what doctors know - vol 1 issue 3

7/27/2019 What Doctors Know - Vol 1 Issue 3

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Vol.1, Issue 3 $ 4.99

Colorectal

Cancer:TheNon-BiasedKiller

The Mystery of MSNo Simple Explanation

Sharon Osbourne's Fight

Bringing Hope & Support toColon Cancer Patient

Special thanks to: Sharon Osbourne,

Sir Elton John, Dr. Edward Phillips,

and Cedars-Sinai Medical Center of

Beverly Hills.


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This is personal.

My mother was the cornerstone of our family.

When she was diagnosed with colon cancer,

it was like the whole family got cancer.

She died when she was only 56.

Let my heartbreak be your wake-up call.

Terrence Howard, actor/musician

Colorectal cancer is the second leading cancer killer in the U.S., but it is largely preventable. I youre 50 or older, please get screened. Screening nds precancerous polyps, so they can be removed

beore they turn into cancer. And screening nds colorectal cancer early, when treatment works best. I youre

at increased riski you have a personal or amily history o polyps or colorectal cancer, or you have

infammatory bowel diseaseask your doctor when to start screening.

Screening saves lives.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

#$#).&/sWWWCDCGOVSCREENFORLIFE


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This issue of What Doctors Know marks ourtransition from a quarterly to monthly publication.In making the change, we ran into a minor problem.

Launching in March, meant we wouldnt have beenable to do justice to February an important HeartHealth Awareness month. Rather than ignoreheart month, we combined it into March. So,technically this issue is a February/March edition.

We have been able to make the transition to monthlybecause of the cooperative efforts of prestigiousmedical centers and universities across the country

who have the same goal as What Doctors Know: Toinform and educate our readers about health care.

The list is growing daily, but we would like to thank

Mayo Clinic, Cleveland Clinic, Johns Hopkins, Mt. Sinai New York, LSU, Cornell University,Harvard, Emory University, University of Florida, University of Virginia, UCLA, Baylor, Tulane,Parkland Hospital, Piedmont Health, Vanderbilt, UC San Francisco, Childrens Hospital ofDallas, UC San Diego, Loyola, National Jewish Hospital, University of Miami and so many more.

As I indicated, we have combined this issue with Heart Health Awareness Month, DiabetesAwareness, Multiple Sclerosis Education Awareness Month and National Colon CancerScreening Month. As a board certif ied Gastroenterologist with more than 23 years experience,I am excited about the opportunity to help inform and educate our readers about the secondmost deadly cancer in our country a cancer, that, for the most part is avoidable.

In this issue I have tried to consolidate a user-friendly guide and provide ourreaders with a better understanding of colon cancer. Most of all, I want to drivehome the importance of early screening and detection to save lives.

In my 20-plus years and after more than 50,000 colonoscopies, I have told far too manypatients they have colon cancer. I don't think I have ever had a patient who did notexpress remorse at having put off a colonoscopy -- especially having just had the procedureand realizing how easy it would have been to get a screening before it was too late.

If you or a member of your family is age 50 or over and has never had a colonoscopy, do what it takesto convince them about the importance of this life saving screening. There truly is no more destructiveand life-altering statement a doctor can make telling a patient: "I'm sorry, you have colon cancer."

Finally, I want to offer a special thanks to Sharon Osbourne and the Sharon Osbourne ColonCancer Foundation for joining in our efforts to call awareness to Colon Cancer Screening. Mrs.Osbourne, a colon cancer survivor herself, has been a champion of Colon Cancer Screeningefforts and has donated, time, money and friendship to the cause. I cant thank her enough.

For more information on her foundation, check out the story on page 78.

Steve Porter, MD

Publisher and Chairman

On Call with Dr. Porter


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HEADlines

31 Lets Talk About AtrialFibrillation & Stroke Risk

34 Todays Teens Will DieYounger of Heart Disease

36 Asthma & AirwayInflammation: The Big Picture

38 Are Stress Tests Wrong?

10 Alcohol is a Buzz-Kill forDeveloping Teenage Brains

12 Seeing the Benefits ofCrystalens More Clearly

15 Whats New in the Worldof Sinus Bugs & Drugs?

18 Does Aspirin TakeYour Breath Away?

22 The Mystery of MS: NoSimple Explanation

24 Mapping a Stroke

26 One for the Memories:Detecting Alzheimers Disease

28 MS-Get the Facts

40 Heart Health &Vitamin D

42 The 411 on 911Chest Pain

44 Cardiologist Tips:Right Lifestyle BuildsSolid Heart Health

46 Colorectal Cancer: TheNon-Biased Killer

50 Colorectal CancerScreening Saves Lives

51 Diabetic Complications

52 Fat Distribution in Black& White Women MayPredict Heart Disease

IN THE TRUNK

BELOW THE BELT

P10

P34

P46

54 Waist Size Linked to MortalityRisks in Kidney Disease

56 Early Detection ofColorectal Cancer

58 Keeping the Change

60 A Real Cause for Concern:Clostridium difficile-associated Diarrhea (CDAD)

WHAT DOCTORS KNOWAnd you should, too!


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Vol. 1 Issue 3

On the Cover

62 Bag the Grocery Guesswork:

Get Healthy with theHeart-Check Mark

66 Americans Cutting Sugar-But Its Still Not Enough

68 School Guide TeachesABCs of Diabetes

MIND, BODY, AND SOUL

70 Waking Up to Anesthesia

74 Reducing Blood Transfusions

76 MyFoodAdvisor

78 Sharon Osbourne's Fight -Bringing Hope& Support to Colon Cancer Patients

80 Colon cancer. Genetics or Bad Luck?

TECHNOLOGY &YOUR HEALTH

01 OnCallWithDr.Porter

06 HouseCalls

08 MeetOurDoctors

In Every Issue

P66

P70

Contents

22 TheMysteryofMS:NoSimpleExplanation

46 ColorectalCancer:TheNon-BiasedKiller

78 SharonOsbourne'sFight--BringingHope&SupporttoColonCancerPatients

Vol.1,Issue3 $ 4.99

ColorectalCancer:TheNon-BiasedKiller

The Mystery of MS:No Simple Explanation

Sharon Osbourne's Fight-Bringing Hope & Support to

Colon Cancer Patients

Special thanksto: SharonOsbourne,

SirEltonJohn, Dr. EdwardPhillips,

andCedars-SinaiMedicalCenterof

BeverlyHills.


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Published byWhat Doctors Know, LLC

Publisher and ChairmanSteve Porter, MD

Editorial Advisory BoardVicki J. Lyons, MD, Chairman

Timothy J. Sullivan, MD

Editorial and Design DirectorBonnie Jean Myers

Senior DesignerSuki Xiao

Design Associate

Cayden ChanExecutive Director, Marketing

Larry Myers

ProductionKai Xiao, Vice President

IT ManagerEric Lu

For more information on ad placementor contributing an article, please email

[email protected],or call (801) 299 -1122.

For information on subscriptions, pleasevisit www.whatdoctorsknow.com

Copyright 2011 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 Knowis purchased and paid for by the advertisers.Products and services are not necessarily endorsed by What Doctors Know,LLC.

Corporate Office

What Doctors Know585 West 500 South, Ste. 200

Bountiful, UT 84010(801) 299-1122

Calling All Doctors. Our readers want to hear from you. What healthcareissues 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 wantto address in What Doctors Know. Remember, we want to inform and

educate our readers. We know, an informed reader has the opportunityto live longer and happier. You can be part of that healing process.

Our readers look forward to hearing from you.

Send story ideas to: [email protected]



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Its hard for me to keep track of all of the

things going on in my life. I choose to face

this disease with strength, dignity and lots

of sticky notes.

Fotini, diagnosed in 2007

Multiple sclerosis is a chronic, unpredictable and often disabling disease of the centralnervous system. The progress, severity, and specific symptoms of MS vary from oneperson to another, and may include walking, balance and coordination challenges,fatigue, numbness or issues with memory and concentration.

MS =

lost memories

Join the Movement at nationalMSsociety.org

i i_ i l i


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Q:

Iaman88year

oldfemalewho

hasbeenhealth

yallofmylife;ho

wever,

inthepast3years,I'veha

d4faintingspe

lls.

Myphysicianha

dmewearamonitorwhich

showedIhadAF

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go,heputs

a"loop"recorder

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rgically).

