by Specialdocs Consultants, LLC | Nov 20, 2017 | Healthy Aging, Medical Conditions, Patient News
In the not so distant past, age-related macular degeneration (AMD), characterized by a loss of central vision, was deemed just another unfortunate consequence of growing older. The gradual breakdown of light-sensing retinal tissue that results in a blind spot directly ahead has caused each generation to struggle with driving a car, reading a printed page or recognizing a friend’s face. As the population ages, the sheer number of people affected grows rapidly. Another case of AMD is diagnosed every three minutes in the U.S. More than 2.1 million Americans with advanced AMD now will grow to 3.7 million by the year 2030, according to the National Eye Institute, who warns the condition will soon take on aspects of an epidemic. A surge of clinical trials and investigative research aims to prevent that from happening, with sights set firmly on restorative, curative solutions.
Scientists exploring the possible causes have made much progress isolating a group of genes that increases the likelihood of an individual developing AMD. Other studies point to inflammation as the trigger. The macula needs a constant, rich blood supply to work correctly, and any interference such as narrowing of the blood vessels, fatty plaque deposits, or a shortage of antioxidants, can cause the macula to malfunction and become diseased.
Treatments have likewise advanced. Last fall, a decades-old drug used to treat HIV/AIDS was reported in Science as unexpectedly exhibiting the capability to halt retinal degeneration. Nucleoside reverse transcriptase inhibitors, known as NRTIs, are already FDA-approved and can be rapidly and inexpensively translated into therapies for both dry and wet AMD (see sidebar), say the study’s authors. At the same time, a nanosecond laser treatment was successfully used to reduce drusen (small fatty deposits beneath the retina) and the thickening of Bruch’s membrane, both hallmark features of early AMD. Importantly, the structure of the retina remained intact, suggesting “this treatment has the potential to reduce AMD progression,” according to Medical News Today. Stem cell transplantation shows enormous promise, as reported in Lancet, with sight restored long-term to a group of patients with severe vision loss. Additionally, injectible drugs and pills that target inflammation associated with AMD are in nationwide trials.
Technological innovations to help AMD patients include the 2013 introduction of a miniature telescope implanted behind the iris to magnify images. Google is moving into the space with a patent for a contact lens containing a built-in camera that will enable audible warnings via a remote device, detect and describe faces, and act as a text reader.
Today’s AMD patients have no shortage of low-vison aids to help them adapt and live well. Google is developing a patent for a contact lens containing a built-in camera that will enable audible warnings via a remote device, detect and describe faces, and act as a text reader. Additional solutions range from ‘smart’ thermostats, watches and remote controls to talking devices.
Finally, understanding who is at risk for developing AMD can be key to prevention. These include: white, female, smoker, family member with AMD, high blood pressure, lighter eye color, obesity, and possibly, over-exposure to sunlight. To minimize risk, follow a healthy diet with plenty of leafy green vegetables and fish high in omega-3 fatty acids, exercise to keep weight and blood pressure under control, eliminate tobacco use, and wear sunglasses to protect from UV rays and high-energy visible (HEV) radiation.
When Dry Becomes Wet
Diagnosis of AMD is first confirmed with a visual acuity exam and testing with an Amsler grid. Those with AMD see the grid’s straight lines as wavy or blurred with dark areas at the center. Additional tests help determine the type of AMD — the dry form affects about 85 percent of AMD patients, and in about 10 to 15 percent of cases, progresses to wet. The difference is significant. The wet form usually leads to more serious vision loss, caused by new blood vessels that leak fluid and blood beneath the retina, resulting in permanent damage. While no treatment currently exists for dry AMD, in the last decade, a number of effective therapies have been implemented for wet AMD. These include monthly, intraocular injections (anti-VEGF) to inhibit a protein that stimulates formulation of new blood vessels, photodynamic or ‘cold’ laser treatment, thermal (heat) laser photocoagulation…and on the horizon are topical eyedrops that may someday replace injections. Nutritional supplements containing antioxidant vitamins, lutein and zeaxanthin are also effective in reducing the chances of dry AMD worsening to wet.
The post In Our Sights: Sharper Focus on Macular Degeneration Offers New Hope appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Nutrition, Patient News
In the multi-lettered world of vitamins and minerals, why did Vitamin D move to the top of the list…and should it be there? Following is a look at the paradox of the “sunshine vitamin,” critical to the body’s healthy function in numerous ways, but may not be important enough to warrant regular screenings, according to the latest national recommendations.
