Identifying Early Symptoms of Parkinson’s Disease

August 25th, 2014  |  The Blog

Parkinson’s disease (PD) is a progressive nervous system disorder. It slowly and adversely affects a person’s movement. PD also:

  • Causes resting tremors
  • Creates muscle rigidity
  • Affects speech, sometimes making it inaudible and slurred
  • Causes a blank facial expression

Medications, which have many potential and potent side effects, are currently used to control the symptoms of PD. There is no cure for Parkinson’s disease.

Hyposmia is a Clue

Interestingly, almost all patients with PD have a decreased sense of smell or hyposmia. This is one of the first clinical symptoms of the disease, although not fully recognized or fully evaluated by the medical community as a whole.

It is important to note that not everyone with a decreased sense of smell has or develops Parkinson’s disease. There are many other causes that can make a patient lose their sense of smell.

New Diagnostic Tools for Parkinson’s Disease

Once hyposmia is established in the clinical setting, further testing is available to determine if the patient is on the path to developing PD. These studies will help to identify patients who will likely develop clinical symptoms of PD. The tests include:

  • Olfactory or smell testing
  • Dopamine transporter (DaT) imaging

The single photon emission computed tomography (DAT-SPECT) is done after DaTscan or I-ioflupane in injected into the patient’s vein to enhance imaging. The DaTscan is visualized and recorded by a special gamma camera.

The U.S. Food and Drug Administration (FDA) have approved DaTscan, a radiopharmaceutical agent. The side effects of this agent include:

  • Headache
  • Dizziness
  • Increased appetite
  • Uneasy or crawling feeling under the skin

Those with a DATdeficiency went on to develop PD in 61% of those tested. Their clinical symptoms developed within four years of testing.

The Benefits of Knowing

The clinical application of the new diagnostic tools remains limited to research-only casess at this time. It remains to be determined if the general population who appears to be at risk of developing PD, according to testing outcomes, would benefit from medication treatment trials. The medications would provide neuro-preventive potential to those at risk.

The International Parkinson’s and Movement Disorder Society (MDS) speculates that treating patients in neuro-protective medication trials will have greater success in treating PD than waiting to treat those who present for treatment with clinical features (tremors, gait issues, inability to swing arms when walking, blank facial expression) of Parkinson’s disease.

One Caveat to the Story

There is also research afoot regarding whether there is a link between hyposmia and Alzheimer’s disease. Currently, the loss of smell in patients suspected of developing Alzheimer’s disease leads to further cognitive testing to solidify a positive diagnosis.

Loss of smell is associated with the first cranial nerve, which is one of the first points impacted by cognitive decline.

Again, early diagnosis of the disease would support earlier treatment intervention to slow the process. Medications are especially helpful in treating early symptoms of Alzheimer’s disease.

More research on the subjects, both Parkinson’s disease and Alzheimer’s disease, is pending.

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A Concern for Hysterectomy Patients

August 11th, 2014  |  The Blog

A hysterectomy is done for a variety of medical reasons. Sometimes it is done to remove fibroids, endometriosis or for other reasons. There might be a cancer diagnosis or not.

It is important to note that this blog discussion focuses on laproscopic hysterectomies, not the traditional open abdominal surgery.

Laproscopic vs. Traditional Open Surgery

Open abdominal surgery requires a 3 to 7-inch incision. There is a longer recovery than laproscopic surgery but it allows the uterus to be removed intact.

Laproscopic surgery is done through several tiny incisions on the abdomen. It allows faster recovery than traditional open surgery. The uterus or fibroids must be cut into small pieces, which are then removed through the tiny incisions on the abdomen.

The Equipment

Recent research shows that a surgical device used during a laparoscopic hysterectomy might spread cancer in the patient’s body. The American Medical Association (AMA) has published a report about the device and called it?risky. The U.S. Food and Drug Administration (FDA) advised physicians to stop using it.

The device, which is causing all of the concern, is a laparoscopic power morcellator. A morcellator utilizes spinning blades to slice uterine fibroids or the entire uterus into fragments that can be removed through the small laproscopic incisions.

The morcellator has been in use in the U.S.for about 20 years but there is very little data about it available prior to the current cancer concerns.

The Problem

A recent study found that 1 in 368 women who have a hysterectomy actually have hidden or undiagnosed uterine cancer. The most common cancers of concern are uterine sarcoma and endometrial cancer.

