what doctors know - vol 1 issue 6

8/15/2019 What Doctors Know - Vol 1 Issue 6

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Grace hears the balancebeam calling.

St. Jude patient GraceFierce Competitor

But at this moment, she’s fighting cancer.That’s why St. Jude Children’s Research Hospital® spends every moment changing

the way the world treats children – with pioneering research and exceptional care.

And no family ever pays St. Jude for anything. Don’t wait. Join St. Jude in finding cures

and saving children like Grace. Because at this moment, her opponent should be

another gymnast. Not cancer.

Help them live. Visit stjude.org.


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Taking Control08 Seeing is Believing

10 Telling Your Kids About

Your Terminal Illness14 For Your Heart’s Sake

21 E=mc2...It Started with a BIG BANG

26 Pediatric Strokes: More commonthan most people think

28 Toric Lenses: The shape of things tocome for patients with astigmatism

30 Heating the Airways to Cool Down Asthma

WHAT DOCTORS KNOWAnd you should, too!

P08

P33

Inquiring Minds33 Impulsive or Cautious?

36 The Effects of Sleep Disordered Breathing in Kids

38 American Adolescents & Liver Disease


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Vol. 1 Issue 6

17 Juvenile Arthritis:Get The Facts

42 10 Minutes CanSave Your Life

48 Smoking Spice Not So Innocent

01 On Call With Dr. Porter

04 Meet Our Doctors

06 House Calls

40 HealthWatchMD: New Diet Pill: Doesit work like magic?

On The Cover In Every Issue

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Contents

Health Hints44 Headphone Safety Tips46 Exercising in Your 50s, 60s, 70s and Beyond

50 Caffeine for Headache?

53 Tips for Traveling With Diabetes

58 Prevention is Key in Early Dental Health

60 Sunblock Your Eyes This Summer

62 Check-up Check List: Be Prepared forYour Child’s Doctor Appointment


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Meet Our Doctors

Copyright 2012 by What Doctors Know, LLC. All rights reserved. Reproduction of this magazine,in whole, or in part is prohibited unless authorized by the publisher or its advertisers. The

Advertising space provided in What Doctors Know is purchased and paid for by the advertisers.Products and services are not necessarily endorsed by What Doctors Know,LLC.

Phillips Kirk Labor, MD

Internationally known for his work in refractive surgery and cataract expertisefor more than 20years. Dr. Labor isan American College of Ophthalmic

Surgeons founding member, and was named by Premier Surgeon as atop U.S. premium IOL innovator.He practices in the Dallas, TX area

with aff iliations to the American Academy of Ophthalmology, AmericanSociety of Cataract and RefractiveSurgery, American College of EyeSurgeons, and Society for Excellencein Eye Care. Contact Dr. Labor at (817)410-2030 or www.eyectexas.com.

Timothy J. Sullivan, MD

Clinical professor at the Medical College of Georgia, Dr. Sullivanspent 25 years in full-time academic medicineat Washington University,University of Texas Southwestern

Medical School, and Emory University.He currently has a full-time allergy and immunology practice in Atlanta, Georgia.Contact Dr. Sullivan at (404)255-2918 or www.trittbreatheandsleep.com.

Vicki Lyons, MD

Founding memberand chairman of theeditorial advisory board of What DoctorsKnow, Dr. Lyons

is a board certified and fellowship trained allergist and immunologist practicing in Ogden,Utah. She has been practicingfor 20 years. Contact Dr. Lyons at (801)387-4850 or www.vicki-lyonsmd.com.

Steven Porter, MD

Founder and publisher of What Doctors Know, Dr.Porter is recognized as one of the topgastroenterologists in the country.He is the medical director of the

endoscopy lab at a leading hospitalin Ogden, Utah and has beenpracticing for more than 25 years.Contact Dr. Porter at (801)387-2550.

Colin Kane, MD

Assistant Professorof Pediatrics at UTSouthwestern MedicalCenter and pediatriccardiologist at Children’s

Medical Center in Plano,

TX. Dr. Kane’s special interests areechocardiography, fetal echocardiography as well as researching cardiotoxicity and myocardial infarction associated withthe use of synthetic marijuana. Contact Dr. Kane at (214)730-KIDS (5437).

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? What’s new in your practice, in your specialty?

Drop us a line and let us know about any healthcare topic you want

to address in What Doctors Know. Remember, we want to inform andeducate our readers. We know, an informed reader has the opportunity to live longer and happier. You can be part of that healing process.

Our readers look forward to hearing from you.

Send story ideas to: [email protected]


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WHAT DOCTORS KNOWAnd you should, too!

Published by

What Doctors Know, LLC

Publisher and Chairman

Steve Porter, MD

Editorial Advisory Board

Vicki J. Lyons, MD, Chairman

Editorial and Design Director

Bonnie Jean Myers

Senior Designer

Suki Xiao

Design Associate

Cayden Chan

Executive Director, MarketingLarry Myers

Production

Kai Xiao, Vice President

IT Manager

Eric Lu

For more information on ad placement or contributing an article, pleaseemail [email protected], or call (801) 825-4600.

For information on subscriptions, please visit www.whatdoctorsknow.com

Corporate Office

What Doctors Know1755 E Legend Hills Dr., Suite100, Clearfeld, UT 84015

(801) 825-4600

Special Thanks To:


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Q :

Is i t o ka y to p u

t m y

ba b y to bed w i t h

a bo t t le ? I

hea rd i t co u ld c

a use de n ta l

p ro b le ms. — Rikk

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A : P ut t i ng y our baby t o be d w i t h a bot t l e c an c ause a c ond i t i on c al l e d “ Baby Bot t l e T oot h D e c ay ” . W he n a

baby ’ s t e e t h ar e e x pose d t o t he sugar i n f r ui t j ui c e s, mi l k , f or mul a,

and e v e n human br e ast mi l k . T he se l i qui d s br e ak d ow n i nt o si mpl e sugar s

i n t he mout h. W he n t he y ar e al l ow e d t o si t i n t he mout h, bac t e r i a c an st ar t

f e e d i ng on t he sugar s and c ause t oot h d e c ay . If t he t e e t h st ar t t o d e c ay and

ar e l e f t unt r e at e d , t he t e e t h c an st ar t t o c ause pai n and mak e i t d i f f i c ul t t o c he w

and e at . K e e p i n mi nd , baby t e e t h se r v e as " spac e sav e r s" f or ad ul t t e e t h. If

baby t e e t h ar e d amage d or d e st r oy e d , t he y c an' t he l p gui d e pe r mane nt

t e e t h i nt o pr ope r posi t i on, w hi c h c oul d r e sul t i n c r ow d e d or c r ook e d

pe r mane nt t e e t h. – Mar k Ne w e y , D D S , Me mbe r of t he Ut ah

A ssoc i at i on of O r al and Ma x i l l of ac i al Sur ge ons.

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.

Q : D o r i d g e s o n y o ur f i ng e r na i l s i nd i c a t e a t h y r o i d p r o

b l e m? — T r e n t C .A :

Y o u r f i n ge r n a i l s

a re a g re a t b a

r o me te r o f y o u

r

he a l t h. T he re

a re t w o t y pe s o

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n a p pe a r

o n y o u r n a i l s: v

e r t i c a l a n d h o r i

z o n t a l. Ve r t i c a

l r i d ge s r u n f r o

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he t i p o f y o u r n

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e se r i d ge s a re t

y p i c a l l y n o c a u

se f o r c o n ce r n

. H o r i z o n t a l

r i d ge s r u n f r o m

s i de t o s i de o n

y o u r n a i l s a n d

a re o f te n re fe

r re d t o a s Be a u

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l i ne s. H o r i z o n t

a l r i d ge s c a n b

e c a u se d b y t r a

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i l a n d m a y be

dee p o r d i s

c o l o re d. T he c

a n a l s o i n d i c a t

e m a l n u t r i t i o n

, p s o r i a s i s o r a

t h y r o i d

p r o b le m. C he c k w i t h

y o u r d o c t o r i f

y o u see h o r i z o

n t a l r i d ge s o n

y o u r

n a i l s; t he y m a y i n d i c a te a m

o re se r i o u s p r o

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a r t i n,

M D, M e d i c a l D

i r e c t o r o f C a r d i o v a s c u l a r

I m a g i n g a n d C

h i e f o f

V a l v u l a r & S t r u

c t u r a l H e a r t D i s

e a s e a t P i e d m o n t H e a r t

I n s t i t u t e, a n d h

o s t o f H e a l t h W a

t c hM D

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The Importance of Eye Examsfor Infants and Toddlers

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Seeing is

Believing


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I

t’s never too early to examine the eyes of aninfant or toddler – early vision screenings candetect vision impairments and prevent seriousproblems from developing as children age.