Iwouldliketok

nowwhatyou

think.Millie

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A:Thankyouforyourinquiry.Faintingspells,orloss

ofconsciousness,commonlyoccurduetoabnormalitiesofthe

heartrhythmbuttherearemanyothercauses.Themedicaltermfor

faintingis"syncope"."AFIB"asyourefertoit,alsoknownasatrialfibrillation,is

acommonabnormalityoftheheartrhythminwhichtheupperchambersoftheheart

beatrapidlyandirregularly.Atrialfibrillationcanbeassociatedwithlossofconsciousness

whenitresultsinlowbloodpressureorwhenthehearthasapauseofseveralsecondsin

atrialfibrillationorwhenthearrhythmiaterminateswithapausebeforethenormalrhythm

oftheheartresumes."Loopmonitors"areimplantabledevicesthatrecordtheheartrhythm

continuouslyinanefforttodetectabnormalitiesthatmightnotbeevidentwithshorterperiods

ofmonitoring.Theseimplantableloopmonitorsarecommonlyusedinanefforttodetect

thecauseof "syncope"andtherebyallowtreatment.Youphysicianshouldbeableto

providemoredetailedinformationspecifictoyourmedicalconditionandanswer

anyquestionsthatyoumighthave.MarkEstes,III,M.D.,AmericanHeart

AssociationSpokesperson;ProfessorofMedicine,TuftsUniversitySchool

ofMedicine;Director,NewEnglandCardiacArrhythmiaCenter,TuftsMedicalCenter,Boston.

House Calls


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Disclaimer:

The information contained in the magazine is intended to provide broad understanding and knowledge of healthcare topics. This information shouldnot be considered complete and should not be used in place of a visit, call, consultation or advice from your physician or other healthcare provider. Werecommend you consult your physician or healthcare professional before beginning or altering your personal exercise, diet or supplementation program.

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whatdoctorsknow.com


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Meet Our Doctors

Steven Porter, MD

Founder andpublisher of WhatDoctors Know, Dr.Porter is recognizedas one of the topgastroenterologistsin the country.He is the medical director of theendoscopy lab at a leading hospitalin Ogden, Utah and has beenpracticing for more than 25 years.Contact Dr. Porter at (801)387-2550.

Vicki Lyons, MD

Founding memberand chairman of theeditorial advisoryboard of WhatDoctors Know,Dr. Lyons is aboard certified andfellowship trainedallergist and immunologist practicing in

Ogden, Utah. She has been practicingfor 20 years. Contact Dr. Lyons at(801)387-4850 or www.vicki-lyonsmd.com.

Nadim Bikhazi, MD

Board President ofa healthcare facilityin Northern Utah,Dr. Bikhazi is and

Otolaryngologist withspecialty trainingin the ear, nose andthroat (ENT). Contact Dr. Bikhazi at(801)475-3000 or www.odgenclinic.com

Brian Wansink, PhD

Director and theJohn Dyson Professorof Marketing ofthe Cornell Foodand Brand Lab inthe Department of

Applied Economics and Managementat Cornell University in Ithaca, NewYork. Contact Dr. Wansink through theCornell Food and Brand Lab website [email protected].

Susan F. Tapert, PhD

Professor of psychiatryat the University ofCalifornia, San DiegoSchool of Medicineand acting chief ofpsychology at theVA San Diego Healthcare System.

Jonathan Malka-Rais, MD

Assistant professor andboard certified allergistand immunologist at

National Jewish Healthin Denver, Colorado.

James Brewer,MD, PhD

Neurologist andassociate professorof radiology andneurosciences at theUniversity of California,San Diego School of Medicine.

N.A. Mark Estes, III, MDSpokesperson forthe America Heart

Association, Dr. Estes isprofessor of medicine,

Tufts University Schoolof Medicine anddirector of the New England Cardiac

Arrhythmia Center at Tufts MedicalCenter, in Boston, Massachusetts.

Timothy J.Sullivan, MD

Contributing editorialadvisory boardmember of WhatDoctors Know, Dr.Sullivan spent 25 yearsin full-time academic medicine at

Washington University, Universityof Texas Southwestern MedicalSchool, and Emory University. Hecurrently has a full-time allergy andimmunology practice in Atlanta,Georgia and is a clinical professorat the Medical College of Georgia.Contact Dr. Sullivan at (404)255-2918or www.trittbreatheandsleep.com.

Phillips KirkLabor, MD

Internationallyknown for his work inrefractive surgery andcataract expertise formore than 20 years.Dr. Kirk Labor is a board certifiedophthalmologist in the Dallas, Texasarea with affil iations to the American

Academy of Ophthalmology, AmericanSociety of Cataract and RefractiveSurgery, American College of Eye

Surgeons, and Society for Excellencein Eye Care. Contact Dr. Labor at(817)410-2030 or www.eyectexas.com.


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Special Thanks To:Joseph D. Spahn, MDAssociate professorand board certifiedallergist at National

Jewish Health inDenver, Colorado.

Frank Smart, MD

Internationallyrecognized for his

work in heart failure,

transplantation andmechanical circulatorysupport, Dr. Smartahs worked as anacademic cardiologist since 1991. Heis Professor of Medicine and chiefof the section of cardiology at theLouisiana State University School of

Medicine. In addition he is the directorof the Cardiovascular Center ofExcellence at the LSU Health ScienceCenter in New Orleans, Louisiana.

Scott Hacking, MDBoard certifiedinterventionalcardiologist, practicingin Salt Lake City, UT.Dr. Hacking completedhis cardiologyfellowship at theUniversity of Rochester, in New York.

Fred A Lopez,MD, FACP

Currently the RichardVial Professor and vicechair in the Departmentof Medicine atthe LouisianaState University Health SciencesCenter in New Orleans, Dr. Lopezis a committed educator and afounding member of the LSUHSC

Academy for the Advancementof Educational Scholarship.


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Alcohol is a

Buzz - Kill orDevelopingTeenageBrains


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A

fter more than a decadeof decline, alcohol useamong teenagers isrising. In fact, it hasbecome alarminglypervasive. According to

various reports, three-fourths of 12thgraders, more than two-thirds of 10thgraders and about two in every five8th graders have consumed alcohol.

For teens who say they drink, theaverage age of first alcohol use is 14.

The rise in consumption appearsto stem primarily from thenotion among teens thatdrinking alcohol is less riskyand health-threatening

than using drugs orother substances. Itsmisguided, to say the least.Every year, approximately5,000 Americans under theage of 21 die as a result ofunderage drinking, mostlyin traffic crashes and otheraccidents. Pre-teens who drinkare also substantially morelikely to engage in violentbehavior or commit suicide.

More often, though, the damagedone is subtler and cumulative. Buzzor no buzz, alcohol is bad for thebrain, especially in young brains stilldeveloping. In a growing number ofstudies, including some conductedat the University of California, SanDiego School of Medicine, researchersreport that alcohol consumption amongteens, particularly popular binge-drinking, measurably and significantlyimpacts cognitive function.

For example, girls who drink heavily

during adolescence are more likely togo downhill relative to girls who don'tin terms of their ability to do non-

verbal, spatial tasks, such as piecingtogether puzzles, reading a map orputting together a book shelf. Forboys, we see problems performing tasksthat require concentration, especiallyif the task is boring and requiresthem to focus for a few minutes.

The effects are most pronounced with

adolescents who drink heavily on arepeated basis, but there are clear risksto drinking a lot in just one sitting.

Theres a substance in the brainswhite matter called myelin. Its a fatty

material that envelopes the fibersconnecting neurons, a sort of insulatingmaterial that helps guide the electricaltransmissions used to form

effects are magnified. Its not so muchthat theyre destroying existing myelinas the fact that they are slowing downthe process of creating the myelinneeded to build a full, healthy brain.

No one knows yet what the long-term effects of teen drinking are.Researchers need to carefullystudy young people who have beenexamined before they started todrink, and later to assess the actualdetrimental changes to their brains.

We have begun doing these studies;we are seeing concerning effects.

Should teens drink? Generallyspeaking, absolutely not. There

is evidence that teens who

quit drinking or at least cutback show improvementin cognitive function.Some problems get betterwith abstinence. Butothers do not. For thisreason, we recommend

that young people who dodrink avoid consumptionto the point of intoxication

or to the point of feelinghung over the next day.

The hangover will pass, thebrain damage may not.

-Susan F. Tapert, PhD

thoughts. The process of myelinationis a very important part of braindevelopment and maturation. You wantto maximize it when youre growing up.

Heavy drinking in adolescence doesjust the opposite. It appears to disruptthe brains ability to produce andlay down myelin. One of our studiesshowed that adolescents normallyincrease white matter development,and probably myelin, in some areas oftheir brains by 5 to 8 percent betweenthe ages of 17 and 18. The process

then tapers off so that by ones 20s,theres little observable change. After30, theres almost no myelination. Infact, you begin to lose myelin with age.

Alcoholic adults generally show lesswhite matter in the brain after chronicheavy drinking. So, presumably, ifsomeone started drinking in their 40s,they start losing white matter theydeveloped in their teens. For adolescentdrinkers, theres less cushion and the


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To begin this series on premium lenses,lets start with a few basic questions. Haveyou ever had to hold a newspaper or menufarther away to see it clearly? Or doesseeing up close and other distances becomemore difficult? Did you find you needed

reading glasses when you never needed glasses before?Starting at around age 40, most of us will experiencedifficulty focusing. As we enter our 60s, focusingbecomes more difficult, because this is when weremore likely to develop a cataract in one or both eyes.

