Johns Hopkins Health Alerts Current Issue

Arthritis in the Shoulder

Mon, 15 Jun 2009 06:00:00 CDT

The shoulder is involved in almost every movement of the upper body, so it should come as no surprise that it can also hurt. About 5% of all visits to primary care physicians are for shoulder troubles, and the American Academy of Orthopedic Surgeons estimates that four million Americans seek medical care each year for shoulder sprains, strains, dislocations, or other problems. Arthritis in the shoulder can cause severe pain and limited range of motion. Here are some common questions about shoulder arthritis.

While it's less publicized than knee or hip arthritis, shoulder arthritis is a crippling condition, causing extreme pain, stiffness, and limited motion. Osteoarthritis of the shoulder can be the result of early trauma (e.g., falling, football, blunt trauma), resulting in dislocation or shoulder fracture. Over the years, this eventually leads to degradation of the articular cartilage and a wearing down of the joint surfaces.

Shoulder arthritis can also be seen in patients with long-standing tears of the rotator cuff, which is the group of muscles and tendons that connects the humerus to the scapula and stabilizes the glenohumeral joint. Immunologic problems, like rheumatoid arthritis also can affect the shoulder joint. This severe form of arthritis is characterized by pain, stiffness, swelling, and warmth in the shoulder joints.

Q. What are the symptoms of shoulder arthritis?

A. The most common symptom of arthritis of the shoulder is pain, with the pain aggravated by activity and progressively worsening. The pain is worse when the arm is gently brought across the chest. It is common for the pain to radiate into the biceps area and down the arm.

Q. Will shoulder arthroplasty (joint replacement surgery) relieve pain and restore shoulder motion for people with arthritis?

A. Yes, arthroplasty can relieve pain and restore motion in people with severe shoulder arthritis. In addition, according to a recent study done at Johns Hopkins, shoulder arthroplasty is just as safe as the much more common hip and knee replacements. Yet people with shoulder arthritis are more likely to stick with conservative treatments.

Why don't more people choose shoulder arthroplasty? Many people don't know that shoulder replacements are available, or think that shoulder arthroplasty is extremely traumatic or that shoulder replacements just don't work.

6 Exercises to Build Bone Strength

Fri, 19 Jun 2009 06:00:00 CDT

When you put demands on bone, it responds by becoming stronger and denser. Any activity that works against gravity, including walking and climbing stairs, stimulates the growth of new bone tissue. Here are six bone-building exercises from Johns Hopkins.

Exercise and adequate calcium are two of the three essentials for preventing osteoporosis. Vitamin D is the third. Regular exercise can help limit bone loss, improve your balance and coordination, and strengthen the leg and torso muscles that help you stand upright. Calcium within bones makes them strong, and taking daily calcium supplements can ensure that your bones will remain strong.

Here are six weight-bearing and resistance exercises you can try to help prevent bone loss. You would achieve the best bone-building results by doing this regimen with exercise machines. However, you can do a similar workout at home using dumbbells and resistance bands (such as Theraband or Dynaband).

For starters, do one set of six to eight repetitions of each exercise and build up to doing two sets. Once you can easily do two sets of six to eight repetitions, increase the weight by a few pounds or move up to a higher-resistance band.

Exercise 1 -- Wall Squat. Stand with your feet shoulder-width apart, back against a wall. Hold a dumbbell in each hand, with your arms at your sides, palms facing inward. Slowly bend your knees and lower your buttocks 8 inches or more (but do not allow your hips to sink below knee level). Pause, then slowly return to the starting position.

Exercise 2 -- Back Extension. Lie face down on the floor with your legs straight, arms extended flat on the floor above your head, palms down. Keep your nose pointed downward and slowly raise your right leg and left arm off the floor (reach out as well as up). Keep your head and neck in line with your arm. Pause, then slowly return to the starting position. Now slowly raise your left leg and right arm together. Change sides and repeat.

Exercise 3 -- One-arm Military Press. Lie with your back on a bed or bench with your feet flat on the floor, holding a dumbbell in each hand on top of your chest. Press the weight straight up with one hand. Pause, then return it back down. Barely touch your chest, then repeat with the other hand. Alternate sides and repeat.

Exercise 4-- Seated Row. Sit on the floor with your legs fully extended. Hook a resistance band on the balls of your feet. Wrap each end of the band around your hands. Keeping your back straight, pull the band toward you with both arms. Pause, then slowly release your arms straight in front of you again.

Exercise 5 -- Leg Press. Lie on the floor, flat on your back, with your knees hugged into your chest. Place the center of a resistance band on the balls of your feet. Wrap each end of the band around your hands. Keep your elbows close to your sides and squeeze your inner thighs together as you press your legs up toward the ceiling. Pause, then draw your legs back down.

