, we found
that Hispanics have a slightly higher
rate of precancerous polyps, said Dr.
Lebwohl. This adds to other recent
evidence that the rate
of colorectal cancer
among Hispanics
may be increasing
with acculturation.
Doctors generally
advise patients to get
an initial screening
test at age 50, when
overall rates of colon
cancer begin to increase.
-This information
provided courtesy of
Columbia University
Medical Center
HIV Cure?
A

team of researchers from Johns Hopkins
Childrens Center, the University of
Mississippi Medical Center and the
University of Massachusetts Medical
School describe the first case of a so-called
functional cure in an HIV-infected
infant. The finding, the investigators say, may help pave
the way to eliminating HIV infection in children.
A report on the case is scheduled for presentation at
a press conference on Sunday, March 3, at the 20th
Conference on Retroviruses and Opportunistic
Infections (CROI) in Atlanta. Johns Hopkins Childrens
Center virologist Deborah Persaud, M.D., lead author
on the report, and University of Massachusetts
Medical School immunologist Katherine Luzuriaga,
M.D., headed a team of laboratory investigators.
Pediatric HIV specialist Hannah Gay, M.D., associate
professor of pediatrics at the University of Mississippi
Medical Center provided treatment to the baby.
The infant described in the report underwent remission
of HIV infection after receiving antiretroviral therapy
(ART) within 30 hours of birth. The investigators
say the prompt administration of antiviral treatment
likely led to this infants cure by halting the formation
of hard-to-treat viral reservoirs dormant cells
responsible for reigniting the infection in most
HIV patients within weeks of stopping therapy.
Prompt antiviral therapy in newborns that begins
within days of exposure may help infants clear the
virus and achieve long-term remission without
lifelong treatment by preventing such viral hideouts
from forming in the first place, Persaud says.
The researchers say they believe this is precisely what
happened in the child described in the report. That infant
is now deemed functionally cured, a condition that
occurs when a patient achieves and maintains long-term
viral remission without lifelong treatment and standard
clinical tests fail to detect HIV replication in the blood.
In contrast to a sterilizing cure a complete eradication
of all viral traces from the body a functional cure
occurs when viral presence is so minimal, it remains
whatdoctorsknow.com
whatdoctorsknow.com
undetectable by
standard clinical tests,
yet discernible by
ultrasensitive methods.
The child described
in the current report
was born to an HIV-
infected mother and received
combination antiretroviral
treatment beginning 30 hours
after birth. A series of tests showed
progressively diminishing viral
presence in the infants blood, until it
reached undetectable levels 29 days after
birth. The infant remained on antivirals
until 18 months of age, at which point the
child was lost to follow-up for a while and, the
researchers say, stopped treatment. Ten months after
discontinuation of treatment, the child underwent
repeated standard blood tests, none of which detected
HIV presence in the blood. Test for HIV-specific
antibodies the standard clinical indicator of HIV
infection also remained negative throughout.
Currently, high-risk newborns those born to
mothers with poorly controlled infections or whose
mothers HIV status is discovered around the time
of delivery receive a combination of antivirals at
prophylactic doses to prevent infection for six weeks
and start therapeutic doses if and once infection is
diagnosed. But this particular case, the investigators
say, may change the current practice because it
highlights the curative potential of very early ART.
Specialists say natural viral suppression without
treatment is an exceedingly rare phenomenon observed
in less than half a percent of HIV-infected adults,
known as elite controllers, whose immune systems
are able to rein in viral replication and keep the virus
at clinically undetectable levels. HIV experts have long
sought a way to help all HIV patients achieve elite-
controller status. The new case, the researchers say,
may be that long-sought game-changer because it
suggests prompt ART in newborns can do just that.
The investigators caution they dont have enough
data to recommend change right now to the
current practice of treating high-risk infants with
prophylactic, rather than therapeutic, doses but the
infants case provides the rationale to start proof-
of-principle studies in all high-risk newborns.
Our next step is to find out if this is a highly unusual
response to very early antiretroviral therapy or something
we can actually replicate in other high-risk newborns,
says Persaud, who is also the scientific chair of the HIV
Cure Committee of the International Maternal, Pediatric
Adolescent
AIDS Clinical (IMPAACT) network, a consortium
of researchers and institutions that was critical in
spearheading the earliest clinical trials of mother-to-child
transmission and early treatment of infants 15 years ago.
A single case of sterilizing cure has been reported so
far, the investigators note. It occurred in an HIV-
positive man treated with a bone marrow transplant
for leukemia. The bone marrow cells came from
a donor with a rare genetic mutation of the white
blood cells that renders some people resistant to
HIV, a benefit that transferred to the recipient.
