by Specialdocs Consultants, LLC | Nov 20, 2017 | Medical Tests, Medications, Patient News
This is the first in a series exploring some of the most promising advances inspired by the Human Genome project. From the burgeoning field of pharmacogenomics to consumer genetic testing such as 23 and Me, the time from discovery to application is progressing rapidly. We’ll look at some of the latest thinking and its impact on personalizing medicine in the future.
To boil down a complex subject to its very human goal, pharmacogenomics means using genomics to get the right dose of the right drug to the right patient at the right time. There is tremendous variability in individual response to drugs, and a large percentage of adverse drug reactions may be due to genetic variables that are just beginning to be really understood.
It’s important to note that while significant progress has been made, the actual use of pharmacogenomics in primary care may be many years away and unlikely to impact the way in which your physician currently prescribes medications for you. However, as research continues to accumulate, the medical community is hopeful that this information will someday help guide prescription decision-making in a much more precise and personalized way.
Did You Know?
1957 – Dr. Arno Motulsky suggests that individual differences in drug efficacy and adverse drug reactions are at least partially attributable to genetic variations
2008 – The Food and Drug Administration releases a table listing genomic biomarkers with established roles in determining drug response
Sources: The National Human Genome Research Project, UptoDate, FDA.gov, JAMA
What we know now
Slightly different, but normal, variations in the human genetic code can yield proteins that work better or worse when they are metabolizing different types of drugs and other substances. Even small differences can have a major effect on a drug’s safety or effectiveness for an individual patient. Your drug-metabolizing enzymes may be set to act in a completely different way than a friend of similar height and weight because phenotypes range from ultrarapid and rapid metabolizers to normal, intermediate and poor metabolizers.
Consider this example from the National Institutes of Health: The liver enzyme known as CYP2D6 acts on 25 percent of all prescription drugs, including the pain reliever codeine. There are more than 160 versions of the CYP2D6 gene, and many of these vary by only a single difference in their DNA sequence. People who manufacture an overabundance of CYP2D6 enzyme molecules metabolize the drug very rapidly, and as a result, even a standard dose can be too much. Conversely, those who carry a CYP2D6 gene that results in a slowly metabolizing enzyme may not experience any pain relief. Armed with this kind of information, a physician may be able to prescribe different types of pain relievers for both of these patients.
The Food and Drug Administration now includes pharmacogenomic information on the labels of some medications, with details on risk for adverse events and side effects, effectiveness for people with specific genome variations, genotype-specific dosing and mechanisms of drug action (the specific biochemical interaction through which a drug substance produces its pharmacological effect). This may eventually help physicians make the right individual patient choices for drugs that include pain relievers, antidepressants, antivirals, statins and blood thinners.
A number of barriers, which includes the lack of clear, evidence-based guidelines, need to be overcome before personalized drug therapy becomes a routine component of mainstream medicine. For now, pharmacogenetics testing is successfully being used in treatment of specific genetically influenced tumors, and for certain medications for cystic fibrosis, inflammatory bowel disease and HIV…important first steps in this promising field.
Defining Terms
- Pharmacogenomics: A field of research focused on understanding how genes affect individual responses to medications.
- Pharmacogenetics: Sometimes used interchangeably with pharmacogenomics, it’s actually a subcategory that refers to the role of genetic variation on response to a drug; can be inherited through the germline or acquired as in a tumor.
- Pharmacokinetics: How a drug moves through an individual’s body, from absorption and distribution through excretion. Blood and urine tests determine where a drug goes and how much of the drug or a breakdown product remains after the body processes it.
The post Unlocking the Genetic Code: Spotlighting Pharmacogenomics appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Healthy Aging, Patient News
We’ve all had the experience of frantically searching for car keys in the morning or walking purposefully into another room only to forget why we were going there, and as we age, it seems to occur with increasing frequency. Are these just signs of normal aging, or harbingers of a more serious condition? It’s a question more seniors and their families are asking, as awareness of progressive memory disorders such as Alzheimer’s disease grows.
The answers can be more reassuring than yo• may imagine. Many symptoms of memory loss are benign,or due to the aging process, and no further evaluation is needed (see the signs of normal aging, at right). Experts agree that most people who are aware of—and nervous about—their own declining memory, most likely do not have mild cognitive impairment or dementia.
However, it’s vital to know that if you do have symptoms of mild cognitive impairment (MCI), this may be due to underlying medical conditions that can be treated, such as thyroid dysfunction, vitamin deficiency, anxiety/depression, sleep disorders and uncontrolled chronic conditions such as diabetes.