The morcellator can spread previously undetected cancerous tissue inside the body. When the uterus or other tissue is morcellated, pieces of the tissue can errantly remain in the body. If they are cancerous, this can spread the disease.

A Suggested Solution

If the uterus is placed inside a protective bag before morcellating, stray tissue pieces remain contained and cannot escape to other areas of the body. There are some U.S. hospitals that have recently started this extra precautionary measure.

The Decision

Supporters of the morcellator argue that banning it is the wrong decision. They say that more women will have unnecessary traditional abdominal hysterectomies, which result in more significant scars, longer recovery time and the risk of more surgical complications.

Opponents of the device argue that the risk of using the morcellator is too high for an elective procedure. They say that there are alternatives to using the device, which should be considered.

Interestingly, in a recent study of 230,000 laparoscopic or minimally invasive hysterectomies, only 16% of them were performed with the morcellator after the safety of the device came into question.

The largest manufacturer of the device is Johnson & Johnson. The company recently suspended sales of the morcellator based on the FDA recommendation.

The FDA is considering whether to restrict or possibly ban the use of morcellators. A decision will be announced within this year.

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Ebola Explained

August 6th, 2014  |  The Blog

Ebola is a deadly virus. It is named for the Ebola River that runs close to where the first cases of the illness were identified in 1976.

Where is the Outbreak?

The virus originally presented in Sudan and the Democratic Republic of the Congo.

Currently, there is an Ebola outbreak in West Africa including the countries of Guinea, Liberia, Nigeria and Sierra Leone.

According to healthcare authorities, the virus is highly unlikely to be a credible threat on U.S. soil.

How Deadly is the Virus?

According to the World Health Organization (WHO), there are over 1,600 cases of the illness in West Africa. Of those cases, nearly 900 have died.

There are five known strains of the virus. The current culprit is Ebola Zaire.

About 90% of people, depending upon the reporting agency, who contract the illness die in underdeveloped countries. The U.S. Centers for Disease Control (CDC) states that the variation in the mortality rate reflects the benefits of early medical intervention. It is still unknown if modern medical care in a U.S. intensive care unit would make a positive difference in the mortality rate.

Patients typically die in 7 to 14 days after the symptoms first occur.

Spreading the Virus

The Ebola virus is not airborne. It takes vey close contact with an infected person in advanced stages to contract the illness. It can spread from infected animals (fruit bats, chimpanzees, gorillas, forest antelope and monkeys) or humans.

The virus spreads by close contact with skin and bodily fluids. Almost all bodily fluid can transmit the virus. They include:

  • Blood
  • Vomitus
  • Feces
  • Urine
  • Sweat
  • Saliva
  • Breast milk
  • Tears

Kissing and sex can transmit Ebola. Patients with the illness are not typically well enough to engage in such activities, according to authorities.

The incubation time for Ebola, when symptoms occur after being exposed to the virus, is 14 to 21 days.

Symptoms of the Illness

Initially, Ebola presents with symptoms of a bad case of the flu. These include:

  • High fever
  • Muscle pain
  • Headache
  • Sore throat
  • Intense weakness

More serious symptoms quickly develop, which include:

  • Vomiting
  • Diarrhea
  • Internal bleeding/hemorrhaging
  • External bleeding/hemorrhaging
  • Kidney failure
  • Liver failure

The virus can be in a person?s system for three weeks before they have any outward symptoms. If they survive the illness, the virus can stay in the body for several weeks after they recover.

Vaccine or Cure Availability

Neither option, a vaccine nor a cure, is currently available.

Treatment options for Ebola are supportive in nature. Support measures include the following: IV fluids including electrolyte replacement, medications to control blood pressure, mechanical ventilation and transfusions.

Until the current outbreak, drug companies did not prioritize an Ebola vaccine or cure. The recent crisis has brought the need to the forefront in the medical field and has accelerated the much-needed process.

Preventing the Spread

Contact precautions are necessary, including gowns, gloves and eye protection. Universal precautions, which covers treating all bodily fluids and blood as if they are infected, are very important. Hand washing is always an important precautionary measure.

Educating the public, in the highly affected areas, to avoid close contact with sick people and dead bodies is critical to preventing the spread of the disease.

The risk of the disease spreading to the U.S. is highly unlikely. The mere distance from West Africa to the U.S. is significant enough that a sick person would have trouble making the trip.