Exercise 6 -- Lat Pull-down. Stand with your feet shoulder-width apart, knees unlocked, and abdominals tight. Grasp a resistance band with your hands slightly wider than shoulder-width apart. Lift your arms just above your head, palms facing forward as you look straight ahead. Extend your arms out to the sides at shoulder height, with your wrists firm and your elbows slightly bent. Pull your shoulder blades back and together and expand your chest. Return to starting position. Repeat.

Coffee – Not Green Tea – Protects Against Colon Cancer

Tue, 16 Jun 2009 06:00:00 CDT

Green tea has gotten a lot of press for its healthy properties. But it turns out that coffee may be better for your colon, according to research reported in the International Journal of Cancer.

Studies show that certain behaviors are associated with colorectal cancer. For example, the risk of developing colon cancer increases if you are physically inactive, obese, drink excessive amounts of alcohol, or eat a diet high in meat, refined grains, and fats, especially those from animal sources. In addition, smokers are 30-40% more likely to die of colorectal cancer than nonsmokers.

Now researchers believe that coffee – not green tea – reduces the risk of colon cancer. When researchers reviewed data on the beverage-drinking habits of more than 96,000 Japanese men and women over a 10-year period, they found that coffee significantly lowered the risk of colon cancer in females.

Women who regularly drank three or more cups of coffee a day had a 32% lower risk of colon cancer than those who almost never consumed coffee -- even after taking into account factors that could have affected risk. Colon cancer risk was not reduced for men, and neither women nor men had a reduced risk of rectal cancer.

Researchers are not sure why coffee appears protective, since caffeine is in green tea as well. The beneficial effect, they say, may have come from another substance in coffee.

The investigators caution that their results need to be confirmed by other researchers, but these findings do provide some degree of reassurance for women who savor a morning brew and have been concerned about possible adverse effects on the colon.

Data reported in the International Journal of Cancer (Volume 121, page 1312).

How Pets Comfort Us

Wed, 27 May 2009 06:00:00 CDT

Pets are more than just furry friends and loyal companions. Yes, they tug at our heartstrings, but they also improve our health, both mental and physical, helping us to live longer and happier lives.

Studies over the past 25 years have shown that stroking a dog or cat can lower blood pressure and heart rate and boost levels of the mood-related brain chemicals serotonin and dopamine. Heart attack sufferers recover more quickly and survive longer when they have a pet at home, and children who are exposed to pets early in life may have a reduced risk of allergies and asthma.

For people with disabilities, pets can offer a lifeline to a more normal existence: guiding the blind, hearing for the deaf, and performing tasks for those who can't do for themselves. Dogs and cats -- even a tankful of fish -- calm frazzled nerves and ease anxiety and depression, according to research. In one study, pets seemed to temper some of the psychological stress of being a caregiver to someone who is ill or suffering from dementia.

Studies performed in nursing homes and hospitals have proven that the elderly in particular can benefit from the companionship of a dog or cat. Having a pet to care for helps fill the long, sometimes aimless hours and reminds seniors to nurture themselves just as they are caring for their pets.

In one study, researchers found that quiet time with a dog made nursing home residents in St. Louis feel less lonely, more so even than visits with both a dog and other residents. The study enrolled 37 nursing home residents with high scores on a loneliness scale who were interested in receiving weekly half-hour visits from dogs. Half of the study subjects had dog-only visits. The other half shared the dog with other nursing home residents. Both groups said they felt less lonely after the canine visit, but the decrease in loneliness was much more significant among those who had the dogs all to themselves.

Bottom line: Why do pets make us feel better? One reason is that pets alter our behavior -- when they are near, we tend to calm down and speak more slowly and softly. All types of animals offer distractions from the worries of the day, because we naturally shift our attention to them when they are around. Pets also provide an opportunity to touch and stroke another living thing, which has been shown to be of value to our mental and physical health.

Clues to the Cause of Type 1 Diabetes

Thu, 18 Jun 2009 06:00:00 CDT

Why do some people get type 1 diabetes? Researchers are still trying to figure it out. It's possible that combined genetic susceptibility and an environmental trigger -- perhaps a virus -- may cause this serious autoimmune disease.

When our bodies are humming along smoothly, we rarely think about all the complex processes that are going on. But when we don't feel well and we're unable to perform our usual activities, we want to know what's causing the problem and how it can be fixed. Type 1 diabetes is an autoimmune disease. Something triggers the body to mount an immune system attack against itself, in the same way the immune system normally attacks harmful bacteria and viruses.

In type 1 diabetes, the immune system produces antibodies that attack and destroy the insulin-secreting beta cells in the pancreas. As the number of beta cells decreases, the amount of insulin that is produced decreases as well. Fortunately, the immune system attack doesn't affect the body's ability to respond to insulin. That's why people with type 1 diabetes can compensate for the lack of insulin production by injecting insulin.