You may want to consider seeking an evaluation if you experience increasing difficulty, compared to your past ability, over a range of everyday activities that include: remembering important details of things you’ve done in the past few weeks; completing complex tasks at work or home, such as keeping track of monthly bills; requiring personal assistance to remember family occasions or holidays; or having trouble finding your way around familiar environments.
Cognitive abilities are also affected by depression, so if you have experienced these feelings during the last month, further evaluation is recommended:
Felt that I cannot stop feeling “down” or “blue,” even with help from family or friends.
- Felt all pleasure and joy has gone from life.
- Felt hopeless about the future.
- Felt that everything was an effort.
- Felt low in energy or slowed down a lot.
- Did You Know?
150 minutes a week
Amount of exercise time needed to improve memory and reduce the risk of dementia. Source: Harvard Health
“Having memory loss does not necessarily mean yo• have Alzheimer’s disease (AD),” says neurologist William Rodman Shankle, MD, chair of California’s Memory and Cognitive Disorders Program at Hoag Neurosciences Institute. “In fact, there is a treatable cause in the majority of patients with cognitive impairment, provided it is detected early.”
Additionally, a rigorous combination of physical exercise, healthy diet, strict control of hypertension and diabetes, medication and ongoing social and intellectual stimulation, has proven highly effective in stopping or slowing down progression of all types of dementia, including Alzheimer’s.
Sources: Medical Care Corporation (www.mccare.com), Alz.org
Did You Know?
Learn, then sleep
While we sleep, memories are shifted to more permanent brain regions; studies have shown that sleeping shortly after learning new information can help retention in the long term. Source: The National Sleep Foundation
Signs of Normal Aging
- Forgetting the name of someone I know well, but remembering it later
- Forgetting what I was going to say in a conversation
- Forgetting what I was going to when going into another room
- Finding things I have recently put down
- Recalling a specific word I want
- Making occasional errors when balancing a checkbook
- Occasionally needing help to record a television show or adjust the microwave settings
- Getting confused about the day of the week but remembering it later
- Misplacing things from time to time, such as a pair of glasses
- Sometimes feeling weary of work, family and social obligations
- Becoming irritable when a routine is disrupted
Sources: mccare.com, Alz.org
Making Memories
- The creation of a memory begins with its perception, a quick sensation that is then stored in short-term memory, which lasts a few minutes to a few weeks before being erased. Strategies to enhance short term memory can be effective, such as dividing a 10-digit phone number into smaller chunks. Important information is gradually transferred from short-term into long-term memory.
- Working memory is the type most affected by normal aging. While a teenager will perform better on memory and word recall tests, a 70-year old can adapt by using associations to remember e.g. ‘Every Good Boy Does Fine’ for lines on a music staff.
- Long-term memory consists of procedural (knowing how to do things like ride a bike), semantic (knowledge of the world), and episodic (information about events you have personally experienced). Long-term memory decays very little over time, and can store a seemingly unlimited amount of information almost indefinitely.
The post Forget Me Not: Normal Aging, Mild Cognitive Impairment or Dementia? appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Nutrition, Patient News
As we become more aware of what comprises healthy eating, sugar is increasingly viewed with a wary eye. Evidence is mounting that a sugar-filled diet – and the resulting weight gain – can lead to increased cholesterol, blood pressure and inflammation, and to a higher risk of obesity and obesity-related conditions such as diabetes, pre-diabetes, cancer and cardiovascular disease (CVD). The key to prevention is understanding exactly what sugars you’re eating.
Naturally occurring sugars are found in foods such as fruit (fructose) and milk (lactose). Any product that contains milk, such as yogurt or cream, or fresh or dried fruit contains some natural sugars. These can be eaten freely.
Added sugars hide in 74 percent of packaged foods, even those that many consider healthy, such as energy bars. They also lurk in savory foods, including ketchup, breads, salad dressing and pasta sauce. The top five sources are sugar-sweetened beverages (soda, specialty coffees, sports drinks); grain-based sweets (cookies, cakes, pies); fruit drinks (juice cocktails, punch); dairy-based desserts (ice cream, frozen yogurt); and candy (lollipops, jelly beans). These should be limited.
“Consider the company the sugar keeps. If it’s accompanied by a nutritional element, it is not a contributor to disease,” advises Jennifer McDaniel, Academy of Nutrition and Dietetics spokesperson. For example, fruit contains fructose, but also fiber, which ensures the natural sugar is absorbed in a slow and controlled manner; the same applies to the protein in plain yogurt.