Declaring the Outbreak Over

Public health officials will declare the Ebola outbreak in West Africa to be over in 6 weeks after the last case is diagnosed. This can take 3 to 6 months, according to the CDC.

The Future

The National Institutes of Health (NIH) have been developing an Ebola vaccine for several years. They plan to begin an early stage vaccine trial in September 2014.

Depending upon the vaccine study results, which are expected by January 2015, it could be available to health workers in affected African countries sometime in 2015.

 

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Afrezza: Inhaled Insulin for Treating Diabetes

July 30th, 2014  |  The Blog

Treatment options for diabetes are ever evolving. Those with type 1 or type 2 diabetes have a new U.S. Food and Drug Administration (FDA) approved treatment option, inhaled insulin. The FDA approval is for safety and effectiveness of the drug.

The new drug, Afrezza, is a fast-acting insulin, which requires no needles. The inhaled drug is taken before each meal. Afrezza does not replace injected long-acting insulin for those patients who need that form of treatment.

It is important to note that there was an inhaled insulin called Exubera, which was FDA approved in 2006. The manufacturer withdrew it from the market in 2007 due to poor sales numbers and an overly complicated administration process for the patient.

Afrezza is the new and improved inhaled insulin.

How It Works

Afrezza is inhaled and absorbed through the cells in the lungs and into the blood stream.

The drug peaks in the blood about 15 to 20 minutes after it is inhaled. This is a difference compared to injected insulin, which peaks about an hour after it is taken.

Afrezza also clears faster from the body than injected insulin. After it quickly peaks, the drug is gone from the body in 2 to 3 hours. This is a difference from injected insulin, which remains in the body for about 4 hours after it is taken. Manufacturers of Afrezza tout this as a major benefit citing that Afrezza?s rapid response and rapid exit from the body mimic a normally functioning pancreas.

How it is Administered

A powdered dose, in an individual cartridge, of Afrezza is administered in a small, whistle-sized inhaler. Each cartridge contains one single dose of the drug.

It is easy to teach a patient how to use the inhaler to administer the drug.

Benefits of Afrezza

There are a few main benefits to this inhaled insulin product, which include:

  • No needles involved; 10% to 15% of insulin dependent patients are adverse to needles
  • Controls blood sugar equally as well as injected insulin, according to research studies
  • Less likely to cause a very low blood sugar, which is a common complication of insulin
  • Less weight gain, probably due to the short length of time the medication is in the body
  • Patients who do not have good blood sugar control using oral medications have better regulation using inhaled insulin
  • Patients might need less insulin than the traditional injected insulin

The Cost

The manufacturer compares the cost of inhaled insulin to the cost of the fast-acting and common pen form insulin. The cost of a fast-acting pen insulin costs $270 a month for those who need an average of 30 units of insulin a day, before health insurance coverage.

Side Effects of the Drug

The most commonly reported side effects of Afrezza are:

  • Low blood sugar
  • Cough
  • Throat pain
  • Throat irritation

The drug warnings also include the possibility of sudden chest tightening or acute bronchospasm. This potential side effect makes Afrezza be contraindicated for patients with asthma, COPD or those who smoke.

Some physicians are concerned about the effect of Afrezza on lung tissue, the mouth and esophagus.?The FDA is investigating whether Afrezza creates any potential risk of lung cancer. This is an important factor in the success of the drug.

Afrezza is not recommended to treat diabetic ketoacidosis, which is a serious complication of diabetes. Diabetic ketoacidosis is a condition in which the body makes high levels of ketones or blood acids.

In Closing

Afrezza is not yet available to the general patient population. With the FDA approval, it will be available in the not-to-distant future, according to the manufacturer MannKind, who is seeking a pharmaceutical partner in the marketing effort.

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A Guide to Childhood Vaccines-Part 2

July 21st, 2014  |  The Blog

Continuing on with the Guide to Childhood Vaccines. Part 2 includes a look at the following important vaccines:

Hepatitis B

Hepatitis B is a virus that attacks the liver. It is contracted by exposure to blood or body fluids of an infected person. The illness is serious and can lead to a higher risk of cancers. There is not treatment.

Dose 1 of the vaccine is given to any age followed by dose 2 at least one month later and dose 3 at six months after the first dose. A 3-shot series protects the patient for a lifetime.

Hepatitis A

This virus affects the liver. People with the disease who do not wash their hands after using the bathroom can spread Hepatitis A.