The cause of type 1 diabetes remains poorly understood, but a recent study reported in the journal Diadabetologia (volume 49, page 900) lends support to one leading theory. Some experts speculate that infections trigger type 1 diabetes in people who are genetically susceptible to diabetes. They believe that exposure to certain viruses may cause the immune system to mistakenly attack the pancreas and to destroy cells that produce insulin. If that's true, then outbreaks of viral infections within a community would likely cause "clusters" of new type 1 diabetes patients -- that is, an unusually large number of new diabetes diagnoses that arise over a brief period.

In the largest study of its kind to date, a group of British researchers examined the medical histories of more than 4,000 people under age 30 who were diagnosed with type 1 diabetes in Yorkshire, United Kingdom, between 1978 and 2002. The team discovered that new cases of type 1 diabetes often occurred in bunches, within confined sections of Yorkshire, specifically among youths ages 10-19. The study's findings suggest that something in the environment that people encounter on an irregular basis -- such as a virus -- may be more likely to cause type 1 diabetes than a more consistent environmental factor such as diet.

Probiotics and Hypnosis: Two Promising Complementary Therapies for Irritable Bowel Syndrome

Mon, 22 Jun 2009 06:00:00 CDT

Many people turn to complementary therapies, such as herbs, meditation, or yoga, when they have a disease that is difficult to treat. Irritable bowel syndrome is one of them -- symptoms are distressing, few treatments exist, and the treatments that are available often provide insufficient symptom relief and sometimes life-threatening side effects.

But is there any evidence that complementary therapies are safe and effective for irritable bowel syndrome? Here's what we know about two nontraditional therapies often touted for irritable bowel syndrome.

Probiotics for irritable bowel syndrome: A wide variety of bacteria (called intestinal flora) live in your large intestine. These bacteria help regulate motility, immune function, and fluid secretion in the intestine. But if one type of bacterium starts to proliferate, irritable bowel syndrome symptoms may occur. Probiotics -- supplements that contain live strains of bacteria and yeast -- may help keep your intestinal flora in balance.

Results from one study showed that women with irritable bowel syndrome who took the probiotic Bifidobacterium infantis 35625 for four weeks noticed improvements in their bowel movements: Women who were constipated started having more bowel movements and women with diarrhea started having fewer. Women who took a placebo had no significant improvements.

One commonly used probiotic is Saccharomyces boulardii, a yeast culture in capsule form (Florastor). Another type, Lactobacillus acidophilus, is a bacterium found in yogurt. The most effective dose appears to be 10 billion live L. acidophilusbacteria. Unfortunately, it's not always easy to tell which yogurts contain this amount. Dannon Activia is the first probiotic yogurt on the market; it contains 10 billion live bacteria in a 4-oz serving. If you don't want to eat yogurt, L. acidophilus is also available in capsules (take 1.5 g per day).

Probiotics have few side effects when taken at recommended doses. In the beginning, you may experience some abdominal discomfort or gas, but these side effects usually go away with continued use. Avoid taking L. acidophilus if you have a weakened immune system, intestinal damage, or overgrowth of intestinal bacteria.

Hypnosis for irritable bowel syndrome: The most promising alternative therapy for irritable bowel syndrome is gut-directed hypnosis (also called hypnotherapy). During a series of weekly sessions, a therapist guides you through relaxation exercises. When you reach a state of deep relaxation, the therapist suggests imagery and sensations to help you with specific symptoms. In a recent study, about 70% of 250 people with irritable bowel syndrome had at least a moderate improvement in their symptoms with hypnotherapy. The participants also reported needing less medication and fewer doctor visits. Another study found that 80% of those who responded to hypnotherapy maintained their improvement for up to six years.

Hypnotherapy likely works by relaxing smooth muscles and relieving psychological stress, both of which may alleviate symptoms. If you're interested in hypnotherapy, it's important to find a therapist who specializes in irritable bowel syndrome. Your gastroenterologist may be able to recommend someone, or you can get a referral from one of the following organizations: Society for Clinical and Experimental Hypnosis (www.sceh.us; click on the Referrals link) or the American Society of Clinical Hypnosis (www. asch.net; click on the Referrals link or call 630-980-4740).

When Should You Treat Your BPH?

Tue, 23 Jun 2009 06:00:00 CDT

How do you know if your BPH is serious enough to require treatment? The International Prostate Symptoms Score was developed to help men evaluate the severity of their BPH symptoms. Johns Hopkins encourages you to take this self-administered test and then read this Health Alert before talking with your urologist about your BPH treatment options.

The progression of benign prostatic hyperplasia (BPH) cannot be predicted for any individual. Symptoms and objective measurements of urethral obstruction can remain stable for many years and may even improve over time in as many as a third of men. In the Medical Therapy of Prostatic Symptoms (MTOPS) study, only 14% of untreated men in the placebo group experienced worsening symptoms during an average follow-up time of 4.5 years.