Guidelines for maximum daily amount of added sugars vary as follows:
- US Department of Health and Human Services: no more than 10% of total calories
- World Health Organization: encourages no more than 5%
- American Heart Association: no more than 6 teaspoons for women or 9 for men
While a complete sugar detox is not recommended – there is little evidence that it improves health or spurs weight loss – cutting back on added sugars to make room for healthier calories is strongly advised. McDaniel suggests:
- Look for the biggest offenders of added sugars in your diet, whether it’s chocolate or soft drinks, and replace them with something yo• look forward to eating.
- Make a super food swap. Enjoy a sweet bedtime snack? Consider blending a frozen banana with a splash of milk and unsweetened cocoa powder.
- Know your sweet tooth personality. If you’re an all or nothing person, it may be easier to eliminate your sweet triggers permanently, but if yo• can handle eating a square of chocolate without needing the whole bar, permit yourself the treat.
- Try the ‘Plain Jane’ version. When you’re in charge of the sweetness factor, you’ll almost always use less than presweetened version, so buy plain oats and add your own fruit and honey.
Can sugar be part of a healthy diet? Thankfully, yes. “It’s all about balance. The majority of our diet should be foods that nourish us, but there’s certainly a place for the sweet treats in life,” says McDaniel.
Sweet Disguise
It can be difficult to discern if a product contains both added and natural sugars, because the nutrition fact panels of food products don’t distinguish between them. That’s set to change in 2018 when federal regulations mandate the break out of added sugars. For now, be on the lookout for sugar in one of its many guises:
- Corn sweetener
- Corn, malt or maple syrups
- Fruit juice concentrates
- Honey
- Molasses
- Agave nectar
- Barley malt
- Cane juice
- Caramel
- Muscovado
- Turbinado
- Sweet Sorghum
- Treacle
The post Sweet Surrender: Is Sugar Off the Table for Healthy Eaters? appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Healthy Aging, Medical Tests, Patient News
It’s called ‘the forgotten virus,’ but after a sustained advertising campaign and years of strong recommendations for testing by the Centers for Disease Control it’s almost certain that the liver-damaging Hepatitis C will be remembered…and for good reason. All people born between 1945 and 1965 – the Baby Boomer years – are now advised to take a screening test for Hepatitis C virus, the most common bloodborne infection in the United States. The reason? Boomers, born in a time before universal precautions and infection control guidelines were fully established, are five times more likely to have Hepatitis C than other adults, but not likely to be aware of it, as symptoms lay dormant for years. Testing was first recommended for all Boomers in 2013, but less than 15 percent of this at-risk generation have heeded the advice, which means many who are infected remain unaware they carry a potentially fatal but very curable virus.
Below we dispel some of the misperceptions and the breakthrough treatments available today. Most importantly, we explain why scheduling a blood screening is a vital act of prevention, and one we encourage every Baby Boomer to take.
What is hepatitis C?
The common, chronic bloodborne infection known as hepatitis C is caused by the hepatitis C virus, and is a major cause of liver disease.
How does it happen?
The virus causes an inflammation that triggers a slow cascade of damage in the liver, with hard strands of scar tissue replacing healthy liver cells. The liver is no longer able to effectively filter toxins or make the proteins the body needs to repair itself.
Why is testing critical?
Hepatitis C can hide in the body for decades without causing symptoms, while it attacks the liver. Since most people don’t have warning signs of hepatitis C, they don’t seek treatment until many years later, when the damage often is well underway. Left untreated, hepatitis C can result in cirrhosis or liver cancer, and is the leading indication for liver transplant in the U.S. If treated, however, the vast majority of patients can be cured within a few months.
Did You Know?
80% – Of the 3.2 million people affected by chronic hepatitis C, almost 80% were born during the baby boomer generation
10.5 million – Out of 76.2 million Baby Boomers, the number who have been tested for hepatitis C
Sources: American Journal of Preventive Medicine, Centers for Disease Control
Why are Baby Boomers at particularly high risk for hepatitis C?
Once thought of as a disease primarily of drug users, contracted from sharing of needles, hepatitis C can also be contracted through inadequate sterilization of medical equipment and the transfusion of unscreened blood. Boomers grew up before the hepatitis C virus was identified in 1979, so it’s likely that many became infected through medical equipment or procedures before universal precautions and improved infection control techniques were adopted. Others may have been infected from contaminated blood before widespread screening nearly eliminated the virus from the blood supply by 1992.
What is the test for Hepatitis C?