Hepatitis A causes nausea, vomiting, jaundice and stomach pain. The illness is usually worse in adults than children. Symptoms usually abate after a few months. There is no treatment, except palliative measures.

The vaccine is administered at 12 to 15 months old and followed by a booster 6 to 18 months after the first dose.

Hemophilus influenza type B (HIB)

Hemophilus influenza type B is a bacterium. It causes meningitis, pneumonia and/or other serious infections which can be fatal. Coughing and sneezing spread the illnesses. Treatment for these illnesses is antibiotics.

The HIB vaccine is administered at 2, 4 and 6 months old followed by a booster at 12 to 15 months. There is an individual vaccine and HIB is also in a combination vaccine called Pentacel.

Poliomyelitis (Polio)

Polio is a virus spread by contact with body fluids like saliva. Most people who contract polio are symptom-free. One percent of cases lead to paralysis or death. The U.S. has been polio-free since 1979 but the disease is still active in other parts of the world.

There is not treatment for the disease.

The polio vaccine is sometimes given as an injection or as a drink, but the U.S. gives it as a shot. It is administered at 2, 4 and 6 months and again at 4 to 6 years old.

Meningococcus

This bacterial illness causes serious and sometimes fatal blood infections and meningitis. Coughing, sneezing and exposure to saliva of an infected person spread it. Meningococcal illnesses can be treated with antibiotics if they are started quickly, otherwise the disease can be fatal.

The vaccine is given at 11 to 12 years old and a booster is administered at 16 years old. In special cases, the vaccine can be given earlier.

Human papilloma virus (HPV)

There are at least 40 types of HPV, all of which are not covered by the vaccine. HPV causes cervical cancer and other cancers in both men and women. It also causes genital warts and can infect oral and throat mucosa. The virus spreads through contact with an infected person’s body fluids. It is the most commonly transmitted sexually transmitted infection. There is no treatment for HPV but the virus resolves in some people after a few years.

The HPV vaccine is a 3-dose series given over a 6-month period. The series is usually started at age 11 or 12, but can be given as early as 9 years old.

Influenza

Influenza is a viral illness, which can lead to pneumonia. People can die from the flu, especially the elderly, the very young and people with pre-existing health issues like asthma.

This illness is spread via coughing, sneezing and contact with saliva. There are medications that can shorten the duration of the illness and make the symptoms milder.

People with a severe egg allergy should not get the regular vaccine; a new egg-free vaccine has been FDA approved. Anyone 6 months and older should get the vaccine every year. For those under age 9 receiving the vaccine for the first time, two doses, at least one month apart, are required for the first season.

Varicella

Varicella or chicken pox is a viral illness. Coughing, sneezing and/or contact with skin lesions spreads it. The illness is very contagious. In extreme cases, varicella can cause brain infections or pneumonia. Infected skin lesions can cause serious bacterial skin infections.

Treatment of varicella includes medication that can lessen the symptoms and shorten the duration for the illness.

The first dose of the vaccine is given at 15 months old. A booster is needed at 3 to 4 years old but can be administered as early as 3 months after the first dose.

The Round Up

As detail-oriented as the typical vaccine schedule seems, pediatricians are adept at following the requirements to keep the pediatric population in the U. S. safe and protected.

 

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A Guide to Childhood Vaccines-Part 1

July 14th, 2014  |  The Blog

Childhood vaccines protect the child receiving them as well as the public at-large. It is important to keep the prescribed vaccine schedule up-to-date.

There is a lot to understand about vaccines schedules. Parents rely heavily on their child’s pediatrician to keep the schedule rolling.

With the onslaught of new and improved vaccines, there are different names and combination vaccines available. It is the individual pediatrician’s choice, with input from the parent/guardian, to determine the best choice for each child.

Diphtheria

Diphtheria is a bacterial infection, which is spread by coughing and sneezing, has been obliterated in the U.S. since 2003. It is treated with an anti-toxin.

This vaccine is part of the DTaP and Tdap series and is also found in the new combination vaccines Pediarix and Pentacel. It is administered in the DTap at 2, 4 and 6 months old with boosters at 12 to 18 months and 4 to 6 years old.

Pertussis

Pertussis, a bacterial infection, is commonly called whooping cough. It causes a serious respiratory illness that is highly contagious.

Pertussis is treated with antibiotics, which are more effective before the whooping sound cough begins. This is difficult to treat in early stages because most people are unaware that they have the illness until the distinct cough starts.

This vaccine is a part of the DTap series.