Men who eventually need treatment for BPH typically experience a progressive decrease in the size and force of their urinary stream or a sensation of incomplete emptying of their bladder. Although frequent nighttime urination is one of the most annoying symptoms of BPH, it does not predict the need for future treatment.

If urethral obstruction worsens and is left untreated, complications can occur. Potential complications include a thickened bladder with a reduced capacity to store urine, infected residual urine, bladder stones, and a backup of pressure that damages the kidneys.

Decisions regarding BPH treatment are based on the severity of symptoms (as assessed by the International Prostate Symptom Score questionnaire, see Do You Have BPH?), the extent of urinary tract damage, and the man's age and overall health. In general, no treatment is needed for men who have only a few BPH symptoms and are not bothered by them.

Treatment -- usually surgery -- is required in the following situations:

kidney damage due to inadequate bladder emptying

a complete inability to urinate after treatment of acute urinary retention

incontinence due to over filling or increased bladder sensitivity

bladder stones

infected residual urine

recurrent blood in the urine despite treatment with medication

symptoms that have not responded to medication and are troublesome enough to diminish quality of life

Energy Drinks: Beverages With an Unhealthy Boost

Wed, 03 Jun 2009 06:00:00 CDT

You've seen them in the grocery store refrigerated coolers, with fancy names, like Red Bull, Monster, Full Throttle, and Rockstar. They're the so-called "energy drinks" that come loaded with caffeine, sugar, vitamins, minerals, and other ingredients. But are they really good for you? Johns Hopkins reviews the data.

The popular high-caffeine, high-sugar beverages, typically sold in 8.3 oz aluminum cans (two-thirds the size of a standard size of Coca-Cola) contain about seven teaspoons of sugar and as much as two to four times the amount of caffeine (9 milligrams per fluid ounce) as Coke.

Caffeine is a drug and should be treated with caution. Some people are now suggesting that warning labels be placed on energy drink cans because of their high caffeine levels and their potential to raise blood pressure. Elevations in blood pressure were the point of small study presented at a recent American Heart Association meeting.

While the increases didn't reach dangerous levels in the healthy volunteers, the increases in blood pressure and heart rate could prove to be clinically significant in patients with heart disease or in those who consume energy drinks often, said James Kalus, Pharm.D., senior manager of Patient Care Services at Henry Ford Hospital in Detroit, Michigan, who led the study. "Individuals with high blood pressure and heart disease should be advised to avoid these drinks," he said.

Most energy drinks contain high levels of caffeine and taurine, an amino acid also found in protein-containing foods such as meats and fish. Both have been shown in some studies to effect heart function and blood pressure. In contrast, "sports drinks" like Gatorade and POWERade are simply mixtures of water, sugars, minerals, and salts, without chemicals aimed at increasing "energy" or alertness.

In Dr. Kalus' study, blood pressure and heart rate levels increased in healthy adults who drank two cans a day of a popular energy drink. According to Dr. Kalus, these changes occurred while the participants were sitting in chairs watching movies. "The increases in heart rate and blood pressure weren't enough for something to happen acutely," he said, "but a person on hypertension medication or who has cardiovascular disease may not respond as well. While energy drinks increase concentration and wakefulness, people with risk factors for heart disease could have a bad reaction. The subjects in this study were healthy, with low blood pressure."

Dr. Kalus feels that the increases in blood pressure and heart rate may be due to the caffeine and taurine in the drinks. The energy drink used in the study had as much caffeine as one to two cups of coffee, but some of the other energy drinks available contain much higher levels of caffeine.

Bottom line: "Energy drinks could affect some individuals if they didn't know they had a blood pressure problem in the first place," he said. "The study raises some concerns." Until further study, Dr. Kalus said people with high blood pressure or heart disease should steer clear of energy drinks because they could affect blood pressure and may even alter the effectiveness of hypertension medications.

Beverages With an Unhealthy Boost

Fri, 26 Jun 2009 06:00:00 CDT

You've seen them in the grocery store refrigerated coolers, with fancy names, like Red Bull, Monster, Full Throttle, and Rockstar. They're the so-called "energy drinks" that come loaded with caffeine, sugar, vitamins, minerals, and other ingredients. But are they really good for you? Johns Hopkins reviews the data.

The popular high-caffeine, high-sugar beverages, typically sold in 8.3 oz aluminum cans (two-thirds the size of a standard size of Coca-Cola) contain about seven teaspoons of sugar and as much as two to four times the amount of caffeine (9 milligrams per fluid ounce) as Coke.

Caffeine is a drug and should be treated with caution. Some people are now suggesting that warning labels be placed on energy drink cans because of their high caffeine levels and their potential to raise blood pressure. Elevations in blood pressure were the point of small study presented at a recent American Heart Association meeting.