A premium lens is an artificial lens that replacesthe natural lens of your eye. Most often used incataract surgery, it is an advanced, amazingly simple

way to correct age-related vision problems. Moreimportantly, these lenses can even enhance visionand reduce the dependency on reading glasses.

Crystalens is one of the various types of advancedpremium lenses available. Other types, which I willcover in later articles, include Multi-focal lenses and

Toric lenses. Crystalens and Multi-focal lenses aredesigned for patients with age-related presbyopia (loss

of near or intermediate vision). Toric lenses are designedfor patients with astigmatism (an irregularly shapedcornea). All of the more advanced premium lensesare designed to improve vision at various distances.

Crystalens: A Natural Fit

Crystalens is the first and onlyaccommodatingintraocular lens (IOL) approved by the FDA accommodating meaning that the lens movesnaturally within the eye. It is also the only FDA-

Seeing the Benefts o

CrystalensMore Clearly


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approved presbyopia-correcting IOL for cataract patientsproviding a single focal point throughout a continuous

range of vision. It works so effectively because ofits amazing flexibility, working in conjunction withyour eye muscles to greatly improve focus on objectsat different distances near, intermediate and far.

Actual ly modeled after the human eye, Crystalens isdesigned to allow the optic, or central circular part ofthe lens you see through, to move back an forth as youchange focus on images around you. Using the eyemuscle, it flexes andaccommodates in order to focus onobjects at all distances. This is a tremendous advantagefor the patient because, in the past, cataract surgery

could correctonly for the cataract itself. The patientwould still be dependent on eyeglasses after surgery,

but because Crystalens also corrects for presbyopia,the need for glasses is reduced dramatically. In fact,some patients hardly if ever need glasses after surgery.

The Crystalens procedure happens during cataractsurgery, which is painless and takes about 15 to 20minutes or less. It usually begins with eye dropsto numb the eye. Then, a small incision is madeat the edge of the cornea, and the natural lens is

washed away and replaced with the Crystalensimplant. After surgery, patients return to see theirdoctor later to assess their results and recovery.


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Real Results. Realistic Expectations.

Its important to rememberas I tell all of mypatientsthat a Crystalens implant is not an overnightfix. No doubt, the benefits of Crystalens are very realand more than worth having the procedure. However,each patients vision must improve over time because

the eye has to re-learn how to focus for the best possiblevision. In a way, its similar to a repaired muscle inyour arm or leg. The muscle has to be rehabilitatedto function normally as it did before. The same istrue for the eye after surgery. The eye muscle (calledthe ciliary muscle) must be rehabilitated so that itcan adjust to viewing objects at varying distances.

With this in mind, I always give my patients post-surgery eye exercises to help regain their best visionas quickly as possible. The length of time this processtakes varies from patient to patient, but most canreturn to their normal activities in two or three days.

Another important point is that premium lenses areconsidered to be elective, and not a part of the cataractprocedure typically covered by insurance. But for mostpeople, the enhanced vision that Crystalens providesis well worth the investment. In fact, based on overallresults, patients with a Crystalens implant see betterat all distances versus those with a standard IOL.

If you suspect you might have cataracts, the firststep is to be evaluated by your doctor. Should youneed surgery, this is when your doctor will discussthe various premium lens options available, and if

Crystalens is right for you. Ask as many questionsas you want, as this is a doctor-patient decision.Remember, its not just about improving your vision;its about the safest, most effective way for your visionto be the absolute best it can be.-Part one of a serieson Premium Lenses-Phillips Kirk Labor, MD

Crystalens isa registeredtrademark oBausch & LombIncorporatedand/or its ailiates.


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whatdoctorsknow.com 5

Whats New in

the World oSinus Bugs andDrugs?


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It is that time of year when seasonal changes,colds and allergies all add up to misery forsinus sufferers. This article will bring youup to speed on the latest buzz in the worldof sinus infections. These are the five mostimportant and exciting areas of improvement:

1. It is not all about oral antibiotics anymore.

With steadily increasing resistance of many bacteriato frequently used antibiotics (think of resistant Staphinfections), a major goal has been to minimize theuse of antibiotics. These strong medications tendto not only kill the bad bacteria but also the goodones. So any measure to treat sinus infections wouldalso address a key question: What is the cause of thesinus blockage? Much like a clogged toilet, unlessdrainage is re-established, no amount of antibiotics

will permanently clean the sinuses (think of theanalogy of an outhouse versus a draining toilet).

Adjunctive medication to antibiotics should includesaline rinses, steroids, and even decongestants for a

short period of time to re-establish drainage. Also,research is focusing on probiotics (beneficial bacterialcultures) and their help in reconstituting the normalsinus flora after a period of intensive antibiotics.

2. Biofilms are the new buzz word.

A key concept that has developed in sinus research isthe importance of bacterial biofilms. Imagine theseas complex mucoid structures that act as safe havensfor bacteria to avoid the penetration of antibiotics.Biofilms tend to accumulate in the sinuses after

prolonged infection and are difficult to remove (likeclearing rubber cement out of cavities). Only surgery,followed by topical antibiotic irrigation will be ableto clear these resistant bacteria colonies. How do youknow if you have them? Odds are that if you haveresistant infections to multiple oral antibiotics, thesemay exist. A CT scan can reveal plugged sinusesoften which may contain bacterial biofilms. Also, themost difficult to treat bacteria (Staphylococcus and

Pseudomonas) seem to form these biofilm structures.ENT physicians and otolaryngologists have evenconducted studies using dilute baby shampoo rinses(do not try this at home!) to remove these films. Muchmore needs to be done to understand this concept,but this a new and interesting field of microbiology.

3. Topical antibiotic and steroid rinsesare important recent advances.

Over the past 10 years, sinus nebulizers have beendeveloped to irrigate the sinuses locally with antibiotics/steroids. This involves placing a machine that nebulizesthese medications directly into the nostrils which

decongests and treats infected sinuses. This can beof particular help to those who suffer from repeatednasal polyps. The medications used are much strongerthan can be given orally. A major push has been madeto minimize the use of oral antibiotics by using nasallavage with salt water (saline). One popular over-the-counter (OTC) rinsing mechanism is the Netipotdevice which reduces post-nasal drip by clearing awaymucus in the nasal cavity. This has been particularlyhelpful in patients suffering from seasonal allergies. Ifthese OTC measures fail, sinus nebulizers using topicalantibiotics or steroids can relieve congested sinuses.


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4. The function of the sinus lining is essential.

Most patients who undergo sinus surgery experiencesignificant benefit (over 85%). For those with persistentsymptoms, the problem may be that the underlyingcondition of the sinus lining is not working. Realizethat the sinus lining has delicate cilia on the cells

whose function is to propel mucus out of the sinus

into the nasal cavity. A simple cold can disable ciliafor up to 30 days! This explains why mucus can buildup after colds for so long afterwards. Also allergiescan inhibit the ciliary function, so no matter howbig a sinus opening is made, poor ciliary functioncan cause major problems. In patients with cysticfibrosis, thick mucus that clogs the sinuses causespermanent ciliary dysfunction. These patients sufferfrom repeated sinus infections. Re-activating ciliaryfunction has been one of the driving forces in recentsinus research. Maneuvers that help removed thicktenacious mucus include Mucinex (an over-the-counter mucous thinning agent) and saline rinses.

5. Recovering from sinus surgery ismuch easier than it used to be.

In the past, sinus surgery was tremendously invasive.Tissue was removed in wanton fashion and manypatients were left with scarred sinus cavities thatcontinued getting infected. Nowadays, attention hasbeen directed to minimally invasive sinus surgery.

Minimal, sinus lining-sparing techniques, have evolvedas has dissolvable packing both of which minimizerecovery times. Most sinus surgery requires a down timeof less than 5 days and patients can breathe throughtheir noses avoiding the completely packed feeling ofyesteryear. Most recently, balloon catheter dilation

(balloon sinuplasty) for blocked sinus outlets has gainedaccelerating interest. A balloon is inserted into thesinus openings which are then enlarged as the balloondilates. This procedure results in quick recovery andexcellent post-operative reduction of sinus infections.

Most of the patients do not even require nasal packingafter this procedure. Also, dissolvable steroid stents havebeen used with amazing success in polyp sufferers.

6. Treating allergies not only helps the upper airways(sinuses) but the lower ones as well (asthma).

A relatively new concept in the world of sinus andasthma is that of the unified airway. To state this

otherwise: what affects the upper airways affects thelower and vice versa. Treating allergies not only reducesoverall nasal congestion but also reduces inflammationaround the lower respiratory tract (asthma). Oneshould picture allergies as causing inflammation orswelling around the sinus openings which increasesnasal congestion and drainage. Efforts are made byotolaryngologists to reduce allergic inflammation as arisk factor for repeated sinus infections and infectionsof the lower respiratory tract (bronchitis, pneumonia,etc.). Allergy therapy may include desensitization shots,sublingual immunotherapy, oral antihistamines, and

topical nasal steroids. One should consult the Cochranedata base (www.cochrane.org) for more informationabout the effectiveness of each of these therapies.