There have been many recent cases of pertussis in the U.S. prompting a concerted effort to get more adolescents and adults immunized. It is important that every pregnant woman be immunized with each pregnancy.

Tetanus

Tetanus or lockjaw is a bacterial infection, which usually enters the body through a skin wound. It presents as a nervous system disorder and can cause death. Immunization has made the disease rare in the U.S. It is treated with Tetanus immunoglobulin.

The vaccine is a part of the DTap vaccine. TdaP is administered at 11 years old. Adults should get the TdaP once and then get the Td every 10 years. Pregnant women should get the TdaP with every pregnancy.

Pneumococcus

Pneumococcus causes a bacterial infection, which is spread by saliva and sneezing. It is especially dangerous to patients with a compromised immune system.

The vaccine is administered at 2, 4 and 6 months old with a booster at 12 to 15 months.

Mumps

Mumps is a viral illness that spreads through close contact with an infected person.

The disease can affect the brain and cause testicular inflammation with subsequent infertility. This is no treatment for mumps.

Mumps vaccine is part of the MMR (measles, mumps, rubella) series. It is given at 12 to 15 months. In unusual cases, it can be given before 12 months of age. In this situation, a second dose is needed at 12 to 15 months. All children receive a booster dose at 3 to 4 years of age. The booster can be given as early as one month after the first dose.

Measles

Measles is easily spread via coughing and sneezing. The illness causes a rash and fever but can evolve into a brain infection or pneumonia leading to death. There is no treatment for measles, except palliative measures.

There are still reported cases in the U.S. for people who are under-immunized with only one dose or have received no measles immunizations.

Measles is part of the MMR vaccine, which is administered at 12 to 15 months. It can be given earlier if a child has been exposed to the disease or is traveling to a country with potential exposure. In this case, a second dose is needed at 12 to 15 months. All children receive a booster dose at 3 to 4 years of age. The booster can be given as early as one month after the first dose.

Rubella

Rubella or German measles is part of the MMR vaccine. It is another virus, which is spread by sneezing and coughing. This is a serious disease for pregnant women because it can cause birth defects to a fetus. There is no treatment.

The MMR vaccine is administered at 12 to 15 months but is given earlier if a child has been exposed to the disease or is traveling to a country with possible exposure. If MMR is given before 12 months old, a second dose is needed at 12 to 15 months. All children receive a booster dose at 3 to 4 years of age. The booster can be given as early as one month after the initial dose.

Follow along next week for the wrap-up with A Guide to Childhood Vaccines-Part 2.

 

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Colorectal Cancer Screening Update

July 7th, 2014  |  The Blog

Colorectal cancer is the 2nd largest cause of death from cancer in the U.S. It takes the lives of 268,783 Americans each year. Lung cancer strongly precedes colorectal cancer as the biggest killer in the U.S. by taking 792,495 lives annually. A close 3rd in the rankings for cancer death is breast cancer, which steals 206,983 lives every year.

The good news, according to the American Cancer Society (ACS), is that the death rate from colorectal cancer has dropped 3% annually from 2001 through 2010. Why is the number dropping? Here are a few ideas from the authorities:

  • Better compliance with colorectal screening for those over 50 years old
  • Improved treatment options
  • Fewer actual colorectal cancer cases because many precancerous polyps are snipped out during screening colonoscopies

The Recommended Plan

The National Cancer Institute (NCI) and the Mayo Clinic, as well as other high profile healthcare groups, agree with the plan of care to prevent and assess colon health. Colorectal screening is recommended for all 50 to 75 year olds.

The screening and testing options include:

  • Annual stool test, which detects early cancers, not polyps
  • Sigmoidoscopy every 5 years OR colonoscopy every 10 years

Annual stool test

  • A sample of stool taken by the patient after a bowel movement and placed on a specimen card to which a drop of a guaiac developer is applied or a stool sample is taken by a physician during a rectal exam
  • While this test gives very preliminary information, it is better than no test at all

Sigmoidoscopy

  • Requires a gentler prep, which is an enema, not the strong laxative used for a colonoscopy
  • Visualizes only the lower one-third of the colon
  • Misses polyps that are higher up in colon
  • Cannot excise polyps using this study so, if any seen, colonoscopy must still be done

Standard colonoscopy

  • Requires a stringent and thorough bowel prep
  • IV sedation is administered for the procedure
  • Allows direct visualization of the colon through an endoscope
  • Polyps can be removed through the endoscope

It is important to note that the new health law provides full coverage for colorectal screening without any co-payment. Since the health law only mandates full coverage of the actual screening, there are exceptions to the no co-payment such as the charge for polyp removal or when a colonoscopy is done after a positive fecal screening.