Melanie Pickett, O.D., clinical assistant professorof ophthalmology at the Eugene and Marilyn Glick Eye Institute, advises parents to take advantage of early screenings for their children. As part of InfantSEE apublic health program for infants in partnership withthe American Optical Association and the Vision CareInstitute of Johnson and Johnson, Dr. Pickett willprovide a free eye exam for children up to age one.

“Often parents are unaware of any visual problemsinfants may have,” Dr. Pickett said. “The InfantSEEprogram allows us to detect vision issues at an earlierage, when they can be prevented or more easily treated.”

For children who are too young to read or talk, optometrists can employ severalnon-invasive tests including:

· Acuity and eye movement – Because babies cannotread letters on a chart, optometrists can use methodsto determine if the child can focus on an object andfollow the object as it moves. Babies also can betested to determine the distance of their vision.

· Correction with glasses – During the exam, theoptometrist will use a handheld object to assess thebaby’s response to various targets, determining if correction with glasses is needed. While many childrenmay be nearsighted, farsighted or have astigmatism,those often correct themselves as the child grows.

· Eye alignment – During the exam, the doctor willcover one eye at time to determine if the child’s eyemuscles are working together. Often called cross-eyes, strabismus can be detected with this test. Babieswho were diagnosed with this condition would bereferred to an ophthalmologist to determine if theywere a candidate for surgery to correct the condition.

· Overall health – An examination of the eye, eyelidsand tear ducts will be performed along with a visualfield and pupil function tests using a handheldmicroscope. The eyes may be dilated, offering awider more comprehensive view of the eye.

“After the initial toddler exam, it’s recommended that children receive an eye exam every two years,and before starting school,” Dr. Pickett said. “Aschildren age, their eyes will continue to grow and develop, so regular exams are important.”

Dr. Pickett said exams are recommended yearly for school age children.

Parents should ask their children if they noticeany vision problems, or watch to see if thechild has problems reading their book or seeingthe whiteboard or blackboard at school.

“Sometimes reading skills could be linked toa potential vision problem,” Pickett said.

For more information on Dr. Pickett, or the IUDepartment of Ophthalmology, visit www.glick.

iu.edu. -

This information provided courtesy of Eugene& Marilyn Glick Eye Institute, Indiana UniversitySchool of Medicine


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Telling Your KidsAbout your Terminal Illness

After Dr. Elizabeth King was finished

with her treatment—double mastectomy,chemotherapy, stem cell mobilizationand reinfusion, and radiation—she sat outside her Atlanta homeand watched her eight-year-old son,

Mitchell, skate in the driveway. After more than ninemonths of dangerous and debilitating treatment forbreast cancer, she enjoyed just feeling the sun onher face as her son showed off some new moves.

The conversation turned to Mitchell's request toplay football in the fall. Given the injury rate in the

sport, King and Mitchell's father weren't keen on the

idea. Mitchell skated over and sat down beside her.

"He looks at me and says, 'You know, I think I'mgoing to play football,'" King recalls. "'I want to scare you as much as you scared me.'"

When Kids Are Scared

A child psychologist, King told her son that she didn't blame him for being mad and scared.

While she was impressed by his ability to expresshis emotions so clearly, she was overwhelmed by the pain and fear her illness had caused him.

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whatever they want to talk about, whenever they'reready. And they'll be ready at the oddest times—in thecar, at church, or even while you're on the phone."

Harpham recommends that you rehearse some answers.She was glad she'd planned ahead for the day herdaughter asked if her cancer, a strain of non-Hodgkin’s

lymphoma known for recurrence, would ever comeback. "I said, 'Darling, right now it's gone and we really hope it will never come back. But yes, it can come back.If it comes back, I can be treated again and we can get through it again. As long as I'm doing fine, let's focus on

what we have now.'" "Don't say, 'I'm not going to die,'"says Levine. "Say, 'If I die, Aunt Carol will take care of you.' Most of the time that's all they want to know. If they make a big deal about it, pay attention to that."

When It's Time to Get Help

Children experience stress and grief at significant moments, like when they get up and Mom isn't there

to make them breakfast. Social worker Allen Levinenotes that while adults act sad when they are depressed,children become agitated; what parents and teachersmight call "acting up" may actually be signs of depression.

Experts say that any significant change in behaviorthat lasts for more than two weeks may indicatethat a child could benefit from counseling. Those

changes could include acting-out behavior at school, changes in the way he plays with hisfriends, difficulty sleeping, and loss of appetite.

The following behavior problems require immediateattention from a professional counselor:

· Dramatic change in school performance

· Drug or alcohol abuse

· Self-mutilation

· Violent behavior toward others

· Eating disorders

· Criminal or risk-taking behavior (shoplifting,speeding, driving under the influence, picking fights)

· Suicidal tendencies

Life Lessons

Regardless of the prognosis, parents can use theillness to teach their children positive life lessons.King's son Mitchell combined his experience with his

mom's breast cancer and his love of art to create theKemo Shark Comic Book, which has been distributed to thousands of children facing the same issues hedid. He helped his mom put together a video called "My Mom Has Breast Cancer" that's helped othermoms talk to their kids. He also plays baseball and basketball, but decided to pass on the football. -This information reprinted courtesy of EBSCO Publishing


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“Diet is just onecomponent of theoverall cause of heart disease,” saysDonna Arnett,Ph.D., chair

of the Department of Epidemiology in the University of Alabama at Birmingham School of Public Healthand president-elect of the AmericanHeart Association. But, Arnett says,it can exert a strong influence.

Heart disease is the most commoncause of death for both men and

women in the United States, accordingto the Center for Disease Control and Prevention. Diets high in saturated fats and cholesterol can lead toatherosclerosis, or a hardening of thearteries caused by build-up of plaque.

Sodium also is considered the culprit for the one in three Americans whodevelops high blood pressure. Sodium

attracts water into your cells; theincreased fluid raises your blood pressure and subsequently raisesyour risk of stroke and heart attack,heart failure and death, Arnett says.

Race also plays a role in risk. UABresearchers recently examined theeffects of sodium intake by race usingdata from the ongoing Reasons forGeographic and Racial Differences in

Stroke and found a stronger association with death in black participants than whites, says Suzanne Judd, assistant professor of biostatistics at UAB and the study’s lead author. Blacks withthe highest sodium intake (averageof 2,600 mg/day) had a 62 percent increased risk of dying, while whiteshad no increased risk, she said.

“This supports the AHA recommendation that there may need to be race-specific sodium guidelines,but everyone should reduce their

sodium intake,” Judd says. The AHA has an aggressive sodium goal of 1,500 mg per day for everyone.

What constitutes a heart-healthy diet?

First, Arnett says, increase theamount of fruits and vegetables youeat daily, especially the leafy kind.

“This provides more potassium, which is associated with lower blood pressure,” Arnett says. “Fresh is the best

For Your Heart's SakeEat Fresh andAvoid Excess Sodium

Food is your friendand your biggest foe.A healthy diet sustainsus, but a poor diet canraise blood pressure,

cholesterol, bloodsugar levels and weightand put you at risk for heart disease.


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source for fruits and vegetables, but canned versions can provide nutrition.”

The primary drawback to canned and frozen foods is added sodium. But

Arnett offers a solution: “Rinse thesefoods before cooking to help reducesodium. Once rinsed, I think they area great option for people on the go.”

Fish also is on Arnett’s list of better food choices.

“You should eat fish twice per week; fish are sources of the good fats associated with reduced risk of heart disease,” says Arnett.

Fish doesn’t have to be fresh every time. Arnett says alternatives likecanned tuna and sardines will do.She says that the AHA recommendstwo 3.5 oz. servings per week, orabout two small cans of tuna.

When preparing your food, limit saturated fats such as those in butter,hard cheeses and red meats.

“Avoid trans fats because they raiseyour bad cholesterol levels. So read food labels and look for partially hydrogenated oils, which is anothername for trans fats,” Arnett says.

Fats considered to be suitable forlow consumption — avocados,nuts, olives and olive oil — aremonounsaturated and polyunsaturated

fats, which can help reduce thecholesterol levels in your blood and lower your risk of heart disease.

A big calorie-causing culprit is sodas and sports and energy drinks, Arnett says.

“The hidden sugars in thesebeverages are a common cause of

weight gain among young people.Limiting yourself to two 12 oz.cans per week to reduce the risk of obesity and diabetes,” Arnett says.

Arnett says keeping a food diary is one of the most effective toolsfor monitoring eating habits and ensuring they are healthy.