7. Kids with sinus infections need to be fully evaluated.

Many children who have recurring sinus infections getover their symptoms with antibiotics. Those that do notimprove will need a full evaluation including allergytesting, CT scan imaging of the sinuses, and evaluationof their tonsils and adenoids. Also, infants with recurringinfections need to be evaluated for possible gastric refluxas this is a known risk factor for not only sinusitis, butalso recurring ear infections. Chronic sinusitis is alsoone of the first presenting symptoms of kids with mild

variants of cystic fibrosis. Otolaryngologists can ablyevaluate all of these conditions to identify the causes ofpersistent infections. Any more than 3 sinus infectionsper year would be considered worthy of evaluation.

It is clear that technological advances have allowedsinus surgeons to improve patient outcomes

from sinus surgery. Challenges still remain in thearena of antibiotic resistance. With continuedresearch, technological advances can help sinussufferers return to an infection-free lifestyle withminimal morbidity.-Nadim Bikhazi, MD


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DoesAspirinTake

Your Breath Away?

A

spirin and some non-steroidal anti-inflammatory drugs (NSAID)can cause acute severe worseningof asthma. Large surveys haveindicated that between 4% and 11%of adult asthmatics have experienced

flares of their asthma after taking aspirin or oneof the other non-steroidal anti-inflammatorydrugs. These medications do not cause asthma,but they can cause dangerous exacerbations.

This susceptibility is often referred to as aspirinexacerbated respiratory disease (AERD).

The typical reaction includes marked shortnessof breath, intense nasal congestion, and waterynasal secretions. Sneezing, nasal itching,redness of the eyes, swelling around the eyes,rash, flushing of the head and neck, nausea,and abdominal pain also may occur.

Many asthmatics are not aware that they haveaspirin sensitivity. Approximately 21% ofadult asthmatics experience acute worseningof their airway functions when given aspirin.

Aspirin sensitivity is present in 30%-40%among patients with asthma who have chronicinflammation of the nose and sinuses, andhave nasal polyps. Allergy may be present,but many AERD patients have no detectableallergy to environmental antigens. This problemappears to be slightly more common among

women. Aspirin sensitivity is rare amongchildren but aspirin challenges of asthmatics 6

to 18 years of age have been positive in 2%.

While there is considerable individualvariation, the problem typically begins withthe development of persistent inflammationof the nose and sinuses. In one large study inthe United States the onset of rhinosinusitisoccurred at an average of 34 years of age. Two tothree years later the patients developed asthmaand at about that same time the susceptibleindividuals developed sensitivity to aspirin andother non-steroidal anti-inflammatory drugs.


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AERD patients then begin to have frequent episodesof bacterial sinus infections. They have frequentexacerbations of asthma and often need oral steroidsto control their problems. Nasal polyps (benigngrowths of tissue arising in the sinuses or the nasalmembranes) may develop and may cause worse nasalobstruction, and anosmia (loss of the sense of smell).

Many of the patients who develop polyps require

surgery to reopen the nasal passages. Polyps canregrow and surgery often is needed multiple times.

Compared to patients without aspirin sensitivity,AERD patients have more severe impairment oflung functions, a need for high doses of inhaledsteroids to gain control of their asthma, a higherfrequency of severe episodes of asthma, and higherrates of hospitalization and intubation for asthma.

The ability of aspirin and other non-steroidal anti-inflammatory drugs to trigger these reactions appears

to be related to their ability to inhibit an enzyme calledcyclooxygenase-1. Inhibition of this enzyme leads tothe release of inflammatory mediators that then causea sudden worsening of asthma and rhinosinusitis.

A diagnosis of aspirin sensitivity, AERD, can besuspected if there is a reaction immediately aftertaking an NSAID. The diagnosis can be confirmed

with a standardized aspirin challenge. Thisprocedure involves the administration of increasingdoses of aspirin over a period of 3 days and willresult in a reaction in aspirin sensitive patients.

Prevention of Reactions and Treatment

Patients with AERD should be provided a list ofNSAIDs to be avoided. Ibuprofen, indomethacin,naproxen and several other NSAID drugs nearlyalways elicit reactions in aspirin sensitive patients.

There are other non-steroidal anti-inf lammatory drugsthat may be tolerated by aspirin sensitive individuals.

Aspirin and other non-steroidalanti-inflammatory drugs(NSAID) can cause acute, severeworsening of asthma, nasalproblems, and sinus problems.

Aspirin sensitivity is presentin approximately 21% ofasthmatic adults, and 30% to40% of adult asthmatics whoalso have chronic inflammationof the nose and sinuses,and have nasal polyps.

Knowledge of which anti-inflammatory drugs should

be avoided and which shouldbe safe is very important.

Aspirin desensitization canreduce the severity of thechronic airway problemsin susceptible patients.Desensitization also can allowthe use of aspirin and otherNSAID when they are neededfor cardiac, rheumatologic,chronic pain, or other disorders.


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Acetaminophen is a very weak inhibitor of thecyclooxygenase-1 and usually can be used safelyin AERD patients. If there is any question aboutthe safety of an anti-inflammatory drug, the f irstdose ought to be administered in a physician'soffice. Allergy and Immunology specialistsand other asthma specialists can provide drugrecommendations and supervise oral challenges.

Desensitization

Early research on aspirin sensitivity indicated that fora period of 2-5 days after a reaction to an NSAID thepatient can tolerate additional exposures to an NSAID

without a reaction. These observations led to thedevelopment of a protocol for administering increasingdoses of aspirin, treating through a reaction, andthen continuing to give aspirin on a daily basis.

AERD patients who have been desensitized andcontinue to take aspirin on a twice-daily basis havebeen shown to have a decrease in the severity oftheir respiratory tract disease, a decreased frequency

of bacterial sinusitis episodes, a decreased needfor surgery for recurrent polyps, improvement inthe sense of smell, a decreased need for systemicsteroids to control exacerbations, and a decreasedfrequency of hospitalization for asthma.

Aspirin desensitization also may be undertaken topermit the use of aspirin in patients with coronaryartery disease, patients with rheumatologic conditionsthat would benefit from NSAID therapy, patients

with chronic pain syndromes, and in patientswith the rare anti-phospholipid syndrome.

Aspirin sensitivity is an important problem thatoften is unrecognized until a serious reaction hasoccurred. Avoidance of potentially hazardousmedications, and selection of safe alternativesis essential. Board certified allergists andimmunologists are specialty trained to providedetailed information about the selection ofmedications and can perform aspirin desensitization.-Vicki Lyons, MD, and Timothy J. Sullivan, MD


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When you consider the alternative, eating right and

staying active really dont seem so bad.

Many of the nearly one million deaths each year from

type 2 diabetes, heart disease and stroke could be

prevented with a few lifestyle changesincluding

regular physical activity, healthier food choices and

not smoking. Its not easy. But it is worth it.

Talk to your doctor about your risk for type 2 diabetes

and heart disease. Its your life. Listen to your doctor.

Eat better. Get moving.

Staying healthy isnt easy.

Then again, neither is dying.

For more information, visit CheckUpAmerica.org, or call 1-800-DIABETES.


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The Mystery ofMultipleNo Simple Explanation

Multiple sclerosis (MS) disruptscommunication between the brain andother parts of the body. In the worstcases, it can bring partial or completeparalysis. Researchers dont yet know

what causes this disease or how tocure it, but theyve been making progress on both fronts.

Symptoms of MS arise most often between the ages of 20 and 40.It often begins with blurred or double vision, color distortion, oreven blindness in one eye. It can cause muscle weakness, vision

loss, numbness or tingling, and difficulty with coordination andbalance. MS can bring many other symptoms as well.

In some people, doctors may not be able to readilyidentify the cause of these symptoms. Patients mayendure years of uncertainty and multiple diagnoses whilebaff ling symptoms come and go. The vast majorityof patients are mildly affected, but in the worst cases,

MS can leave a person unable to write, speak or walk.

MS is a disease in which the bodys immune system


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Sclerosis

inappropriately attacks the brain and spinal cord.Specifically, the immune system targets the fattyinsulating material around nerves called myelin.

When myelin is damaged, the messages that nervecells send and receive can be interrupted.

Researchers estimate that 250,000 to 350,000people in the United States have been diagnosed

with MS. Scientists dont yet understand whattriggers the immune system to attack myelin inthese people. But researchers do know that whites

are more than twice as likely as others to develop

MS, and women almost twice as likely as men.

Geography seems to play a role in MS. Thedisease is much more prevalent in temperateclimates than in tropical regions. Your risk for

MS seems to depend on where you live

before the age of 15. Some studies have found that aperson who moves before the age of 15 tends to adoptthe risk of the new area. People moving after age15 seem to maintain the risk level of the area wherethey grew up. Some researchers believe that vitaminD, which the body makes when sunlight strikes the

skin, may lower the risk of MS and help explain thesefindings, but studies havent yet confirmed this link.