Such a complex treatment approach, however, HIV
experts agree, is neither feasible nor practical for the
33 million people worldwide infected with HIV.
Complete viral eradication on a large scale is
our long-term goal but, for now, remains out
of reach, and our best chance may come from
aggressive, timely and precisely targeted use of
antiviral therapies in high-risk newborns as a way
to achieve functional cure, Luzuriaga says.
Despite the promise this approach holds for infected
newborns, the researchers say preventing mother-
to-child transmission remains the primary goal.
Prevention really is the best cure, and we
already have proven strategies that can prevent
98 percent of newborn infections by identifying
and treating HIV-positive pregnant women, says
Gay, the HIV expert who treated the infant.
The research was funded by the National Institutes of
Health and by the American Foundation for AIDS
Research (amfAR). -This information provided courtesy
of the University of Mississippi Medical Center
whatdoctorsknow.com
What's The Rush?
A new approach to fast allergy relief.
R
ush Immunotherapy is a method for
providing rapid relief from allergies. What
is this new procedure and where does this
fit into the treatments we already have?
Seasonal or persistent nasal itching,
sneezing, runny nose, nasal congestion,
sinus headaches, postnasal drainage, sleep disturbance
because of nasal obstruction, as well as itching and
burning of the eyes (allergic conjunctivitis) affects
10-25% of people in Western countries. Pollen and
airborne substances arising from molds, animals, mites
and other insects are common causes of these problems.
Allergic reactions in the lungs result in asthma in
approximately 5% of the worlds population. Tightness
in the chest, shortness of breath, wheezing, and
coughing are common asthma symptoms. Asthma
can limit activities, disrupt sleep, and have a very
negative effect on quality of life. Acute respiratory
tract infections or exposure to allergic triggers can
cause severe or even fatal worsening of asthma.
The goals of therapy for upper airway allergic
reactions (allergic rhinitis, hay fever) include
relief from annoying symptoms, relief from
disturbed sleep, and avoidance of complications
such as middle ear infections or sinus infections.
Antihistamines, decongestants, nasal steroid sprays,
and other nasal allergy sprays often provide relief.
The goals for asthma are control of the symptoms,
prevention of limitations on activities, and
protection from severe worsening during
respiratory tract infections or exposures to allergic
triggers. Bronchodilators, inhaled steroids, oral
asthma medications, and other medications can
provide symptomatic relief for some patients.
Allergic rhinitis, allergic conjuctivitis, and allergic
asthma, often need immunotherapy (allergy shots).
These injections provide control of symptoms and then
resolution of the allergies. Currently this is the only
therapy that can actually reduce or eliminate the body's
unwanted allergic reactions to environmental substances.
whatdoctorsknow.com
RushImmunotherapyisanewinjectionprocedure
thatisrevolutionizinghowwetreatallergies.
Traditional immunotherapy typically involves
injections twice a week with increasing amounts of
antigens (the substances that cause the allergies).
This process usually takes 16 weeks to reach
full treatment doses (maintenance doses).
The Rush Immunotherapy revolution has centered on
the recently acquired knowledge that relief from allergy
symptoms requires lower doses of antigens than are
required to make the allergies go away entirely over
time. Research in United States and Europe has led
to Rush Immunotherapy procedures that allow us to
reach levels of antigens that begin to relieve symptoms
in one day rather than over a period of 2-3 months.
Patients are given high doses of allergy suppressing
medication to minimize reactions at the sites of
injections, or in the rest of the body. Typically 8
injections are given over a period of 5 hours and
the patients are then observed for 2 more hours
as the materials are absorbed into the body.
Rush immunotherapy can be a great convenience for
patients with demanding work
or school schedules. While the
procedure requires a full day in
the office, we avoid nearly 3/4 of
the visits needed to build up to
maintenance doses. A day in the
office also affords time for the
patient to ask questions about
allergic disease and treatment.
There is time to discuss and
demonstrate how to deal with
unexpected late allergic reactions.
As allergy symptoms improve
after Rush Immunotherapy,
patients are much more likely to
return for the final doses to build
up to maintenance. These higher
doses are required not to relieve
symptoms, but rather to gradually
eliminate or markedly decrease
the severity of the allergy itself.
Noteveryoneisagoodcandidate
forRushImmunotherapy.If
asthmacontrolisnotstable,
iflungfunctionsarenotnear
normal,RushImmunotherapy
maynotbesafe.