Also, Arnett recommends www.mylifecheck.org, a helpful websiteprovided by the AHA that outlinesLife’s Simple 7, which are the sevensteps you need to practice to live aheart-healthy life. -This information provided courtesy of the University of Alabama at Birmingham Medicine


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Ju venile

Ar thri ti s:

Get the

Facts

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C

hildren can get arthritis just like adults. Arthritis is caused by inflammation of the joints.It causes pain, swelling,stiffness, and loss of motion.

Juvenile arthritis is the term

used to describe arthritis in children. Themost common type that children get is

juvenile idiopathic arthritis (idiopathicmeans “from unknown causes”). There areother forms of arthritis affecting children,including juvenile rheumatoid arthritis.

Who Gets Juvenile Arthritis?

Juvenile arthritis affects children of all agesand ethnic backgrounds. About 294,000

American children under age 18 havearthritis or other rheumatic conditions.

What Causes Juvenile Arthritis? Juvenile arthritis is usually an autoimmunedisorder. As a rule, the immune systemhelps fight off harmful bacteria and

viruses. But in an autoimmune disorder,the immune system attacks some of thebody’s healthy cells and tissues. Scientistsdon’t know why this happens or what causes the disorder. Some think it’s atwo-step process in children: somethingin a child’s genes (passed from parentsto children) makes the child more likely to get arthritis, and something like

a virus then sets off the arthritis.

What Are the Symptoms andSigns of Juvenile Arthritis?

The most common symptoms of juvenile arthritis are joint swelling,pain, and stiffness that doesn’t go away.Usually it affects the knees, hands, and feet, and it’s worse in the morning orafter a nap. Other signs include:

• Limping in the morning because of a stiff knee

• Excessive clumsiness

• High fever and skin rash

• Swelling in lymph nodes in the neck and other parts of the body.

Most children with arthritis have times whenthe symptoms get better or go away (remission)and other times when they get worse (flare).

Arthritis in children can cause eye inf lammationand growth problems. It also can causebones and joints to grow unevenly.

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How Do Doctors Find Out if YourChild Has Juvenile Arthritis?

There is no easy way a doctor can tell if your child has juvenile arthritis. Doctors usually suspect arthritis whena child has constant joint pain or swelling, as well asskin rashes that can’t be explained and a fever along

with swelling of lymph nodes or inflammation in thebody’s organs. To be sure that it is juvenile arthritis,doctors depend on many things, which may include:

• Physical exam

• Symptoms

• Family history

• Lab tests• X rays.

Who Treats Juvenile Arthritis?

A team approach is the best way to treat juvenile arthritis.It is best if a doctor trained to treat these types of diseases in children (a pediatric rheumatologist) managesyour child’s care. However, many children’s doctors and “adult” rheumatologists also treat children with arthritis.

Other members of your child’s healthcare team may include:

• Physical therapist

• Occupational therapist

• Counselor or psychologist

• Eye doctor

• Dentist and orthodontist

• Bone surgeon

• Dietitian

• Pharmacist

• Social worker

• Rheumatology nurse

• School nurse.

How Is Juvenile Arthritis Treated?

Doctors who treat arthritis in children will try tomake sure your child can remain physically active.

They also try to make sure your child can stay involved in social activities and have an overall good quality of life. Doctors can prescribe treatmentsto reduce swelling, maintain joint movement, and relieve pain. They also try to prevent, identify, and treat problems that result from the arthritis. Most children with arthritis need a blend of treatments –some treatments include drugs, and others do not.


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It Started witha BIG BANG

E=mc2


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W

hat do a forest fire and cells in thehuman body have in common?

When I was in college, I worked clearing land for my parents to earnmoney to buy an engagement ringfor my wife (we just celebrated our

twenty-ninth anniversary). One day, while working with a chainsaw and burning enormous piles of trees,my pants caught on fire. I panicked when I found my right leg was stuck between two burning logs. Ibraced my left foot against a log while trying to freemy right foot. I slipped and accidentally pulled thespinning chain saw across the front of my right thigh.

What did I learn?

I learned then that denim offers pretty good flame

protection, but not protection from chain saws. Ialso learned that a ten feet high, thirty feet long pileof logs on fire is powerful stuff. Thirty years later,the scar has faded, but the lesson I learned has not.

The heat energy was staggering. I could easily havebeen consumed – and I’m sure there are those who wish it hadn’t turned out so fortunate for me.

The point I’m trying to drive home is about energy: whether it’s a raging fire or the

working body. Organic matter is energy.

The question is where does energy come from?

The answer is: The Big Bang Theory.

About five tril lion years ago all the matter in theuniverse was compressed into a sphere the size of a

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ping pong ball. Then suddenly – BLAM!!! The Big Bang – or as scientists would explainit – there was an explosion at the speed of light, producing all of the energy and matterin the universe as we know it today.

So now what makes life possible on our planet

with the sun in the center of our solar systemproviding our primary source of light energy?

First of all, we have to understand all matteris composed of atoms clumping togetherto form molecules. However, before any of this clumping can happen, energy has to beadded to the equation. Molecules can beclumped together with more energy to formorganic matter. Such as wood, grass, etc.

Albert Einstein said it best. E=mc2. Thefirst thing to notice is this equation is algebra,so it expresses a relationship. E(energy) =

M(mass) times C(speed of light) squared.Energy and mass are related, energy canbecome mass and mass can become energy or really energy and mass are different manifestations of the same principle.


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So How Does This All Work?

The principles of conservation of mass and conservationof energy tell us that energy in the universe is never lost orgained, it only changes form. The same principle appliesto matter. Matter is formed by photosynthesis, plant cells grab protons from the suns energy entering the cellthrough a series of reactions involving electron transport requiring conversion of NADP to NADPH and producing ATP From ADP (these terms and concepts

will be explained further next month) and producingglucose (sugar) and oxygen. Energy from the sun is

then locked in the chemical bonds of the new molecule. Now the energy is contained in newly formed matter –remember neither lost nor gained, it only changes form.Energy from sunlight is captured in the glucose and held there to be released in our body through metabolism.

How do we use the energy?

Animals breath in the oxygen produced by the plant and then eat the plant glucose. Through metabolismin the cells using hydrogen (electron donor) in thepresence of NADP and ADP (sound familiar?)glucose is broken back down to carbon dioxide which

we breathe out, and water we excrete in the formof urine. The energy that was put into the bondsby solar power is released. It is energy equal to theenergy required to form the glucose in the first place.

Someday I will tell you more about our surprisingly close plant cousins with which we are metabolically morealike than you can imagine. They are our metabolicmirror, and without them there is no “circle of life.” Inessence, plants thrive in our waste and we in theirs.

What if we don’t use this Energy?

Most of it we don’t. The plants will die and be covered in the earth, eventually buried deeper where pressureand time change the organic plant material to oil and coal. Millions of years later we dig up the coal and pump up oil to burn it as energy and fuel to run ourcars, heat our homes, and produce electricity - releasingthe same energy put in the chemical bonds by the sunmillions of years before. It is the ultimate solar battery.

What does this have to do with foodfor the cells of our body?

The answer is everything. A calorie is simply a

PHOTOSYNTHESIS


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measure of heat (calor is latin for heat). We refer tocalories in food but the term Ca refers to any fuel.Simply, a calorie is the amount of heat from thecombustion or metabolism of organic fuel needed to raise the temperature of 1 cc (cubic centiliter)of water 1 degree centigrade at sea level.

Food fuels vary in chemical composition and in theamount of energy available. You should rememberfrom my article last month on digestion that thecaloric content of the food groups included:

• Carbohydrates. Four calories per gram.

• Proteins. Five calories per gram.

• Fats. Seven calories per gram.

• Alcohol. Nine calories per gram.

This tells us is that as fuels, foods are very different. The best analogy would be the difference betweenburning a soft wood like pine, or a hard wood like hickory or oak. Of the three, pine burns faster

with less heat output than oak or hickory.

Coal, oil, wood, or a hamburger and fries are essentially the same from a calorie perspective but not to our body,

which can’t process wood and is poisoned by petroleum.

Glucose is the basic sugar structure. Multipleglucose molecules are linked together toform other sugars and starches.

Herbivores (plant eating animals) are specially evolved with bacteria in their intestines to allow digestion of plant matter indigestible to humans.

The herbivores consume the carbohydrates (sugarsand starches) from the plants, which are converted into proteins and fats. We gain these proteins and fats when we eat their flesh and drink their milk.

The energy contained in these molecules isreleased when they are metabolized and thebonds are broken back into individual atomsreleasing energy to power our bodies.