A simple blood test for hepatitis C antibodies will indicate if you’ve been exposed to the virus at some point in your life. If you test positive, further testing will be done to determine if the virus remains in your body, how much is circulating and what specific strain or genotype you have. At least six strains of hepatitis C exist and treatment is based on the specific genotype. Other tests, including ultrasound, magnetic resonance imaging (MRI) and a liver biopsy can be performed to identify inflammation and see if any permanent scarring has taken place in the liver.
What treatments are available?
Today’s regimens of direct acting oral antivirals stop the virus from reproducing and clear hepatitis C from the body in a matter of weeks. These breakthrough drugs, first made available in 2013, represent a tremendous step forward in treatment, with a success rate upwards of 95% in those infected with the hepatitis C virus. Medication is targeted to the specific genotype of the virus, and most patients experience few side effects – a vast improvement over previous options of pegylated interferon and ribavirin which caused uncomfortable side effects and were effective less than half the time.
The post Hepatitis C Testing Recommended for All Baby Boomers appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Patient News, Wellness
“I think that you will all agree that we are living in most interesting times. I never remember myself a time in which our history was so full, in which day by day brought us new objects of interest, and, let me say also, new objects for anxiety.”
Was the above heard: 1. At a recent town hall meeting in Florida? 2. On the 2016 campaign trail? 3. During an 1898 address by a British statesman?
It may surprise you to learn that number 3 is the correct answer, and provides a welcome bit of perspective on the stress felt by every generation. While current times are considered stressful by a majority of adults, we also have better ways to identify, manage and prevent it than before.
Did You Know?
60-80% Percentage of visits to primary care physicians for stress-related conditions. Sources: APA, Mayo Clinic, Benson Henry Institute
Causes of stress
While stressors of American adults have remained fairly stable over the years, some are specific to the decade. As the American Psychological Association’s “2017 Stress in America” survey shows, the political climate and technology-centric world has caused an uptick in stress:
One nation, over stressed. 57% of Americans report the political climate is a significant source of stress; 66% say the same about the nation’s future. Stress about acts of terrorism was high at 59%, while worries over personal safety rose to 34%, the highest since the question was first asked in 2008.
Money, money, money. Other top causes of stress include money (61%), work (58%) and the economy (50%).
Media overload. Although nearly all adults own at least one electronic device, and more than 86% check emails, text or social media accounts daily, those who do so constantly report higher stress levels.
How to cope: For decades, stress-related issues have been recognized as the leading cause of visits to a primary care physician. Stress-relieving techniques continue to evolve:
Eat, pray, love. Exercise and going online are frequently used to manage stress. Women, how- ever, also reported spending time with friends or family, reading, engaging in prayer or eating as their primary methods of relieving stress.
Unplug. Interestingly, while 65% of Americans agree that periodically disconnecting is important for mental health, only 21% actually report doing so. Some techniques that work include no cell phones at the dinner table or while with friends, periodic digital detoxes, watching less tv, and turning off notifications for social media apps.
Trigger your relaxation response. Based on Dr. Herbert Benson’s 1974 discovery of an opposite state to the fight-or-flight response, the relaxation response puts the body in a state of deep rest. Techniques include mindful meditation, repetitive prayer, focused breathing, progressive muscle relaxation, tai chi and yoga. Studies have shown significant short-term impact on stress symptoms, as well as profound long-term improvements. Immediate reductions in blood pressure, heart and breathing rate helps manage periods of acute stress. If practiced regularly, the relaxation response can also help decrease inflammation and stress hormone levels and improve insulin activity and gastrointestinal issues.
Types of stress
Acute stress, the most common form, is experienced by virtually everyone at some point. Arising from the pressures of current conditions, and anticipated ones in the near future, acute stress can be exciting, even motivating, but too much is simply exhausting.
Symptoms: Emotional distress, such as anger, irritability, anxiety or depression; muscular problems including tension headache, back or jaw pain; stomach and bowel problems; temporary elevation in blood pressure; rapid heartbeat; sweaty palms, heart palpitations; dizziness; shortness of breath.
Solutions: This stress is short-term and highly manageable. Techniques to slow your breathing and focus your attention, as well as walking outdoors or participating in sports, can all help dispel it.
Episodic acute stress is a fact of life for those people who are always rushed, late and dealing with a plethora of self-inflicted demands and pressures. This category includes “Type A” personalities – aggressive, impatient, short-tempered. Another type of person who feels episodic acute stress is the worrier – those with a pessimistic world view and a tendency to catastrophize every situation; likely to also feel anxious and depressed.
Symptoms: Persistent tension headaches, insomnia, migraines, hypertension, chest pain and heart disease.