Downsides of a Colonoscopy

The vast reluctance to undergo a standard colonoscopy is rooted with some of the following points:

  • An intense bowel prep is needed to clean out the colon
  • The risks of anesthesia, which is actually sedation, not general anesthesia
  • The chance of colon perforation during the procedure, which is less than 1%

More Improvement Needed

Currently, one in three adults, 50 to 75 years old, do not get screened as recommended.

A major healthcare goal is to increase the number of American screened for colorectal cancer. The U.S Department of Health and Human Services wants to drop the compliance rate to one in five by 2018.

New Options

According to the New England Journal of Medicine, there is a new and improved stool test, which detects DNA found in cancer cells. It is 93% accurate in detecting colorectal cancer.

There are a few new screening options on the horizon, which include:

Virtual colonoscopy

  • This is a low-dose CT scan that takes images of the colon
  • Currently, it requires the same prep as a standard colonoscopy
  • Software is being developed to remove fecal matter from the images and allow visualization of the colon, tumors or polyps

PillCam Colon

  • An image capsule called a the PillCam Colon, which is swallowed, takes pictures in the large intestine as it travels through the system. The image capsule requires the same vigorous prep as a colonoscopy
  • It can detect but not remove any polyps that it identifies. If a polyp is photographed, a colonoscopy must still be done to remove it

In the End

As more and more screening options become available, the hope and goal is to have better overall colorectal cancer screening compliance in the U.S. Colorectal cancer takes too many lives, which can be saved with a little preventive healthcare.

 

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A New Drug for Type 2 Diabetes

June 30th, 2014  |  The Blog

Diabetes is a serious, incurable disease.

There are 24 million Americans who have Type 2 diabetes. This number accounts for 90% of all diagnosed cases of diabetes in the U.S. The U.S. Centers for Disease Prevention and Control (CDC) estimates that by 2050, one in three adults could be diagnosed with diabetes.

While currently there are medications to help control the disease, there are several more on the cusp of being available to the public for even better blood sugar control.

The Risks Associated with High Blood Sugar

There needs to be good control of blood sugar levels in the diabetic population because a consistently high blood sugar can lead to serious complications including:

  • Heart disease
  • Blindness
  • Nerve damage
  • Kidney damage

A New Drug

The U.S. Food and Drug Administration (FDA) recently approved a new drug to treat Type 2 diabetes. The drug is Tanzeum or albiglutide, which is manufactured by GlaxoSmithKline (GSK). It is a glucagon-like peptide-1 (GLP-1) receptor agonist or, more simply, a hormone that helps normalize a person’s blood sugar level.

Tanzeum or albiglutide is a new Type 2 diabetes drug formulated to help control the blood sugar levels. When taking this new drug, there has been significant improvement in the affected patient’s hemoglobin A1c, which is an accurate measurement of blood sugar control over a period of time (2 to 3 months).

The drug will be marketed to the public in the third quarter of 2014.

The Particulars of the Drug

Tanzeum is a once a week subcutaneous injection. It can be used alone or with existing diabetes treatment medications like metformin, glimepiride, pioglitazone (Actos) and insulin.

This drug is not a first-line therapy for people whose blood sugar is not controlled with diet and exercise. It is important to note that the drug is most effective when paired with a strict and appropriate diet regime and an adequate exercise plan.

Side Effects

Common side effects of Tanzeum include:

  • Diarrhea
  • Nausea
  • Injection site reactions

This drug is not approved to treat Type 1 diabetes or those with diabetic ketoacidosis or increased ketones in their urine.

Cautions

Tanzeum is labeled with a warning stating that some GLP-1 receptor agonists have cause thyroid tumors in rodents. With this warning in mind, Tanzeum is not prescribed for patients with a personal or family history of medullary thyroid carcinoma (MTC), a type of thyroid cancer, or those with Multiple Neoplasia syndrome type 2, a disease with multiple tumors.

There are ongoing clinical trials to further investigate the cardiovascular effects, the use and safety for pediatric patients and a possible increase in pancreatitis or medullary thyroid cancer associated with the drug.

For now, this is a promising drug to control a serious health condition, Type 2 diabetes.