While the increases didn't reach dangerous levels in the healthy volunteers, the increases in blood pressure and heart rate could prove to be clinically significant in patients with heart disease or in those who consume energy drinks often, said James Kalus, Pharm.D., senior manager of Patient Care Services at Henry Ford Hospital in Detroit, Michigan, who led the study. "Individuals with high blood pressure and heart disease should be advised to avoid these drinks," he said.

Most energy drinks contain high levels of caffeine and taurine, an amino acid also found in protein-containing foods such as meats and fish. Both have been shown in some studies to effect heart function and blood pressure. In contrast, "sports drinks" like Gatorade and POWERade are simply mixtures of water, sugars, minerals, and salts, without chemicals aimed at increasing "energy" or alertness.

In Dr. Kalus' study, blood pressure and heart rate levels increased in healthy adults who drank two cans a day of a popular energy drink. According to Dr. Kalus, these changes occurred while the participants were sitting in chairs watching movies. "The increases in heart rate and blood pressure weren't enough for something to happen acutely," he said, "but a person on hypertension medication or who has cardiovascular disease may not respond as well. While energy drinks increase concentration and wakefulness, people with risk factors for heart disease could have a bad reaction. The subjects in this study were healthy, with low blood pressure."

Dr. Kalus feels that the increases in blood pressure and heart rate may be due to the caffeine and taurine in the drinks. The energy drink used in the study had as much caffeine as one to two cups of coffee, but some of the other energy drinks available contain much higher levels of caffeine.

Bottom line: "Energy drinks could affect some individuals if they didn't know they had a blood pressure problem in the first place," he said. "The study raises some concerns." Until further study, Dr. Kalus said people with high blood pressure or heart disease should steer clear of energy drinks because they could affect blood pressure and may even alter the effectiveness of hypertension medications.

Tweaking Your Diet to Lower Your Blood Pressure

Tue, 30 Jun 2009 06:00:00 CDT

A study led by Johns Hopkins professor Dr. Lawrence Appel shows that making lifestyle adjustments can lower blood pressure and improve the effectiveness of blood pressure-lowering medication.

Hypertension is more treatable than ever before, thanks to a wide variety of lifestyle measures and blood pressure medications. When effective, these treatments can not only lower blood pressure, but also reduce the risk of complications from hypertension -- specifically, stroke, heart attack, heart failure, and kidney disease.

Research shows that the effects of lifestyle changes are additive. Thus, the more you adopt, the greater the benefits. In a study led by Dr. Lawrence Appel (coauthor of the Johns Hopkins Hypertension and Stroke White Paper), people with prehypertension or mild hypertension who lost weight, followed the DASH diet, reduced salt and alcohol intake, and exercised regularly lowered their systolic blood pressure by an extra 4 mm Hg over a six-month period, compared with people who only received advice on these lifestyle changes. By making lifestyle adjustments, you’ll also improve the effectiveness of your blood pressure-lowering medication and lower your risk of hypertension complications such as heart attack and stroke.

Many people can keep up the diet and other lifestyle changes that help control hypertension and ward off disease, according to a study in the Annals of Internal Medicine (Volume 144, page 485 ). In a study of 810 adults with prehypertension or mild hypertension, researchers found that those who underwent a lifestyle overhaul were generally able to maintain the changes during the 18-month study. But it did take some work.

Participants had regular counseling sessions on how to incorporate lifestyle changes into their daily routines -- which included eating more fruits, vegetables, whole grains, and low-fat dairy products and cutting down on saturated fat and sodium; getting at least three hours of exercise a week; and, if overweight, trying to shed 15 lbs. Some participants received only advice on making these lifestyle changes, and they served as the control group. Compared with the advice-only group, those in the counseling group were about one fifth less likely to have hypertension at the study’s end. These findings show that with some help you can shake up your lifestyle and stick with it.

Interested in learning more about the DASH diet? See these articles:

Should You Try a DASH-Style Diet?

Tweaking the DASH Diet

DASH Diet Tips

All That Wheezes Is Not Asthma

Thu, 25 Jun 2009 06:00:00 CDT

Short of breath? Coughing? Chest pain? Johns Hopkins doctors explain why you should take your symptoms seriously.

Many lung disorders produce similar symptoms, but the severity and duration of these symptoms can vary considerably from disease to disease. The lung disorders can be acute (short and relatively severe) or chronic (persisting over a long time).

Chronic lung conditions may wax and wane in severity and can worsen quickly and markedly if another problem, such as a lung infection, occurs. Some people, however, have only mild symptoms or none at all. In these individuals, the lung disorder may be detected on a chest x-ray or by a test to check lung function.