Solutions: Lifestyle changes, such as daily physical exercise, meditation and mindful prayer, as well as expanding social support, can help. Additionally, consider consulting with a psychologist or other mental health professional, who can offer a range of treatment, from pharmaceutical to biofeedback. For example, insomnia, a considerable source of stress in adults, can be remedied with cognitive behavioral therapy, CBT-I, a structured program to help replace negative or obsessive thoughts that keep you up at night with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.
Chronic stress wears people down on a daily basis, often for years. Whether the cause is a dysfunctional family situation a bad career fit, people suffering from chronic stress often can’t see a way out.
Symptoms: Anxiety, insomnia, muscle pain, high blood pressure, weakened immune system; can contribute to the development of heart disease, depression and obesity.
Solutions: The most effective strategy is to seek help from professionals who can help you develop and implement lifestyle and behavior changes, recommend therapy, and prescribe medication when needed.
The post Stressed Out? A Guide to Signs, Symptoms appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Healthy Aging, Patient News
“Walking is man’s best medicine.” Hippocrates
Put away the handheld brain games and turn your focus from lifelong learning to lifelong walking. The road to sustaining brain health is an active one and taking that first step, followed by thousands more on a daily basis, can make an enormous difference in quality of life in your later years. Arthur Kramer, PhD, director of the Beckman Institute for Advanced Science and Technology at the University of Illinois, has amassed decades of research that clearly points to the prescience of Hippocrates’s ancient wisdom. His studies have become a focus of public health policy as well, sparked by 10,000 Baby Boomers crossing the over-65 threshold each day for the next 15 years, each hoping to age with vigor and dignity intact. We checked in with Dr. Kramer for an update on how physical activity keeps the brain healthy over the lifespan.
What are the most striking results seen in your research?
Our 2006 study was one of the first to report actual increases in brain volume in the prefrontal and temporal cortices of seniors who participated in aerobic exercise. These areas of the brain normally decline with age, but in our group, significant improvements in cognitive performance and memory were noted. We subsequently explored the impact of exercise on white matter, which allows information to be transferred within the brain, and found that connectivity is markedly improved, which is linked to more efficient memory, attention and decision making capabilities. All this points to the fact that age-related cognitive and brain changes are not inevitable, and can actually be reversed.
Why does exercise trigger these changes?
Several theories: increased blood flow, which improves cerebrovascular health; the release of proteins in the brain that stimulate the growth of new neurons; and the benefits of glucose and lipid metabolism which bring nourishment to the brain.
What type of exercise is most effective?
Only modest increases in physical activity are needed. Walking 40 minutes three times a week for a year, at up to 70 percent of maximum heart rate, resulted in increased volume of the hippocampus, a part of the brain responsible for memory. You don’t have to run marathons – just walk, bike or swim at moderate intensity.
Tell us why you joined an international group of leading scientists who posted a strongly worded statement on the Stanford Center on Longevity website as to the unproven efficacy of ‘brain games.’
We felt that the scientific literature does not support claims made by the manufacturers of software-based brain games…that these can make people smarter, more alert, able to learn faster, and even prevent or reverse Alzheimer’s disease. What we discerned from the research was that when people practice a task repeatedly, they will get better at that task, but it is not necessarily applicable to real-world functions. The relationship between brain training games and real-world performance and cognition needs to be explicitly tested. Unfortunately, this is rarely done. Further, time spent on brain training can be better used for activities we know improve cognitive functioning – aerobic exercise, learning a new sport or a new language, staying socially connected. Our consensus was that the promise of a magic bullet detracts from the best evidence to date…cognitive health in old age reflects the long-term effects of healthy, engaged lifestyles.
As a contributor to the recent Institute of Medicine report on cognitive aging, what lifestyle modifications do you suggest?
Being physically active is unquestionably a top recommendation for enhancing cognition and longevity. We also noted the critical importance of reducing and managing cardiovascular disease risk factors; staying socially and intellectually engaged; getting adequate sleep and receiving treatment for sleep disorders as needed; and regularly reviewing health conditions and medications
that might influence cognitive health with a physician. What’s on your radar for future research? We are looking at what types of exercise lead to the largest cognitive and brain benefits. Dance is
particularly interesting because it’s physical, social and intellectually complex. Defining the optimal doses of exercise, and how these might differ with age, health and other factors are also a focus. We are working with children, who increasingly suffer from adult diseases like diabetes, due to obesity and inactivity. And we want to determine whether a combination of nutrition and exercise provides greater benefits than either of these factors alone. The definitive answers have not yet been found. We’ll continue to seek them out, to ensure we don’t just live long, but live well.
The post The Healthy Aging Brain: Making Strides by Taking Strides appeared first on Specialdocs Consultants.
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