 

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The Truth About Vitamin D

June 23rd, 2014  |  The Blog

Just about everyone is taking it. Vitamin D is the new health rage. So, what is so special about it?

Most healthcare providers agree that a sufficient level of vitamin D is essential to good long-term health.

There are two types of vitamin D supplements:

  • D2, which is found in food
  • D3, which is made from exposure to sunlight

Vitamin D Deficiency Testing

A simple blood test called the 25-hydroxyvitamin D test is performed to check vitamin D levels. Normal result: 20 nanograms per milliliter (ng/mL) for good bone and general health; some MDs target 30 ng/mL.

Risk of Vitamin D Deficiency

These are the populations who are at risk of vitamin D deficiency:

  • 50 years and older
  • Dark-skinned
  • Residing north of the equator
  • Overweight, obese or those who have undergone gastric bypass surgery
  • Lactose intolerance or those with a milk allergy
  • Liver or GI diseases like Crohn’s or celiac disease

Consultation with a healthcare provider is important to determine each individual’s risk and plan of care.

What It Does (We Think)

There are many proven and speculative benefits to taking vitamin D, which include, but are not limited to:

  • Enhances general bone health by helping the body absorb calcium from food
  • Prevents bone fractures and brittle bones in older adults
  • Builds bone strength and prevents rickets, which cause weak bones and bowed legs in children. Note: since the U.S. has fortified milk with vitamin D in the 1930′s, rickets have been almost eradicated
  • Some researchers believe that it helps fight multiple sclerosis. MS is less common for those living close to the equator where there is more sunshine. Many diagnosed cases of MS exhibit low vitamin D levels
  • Some obese people have low vitamin D levels because fat cells trap vitamin D and make it less beneficial to the body. Research needs to be conducted to determine if obesity causes low vitamin D levels or if low vitamin D levels contribute to the obesity epidemic in the U.S.
  • Low levels of vitamin D might impact type 2 diabetes. More research needs to be conducted to determine if obesity affects vitamin D levels, which in turn can cause diabetes.
  • Since vitamin D impacts brain development and function, it also influences mild cases of depression.
  • Some researchers speculate that higher levels of vitamin might lower the risk of colon cancer and prevent breast and prostate cancer
  • Low levels are linked to heart disease, stroke and heart attack but high levels can be detrimental to the cardiovascular system due to increased amounts of calcium in the blood
  • Dementia has been connected to low vitamin D levels. More research is needed to determine if vitamin D supplements could prevent dementia or, at least, slow a person’s mental decline.
  • On the downside, too much vitamin D might increase the risk of pancreatic cancer

Deficiency Symptoms

Most people are unaware of specific symptoms related to vitamin D deficiency.

Adults with a severe deficiency can suffer from soft bones or osteomalacia. Symptoms of this problem include bone pain and muscle weakness.

Although rare in the U.S., children with a severe deficiency get rickets, which presents with similar symptoms to osteomalacia.

How To Get It

Vitamin D is manufactured by the body as the skin’s reaction to sunlight. When the sun shines on bare skin, the body makes vitamin D.

Fair-skinned people need 5 to 10 minutes of exposure a few days a week for sufficient vitamin D. Older people and dark-skinned people don?t manufacture as much vitamin D with sun exposure so need more time in the sun or supplements.

Experts on the subject state that vitamin D in foods and supplements are the more reliable resource than just sun exposure.

Also, most multivitamins contain 400 IU each.

Food Sources

  • Fish, especially salmon, swordfish and mackerel have good amounts of vitamin D per serving
  • Lower amounts available in tuna and sardines
  • Small amounts are found in egg yolk, beef liver and fortified foods including milk, cereal and orange juice
  • Soymilk has some vitamin D
  • Cheese and ice cream do not have added vitamin D

Reading food labels is important to check how much vitamin D is in each food.

The amounts of vitamin D in some common foods include:

  • Salmon 3 ounces=794 IU
  • Fortified cereal 1 cup=40 IU
  • Egg yolk 40 IU
  • Fortified milk 1 cup=120 IU

Reading food labels is important to check how much vitamin D is in each food.

How Much To Take

Adults up to 70 year olds need 600 IU/day and those over 71 years old need 800 IU/day.

Breast milk has minimal vitamin D, although it is the best source of nutrition for an infant. Breastfed babies need 400 IU until they start fortified formula, when supplements are no longer needed.