Shortness of breath. Shortness of breath can dramatically compromise quality of life. The underlying cause of shortness of breath is usually a mechanical problem in the lungs or diaphragm (the large, dome-shaped muscle located at the base of the lungs). Examples of mechanical problems are airway obstruction (as occurs in asthma, COPD, and some lung cancers); increased stiffness of the lungs (as in interstitial lung disease, pneumonia, and heart failure); severe spine and rib cage abnormalities; and obesity.
If left untreated, shortness of breath can lead to fatigue and weakness that may profoundly limit activities. In turn, weakness related to being out of shape or musculoskeletal disease, such as severe curvature of the spine, may aggravate shortness of breath.

Coughing. Coughing up phlegm, infectious germs, and foreign substances is one of the ways in which the lungs protect themselves. Severe coughing, however, may signal lung disease. Obstructive diseases of the lungs (asthma and COPD) and lung cancer often cause a person to cough up phlegm, which, if yellow or green, may signal an infection. Coughing up blood is a critical sign, especially in a current or former cigarette smoker. It may suggest a potentially life-threatening disease, such as lung cancer or pulmonary embolism, although it can also be a sign of a less serious lung problem such as bronchitis.

Noisy breathing. Noisy breathing is an especially common sign of lung disease. Abnormal sounds range from a high-pitched crowing during inhalation to continuous musical sounds during exhalation (wheezing, which occurs with asthma and some other disorders). The maxim “all that wheezes is not asthma” underscores the fact that many health conditions, including diseases of the larynx, heart failure, pulmonary embolism, and COPD, can cause wheezing. Repetitive loud snoring during sleep, interrupted by periods of silence in which there's no air flow, is a major sign of sleep apnea.

Chest pain. Chest pain or other discomfort has numerous causes, and determining whether the cause is a heart, esophageal, or lung disease is often challenging. Pain on one side of the chest that worsens with deep breathing, coughing, or laughing suggests pleurisy, an inflammation of the pleura (the membrane around the surface of the lungs and the inner chest wall). Pleurisy may be caused by an infection, such as pneumonia; pulmonary embolism; cancer; or a systemic (affecting the entire body) inflammatory disease such as systemic lupus erythematosus. Alternatively, pain that worsens on inhalation may be due to a chest wall injury such as a broken rib.

10 Alzheimer's Treatment Myths Revealed

Mon, 29 Jun 2009 06:00:00 CDT

In this article from an issue of The Johns Hopkins Memory Bulletin, the authors discuss 10 of the most common misunderstandings about Alzheimer's disease treatments.

Myth 1: Dementia is just old age, so it is best to leave the person alone.

Truth: Because dementia, especially Alzheimer's, was traditionally viewed as "senility" or normal aging, physicians and families long held that dementia was untreatable or not worth treating. We now know there are numerous dementia copycats, including depression, vitamin deficiencies, and thyroid problems, that can be improved or even halted through treatment.

Myth 2: Alzheimer's is untreatable.

Truth: Alzheimer's is incurable, but it is not untreatable.

Myth 3: There is no need to start Alzheimer's treatment early -- it's all downhill, anyway.

Truth: Studies suggest that people who start Alzheimer's treatment early usually remain better off than those who start treatment months later. That is why most expert doctors begin treatment right after a person is diagnosed.

Myth 4: Treatment will stop the course of Alzheimer's or bring someone back to normal.

Truth: Unfortunately, the available medicines cannot do this, but they can help people with Alzheimer's to think more clearly and function better and longer than they would have without the medication.

Myth 5: Memory pills should be stopped after a few weeks if there aren't any clear benefits.

Truth: It may take from several months or longer to tell if a memory drug is working.

Myth 6: Drugs for Alzheimer's work only in the early stages, so there is no use treating people in the moderate or severe stages.

Truth: These drugs are effective for treating moderate and severe Alzheimer's. They may help people in the moderate stage even more than those in the early stage. People at every stage should have access to any treatment that helps.

Myth 7: Vaccines and stem cells to cure Alzheimer's will soon be on the market, so let's just wait until they're available.

Truth: It will be years, if ever, before vaccines and stem cell therapies are available for Alzheimer's. To date, researchers have found no experimental treatment that improved thinking and memory better than the four drugs already in use: Aricept, Exelon, Razadyne, and Namenda.

Myth 8: It is worth trying a memory supplement or herbal pill before trying these drugs.

Truth: It's best to make a choice such as this after you discuss it with your doctor. Supplements or herbal treatments vary widely in their benefits and risks, and none are as well studied for Alzheimer's as are the four prescription drugs.

Myth 9: Not seeing any change after treatment means the drug is not working.

Truth: The course of untreated Alzheimer's is a progressive decline. So not seeing a change is usually a good sign because it suggests that the disease has stabilized, at least for the time being.

Myth 10: The side effects of the current Alzheimer's drugs are too strong to justify taking them.

Truth: Most beneficial drugs have side effects, and most people generally tolerate the cholinesterase inhibitors and Namenda quite well.