Some microbes, such as the Epstein-Barr virus,have been suspected of causing MS. But researchershavent been able to prove for certain that anymicrobes raise your chances of getting MS. Cigarettesmoking, however, does appear to raise your risk.

Genes clearly affect how likely you are to develop MS.Having a sibling with MS raises your risk of getting

MS to about 4% to 5%; having an identical twinraises your risk to about 25% to 30%. These factssuggest a strong genetic component to MS. However,

although some studies have linked specific genesto MS, most of the results havent been definitive.Researchers are now working on more detailed studies.

Theres no cure yet for MS, but various therapies cantreat it. Researchers are continuing to develop new andbetter therapies for MS, with several now in the pipeline.

-Source: NIH News in Health, March 2011,published by the National Institutes of Health andthe Department of Health and Human Services. Formore information go to www.newsinhealth.nih.gov

Signs and Symptoms of MS

Muscle weakness Blurred or distorted vision Numbness o tingling Coordination problems

Speech disturbances Vertigo or dizziness Trouble concentrating Fatigue Tremor


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Vanderbilt radiologists arerolling out powerful newimaging techniques thatprovide clearer pictures of

the delicate ebb and flowof blood through brain

tissue in patients at risk for stroke.

One of the neuroimaging techniquesis called blood oxygenation level-dependent functional magneticresonance imaging, or BOLD fMRI.It allows radiologists to non-invasivelymeasure how near tissue is to exhaustingits supply of blood, which is believed tobe a sensitive indicator of stroke risk.

Mapping a StrokeNew imaging techniques provevaluable tools to assess stroke risk

While BOLD fMRI is a popularresearch tool for cognitiveneuroimaging, it is currentlybeing used clinically at only a

few centers across the country.

At Vanderbilt, Megan Strother, M.D.,assistant professor of Radiologyand Radiological Sciences and

Neurological Surgery, and colleagueManus Donahue, Ph.D., are currentlyusing the technique to assess the stokerisk of patients with Moyamoya, acomplex disorder causing intracranialstenosis the narrowing ofarteries leading into the brain.

Patients with Moyamoya are at aheightened risk for stroke in the firsttwo years after diagnosis, so thegoal is to image them every three to

six months within that time frameto help guide treatment decisions.Surgical intervention options includearterial bypasses and encephalo-dura-arterial synanastomosis (EDAS).

The conventional way these patientswould be evaluated is by doing acerebral angiogram, Strother said.

Although angiograms providegreat pictures of the blood vessels,


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angiograms are invasive procedureswhich require neuro-interventionaliststo access the artery with a smallcatheter through the patients groin,

move the catheter through the patientsaorta to the cervical vessels, and thenimage the injected contrast as it flowsthrough the brain. Angiograms arehigh-risk invasive procedures whichcan cause complications includingstroke. Additionally, patients areexposed to radiation and the contrastcan harm patients kidneys.

These risks are eliminated with BOLDimaging. BOLD is non-invasive and

does not expose patients to contrast orradiation. Instead of receiving contrast,patients breathe slightly elevatedlevels of carbon dioxide through afacemask while they lie in the MRIscanner. The carbon dioxide acts asa vasodilator, which increases theamount of oxygenated blood in vessels.

Water surrounding oxygenated anddeoxygenated blood has differentmagnetic properties, and therefore

MRI images acquired as the patientsblood vessels dilate allow physicians togauge tissue level hemodynamics orchanges in the amount of blood volumeand blood flow. This allows cliniciansto assess better the wide range of

vascular compensation strategiesthat may be present, and whetherpatients have adequate blood supply

beyond areas of arterial narrowing.

Strother said patients are thrilledwith the ease of the 15-minuteimaging technique, and more than20 BOLD MRI scans have beenperformed over the pastseveral months. She beganinvestigating the feasibilityof employing the techniqueat the urging of Vanderbiltneurosurgeons who treatpatients with Moyamoya

and who were discouragedby insufficient diagnosticimaging approaches availablefor this population.

A key component toimplementing BOLD andto increasing the number ofpatients who can be assessed

with the technique was thearrival last Novemberof medical physicistDonahue from JohnsHopkins University.

Donahue useshemodynamic models toconvert the data generatedby the BOLD technique intophysiologically meaningfulmaps of cerebral perfusion andblood volume reactivity that canbe readily interpreted by clinicians.

Donahue has also added newnoninvasive vessel selective arterial spinlabeling approaches for quantifying

collateral blood flow, or the precisemanner by which tissue receives blood

when a feeding vessel is occluded.

BOLD imaging adds a critical piecein the puzzle to decide who needssurgical treatment, by identifyingpatients who are at highest risk

for stroke, Strother said.

Over the next few months, BOLD fMRIand other non-invasive measures oftissue-level hemodynamics will be addedto MRI scans performed on Vanderbiltstroke patients. Strother and Donahueare working with Howard Kirshner,

M.D., director of the Vanderbilt StrokeCenter, on this initiative in hopes thatthese imaging techniques will be helpfulin explaining the pathophysiology ofstroke, potentially leading to refinements

in stroke treatment and prevention.-

This information provided courtesy ofVanderbilt University Medical Center


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One or the Memories:Detecting Alzheimer's Disease

T

he devastating effects of full-blown Alzheimers disease (AD)are well-known and much-feared. It progressively robs its

victims of their memory and other intellectual abilities.

But some degree of memory loss and diminution ofcognitive function are also part of the natural aging

process. It happens to everybody. The challengeis differentiating between the first signs of looming AD andthe normal, inevitable annoyances of just getting old.

As a neurologist and Alzheimers disease researcher, I often see patients intheir golden years who have become excessively worried about mild andintermittent memory dysfunction, who are having senior moments likemisplacing keys or forgetting where they left their car in a large parking lot.

In such cases, the first step is usually to determine and confirm theexistence of a real memory problem. At UC San Diego, we do this byperforming tests that gauge how well a patient forms new memories and


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retains that information despite delaysand distractions. The goal is to determinehow impaired memory function is and

whether this impairment appears tobe progressing at a rate beyond thatexpected with normal aging. If theresults are worrisome, we may sendthe patient for more detailed testing of

memory and other cognitive functions.

Right now, theres no definitive orpredictive test for AD in living patients,a test based on well-understood,measurable biomarkers that can bothdetermine the presence of the disease andaccurately predict its probable course.

Unfortunately, AD is not astraightforward disease. Hundredsof millions of dollars have beenspent in recent decades trying to

better understand the biology andpathology of AD, but it continuesto throw confounding curveballsthat have thwarted many promisingapproaches. Despite these challenges,medical science is getting better at

providing more accurate and predictive tests for AD,which may allow us, in the future, to intervene at atime well before significant impairment occurs.

For example, in cases where screening of a patientsuggests mild but abnormal memory loss, we use animaging technology called volumetric MRI to assessthe degree of degeneration to structures in the brainmost likely to be affected by AD. In special cases, wemight also sample the cerebrospinal fluid for levelsof a protein that accumulates in AD. These are allbiomarkers that can help in determining which patients

with memory problems will progress to dementia.

Memory screening for individuals concerned aboutmemory loss is available, but the decision to seeksuch information is a very personal decision. Nocurrent treatments directly alter the course of

AD, though it is possible to sometimes slow the

progression of symptoms, such as cognitive problems,by working to keep the brains vasculature ashealthy as possible through blood pressure control,smoking cessation, optimal diet and exercise.

Screening provides an objective baseline with which toevaluate changes, should new concerns crop up. If thescreening detects a potential problem, research suggeststhat it will be best to intervene as early as possible,before significant brain damage accrues. It might alsopoint to other, perhaps curable, explanations for onesmemory complaints.-James Brewer, MD, PhD


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Facts About MS and The National Multiple Sclerosis Society

MS stops people from moving. The National MSSociety exists to make sure it doesnt. We help

each person address the challenges of living with

MS. In 2010 alone, through our national office and

50 state network of chapters, we devoted $159

million to programs and services that assisted more

than a million people. To move us closer to a world

free of MS, the Society also invested $37 million to

support 325 research projects around the world.

The Society par tners

with the healthcare

community to promote

quality healthcare.

Information on MS and

the Societys services

are available 24-hours

a day by calling (800

344-4867. We are

people who want to do

something about MS

now. You can join the

movement at www.nationalMSsociety.org

There are approximately 1,200 positions filled by professional staff

members and over 500,000 positions filled by volunteers. Together they

carry out the Societys daily operations. The Society has some 750,000

general members, including over 370,000 individuals who have MS.

Nationwide income in

2010 was $217 million.

The majority of Societyincome comes from private

contributions, 66% of which

is generated through special

events. Approximately 7%

is received from corporate

support, including

pharmaceutical companies

and government grants.

Approximately 73% of

Society income is devoted

to research and service

programs while the

remainder is invested in

support services such as

fund raising and Society

management. It costs

the Society about 15

cents to raise a dollar.