Preschool children may be good
candidates from the point of
view of clinical improvement,
but being kept in a relatively small space can be
very difficult for them. For many patients, Rush
Immunotherapy is an alternative with several advantages
over medications alone, or traditional immunotherapy.
Any form of immunotherapy carries a risk that
the patient may have a troublesome reaction at the
injection site, or that a more severe reaction involving
the whole body may occur. This could include hives
(urticaria), swelling of the eyes, lips, or other structures
(angioedema), even anaphylaxis (reactions that cause
trouble breathing or decreases in blood pressure).
The possibility of an allergic reaction is why allergists rely
upon patient education, observation in the office after
injections, and having an emergency plan for dealing
with rare severe reactions. Rush Immunotherapy patients
are taught about the characteristics of the late allergic
reactions, are given medications to use in case of a reaction,
and are taught the use of self-injectable epinephrine.
Rush Immunotherapy provides a method for
achieving clinical improvement very rapidly and
greatly reduces the number of visits required to
achieve long lasting freedom from allergy. -Vicki
Lyons, MD and Timothy J. Sullivan, MD
Advantages of Rush Immunotherapy
Convenience for patients with limited time.
Doses of immunotherapy that begin giving relief of symptoms
can be reached in one day, rather than over 2-3 months.
The time required to reach full treatment maintenance doses is markedly reduced.
Both the patient and the doctor can quickly determine whether
or not this form of therapy will be successful.
whatdoctorsknow.com 0
Helping Epilepsy
in Children
Minimally invasive technique
is having promising results
E
pilepsy specialists at Miami
Childrens Hospital are the
first in the Southeast--and
the second in the nation--
to offer minimally invasive
laser surgery for children
with seizures that dont respond
to anticonvulsant medications.
Approximately one in five children
with epilepsy (totaling thousands
of children a year) experience
frequent seizures that dont stop with
medication. Miami Childrens Brain
Institute has long been a leader in
helping these children with medically
resistant (or intractable) epilepsy. The
Miami Childrens Hospital (MCH)
program has been ranked among
the top programs in the nation for
pediatric neurology and neurosurgery
by U.S. News and World Report.
Due to the hospitals reputation and
its case experience with more than 850
epilepsy surgeries, the manufacturer of
a new image-guided laser technology
approached Miami Childrens in
2010 to establish protocols for
use of the new technology, called
Visualase. The first patient at MCH
was successfully operated on in May
of 2011. Prior to laser surgery, the
patient was experiencing one or two
seizures per week. Since
the procedure, she has
been seizure free for nine
months and has an excellent
prognosis, according to
Dr. Ian Miller, Director
of Neuroinformatics at
Miami Childrens Hospital,
who is spearheading the
Visualase initiative.
The Visualase system works
by placing a laser probe
at the surgical site using
stereotactic, 3D-computer
guidance in the operating
room. The patient is then
moved to the MRI scanner
where the laser removes the
target brain tissue using
heat under continuous
MRI monitoring. This
allows a very precise region
of tissue to be treated and
minimizes risk of injury to
other parts of the brain.
Doctors hope this method
(as compared to traditional brain
surgery for epilepsy) will allow a very
small incision (so that very little hair
needs to be removed), less postoperative
pain, reduced risk of infection, faster
recovery time and no need for removing
portions of the skull, which reduces
the chance of jaw problems later on.
To date, three patients have
undergone the new treatment at
Miami Childrens, including one child
who came from out of state for the
procedure. Among these children, the
longest hospital stay was three days,
compared with a seven to 10-day stay
required for conventional surgery.
Dr. Miller expressed optimism about
the technology. This is one of the
newest tools in our toolbox to help
children with epilepsy. It is perfectly
suited for small, well-defined lesions in
the brain that cause seizure activity, he
noted. He observed that there are many
causes of epilepsy in children and that
this therapy is a particularly good fit
for conditions such as cortical dysplasia,
hypothalamic hamartoma and tuberous
sclerosis. -This information provided
courtesy of Miami Children's Hospital
Twelve year-old Jessie
Fernandez undergoes
the first Visualase
procedure at Miami
Childrens Hospital
A los 2 aos y medio un
trasplante de corazn salv
la
vida
de Priscilla.
Los mdicos le dijeron a su
madre que Priscilla no habra
vivido un da ms sin un corazn
nuevo. Ahora ella puede nadar,
saltar la cuerda y jugar con sus
amigos. Ella puede hacer todo
lo que los otros nios hacen.
Usted puede ayudar a salvar vidas.
Hgase donante de rganos y tejidos.
Para ms informacin, visite www.donevida.org
o llame al 1-800-485-8432.