Most children and teens do not get sufficient vitamin D from milk and need a supplemental dose, usually found in a chewable multivitamin. Cystic fibrosis increases the risk of vitamin D deficiency.

No one can overdose with vitamin D from exposure to sunlight. The body stops manufacturing it when the limit is reached. Caution should be taken to protect the skin from damage by regularly using sunscreen with the appropriate SPF.

According to the Institute of Medicine, over 4,000 IU/day increases the risk of nausea, vomiting, loss of appetite, increases thirst and muscle aches. It also increases the blood calcium, which causes potential damage to the blood vessels, heart and kidneys.

Laxatives, steroids, anti-seizure and cholesterol-control drugs interfere with vitamin D absorption. Taking too much vitamin D with Digoxin, a heart medication, can result in an irregular heart rhythm or arrhythmia because the combination can increase blood calcium levels.

Outcomes

Current research and statistics indicate that vitamin D, in the suggested doses, has more benefits than detriments.

 

nburgess
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Important Life Lessons: Eat Slower, Walk Faster

June 16th, 2014  |  The Blog

Let us look at how a person eats and moves. The speed at which a person eats and the pace at which they walk has a strong impact on their weight management plan and goals.

Obesity is an epidemic in the U.S. Following some simple tips in changing how we eat and move can help reduce the staggering obesity statistics. This will save lives and improve general health in the process.

How We Eat

The general public eats too fast. Eating at a fast pace leads to overeating and often leads to obesity. It important to note that it takes the stomach 20 minutes to send a signal to the brain that it is satiated. Eating slowly allows the brain to catch up with the stomach.

Benefits of Eating Slower

By implementing the simple suggestions on how to eat, a recent study showed that people eat an average of 88 fewer calories per meal. Here are a few other improvements:

  • Slow eaters savor their food more. Everything will taste better.
  • Slower eaters are less hungry one hour after eating.
  • Drinking water between bites helps to reduce overall food consumption.

How to Slow Down Eating

Here are a few ideas collected by various obesity experts to help slow down the eating pace:

  • Foods in a shell like lobster, nuts and edamame naturally slow down eating up to 41%. Getting the food out of the shell is a work in progress and slows the pace.
  • Drink water with each meal.
  • To help chew and swallow before taking the next bite, put down the fork and knife after every bite.
  • Use chopsticks for every meal, not just when the main meal is Chinese food.
  • Eat with the opposite hand to slow things down.
  • Soup should be a primary source of food. It takes longer to eat and satisfies hunger.
  • Eat without any time constraint.
  • Focus on eating, not multi-tasking while eating. This helps to focus on taste, texture and smell of the food, which will lower the overall intake.

How We Walk

Pick up the pace. Faster is better when it comes to walking.

Walking Paces

The average fitness walking pace is a 15-minute mile.

The best walking pace with the lowest death rate is walking a mile in under 14 minutes. That equates to 4.3 miles per hour (mph) or right on the cusp of jogging.

Walking at a modest pace or slower than 3.5 mph, which is less than a 17-minute mile, confirmed an 18% higher risk of death. When the pace slows, most people walk one mile in an average of 20 minutes.

Ideally, walking at a pace that increases the heart rate and can be maintained for 30 to 60 minutes is best for general fitness. The pace at which a person walks should allow them to speak normally.

Benefits of Walking Faster

Lowers the risk of dying from heart disease, diabetes or dementia, according to the National Walkers Health Study, than those who walk at a slow pace.

Walking at a faster pace has more health benefits than walking slower for the same amount of time and distance.

Walking is free, convenient and the most popular form of physical activity in the U.S. Everyone just needs to do it a little faster.

How to Increase Walking Pace

There are many ways to increase a walking pace including the following:

  • To start, wear the proper footwear; low heel, flexible sole, lightweight and breathable fabric and great fit
  • Rotate two pairs of shoes, if used daily
  • Replace walking shoes/sneakers every 3 to 6 months or every 300 to 500 miles
  • Walk fast for short distances. Walk fast for 15 to 45 seconds followed by a rest period for 1 to 2 minutes
  • Check the walking form; push off the toes with every stride. Quicker steps, not a longer stride, gains the most benefits
  • Walk with elbows at a 90-degree angle
  • Walk up and down hills; uphill takes short, fast strides and downhill requires quick steps to control stride

End Result

We should eat slower and walk faster. It is that simple.

 

nburgess
About nburgess

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