Adapted from The Alzheimer's Action Plan by P. Murali Doraiswamy, M.D., Lisa P. Gwyther, M.S.W., and Tina Adler. Copyright © 2008 by the authors and reprinted by permission of St. Martin's Press, LLC

Can You Be Fat But Fit?

Wed, 10 Jun 2009 06:00:00 CDT

Everyone knows that it’s unhealthy to be very overweight. But what if you are obese but still relatively physically fit? Does being fit cancel out the health risks of being obese, or at least some of them? In other words, is it possible that being obese isn’t the real problem, but rather being unfit?

Although some obese people, as well as some researchers, make this claim, there are no easy answers to these questions. First, it’s hard to define the terms. Overweight and obesity are usually defined in terms of body mass index (BMI), which is an imperfect gauge of body fat. Physical fitness varies from person to person and by age. Fitness means different things to a dancer, lumberjack, mailman, or weight lifter. But for researchers, fitness is generally defined as cardiovascular (aerobic) fitness -- the ability to carry on a vigorous activity such as running or brisk walking for an extended period.

Obese people face many increased risks -- for diabetes, high blood pressure, and high cholesterol, all of which boost the risk for cardiovascular disease. Obese people also face an elevated risk for many types of cancer and several other diseases. Thus, obese people, almost across the board, have significantly lower life expectancy than leaner people.

However, there is some evidence that for obese people who are fit, the risks are less dramatic. For instance, in a study looking at more than 5,000 men and women (age 30 to 75), researchers at the University of North Carolina reported that being obese and being unfit both increase the risk for premature death, while fitness reverses some, but not all, of the increased risk associated with excess body fat.

Some of the best-known research on this subject comes from the Cooper Institute for Aerobics Research in Dallas. Its studies have reported that obese men who become fit lower their risks. Men who are obese and fit actually face lower risks than those who are lean but unfit. Therefore, when it comes to cardiovascular mortality, fitness may be more important than weight, at least for men.

Being sedentary and unfit are major contributors to being overweight and obese. And when overweight people start to exercise more, they usually lose weight (especially if they control their calorie intake) and lower their blood pressure and cholesterol levels. That’s why, in these studies, relatively few obese people are very fit. Most obese people don’t (or can’t) exercise much, and those who truly become fit tend to lose weight. Just because there are some fit, healthy obese people, you shouldn’t conclude that it’s healthy for most people to stay obese.

Why Generic Drugs Cost Less

Tue, 23 Jun 2009 06:00:00 CDT

Between 2005 and 2010, brand-name drugs with a market share of about $100 billion will lose their patent protection. Taking advantage of these generics could save you up to $5,000 a year in out-of-pocket expenses. Here's what you should know …

Once the patent for a drug expires, any company can manufacture and sell the drug as long as it proves to the U.S. Food and Drug Administration (FDA) that its generic meets the following criteria:

The generic drug contains the same active ingredient as the branded product.

The generic drug is available in the same dosages and is administered in the same way.

The generic drug is of equal purity and quality.

The generic drug enters the bloodstream as quickly as the brand and results in similar blood levels of the drug.

Because federal regulations stipulate that the generic version of a drug must look different than the branded version, the generic drug will contain different inactive ingredients.

In general, a generic drug costs less than the brand, but how much less depends on a number of factors. Typically, the first generic drug to receive FDA approval is awarded six months of market exclusivity, which means that no other generic drug can enter the market during that time. Because of a lack of competition, the first generic usually sells for 94% of the branded medication -- not much of a cost savings.

But after this half-year period, as the market floods with generic drugs from other companies, the generic drug price begins to drop, often dramatically. For example, with two generic drugs on the market, the price drops to half that of the brand; with five generics it falls to a third and then hovers at a fifth of the brand price once seven or more generics are available.

Generic companies are able to offer the same medication as the branded companies for far less money because they spend little on research, development, and marketing. They do not need to conduct extensive trials to prove a drug's safety and effectiveness.

Taking Advantage of Savings: As more drugs go generic in the coming years, taking advantage of them could make a considerable dent in your drug expenditures, even if you have prescription drug coverage. The copays for generics are usually lower, and some plans require no copay for generic drugs.

To keep abreast of new generic drug approvals, visit www.fda.gov/cder/ogd/approvals. And it also makes sense to comparison shop, because price can vary considerably. Many chain pharmacies and mail-order and Internet drug retailers have websites that list prices. For convenience, check out www.destinationrx.com, a site that compares prices from major online pharmacies. Consumer Reports offers advice on best buys at www.crbestbuydrugs.org.

Getting A Second Opinion

Thu, 02 Jul 2009 06:00:00 CDT

Prostate cancer is usually not an emergency. By taking your time, learning about your illness, and exploring your options, you're likely to make an informed decision that's right for you. And since doctors don't always agree on prostate cancer treatment, many men find it helpful to get a second opinion.