My oldest daughter, Molly presented a schoolscience project several years ago I think illustratesthe differences in fuels, foods, etc. very well. Shehad learned what a calorie was and she reasoned

that since the amount of fuel was constant there was something about the fuel itself causing thedifference. She took different kinds of nuts and burned them under an oven thermometer and measured themaximum heat produced by each variety of nut. Eachnut produced a different degree of heat. The graphof the temperatures paralleled the known caloriecontent for each variety. The results illustrated thetrue nature of energy released from different foods.

The difference is the amount of energy stored ineach bond between atoms. For example, the energy

in a carbon-to-carbon bond is not the same energy in a carbon-to-oxygen bond. Different foods withdifferent component bonds release correspondingly different amounts of energy. There is no magic hereaccording to the laws of physics and chemistry.

This has been a primer for next month’s issue, to teach

you how to think about food as a source of energy only. Nutrition and fuel are two very different things.

We will cover that next month. But as a teaser, let mesay this. Human beings have been conditioned by 1.7 million years of starvation to become an extremely efficient machine (eco-friendly…ha,ha). Considerthe average adult male needs 2,000 calories per day to sustain and maintain weight. The average femaleneeds about 1,200-1,500 calories per day. From what you have learned above, a man needs enough food calories to raise a two-liter bottle of water one degreecentigrade. That is not much fuel. That is a very efficient machine. Now consider a female age 40, who

eats 2,000 calories a day and drinks a two-liter bottle of soda (an additional 2,000 calories). She just has takenin nearly four times her daily caloric requirement.

Does the light start to pierce the fog? Finalteaser. A starving mouse will live much longerthan a well-fed mouse. Have a nice month.

Warning: you may not like my story next month. -Steve Porter, MD


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Another issue regarding treatment is that it is often delayed because people don't recognize the symptoms as being that of a stroke, said Dr. Donald Yee, assistant professor of pediatrics – hematology at BCM. Yee treats pediatric strokepatients through the hematology serviceat the Texas Children's Cancer Center.

"Because people aren't often aware of thisissue, it can lead to underrecognitionand misdiagnosis, which in turn canmean delays in therapy," Yee said.

Studies have shown that the delay frompresentation of symptoms to diagnosisof stroke can be one or two days, whichgoes beyond the recognized window for treating acutely with methods liketissue plasminogen activator, or tPA,

and clot-busting drugs, Yee said.

Recovery

Stroke recovery is another focusof current research, Nassif said.Some studies have indicated that children experience recovery beyond the one-year mark, which isconsidered the point in adults after

which strides in recovery end.

In addition, children's brains, especially the younger they are, are able tohandle injury differently than adult brains because of their plasticity,Yee said. He cautioned not to draw too much reassurance from this,however. As much as 70 percent of children who suffer strokes will havelong-lasting neurological effects.

"Children definitely can make bigstrides in recovery but still comeout different than they were before,

with long-term learning and thought processing disabilities and often physicaldisabilities," Nassif said. "Pediatric

strokes are dramatic when they dohappen because children have so muchlife ahead of them and will be dealing

with their disabilities for a long time."

While sti ll relatively rare, both Nassif and Yee stressed the importanceof awareness of pediatric strokes –especially among patients and parentsof patients with heart disease and sicklecell anemia. -This information provided courtesy of Texas Children's Hospital

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Toric lenses: the shape

of things to come forpatients with astigmatism

C

ataract patients typically need an artificiallens implant to correct presbyopia, whichis the inability to see objects up close.

These include the Crystalens, Tecnis,and ReSTOR lenses I have writtenabout previously in What Doctors Know.

But a condition called astigmatism is also fairly

common, and there are special lens implants, called Toric lenses, designed to specifically correct it.

If you’re not familiar with astigmatism, this occurs when the front surface of your eye (your cornea), or thelens inside of your eye, isn’t curved correctly. One way to

look at it is that your cornea or lens should be round and smooth like a ping pong ball. An astigmatic cornea orlens is often compared to having the shape of a football.

Sports analogies aside, how do you know if youhave astigmatism? Perhaps you’ve already have beendiagnosed at a younger age, and find your vision getting

worse as you get older. If not, most symptoms includeblurred or distorted vision, frequent headaches, and eyestrain. If this tends to worsen (particularly if over40), let your eye doctor take a look. If you do have astigmatism, this is a mild vision problem that can easily be treated. You can be born with it, or it can develop


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after an eye injury, disease, or surgery. It can also occurin combination with nearsightedness or farsightedness.Once again, I stress to my patients that, generally,astigmatism is not serious and can be easily corrected.

Treatment Options

If occurring at a younger age, astigmatism is usually treated with glasses, contact lenses, or refractive surgery (such as LASIK). Toric lenses are becoming morecommon for cataract patients with different levels of astigmatism, because they also treat the cataract and other vision problems as well. Patients in their 40’sand 50’s without cataracts are electing this optionas part of a procedure called Clear Lens Extraction,

which can actually prevent cataracts later on.

What Is A Toric Lens?

“Toric” refers to the lens having two different curvesinstead of just one. In other words, it has two “powers”and can be designed to correct astigmatism withfarsightedness or nearsightedness. Just like other lensimplants, a Toric lens replaces the clouded, naturallens during the cataract procedure. There are twoadvanced Toric lenses used in our practice. Both aredesigned to not only achieve that of a high quality

Toric lens, but also to help correct distance vision and reduce the dependency on eyeglasses after surgery.

The AcrySof® IQ Toric IOL is for patients with asignificant amount of astigmatism. It’s an “aspheric”lens, meaning it can adapt to the unique curvatureof the patient’s eye. This Toric lens is also designed to reduce or visual disturbances, and can possibly improve intermediate as well as distance vision.

The STAAR Toric IOL™ is for patients with regular,pre-existing astigmatism. Currently, it’s the only lensmade from non-toxic silicone, providing a flexible,natural fit within the eye. This Toric lens can furtherimprove results, designed to minimize glare or halos.

Expectations

It’s always important for your doctor to be honest and up front with any expectations. As I tell my patients,having Toric lenses implanted reduces the dependency on eyeglasses, but won’t eliminate it altogether. Inaddition, a Toric lens doesn’t improve vision at all

distances like a multifocal or accommodating lens,for example. Astigmatism is a specific vision problemthat requires a special type of lens, but one can stillexpect the same general improvements in their visionas with other types of lenses, and see young again.

The Bottom Line

As always, make sure you are seen by a reputabledoctor that specializes in diagnosing and correctingastigmatism. An Optometrist can examine you,and determine if you may have astigmatism. If you do, and you’re interested in surgical correctionof your astigmatism, he or she will refer you toan Ophthalmologist for further examination and treatment. The Ophthalmologist will go overyour overall health history and decide if you’re acandidate for a Toric intraocular lens implant.

Finally, remember that you have choices. The right doctor won’t try to “sell” you something you don’t need. His or her first concern should be about helping you make the absolute right decision. Toriclenses are considered premium lenses, and not covered by insurance. However, if astigmatism isgetting in the way of everyday activities and work,particularly if you have cataracts, the benefits canoutweigh the costs for many years. - Part threee of a

series on premium lenses-Phillips Kirk Labor, MD


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Heating theAirways to CoolDown AsthmaBronchial thermoplasty - a new procedurefor patients with severe asthma

Asthma affects a lot of people, 8 percent of the population inthe United States, some 25 million people. Approximately 10 percent of those patients have severe asthma and wakeup every day with chest congestion, shortness of breath,tightness in the chest, wheezing, and coughing. Patients

with severe asthma often are taking a complicated regimen of multiple daily medications for asthma and still are not well controlled.

Current management of asthma relies upon minimizing exposures to asthma

triggers, using anti-inflammatory and bronchodilator medications, and immunotherapy to eliminate allergic triggers. Patients with more severe asthmamay need more advanced therapy with biological drugs such as omalizumab(Xolair) or even bursts of oral steroid medications, or daily oral steroids. Existingtreatments can provide satisfactory control or even resolution of asthma. However,there are a substantial number of patient for whom this therapy is not sufficient.

We know this because the number of visits each year to physician offices, and hospital outpatient and emergency departments with asthma as the primary diagnosis is staggering, approximately 17 million. Hospital admissionsfor asthma are still high, 479,000 admissions in the most recent year for

which analysis is complete. The average length of stay was 4.3 days.


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Asthma remains a deadly disease. There were3,388 deaths from asthma in the most recent year reported. 185 children and 3,262 adultsdied from asthma in 2007. One in every 8,000asthmatics dies from asthma each year.