24/7

$217million


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Since the founding

by Sylvia Lawry in

March 1946, the

Society has expended

over $721 million to

advance MS research.

During the last 65

years, the Society

has been at the core

of virtually every

major breakthrough

in treating and

understanding

the disease.

Joyce Nelson, the

president and CEO

of the Society, came

up through the ranks

of the organization,

devoting more

than two decades

to the MS cause.

The progress, severity and specific

symptoms of MS in any one person

cannot yet be predicted. Advances in

research and treatment are moving

us closer to a world free of MS. Mostpeople with MS are diagnosed between

the ages of 20 and 50, with at least two

to three times more women than men

being diagnosed with the disease. MS

affects more that 400,000 people in

the US, and 2.1 million worldwide.

Some prominent American with MS

are: actress Teri Garr, Actress Annette

Funicello, country-music singer ClayWalker, R&B singer Tamia Washington,

newscaster Neil Cavuto, newscaster

Janice Dean, comedian David Squiggy

Lander, comedian Jonathan Katz, Seattle

Seahawks mascot Ryan Asdourian,

extreme sports activist Wendy Booker,

marathoner Zoe Koplowitz, writer/

director Henriette Mantel, singer Alan

Osmond and his son David, author

Ellen Sue Stern, author Jackie Waldman,

singer Victoria Williams, Triple Crown

horse trainer Kiaran McLaughlin, and

television hos Montel Williams, as well as

the late Congresswoman Barbara Jordan,

cellist Jacqueline du Pr, singer Lena

Horne, and comedian Richard Pryor.

Multiple Sclerosis is an unpredictable, often disabling disease of the central

nervous system. The disease interrupts the flow of information within the

brain, and between the brain and the rest of the body. Every hour in the

United States, someone is newly diagnosed with MS. Symptoms range fromreduced or lost mobility to numbness and tingling to blindness and paralysis.

Some prominent American with ties to MS are: model Alessandra Ambrosio

(father), TV personality Phil Keoghan, actor Martha Madison (mother), actor

Shemar Moore (mother), actor Bill Pullman (friend), model Emme Aronson

(father), actor Michael McKean (friend), and author Jacquelyn Mitchard (friend).

-Source: National Multiple Sclerosis Society. www.nationalmssociety.com

65years

2.1years

The US Society is one

of 43 sister Societies

forming the Multiple

Sclerosis International

Federation also

founded by Sylvia

Lawry, who died at

age 86 in 2001.


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Let's Talk AboutAtrialFibrillation and Stroke Risk

Theres an alarming gap in knowledge about a commonheart condition, called atrial fibrillation (or AFib). Byclosing the gap and arming people with what they needto know, we could prevent disabling, and even deadly,strokes. Perhaps, thousands of strokes each year.

Work weve recently done at the American Heart Association/American Stroke Association to identify gaps in AFib knowledge andtreatment suggests about half of the estimated 2.7 million Americans whohave AFib have not been properly educated about their stroke risk. Physicians

and health care providers commonly provide AFib patients with theinformation they need to make informed decisions about individual stroke risk.


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The gap? We know that peoplewho have AFib are at higherrisk of stroke than people whodo not have the condition. Yet,this information (and resultingproven prevention) isnt trickl ingto the people who need it most.

The solution is as simple, inexpensiveand grassroots as having frank, one-on-one conversations. Patients needto be aware of this risk and haveserious conversations with theirhealth care providers about what theyshould be doing to prevent stroke.

Conversation starters

AFib is an irregular heart rhythm thatoccurs when the hearts two upperchambers beat erratically, causingthe chambers to pump blood rapidly,unevenly and inefficiently. Bloodcan pool and clot in the chambers,increasing the risk of stroke.

The basic message is clear: AFibis associated with a five-foldincreased risk of stroke. Not onlyis it associated with an increasedstroke risk, but also a greaterlikelihood that the stroke will lead tosignificant disability--even death.

Identifying challenges

In June 2010, the American HeartAssociation held an AFib summit,attended by a wide range of

researchers, clinicians, health careproviders and patients. Our goal

was to sort out AFib knowledgegaps and make recommendationsabout how to address them.

While we identified many areas needingattention, including a focus on researchthat will result in ways to prevent

AFib, one of the most significantfindings was the need for consumereducation. (The summits findings

were published online June 27, 2011,in the American Heart Associationscientific journal Circulation.)

A survey conducted in July 2011by Synovate, Inc. for the AmericanHeart Association, confirmed theneed to talk. One of the findings:90 percent of patients get AFibinformation from their doctors.

Of the 502 adult AFib patientssurveyed, half thought they were at

risk for stroke; 25 percent claimed theywere not at risk; and the remaining25 percent didnt know. A few othersurvey findings: Only two-thirds ofpatients surveyed recalled that theirhealth care provider talked withthem about their elevated stroke risk.

Also troubling is how these patientsperceived the information: Amongthe 66 percent who talked withtheir doctors, 21 percent said they

were told they have no stroke risk.

Connecting people to information

Lets get the word out now. Thereare several proven ways to reduce the

AFib-associated stroke risk. A healthylifestyle with maintenance of an idealbody weight through exercise anddiet can prevent high blood pressureand diabetes that predispose to AFib.For individuals with AFib new andeffective medications are available tothin the blood in order to preventthe clotting associated with stroke.

The fact is that despite substantialbenefits from taking thesemedications, many patients dontreceive or dont take them. There isa big disconnect in our knowledgeof stroke risk; our knowledge bloodthinning medications can reducethat risk; and the actual use of the

blood thinning medications.

One of the hurdles could be that bloodthinners have a reputation they dontdeserve. Its true that one popularblood thinner, called warfarin,requires monitoring to adjust thedosing. But newer medications donot require monitoring. We alsobelieve physicians and patients tendto overestimate the risk of bleedingcomplications from these medications.

See? We need to talk.

Your life-saving assignment

If you have AFib, make anappointment with your doctors office.

With todays health care system, youmight have the bulk of your AFibconversation with your doctors nursepractitioner or physician assistant.

These people are often charged withtaking more time with patients toanswer questions and educate.

Learn all you can about the condition.Youll find credible and extensive

AFib information from the AmericanHeart Association/American Stroke

Association at: www.heart.org/afib.

The solution to closing this gapis simple communication. Wehave to start talking about AFiband stroke. At a time when theeconomy is in turmoil and fundingis scarce, talking doesnt cost adime.-N. A. Mark Estes, III, MD


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Today's Teens will DieYounger o Heart DiseaseHigh blood sugar,obesity, poor diet,smoking, little exercisemake adolescentsunhealthiest in U.S.

Anew study that takes acomplete snapshot ofadolescent cardiovascularhealth in the UnitedStates reveals a dismalpicture of teens likely

to die of heart disease at a youngerage than adults do today, reports

Northwestern Medicine research.

We are all born with idealcardiovascular health, but right

now we are looking at the loss ofthat health in youth, said DonaldLloyd-Jones, MD, chair andassociate professor of preventivemedicine at Northwestern UniversityFeinberg School of Medicine and aphysician at Northwestern MemorialHospital. Their future is bleak.

Lloyd-Jones is the senior investigatorof the study presented Nov. 16 atthe American Heart AssociationScientific Sessions in Orlando.

The effect of this worsening teenhealth is already being seen in youngadults. For the first time, there is anincrease in cardiovascular mortalityrates in younger adults ages 35 to 44,particularly women, Lloyd-Jones said.

The alarming health profiles of 5,547children and adolescents, ages 12to 19, reveal many have high bloodsugar levels, are obese or overweight,have a lousy diet, dont get enough


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The study used measurements from the AHAs 2020 StrategicImpact Goals for monitoring cardiovascular health inadolescents and children. Among the findings:

TERRIBLE DIETS All the 12-to-19-year-olds had terrible diets, which, surprisingly,

were even worse than those of adults, Lloyd-Jones said. None of their diets metall five criteria for being healthy. Their diets were high in sodium and sugar-sweetened beverages and didnt include enoughfruits, vegetables, fiber or lean protein. They areeating too much pizza and not enough wholefoods prepared inside the home, which iswhy their sodium is so high and fruit andvegetable content is so low, Lloyd-Jones said. HIGH BLOOD SUGAR Morethan 30 percent of boys and morethan 40 percent of girls have elevatedblood sugar, putting them at highrisk for developing type 2 diabetes.

OVERWEIGHT OR OBESE Thirty-five percent ofboys and girls are overweight or obese. These arestartling rates of overweight and obesity, and weknow it worsens with age, Lloyd-Jones said. Theyare off to a bad start. LOW PHYSICAL ACTIVITYApproximately 38 percent of girls had an ideal physicalactivity level compared to 52 percent of boys.

HIGH CHOLESTEROL Girls cholesterol levels wereworse than boys. Only 65 percent of girls met the ideal

level compared to 73 percent of boys. STILL SMOKINGAlmost 25 percent of teens had smoked within thepast month of being surveyed. BLOOD PRESSUREMost boys and girls (92.9 percent and 93.4 percent,respectively) had an ideal level of blood pressure.