Although most people don't realize it, doctors don't always agree on the "best" treatment for early-stage prostate cancer. A recent study presented at the American Society for Clinical Oncology meeting found that men with early prostate cancer who consult only a urologist -- the doctor who performs radical prostatectomy -- are likely to choose that procedure. But men who see a urologist and a radiation oncologist are more likely to choose radiation therapy. This means it's wise to consult with a urologist and a radiation oncologist to get a clear understanding of your options. Health insurers generally pay for second opinions, and some even require them before certain procedures.

Getting a second opinion. You might be reluctant to suggest getting another opinion for fear of offending your doctor or thinking that he or she may not want to involve another physician. But many doctors welcome such discussions. If yours doesn't, strongly consider changing doctors.

Your primary care doctor and the urologist who performed your biopsy are the best sources for referrals. Request that, if possible, they suggest a colleague affiliated with a different hospital. Although this is not absolutely necessary, the practice is prudent because doctors who work at the same institution often share similar views and may not want to contradict one another. The American Medical Association (www.ama-assn.org) and the American Urological Association (www.urologyhealth.org) offer referral services.

Before your appointment. Check to be sure the doctor you consult is board-certified in the appropriate specialty. Ask your doctor's office to send a written summary and test results to the doctor you'll be consulting with. Call his or her office before your appointment to be sure the records have arrived as it will be impossible for your evaluation to take place without them.

At your consultation. Ask the doctor to explain why he or she is recommending a certain treatment, and take notes. Or bring a trusted family member or friend to help you remember the discussion, take notes, or ask questions you may have forgotten. Ask the consulting doctor to send a written report containing the recommendations to you and your referring physician.

Still not sure? If the specialists you see don't agree, schedule a consultation with a medical oncologist -- a cancer treatment specialist who does not perform radiation or surgery. Another option is to meet with a second urologist or radiation oncologist -- or both).

If you're having trouble making a decision, ask your primary care doctor -- or another specialist -- to help you sort through the options. Or, consider seeking an opinion at a nationally recognized cancer center, such as one that is affiliated with the National Comprehensive Cancer Network (www.nccn.org). It might also help to talk to men who have been treated for prostate cancer.

Remedies for Allergy Eyes

Fri, 12 Jun 2009 06:00:00 CDT

Do your eyes turn red and itchy every spring and summer? It could be allergic conjunctivitis – a treatable, but uncomfortable allergy condition.

Allergic conjunctivitis is a common cause of red, itchy eyes. Although allergies are best known for causing nasal symptoms, they also can be irritating to the eyes. In allergic conjunctivitis, the affected part of the eye is the conjunctiva, the thin, elastic tissue that covers the white of the eye and lines the inside of the eyelid. Fortunately, doctors and patients have an array of therapies at their disposal to prevent or treat allergic conjunctivitis.

Conjunctivitis can be caused by either allergies or infection. In allergic conjunctivitis, the eyes become red and itchy, with a watery, stringy, or ropelike discharge. Both eyes are usually affected. In addition, people with allergic conjunctivitis often have a history of allergic rhinitis, asthma, or eczema. Infectious conjunctivitis also leads to eye redness but is more likely to produce tearing and discharge in one or both eyes. People with these symptoms may need antibiotics and should see an eye doctor.

Allergic conjunctivitis can be seasonal (occurring only at specific times of the year) or perennial (occurring year-round). Seasonal allergic conjunctivitis is typically caused by outdoor allergens, such as pollen, and the perennial form is usually caused by indoor allergens, such as cockroaches, dust mites, or pet dander. Skin or blood testing by an allergist can pinpoint a patient’s specific triggers.

Treatments for allergic conjunctivitis
To prevent symptoms of allergic conjunctivitis, patients should learn to avoid or limit their exposure to triggering substances. When symptoms do erupt, cold compresses on the eyes may help relieve conjunctivitis symptoms in the short term.

Medications are a mainstay of treatment for allergic conjunctivitis. Some doctors recommend using artificial tears, which provide a barrier between allergens and the eye; they also help dilute and flush out the allergens that contact the eye. Other conjunctivitis medications include:

Antihistamine eyedrops -- for acute treatment of ret, itchy eyes

Oral antihistamine medication -- to reduce itchy eyes

Vasoconstrictors -- for short-term treatment of redness and swelling

Nonsteroidal anti-inflammatory eyedrops -- for reducing symptoms in some patients

Mast-cell inhibitors -- to treat a range of symptoms, including itching, swelling, and watery eyes

Doctors usually prescribe corticosteroid eyedrops only for severe cases of allergic conjunctivitis and only for short periods because of the risk of side effects, including cataract and elevated eye pressure, which may lead to glaucoma. For some conjunctivitis patients, allergy shots may be a useful way to prevent allergies from recurring.