As an Allergist & Immunology specialist, we often see a

patient in the prime of their life missing school or work because of asthma, sometimes developing significant sideeffects from frequent use of oral steroids. The biggest issue is the impact of asthma on quality of life. In 2008,more than half (59 percent) of children and one-third (33 percent) of adults missed school or work because of asthma. On average, in 2008, children missed 4 daysof school and adults missed 5 days of work because of asthma. More than half (53 percent) of people withasthma had an asthma attack in 2008. More children(57 percent) than adults (51 percent) had an attack.

In 2010 bronchial thermoplasty was approved by the

FDA as the first non-pharmacologic treatment of asthmafor patients, 18 years of age or older, with moderate and severe asthma. It is a medical procedure in which thebronchial tubes (airways in the lungs) are heated for 10seconds to 65 degrees C, 149 F. Small, 5 mm portionsare treated sequentially over three treatments, with athree week recovery period between each treatment.

The heat (radio frequency) kills smooth musclecells and disrupts airway inf lammation, leading toimprovements in patients with difficult to treat asthma.

The procedure is performed under moderate sedation,sometimes called “twilight sleep” or “conscioussedation”. The flexible bronchoscope is introduced

through the nose or the mouth and passed intothe lungs. The bronchoscope is navigated to thedesired site and the treatment begins. The treatment is delivered using a specially designed for 4 wirethermoplastic probe. A special catheter tip is passed through the bronchoscope into the small airways.

The tip is expanded so that it makes contact with the walls of the airway. The physician then activates aradiofrequency device that heats the airway to 65°Cfor 10 seconds. The device is then pulled back toward the center of the lungs 5 millimeters and the procedureis repeated until the entire region has been treated.

Airways as small as 3 mm in diameter can be treated.

Bronchial thermoplasty is performed in threeoutpatient visits approximately three weeks apart.Each procedure lasts between 45 and 60 minutes.

The first procedure treats the lower part of the right lung; the second treats the lower portion of the left


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lung: and the third procedure treats the upper lobesof both lungs. This procedure can reduce the amount of smooth muscle surrounding the airway and thereby decrease the spasms the smooth muscles can cause. Theheating process may also suppress the inflammatory process which is the fundamental basis of asthma.

This treatment can significantly improve asthma control

in selected patients. In one recent study enrollingpatients with severe asthma, bronchial thermoplasty wascompared to bronchoscopy without heat treatment (shamtreatment – placebo). The main outcome studied over aperiod of 12 months was improvement in the quality of life. 79 percent of bronchial thermoplasty patient’s had asignificant increase in the quality of their life compared to 64 percent of sham-placebo treated patients.

Complications can occur. Approximately 6 percent more bronchial thermoplasty patients were hospitalized in the 6 weeks following treatment than the control

subjects. Often there is a brief flare in asthma symptomsafter the procedure, particularly in the first week.Shortness of breath, cough, and wheezing werenoted in approximately 50 percent of treated patientsimmediately following the procedure. This reactionsubsides and then the clinical benefits become evident.In follow-up of patients in the bronchial thermoplasty group, so far, high resolution chest CT scans have not detected evidence of pulmonary (lung) scarring orabnormal widening of the airways (bronchiectasis).

In the post treatment phase, the bronchial thermoplasty

patients experienced fewer severe exacerbations, fewer

emergency room visits, and fewer days lost from work

and school compared with the sham treated group.

In a study of patients with asthma severity sufficient to have large potential benefits from bronchialthermoplasty, but not so severe as to be at high risk of requiring hospitalization after the treatment, a total

of 297 subjects were treated with a 2:1 ratio of active versus sham-placebo treatment. The primary outcomeit measured was change in quality of life. Both thebronchial thermoplasty group and the sham-placebotreated patients had improved quality of life, but theimprovement was greater in the bronchial thermoplasty patients. Severe asthma exacerbations were substantially fewer in patients with severe asthma. Unscheduled office visits, emergency room visits and admissionsfor asthma were lower in the bronchial thermoplasty treated group than in the sham treated control group

Current asthma therapy is focused upon reducing theinflammation that underlies asthma and trying to eradicateinflammatory reactions that drive asthma. However,approximately 10 percent of patients with asthma havepoor control despite these measures and often accessthe emergency room and are hospitalized for asthma.

Bronchial thermoplasty is a new innovativeprocedure that can potentially help patients withsevere, persistent, treatment-resistant asthma.

Studies have demonstrated:

· 32% decrease in severe exacerbations,

· 84% decrease in emergency room visits

· 73% decrease in hospitalizations for asthma

· 66% decrease in days lost from school/activities

· 36% decrease in patient reported asthmasymptoms with bronchial thermoplastycompared to sham bronchoscopy.

· Benefit from bronchial thermoplasty is maintainedfor at least two years post procedure

Additional information can be obtained by visitingYouTube: Bronchial Thermoplasty – Patient DVD, and also www.BTforAsthma.com.

–Timothy J. Sullivan, MD and Vicki J. Lyons, MD


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Impulsive or Cautious? Brain Networks Connected to Teen Drug Abuse


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T hat teenagers push against boundaries— and sometimes take risks — is aspredictable as the sunrise. It happens inall cultures and even across all mammalspecies: adolescence is a time to test limits and develop independence.

But why do some teenagers start smoking or

experimenting with drugs — while others don’t?

In the largest imaging study of the human brain everconducted — involving 1,896 14-year-olds — scientistshave discovered a number of previously unknownnetworks that go a long way toward an answer.

Robert Whelan and Hugh Garavan of theUniversity of Vermont, along with a large group of international colleagues, report that differences inthese networks provide strong evidence that someteenagers are at higher risk for drug and alcoholexperimentation — simply because their brains

work differently, making them more impulsive.

Their findings are presented in the journal Nature Neuroscience, published online April 29.

Drug use biomarker

This discovery helps answer a long-standing chicken-or-egg question about whether certain brain patternscome before drug use — or are caused by it.

“The differences in these networks seem to precededrug use,” says Garavan, Whelan’s colleague in UVM’spsychiatry department, who also served as the principal

investigator of the Irish component of a large European research project,called IMAGEN, that gathered thedata about the teens in the new study.

In a key finding, diminished

activity in a network involvingthe “orbitofrontal cortex” isassociated with experimentation

with alcohol, cigarettes and illegaldrugs in early adolescence.

“These networks are not working as well for some kids as for others,” says Whelan, making them more impulsive.

Faced with a choice about smokingor drinking, the 14-year-old with aless functional impulse-regulatingnetwork will be more likely to say,

“Yeah, gimme, gimme, gimme!” saysGaravan, “and this other kid is saying,‘No, I’m not going to do that.’”

Testing for lower function inthis and other brain networks could, perhaps, beused by researchers someday as “a risk factor orbiomarker for potential drug use,” Garavan says.

Understanding brain networks that put some teenagersat higher risk for starting to use alcohol and drugscould have large implications for public health. Deathamong teenagers in the industrialized world is largely caused by preventable or self-inflicted accidents that are often launched by impulsive risky behaviors — and alcohol and drug use often is a root of these behaviors.

Additionally, “addiction in the western world is ournumber one health problem,” says Garavan. “Think about alcohol, cigarettes or harder drugs and all theconsequences that has in society for people’s health.”

The links with ADHD

The researchers were also able to show that othernewly discovered networks are connected withthe symptoms of attention-deficit hyperactivity disorder. These ADHD networks are distinct

from those associated with early drug use.

In recent years, there has been controversy and extensivemedia attention about the possible connection between

ADHD and drug abuse. Both ADHD and early drug use are associated with poor inhibitory control— they’re problems that plague impulsive people.

But the new research shows that these seemingly related problems are regulated by different networks in thebrain — even though both groups of teens can scorepoorly on tests of their “stop-signal reaction time,” a


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The Efects o Sleep-Disordered Breathing in KidsKids' abnormal breathing in sleep linkedto increased risk for behavior problems

A study of more than 11,000 childrenfollowed for over six years has found that young children with sleep-disordered breathing are prone todeveloping behavioral difficulties suchas hyperactivity and aggressiveness,

as well as emotional symptoms and difficulty withpeer relationships, according to researchers at theUniversity of Michigan and the Albert EinsteinCollege of Medicine of Yeshiva University.

Their study, the largest and most comprehensive of itskind, published online today in the journal Pediatrics.

“This is the strongest evidence to date that snoring,mouth breathing, and apnea [abnormally long pausesin breathing during sleep] can have serious behavioraland social-emotional consequences for children,”said study leader Karen Bonuck, Ph.D., professorof family and social medicine and of obstetrics and gynecology and women’s health at Einstein. “Parents


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and pediatricians alike should be paying closerattention to sleep-disordered breathing in young

children, perhaps as early as the first year of life.”