The problem wont be easy to fix. We are much more sedentary and get lessphysical activity in our daily lives, Lloyd-Jones said. We eat more processed food,and we get less sleep. It s a cultural phenomenon, and the many pressures onour health are moving in a bad direction. This is a big societal problem we mustaddress. -This information provided courtesy of Northwestern Memorial Hospital.

50s start to form in adolescenceand young adulthood. Theserisk factors really matter.

After four decades of decliningdeaths from heart disease, weare starting to lose the battleagain, Lloyd-Jones added.

The American Heart Association(AHA) defines ideal cardiovascularhealth as having optimum levels ofseven well-established cardiovascularrisk factors, noted lead study authorChristina Shay, who did the research

while she was a postdoctoralfellow in preventive medicine at

Northwesterns Feinberg School.Shay now is an assistant professorof epidemiology at the University ofOklahoma Health Sciences Center.

What was most alarming about the

findings of this study is that zerochildren or adolescents surveyed metthe criteria for ideal cardiovascularhealth, Shay said. These dataindicate ideal cardiovascular healthis being lost as early as, if notearlier than the teenage years.

physical activity and even smoke, thenew study reports. These youth are arepresentative sample of 33.1 millionU.S. children and adolescents fromthe 2003 to 2008 National Healthand Nutrition Examination Surveys.

Cardiovascular disease is a lifelong

process, Lloyd-Jones said. Theplaques that kill us in our 40s and


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whatdoctorsknow.com

Asthma is a disorder that causes the airways of thelungs to swell and narrow, leading to wheezing,shortness of breath, chest tightness, and coughing.

This swelling and narrowing are commonly referredto as airway inflammation and airway constriction.

Airwayconstriction can be measuredusing traditional lung function

tests such as spirometry.However, while measuringairway constriction is important,it may not tell the whole story.

Many studies show that evenwhen lung function tests arenormal, airway inflammationcan be present and may indicate apotential loss of asthma control.

Understanding airway inflammation

Airway inflammation can often be caused by exposure to allergensin the air such as seasonal pollens, mold spores, and indoorallergens (e.g., animals, cockroaches, or dust mites). When thelungs are inflamed in this way, the cells that line the airwaysrelease large amounts of a chemical called nitric oxide (NO).

This gaseous molecule then appears in the air that is exhaled.

In the early 1990s, researchersfound that high levels of nitricoxide (NO) in the breathare a telltale sign of airwayinflammation, and people

with asthma have higherconcentrations of NO in theirbreath than those withoutasthma. The measure of the

concentration of NO in thebreath is referred to as fractionalexhaled nitric oxide, or FeNO.

Until recently, there has been no easy way to measureairway inflammation, but now FeNO can be measured

with a simple, noninvasive breath test.

Measuring FeNO

In 2003, the first device used to measure FeNO was clearedby the US Food and Drug Administration. Then in 2011, the

American Thoracic Society (ATS) published a guideline for

Asthma and Airway

Infammation:The Big Picturethe use of FeNO in asthma management in clinicalpractice. They concluded that FeNO is directly relatedto airway inflammation and that it can be used toreliably assess and manage asthma symptoms. Inaddition, many studies have shown that regularlymeasuring and monitoring airway inflammation usinga FeNO test can help healthcare providers preventasthma exacerbations in their patients and bettermanage patients asthma on a long-term basis.

Long-term asthma management

The preferred therapies for asthma are inhaledsteroidsthey are highly effective in controlling asthmasymptoms, such as nighttime cough, daytime cough, orcough with exercise. Although these medicines work wellto control asthma inflammation, they can be associated

with risks, including growth suppression in children.

By regularly monitoring asthma inflammation usinga FeNO test, providers can help control asthma usingthe lowest possible inhaled steroid dose. FeNO tests

are inexpensive and used routinely in the offices ofdoctors who specialize in asthma. Currently, the onlyhand-held FeNO measurement device available inthe United States is NIOX MINO by Aerocrine.

Controlling asthma

Asthma has no cure, but fortunately, it can becontrolled. Regularly monitoring airway inflammationalongside measures of lung function can give thebig picture of asthmahelping healthcare providersand patients begin to control it.-JonathanMalka-R ais, MD and Joseph D. Spahn, MD


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By the time you notice asthma symptoms, you might already be losing control.

Be in the knowmonitor airway inflammation with NIOX MINO and help stay a

step ahead of asthma.

Rewrite your asthma storyask your healthcare provider about NIOX MINO today!

Personalized asthma

management

www.nioxmino.com

NIOX MINO, NIOX, and Aerocrine are registered trademarks of Aerocrine AB. 2012 Aerocrine Inc

Important note: NIOX instruments are medical devices regulated in the United States by the US Food and Drug Administration. Complete Labeling for our devices may be found at FDA.gov.The cleared Labeling is the final authority for Indications, Directions for Use, Risks, Limitations, Performance, and other information.

Every breath tells a storyI N A S T H M A


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Are Stress TestsWrong?

We have all heard stories of friendsand family who have had stress teststo look for heart disease and got aclean bill of health only to dropdead from a heart attack not longafter. Are these stories exaggerations

of those who dislike doctors or does this really happen.The scary answer is this is a real occurrence, and it happensall too frequently. The reason is that we currently do notpossess the ability to find a heart attack before it happens.

Heart attacks come from a blood clot in one of the majorarteries of the heart. This clot usually forms on top of

a plaque, a small area filled with cholesterol in the wallof an artery. Stress tests and other non-invasive tests can

find blockages that take up three-fourths of the arterydiameter, but heart attacks can occur where the diameteris narrowed only one-fourth to one-half. This means alarge number of future heart attacks can occur with no

warning and no way to reliably detect it beforehand.

Even if doctors do invasive tests like an angiogram whichis an injection of dye in the artery, they can f ind aplaque but have no idea if it is getting ready to cause aheart attack. Today the main focus of cardiologists inthis f ield is the detection of vulnerable plaque. That isa cholesterol plaque that for whatever reason is about tobreak and cause a clot and heart attack. We know that

stress and cigarettes can cause such a crack, and in addition,things like viruses and even dental infections can result


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a heart attack. We can say what theoverall risk of having a blockage is,however, and by managing this risk, aperson can reduce their overall heartattack risk. Lowering LDL or badcholesterol and high blood pressure,as well as quitting cigarette smokingare established ways to reduce risk. If a

person has diabetes, good sugar controlis also a big factor. Finally knowingyour risk, especially if someone in theimmediate family has had a heart attackbefore 60, is a time-tested method tolower the chance of a heart attack.

In addition to following your doctorsadvice on risk factor control, a dietthat is high in anti-oxidants may bebeneficial. If you have high cholesterolor had a prior heart attack, cholesteroldrugs call statins have also been shown

to make vulnerable plaque more stable.If you exercise routinely great! If not,start slow and work up to a healthyexercise level since sudden extremephysical exertion can increase risk. It isalways a good idea to talk to your doctorabout risk factors during a routine checkup, and if you have any symptoms ofabnormal breathing or pressure in thechest or back with exertion, you shouldlet your doctor know immediately.

Until we have the tools to find heart

attacks before they happen, we will allhave to accept that predicting who willdie from a heart attack is like predictingnext weeks weather by looking out ofthe window today. But by reducingthe risk factors we can and carrying anumbrella, well be as covered as we canbe until then.-Frank Smart, MD

in a plaque crack and heart attack. Otherthings that make the blood clotting morepronounced can increase this risk as well.

Looking for vulnerable plaque is a research

quest at medical schools across the country.Researchers now measure the temperatureof plaque since it seems that vulnerableplaque, which is inflamed and primedfor a heart attack, is warmer than stableplaque. There are also certain chemical andstructural changes that may give a clue asto the true risk of a future heart attack.

Until there are better detection tools,we will all have to accept the fact thatdoctors cant tell us who is about to have


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H

opkins research suggests more is notbetter and may cause harm

New research by Johns Hopkins scientistssuggests that vitamin D, long known to beimportant for bone health and in recent yearsalso for heart protection, may stop conferring

cardiovascular benefits and could actually cause harm as levels inthe blood rise above the low end of what is considered normal.

Study leader Muhammad Amer, M.D., an assistant professorin the division of general internal medicine at the JohnsHopkins University School of Medicine, says his findingsshow that increasing levels of vitamin D in the blood arelinked with lower levels of a popular marker for cardiovascularinflammation c-reactive protein (also known as CRP).

Heart Health and Vitamin DWhen it comes to heart health,

how much is too much vitamin D?


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Amer and his col league Rehan Qayyum, M.D.,M.H.S., examined data from more than 15,000adult participants in the continuous National Healthand Nutrition Examination Survey, a nationallyrepresentative sample, from 2001 and 2006. Theyfound an inverse relationship between vitaminD and CRP in adults without cardiovascularsymptoms but with relatively low vitamin D levels.