Sleep-disordered breathing (SDB) is a general termfor breathing difficulties that occur during sleep. Itshallmarks are snoring (which is usually accompanied by mouth breathing) and sleep apnea. SDB reportedly peaks from two to six years of years of age, but alsooccurs in younger children. About 1 in 10 childrensnore regularly and 2 to 4 percent have sleep apnea,according to the American Academy of Otolaryngology–Health and Neck Surgery (AAO-HNS). Commoncauses of SDB are enlarged tonsils or adenoids.

“The importance of these new findings,” noted University of Michigan co-author Ronald D.Chervin, M.D., M.S., “is that most previous large,epidemiological studies showed only showed associations between SDB and disruptive behavior at the same point in time when the survey was done.

"We really did not have strong evidence that SDB actually comes before problematic behavior such as hyperactivity.Our new study now shows that SDB symptoms clearly do precede behavioral problems, in a robust mannerthat suggests any underlying causal effect could be quitestrong,” says Chervin, who is the Michael S. AldrichCollegiate Professor of Sleep Medicine, Professor of

Neurology, and Director, Sleep Disorders Center.

Prior studies suggesting a possible connection betweenSDB symptoms and subsequent behavioral and social-emotional problems, was less definitive because they included only small numbers of patients, short follow-upsof a single SDB symptom, or limited control of variablessuch as low birth weight that could skew the results.

The new study analyzed the combined effectsof snoring, apnea and mouth-breathing patternson the behavior of children enrolled in the Avon

Longitudinal Study of Parents and Children,a project based in the United Kingdom.

Children whose symptoms peaked early—at 6 or 18months—were 40 percent and 50 percent more likely,respectively, to experience behavioral problems at age 7 compared with normally-breathing children. Children

with the most serious behavioral problems were those with SDB symptoms that persisted throughout theevaluation period and became most severe at 30 months.

Researchers believe that SDB could cause behavioralproblems by affecting the brain in several ways:decreasing oxygen levels and increasing carbon dioxidelevels in the prefrontal cortex; interrupting the restorativeprocesses of sleep; and disrupting the balance of variouscellular and chemical systems. Behavioral problemsresulting from these adverse effects on the brain includeimpairments in executive functioning (i.e., being able toto pay attention, plan ahead, and organize), the ability

to suppress behavior, and the ability to self-regulateemotion and arousal. -This information provided courtesy of the University of Michigan Health System

Risk of problems later in childhoodcan double with snoring and apnea


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Non-Alcoholic Fatty LiverDisease on the Rise

Suspected non-alcoholic fatty liverdisease (NAFLD) is increasingin teens, affecting approximately

10 percent of the age group.Historically seen more often inadults, NAFLD can lead to liver

damage, diabetes, hypertension and cancer.

In a study funded by the National Institutesof Health (NIH), researchers led by MiriamVos, MD, MSPH, assistant professor of pediatrics at Emory University School of

Medicine and a pediatric hepatologist at Children’s Healthcare of Atlanta, sought todetermine whether rates of NAFLD seemhigh because people are studying them

more closely or whether there really aremore cases of teenagers with NAFLD.

The study was presented at DigestiveDisease Week, an annual conference jointly sponsored by the American Associationfor the Study of Liver Diseases, the

American Gastroenterological AssociationInstitute, the American Society forGastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract.

Investigators reviewed nationally representative data of more than 10,000

12- to 18-year-olds from the National

American Adolescents

Liver Disease&


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Health and Examination Survey datasets,spanning 1988 to 2008. Suspected NAFLD

was defined as overweight/obese (those with a body mass index greater than the85th percentile) with elevated alanineaminotransferase (ALT), a blood test that is typically used to detect liver injury.

According to the study, the prevalence of NAFLD among U.S. teens grew from 3.6percent to 9.9 percent, increasing at a ratefaster than teen obesity during the sametime. In looking at cross-sectional datato explain the increase in prevalenceof NAFLD, researchers found a link to increased NAFLD and waist circumference -- the measure of thedistance around the abdomen half way between the inferior margin in thelast rib and the crest of the hip bone.

"We know that if a child isoverweight, they are more likely tobe overweight as an adult," says Vos."We know from national data that teens with fatty liver disease becomeadults with fatty liver disease, unlessthey improve their diet and lose asignificant amount of weight."

Vos noted that early interventionfor NAFLD is essential,as is a coordinated plan of lifestyle modification and insome cases, medication.

"Adolescents may have an easier timelosing weight compared to adultsbecause they have been overweight for a shorter period of time, so thereis less resistance to improving lifestylehabits like diet and exercise," says Vos."My hope for the future is that we willhave medications to help treat the most severe cases of NAFLD to help complement ahealthy regimen of diet and physical activity."

This summer, the -NIH-sponsored NASHClinical Research Network will start a new clinicaltrial to research the treatment of NAFLD.

In the past, Vos and colleagues have studied theconnection between diet and fat in the liver and increased cardiovascular risk. Data shows that cardiovascular disease is prevalent in adults with

NAFLD, and multiple studies have shown that adolescents with NAFLD have markers that show increased risk for cardiovascular disease. -This information provided courtesy of Emory Healthcare

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HealthWatchMD

with Dr. Randy Martin

Provided courtesy of Piedmont Healthcare

New Diet Pill:Does it work like magic?Dr. Randy Martin: While this newcombination drug may not be the silverbullet for weight loss, it does seem,

with these preliminary studies, to showsome promise in helping to ‘jump start’people to losing weight and improvingthose all important risk factors for heartdisease and diabetes. But the bottomline, as Dr. Miller stressed, is really lifestylechanges and that really involves exercisingregularly and eating a proper diet.


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“T

his is yet another drug trial where folks are trying to find the ‘silver bullet,’” says Joseph

Miller, III, M.D., preventivecardiology, Piedmont Hospital. “Researchers have

taken two common medications that, in the past, were proven to help people lose weight, but had sideeffects. This time, they took much lower doses of eachof these two drugs and combined them into one pill.

The lower dosage helps offset some of the side effectsthat commonly occurred with these two medications.”

The two drugs used in the trial are phentermine, astimulant often used for those with hyperactivity disorders,and topiramate, an anti-seizure medication. One of theobserved side effects of both has been weight loss.

Researchers tested the two different dosages of thecombination pill and found that both dosages, when

taken for almost a year, led to more weight loss than the

placebo pill, with those taking the highest combinationdosage losing the most weight. Additionally, thosetaking both doses saw a decrease in their blood pressure,blood cholesterol levels, as well as their blood sugar.

“This is a significant finding,” says Dr. Miller, “I think one of the key things about this drug is that it may bea way to help people get started losing the weight – but the real goal is to get them to change their lifestyle.

“This drug is promising because so often, oncepeople lose a little weight, they feel better and find exercise easier,” Dr. Miller continued.

There were side effects seen with both dosages, whichincluded dry mouth and a pins and needles tinglingsensation. However, patients on the higher dose of thedrug did notice some increased sensation of anxiety and a mild increased risk of depression. The Food & Drug

Administration has asked the drug maker for additional

safety studies before it will approve the drug for use.”

Dr. Randy Martin: While this new combination drug may not be thesilver bullet for weight loss, it does seem, with these preliminary studies,to show some promise in helping to ‘jump start’ people to losing weightand improving those all important risk factors for heart disease anddiabetes. But the bottom line, as Dr. Miller stressed, is really lifestyle changesand that really involves exercising regularly and eating a proper diet.


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10 MinutesCan Save Your Life


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J

ust because you can't feel it,doesn't mean it isn't there.

Just ask the more than50,000 Americans who werediagnosed with cancers of the head and neck last year.

Unfortunately, many Americansdo not recognize the symptoms of these life-threatening diseases.

Oral, head and neck cancer refers toa variety of cancers that develop inthe head and neck region, such as thetongue, tonsils, sinuses, larynx (voicebox), thyroid and salivary glands,skin of the face and neck, and thelymph nodes in the neck. They claimapproximately 12,000 lives per year.

If diagnosed early, these cancers

can be more easily treated without significant complications, and thechances of survival greatly increase.

Experts say that every adult should be tested for oral cancer. Althoughtobacco and alcohol users are most at risk, throat cancer is on the risein young adults who do not smoke.Researchers attribute this rise to theincrease of the cancer-causing humanpapillomavirus (HPV) infection,

which can be transmitted by oralsex. These cancers are harderto detect because they occur onthe back of the tongue or on thetonsils, providing all the morereason to get screened regularly.