Healthier, lower levels of inflammation werefound in people with normal or close to normal

vitamin D levels. But beyond blood levels of 21nanograms per milliliter of 25-Hydroxyvitamin D considered the low end of the normal range for

vitamin D any additional increase in vitaminD was associated with an increase in CRP, afactor linked to stiffening of the blood vessels andan increased risk of cardiovascular problems.

The inflammation that was curtailed by vitaminD does not appear to be curtailed at higher levelsof vitamin D, says Amer, whose newest finding

appears in the Jan. 15 issue of the AmericanJournal of Cardiology. Clearly vitamin D isimportant for your heart health, especially if youhave low blood levels of vitamin D. It reducescardiovascular inflammation and atherosclerosis,and may reduce mortality, but it appears that atsome point it can be too much of a good thing.

Amer says consumers should exercise cautionbefore taking supplements and physicians shouldknow the potential risks. Each 100 internationalunit of vitamin D ingested daily producesabout a one nanogram per milliliter increase

25-Hydroxyvitamin D levels in the blood. Peopletaking vitamin D supplements need to be sure thesupplements are necessary, Amer says. Thosepills could have unforeseen consequences tohealth even if they are not technically toxic.

Amer and Qayyum, also an assistantprofessor in the division of general internalmedicine at Hopkins, say the biological andmolecular mechanisms that account for theloss of cardiovascular benefits are unclear.

Vitamin D is often called the sunshine vitaminbecause its primary source is the sun. It is found

in very few foods, though commercially soldmilk is usually fortified with it. As people spendmore and more time indoors and slather theirbodies with sunscreen, concern is rising thatmany are vitamin D-deficient, Amer notes.

As a result, Amer says, many doctors prescribevitamin D supplements, and many consumers, afterreading news stories about the vitamins benefits,dose themselves. Older women often take large dosesto fight and prevent osteoporosis.-This informationprovided courtesy of Johns Hopkins Medicine.


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The 411 on 911Chest PainWhat do chest pains mean?


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Chest pain is one of the mostcommon reasons thatmillions of people go tothe emergency room (ER)each year. Yet, each year,a substantial number of

people stay at home and suffer fromuntreated cardiac conditions. Chest paincan come on suddenly and at any time.Could you be having a heart attack?Can you ignore the pain for now?Should you go to the ER or cal l yourprimary care physician? Do you callan ambulance or just drive yourself?

Fortunately, chest pain does not alwayssignal a heart attack. Often, the pain is

unrelated to any heart problem at all. Eventhough the pain may not be related to theheart, it may still represent serious medicalconditions, which need to be addressed.

A significant number of conditions maycause chest pain. Sometimes only a physicianor additional testing can tell the differencebetween cardiac trouble or other causes.

Chest pain caused by a heart attack or anotherheart problem is usually associated with oneor more of the following symptoms:

Pressure, fullness or tightness of the chest.Many people describe this as a heavy or squeezingfeeling. To some, the sensation may not necessarilyseem like pain but more like pressure. The sensationis not usually sharp or positional (decreasing orincreasing with various body positions), and doesn'tusually occur when taking a deep breath.

Pain that lasts for more than a minute or two but doesnot persist for more than an hour without change.

Shortness of breath, sweating,dizziness and/or nausea.

Pain that radiates or spreads to the arms, jaw or back.

Heart-related chest pain is often, but not always,associated with other risk factors like smoking, obesity,diabetes, sedentary lifestyle, high cholesterol and highblood pressure. It can also be associated with a familyhistory involving a first-degree relative with diagnosedheart attacks or blockages prior to the age of 55.

You may have had prior heart attacks or aheart condition requiring bypass surgery, anangiogram or stents. Recurrent heart problemsmay mimic the sensations you felt in the past.

Pain that is not related to a heart attack oftenpresents with the following signs and symptoms:

A burning sensation behind the breastbone,sometimes associated with a sour taste in

the mouth or regurgitation of food. Sharp, stabbing pain that lasts for only a few seconds. Pain that gets better or worse with

changes in body position. Pain that intensifies with coughing or deep breathing. Pain that can be recreated by

pushing on the chest wall.

Pain associated with swallowing.

If you experience new or unexplained chest pain orsuspect that you are having a heart attack, you shouldseek immediate medical attention. Persistent chest painshould be evaluated at the hospital. Fleeting, intermittentchest pain that goes away completely needs to be

discussed promptly with your primary care physicianor cardiologist. When in doubt, a trip to the ER couldsave your life or at least bring you peace of mind.

If you experience symptoms related to a heart attack,do not drive yourself to the hospital unless you haveno other option. If you drive in this condition, itis dangerous not only for you but also for otherson the road. Call an ambulance instead. Qualifiedambulance personnel can start critical life-savingtreatment immediately. Remember, when in doubt, seekimmediate medical attention.-Scott Hacking, MD


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Cardiologist Tips:

Right Liestyle BuildsSolid Heart Health

Make the right lifestylechoices, and youll builda solid foundation foryour heart. Phillip J.Hecht, M.D., FACC,a cardiologist on the

medical staff and medical director ofcardiovascular services/cardiac rehab, BaylorRegional Medical Center at Grapevine,shares his top five tips for peak heart health.

Swap some foods.Turn to chicken and ishirst, and skip the redmeat. Reach or ruits andvegetables in place o dairy.

Get walking.You dont have to joina health club or buyany equipment, exceptmaybe a pair o walkingshoes. Get out there anddo some walking everyday, Dr. Hecht says. Hedoesnt make one-size-

its-all recommendationsbut notes that you shouldwork up a sweat andeel yoursel breathingaster to get heart-healthybeneits rom your walk.


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Maintain a healthy weight.With healthy ood choicesand a solid exercise program,weight loss should ollow.Go to http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/ to seehealthy recipes.

Check your levels.See your doctor once a

year to make sure yourblood pressure andcholesterol levels arenormal. I theyre not, yourdoctor can help you getthem under control.

Quit smoking.All smokers know its bad, even

i they dont want to admit it,Dr. Hecht says. It takes manysmokers several tries to stopor good, so keep at it. -Thisinormation provided courtesyo Baylor Health Care System


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Colorectal Cancer:

The Non-Biased Killer

Colorectal cancer is thesecond leading causeof cancer deaths in theUnited States. Thisyear approximately160,000 Americans

will be diagnosed with coloncancer. Of those diagnosed, anestimated 50,000 will die.

The 50,000 kil led by colon cancer isabout the same number of Americansthat will die in an automobile accident.

The difference is that most, if notall, of colon cancer deaths can beavoided with a simple screening test.

Fortunately, aggressive CancerScreening Awareness campaigns arehaving an impact and more and morepeople are becoming conscious of theneed to get screened. As a result, we

are seeing an increase in the numbersfor colon cancer screenings for all racesand genders. After all, colon cancerisnt biased about whom it kills.

In the past 10 years, about 60 percentof American Caucasians who fit thecriteria for colon cancer screeninghave been making that importantappointment and getting the test done.

This number is up about 10 percentover the previous 10-year period. The

word is getting out to the AfricanAmerican and Hispanic communitiesas well, since we have seen increasesin screenings for these groups.Unfortunately, the screening numbershave decreased for Native Americans.

A recent study in the New EnglandJournal of Medicine show a clear benefitof a colonoscopy. Just think how much

better it would be if wecould double the numberof people we screen.

Are There WarningSigns for Colon Cancer?

Colon cancer has fewif any warning signs.

Thats why a screening isso important. However,there are some signs thatcould by symptomaticor indications coloncancer might be present.

Among the warningsigns of colon cancer:

Change in bowelssuch as constipationor diarrhea.

Blood in the stool eithergrossly or on guaiactesting cards provided byyour primary care doctor.

Abdominal pain.Weight loss

Unfortunately, by thetime these symptoms

appear -- with the exception ofminor traces of blood in the stool and if cancer is the cause, it meansthe disease is fairly advanced. Atthis stage, removal of the tumorprobably wont offer total curebecause the disease has most likelyspread into lymph nodes or otherorgans. Chemotherapy may prolong

life, but the treatment will not curethe disease in advanced stages.

What Are The Risk FactorsFor Colon Cancer? Am I AtHigher Risk Than Others?

Just as with any other cancer ordisease, there are risk factors andgroups. Keep in mind, colon canceris the second leading cancer killer inthis country and it's not particularlypicky about who it affects.


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Among the risk factors for colon cancer:

Age. Sporadic colon cancer is thought to occur aroundage 65 for the majority of the population.

Genetic predisposition and Lynch Syndrome. People withFamilial Adenomatous Polyposis (FAP), an inheritedcondition in which numerous polyps form mainly in thetissue of the large intestine. While these polyps startout benign, malignant transformation into colon cancer

occurs when not treated. This group may develop thepotential for colon cancer in their 20s or even earlier.Screenings should even start in the early teens.

Prior pol

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