Potential Warning Signs

• A sore in your mouththat doesn't heal or thatincreases in size

• Persistent pain in your mouth

• Lumps or white or redpatches inside your mouth

• Difficulty chewing or

swallowing or movingyour tongue

• Soreness in your throat orfeeling that something iscaught in your throat

• Changes in your voice

• A lump in your neck

-This information provided courtesy of Emory Healthcare


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HeadphoneSafety Tips

With the proliferation of smart phones, portablegaming systems and media

players, more children—especially teenagers—are listening to ear budsand headphones atdangerously high volumelevels. Vanderbilt isoffers tips to parents andteenagers to help preventlong-term hearing loss.

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Other suggestions include:

• Investing in high-quality, “noise cancelling”

headphones that cover the entire ear. Ear budsallow more background noise to seep in, so childrenoften turn up the volume to compensate.

• Using hearing protection such as custom-madeear plugs. These can be used while playing music,attending concerts or in other loud environmentslike movie theaters and firework shows.

• Setting volume restrictions on yourchild’s personal electronic devices.

-This information provided courtesy of Vanderbilt University Medical Center

A

ccording to a Vanderbilt-led study published in Journalof the American Medical

Association, hearing loss is now affecting 20 percent of U.S.adolescents ages 12 to 19, which

is a 5 percent increase over the past 15 years. A separate study by the AmericanSpeech-Language-Hearing Associationfound that teenagers typically listen todevices at a louder volume than adults,and that these same teenagers already have symptoms of hearing loss.

Kristina Rigsby, Au.D., a pediatricaudiologist at the Vanderbilt Bill WilkersonCenter, says listening to devices withlevels over 80 dB for extended periodsof time may be potentially dangerous.

Prolonged exposure to high volumeexhausts the auditory system, she explains.Over time, the hair cells in the ear start todegenerate because they aren’t receivingproper blood flow and oxygen.

“When you are listening to these devicesat high levels and for long periods of time, you are putting yourself at risk forhearing loss,” Rigsby said. “Hearing lossis permanent, so once you’ve done thedamage, there’s no getting it back.”

If parents can hear sound coming from theirchild’s headphones while they are wearingthem, it’s too loud, Rigsby said. A good rule of thumb is the “60/60 rule,” whichmeans using only 60 percent of the device’s

volume level for no more than 60 minutesat a time. After 60 minutes, give your earsa break for at least an hour, she said.


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Exercising In Your50s, 60s, 70s And BeyondWhy Exercising is Vital to Health as We Age

A recent study has shown that exercise canadd years to a person’s life. Still, as we ageit can become more tedious and sometimesmore difficult to exercise. Many peoplesee aging as a time to slow down and take it easy. The reality is the more we

age, the more we need exercise to keep us independent and healthy. Still, it sometimes takes a prescriptionfrom the doctor to get adults up and moving.

“Exercise is important for almost everyone. Thereare very few medical conditions that exercise won’t benefit. In fact, I sometime write a prescription toget my patients to start taking this seriously and helpthem understand exercise can be just as helpful asmedication,” said Dr. Keith Veselik, director of primary care at Loyola University Health System and associateprofessor in the Department of Medicine at LoyolaUniversity Chicago Stritch School of Medicine.

“Around age 35 is when our muscle mass and restingmetabolism starts to decrease. When this happens our

bodies require more, not less exercise to manage ourcaloric intake. When this starts to happen we can eat the same things, do the same things and may gain 3pounds a year. That’s 30 pounds in a decade," he said.

Though exercising is beneficial to nearly everyone,before starting a program he advised that people,especially those who have not been active, consult adoctor to determine their baseline and to get guidanceabout what exercises would be most beneficial.

“In my own life I’ve seen the benefits of exercising. When that alarm goes off in themorning I want to just roll over, but I’ve seensuch a positive change in so many ways. It canbe diff icult, especially at f irst, but the benefitstruly outweigh the struggles,” Veselik said.

Veselik said the best workout program balancescardiovascular exercise, strength training and flexibility. He recommends an hour of cardiovascularexercise four days a week, two days of strength training


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for 30 minutes and balance and flexibility exercises suchas stretching, yoga or pilates, one to two times a week.

But what is optimal doesn’t always translateinto what is doable. Each decade has uniquechallenges. Veselik gives some ideas on how touse exercise to counter those health hurdles.

increase flexibility as well as balance to help prevent accidental falls. Weight-bearing exercise is crucialto bone health and keeping bone density strong.

In addition, many adults in their 60s beginto experience symptoms from arthritis, which can make exercise diff icult.

“Exercise has been proven to help people deal withtheir arthritis. It’s just making sure your exerciseroutine is working for you, not against you. Somepeople forget that walking is a great form of exercise, just make sure youget your heart rate up. Also, aquaticclasses or swimming are a great

way for people with arthritis orfibromyalgia to exercise,” Veselik said.

In Your 70s and Beyond:“The biggest worry I hear from my patients who are entering their70s, 80s and beyond is dementia.

The two most common formsare Alzheimer’s and vasculardementia,” Veselik said.

He also said that exerciseis the only thing that is proven to prevent

Alzheimer’s. And, many of the major risk factors

for vascular dementia,high blood pressure, highcholesterol and diabetes, canbe countered with exercise.

“Exercise is important, but it’s not the end-all. It needs to be coupled

with eating right and incorporatingother healthy habits to lead to a betterquality of life,” Veselik said. -This information provided courtesy of Loyola University Health System

In Your 50s: Muscle and joint aches and pains start becomingmore apparent, so Veselik said get creative about how to keep up cardiovascular exercise that iseasy on the joints but gets the heart rate up. Hesuggests exercising in a pool or riding a bike instead of running. If you do run, make sure you havegood shoes and try to run on softer surfaces.

Cardiovascular exercise also helps to fight many of the most common and deadly medical concerns,including heart disease, asthma and chronicobstructive pulmonary disease (COPD).

“But don’t go from doing nothing to running amarathon. Talk to your doctor, ask about risk factors and together create a plan that’s right for you,” Veselik said.

Another nearly universal complaint forpeople in their 50s is back pain.

“The best way to protect your back is to build

strong core muscles and make sure you arelifting heavy objects correctly,” Veselik said.

In Your 60s: As we enter our 60s, balance and strength should bea major focus. Many people are scared of breakinga hip, which can limit independence. Also, ourbones aren’t as strong and both men and womenbecome more susceptible to osteoporosis.

To help battle these concerns, Veselik suggested incorporating balance and leg strengthening exercises to


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Not So InnocentDoctors concerned about side effects, including death

S

ynthetic marijuana or “fake pot” has beena hot topic in recent months. Marketed under various names such as Spice, K2,Zohai, Dream, Genie and Serenity, syntheticmarijuana has been sold as a legal alternative

to actual marijuana. Officially marketed asincense and labeled “not for human consumption”,these products are a collection of herbs and spicestreated with chemicals that act in a similar manner tothe active chemical in marijuana. Teen users report aneffect similar or more intense to the high associated

with traditional marijuana. Although recent legalactions have made some versions of Spice illegal, they are still available in many shops and on the internet.K2 and similar products gained popularity withadolescents and young adults both because of the easein which they can be obtained, and because standard

drug tests do not screen for their use. Clearly, thismakes synthetic marijuana attractive to teenagers and adolescents who may be subject to drug screeningtests in school or prior to participation in sports.

Although these products are stil l easily available, it hasbecome apparent that they are not a safealternative tomarijuana. Teenagers have been admitted to hospitalsaround the country after smoking Spice and similarproducts. The presenting complaints have been primarily chest pain and palpitations, but other symptoms suchas hallucinations and seizures have been reported as

well. I personally know of 3 teenage boys who suffered heart attacks following the use of K2. There have evenbeen several deaths of teenagers associated with theuse of Spice and K2. Because synthetic marijuana usedoes not show up in a routine drug screen, the use of

Smoking Spice

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Spice and similar products can only be discovered by direct questioning. I recommend that parents ask their teenagechildren about drug use in general, and specifically about these new synthetic versions of marijuana; teens may not volunteer that they are using these products becausethey feel that they can’t be caught by a drug test. Teensand parents alike need to know that the use of Spice, K2and similar products is not safe, and could be deadly.

Tips for keeping your teen out of danger:

• Keep the lines of communication open. Ask not only about K2, but drugs in general.

• Watch for tracings of an herb-like substancein your teen’s bedroom or backpack.

• Educate your teen about the real dangers of smoking K2.

• Be on the lookout for side effects of K2 use,including paranoia and a soaring heart rate.

Additional information can be found on YouTube by searching -Cardiologist speaks on the dangers of K2.

-Colin Kane, M D, pediatric cardiologist,Children's Medical Center of Dallas


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Also make one jittery and worsen

quality of sleep. People vary in theircaffeine sensitivity, both becauseof inborn differences and tolerancebuilt up from exposure (i.e., how long you’ve been consuming

caffeinated products and how much you consume).

You may be taking medications prescribed to help you relax; in this case, excessivecaffeine intake could make it difficult forthose medications to work properly. On theother hand, you may be taking medicationscontaining caffeine to help treat headache.

So is caffeine good or bad for headache?It’s best to consult with your headachespecialist who can determine the appropriatetreatment for your specific condition.But here are some general guidelines:

1. Moderation is key.For most people, moderate caffeine

intake is okay. Moderation generally means less than200 mg of caffeine per day if you have headache issues.

Above that level, caffeine can increase your headache risk.Some people may need to avoid caffeine entirely. Note:Historically a cup of coffee contained about 75 to 100mg of caffeine. An increase in drink size changes that equation. See the table below for caffeine amounts.

2. Watch out for withdrawal. Caffeine withdrawal headachesusually are associated with taking in 500 mg or morecaffeine per day and then delaying/reducing intake. If you typically take in this amount of caffeine each day and then you sleep in one Saturday and miss your 6 am

cup, expect that you might have a withdrawal headache.

3. Reduce gradually. If you decide to decrease caffeineintake, try to do it gradually so that your body can adapt toit. - Leslee Carver, RD, MSPH, LDN, Saint Joseph Hospital, Provena Health-Resurrection Health Care in Chicago


Cafeine or Headache?


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Sample Caffeine Content of CommonItems (approximate)1

Food Item Amount Caffeine

Cola 12 oz 35 mg

Coffee, Brewed 8 oz 135 mg

Coffee, Brewed Decaf 8 oz 2 mgStarbucks® Espresso 1 shot 80-90 mg

Starbucks® Brewed Venti (20 oz) 480 mg

Starbucks® Decaf Venti (20 oz) 20 mg

Tea, black 3-minute brew 8 oz 45 mg

Tea, green 5-minute brew 8 oz 30 mg

Nestle Crunch® Bar 1.55 oz 10 mg

Chocolate Chips 1/4 cup 10-25 mg

Red Bull® 8.4 oz 75 mg

5 Hour Energy® 2 oz 205 mg

1 Information in this chart was compiled fromthe National Headache Foundation, the USDepartment of Agriculture, Starbucks.com.

Does caffeine trigger or treat headaches?

Caffeine can be a headache trigger or headache inhibitor.Caffeine can be found in beverages, chocolate and even in somepopular over-the-counter and prescription pain relievers.

Before a headache or migraine, blood vessels tend to enlarge. Becauseit contains “vasoconstrictive” properties that cause the blood vesselsto narrow and restrict blood flow, caffeine can aid in head painrelief. When caffeine is added to the combination of acetaminophenand aspirin, the pain relieving effect is increased by 40%.

Though caffeine does not directly cause headache, too much of thesubstance can trigger “caffeine rebound.” A caffeine rebound headacheoccurs from withdrawal of caffeine after a sufferer continually consumestoo much of the substance. Though the physical side effects can besevere, only 2% of the population suffers from caffeine rebound.

Although most headache sufferers can consume up to 200 mg. perday, the NHF advises patients with frequent headaches to avoiddaily use. The average American consumes about 200-300 mgof caffeine a day (or the equivalent of 2-3 cups of drip coffee).

Visit www.headaches.org for more information.


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PRODUCTMILLIGRAMSOF CAFFEINE

(Approximate)

Coffee (5 oz. cup)

Drip, regularPercolated, regularInstant, regularDecaffeinatedEspresso (1 oz cup)

106-164 mg93-134 mg47-68 mg

2-5 mg30-50 mg

Loose-leaf Tea (imported, 5 oz. cup)

Black OolongGreen

25-110 mg12-55 mg8-36 mg

Tea (black tea assumed, 5 oz. cup)

Brewed, major U.S. brands-1 minute brew-3 minute brew-5 minute brewCanned iced teaIced tea (12 oz)Instant tea

20-80 mg21-33 mg35-46 mg39-50 mg22-36 mg67-76 mg22-36 mg

Cocoa and Chocolate

Cocoa Beverage (mix, 6 oz.)Milk Chocolate (1 oz.)Baking Chocolate (1 oz.)Sweet Chocolate (1 oz.)OvaltinePostum

2-8 mg6 mg

35 mg20 mg

0 mg0 mg

Soft Drinks

Mr. Pibb, Diet 12 oz.Mountain Dew 12 oz.Coca Cola, Diet Coke 12 oz.

Tab 12 oz.Shasta Cola 12 oz.Mr. Pibb 12 oz.Dr. Pepper 12 oz.

Pepsi Cola 12 oz.Pepsi Light, Diet 12 oz.Diet Right Cola 12 oz.Royal Crown Cola 12 oz.Craigmont Cola7-UpSpriteFantaFrescaRoot BeerClub SodaGinger Ale

Tonic WaterOrange SodaGrape Soda

57 mg54 mg46 mg46 mg45 mg44 mg41 mg

40 mg38 mg36 mg36 mg36 mg

0 mg0 mg0 mg0 mg0 mg0 mg0 mg0 mg0 mg0 mg

Sports / Energy drinks AMP Tall Boy Energy Drink 16 oz.Enviga 12 oz.FIXX 20 oz.Full Throttle 16 oz.Full Throttle Fury 16 oz.Monster Energy 16 oz.No Name (formerly known as Cocaine 8.4 oz.Red Bull 8.3 oz.Rockstar 16 oz.SoBe Adrenaline Rush 16 oz.SoBe No Fear 16 oz.Vault 8 oz.

143 mg100 mg500 mg144 mg144 mg160 mg280 mg

76 mg160 mg152 mg174 mg

47mg

Food / Other Products

Foosh Energy Mints, 1 mintHaagen-Dazs Coffee Ice Cream, 1/2 cupHershey's Chocolate Bar 1.55 oz.Hershey's Special Dark Chocolate Bar 1.45 oz.Jolt Caffeinated Gum, 1 stick 16 oz.

130 mg100 mg

30 mg9 mg

18 mg33 mg

Non-prescription Stimulants

Caffedrine CapsulesNoDoz TabletsNoDoz Maximum Strength, 1 tabletVivarin Tablets

200 mg200 mg200 mg200 mg

Non-prescription Pain RelieversMILLIGRAMSOF CAFFEINE

/ PILL

AdvilAnacinBufferinExcedrin MigraineExcedrin, Extra Strength, 2 tabletsMidolMotrinPlain Aspirin

TylenolVanquish

0 mg32 mg0 mg

65mg130 mg32 mg0 mg0 mg0 mg

33 mg

Diuretics (standard dose)MILLIGRAMSOF CAFFEINE

(Approximate)

Aqua BanFluidexPermathene Water Off Pre-Mens Forte

200 mg0 mg

200 mg100 mg

Cold Remedies

ActifedContacComtrexCoryban-D.DristanNeo-SynephrineSudafed

Triaminicin

0 mg0 mg0 mg

30 mg16 mg15 mg0 mg

30 mg

To help monitor caffeine intake,the National Headache Foundationhas complied a chart that suppliesthe caffeine content for severalfoods and beverages.


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Tips or Traveling With

Diabetes

V acations can seem idyllic until you pack.

That’s when reality hits: You’ve filled yourcarry-on with an entire wardrobe, a pair of shoes, and backup toiletries—but what about diabetes stuff? Start here to head off hassles.

Before You Leave

People have a tendency to over pack—bringingthose backup shoes just in case the safari includesa formal dinner—except when it comes tomedications. Along with any meds, there area few other items that will come in handy.

Stock Up. Refill any prescriptions and otherwise ensureyou’re well stocked with medications and devices (see“What to Pack”). Alene Kelsey Metcalf, 38, of San

Antonio always brings double the amount of suppliesshe needs. “I learned the hard way over 9/11. I wastraveling and got stuck in Seattle for four days. I ranout of syringes.” If you use a pump, bring syringesand vials of long- and short-acting insulin as backup.

Note Your Contacts. Make a list of your healthcare providers, including their names and phonenumbers, note your medications, and carry a


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copy of your health insurance card. If yourun out of medication, experience a healthproblem, or have a medical emergency, you ora travel companion will know whom to call.

Plan to Communicate. If you don’t speak the languageof your destination, write down translations of

diabetes terms. Include phrases such as I have diabetes, I need juice, and Where is the hospital? A good site forquick translations is babelfish.yahoo.com. Metcalf asked a coworker who spoke Mandarin to write“Type 1 Diabetic” on insulin pump. The note helped

Metcalf get through airport security in Shanghai.

Anticipate Screenings. To smooth your way through airport security,

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