The undisputed connection between Vitamin D, the sun and bone strength was established early in the 20th century, when doctors discovered that sunlight triggers the production of Vitamin D and helped cure rickets in children. Essential for strong bones, Vitamin D helps the body absorb calcium. Unlike other vitamins, however, it is naturally present in very few foods (fish like salmon and mackerel, eggs, mushrooms and commercially fortified milk). Dr. John Cannell, who founded the Vitamin D Council to better advocate for its use, cautions: “It’s nearly impossible to get what you need from food.”
For many Americans, lack of sunshine except during the short summer season poses a concern because exposure to the sun is necessary to turn a chemical in the skin into Vitamin D. Even in sunny climates, people who spend most of their day indoors or faithfully apply sunscreen are at risk of Vitamin D deficiency, according to research that emerged in the 2000s. Low levels of the vitamin were increasingly linked to a litany of the world’s ills—cancer, heart disease, diabetes, arthritis, even depression. By 2012, researchers had discovered that Vitamin D receptors were found not only in the intestines, but in many other organs. “We know that basically every cell in your body has a Vitamin D receptor; it has been found in the brain, skeletal muscle, colon, breast, prostate, and the list goes on,” Dr. Michael F. Holick, a prominent expert at Boston University Medical Center, told Endocrine News.
Additional research bolstered the importance of Vitamin D, such as a recent British Medical Journal study that tracked more than 95,000 participants for nearly 40 years to find that genes associated with permanent low levels of Vitamin D raised the risk of early death by up to 40 percent. However, the study’s author cautioned that the relationship was not proven to be causal and therefore, no recommendations for supplements can be made.
The chicken-egg conundrum is explained by Dr. JoAnn Manson, Professor of Medicine at Harvard Medical School: “We’re at a crossroads because we really don’t know if there’s a cause and effect relationship between Vitamin D status and outcomes such as heart disease and cancer.” Obesity and lack of exercise contribute to higher rates of cancer and heart disease, so those factors could explain the illnesses, rather than a low Vitamin D level, she said.
In fact, despite the mountains of research, the U.S. Preventive Services Task Force (USPSTF) stated late in 2014 there is insufficient evidence to justify taking mega-doses of Vitamin D to prevent chronic diseases, and did not recommend regular testing of blood levels. All eyes are now on the national, 26,000-participant VITAL trial, which will conclusively report in 2017 the effects of Vitamin D or fish oil on reducing the risk of cancer, heart disease and stroke.
Different medical experts suggest different guidelines for Vitamin D supplementation. The Institute of Medicine’s guidelines state 600 IU (International Units) for ages 14 to 70, and 800 IU for age 71 and above; the Endocrine Society recommends 1,500-2,000 IU per day, and the Vitamin D Council advises “safe, sensible sun exposure, and if that’s not possible, 5,000 IU a day.” Please call my office for recommendations on the right amount of Vitamin D for you.
The post How Much Vitamin D Do We Really Need? appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Patient News, Staying Active
Every step you take is a physiological marvel, made possible by the 26 bones, 33 joints and over 100 ligaments of the foot working together to ensure maximum movement. The intricate sequence begins as your heel hits the ground, and ends with a push off the big toe at the same time the Achilles tendon lifts the heel, requiring a force that is about 50 percent greater than your body weight. Now consider that during a typical day, people spend about four hours on their feet and take 8,000 to 10,000 steps – that means the feet support a combined force equivalent to several hundred tons every day.
While feet were designed to propel you through life with powerful ease, many factors can affect function. Age, obesity, long periods of standing, certain diseases such as diabetes, some types of exercise, faulty foot mechanics, overuse or misuse of muscles, even ill-fitting shoes, result in pain that can sideline even the most determined walker. However, today’s treatment of choice – a combination of non-invasive measures and time – will get most people back on their feet without the complications of surgery.
Plantar Fasciitis, the most common cause of foot pain. Although it is known as jogger’s heel, there are multiple causes of plantar fasciitis, responsible for one million visits to the physician each year. Exercise such as dance and aerobics can contribute to plantar fasciitis, as can being flatfooted or having a high arch, carrying extra weight, or working in an occupation that requires frequent standing or walking on hard surfaces. The plantar fascia is a band of tissue from the heel to the ball of your foot that supports your arch like a bowstring; too much tension on it creates small tears. Repetitive stretching and tearing causes the fascia to become inflamed and irritated, and results in a stabbing pain felt most acutely in the morning or after any period of inactivity.
Physical therapy can help relieve the pain, which is often aggravated by tight muscles in your feet and calves. Exercises to stretch the plantar fascia and Achilles tendon and strengthen lower leg muscles are often prescribed initially. Notably, one of the most effective treatments for plantar fasciitis may also be the simplest. Patients who tried slowly raising and lowering the affected heel while standing barefoot on a stair or a box, 12 times every other day, reported a vast improvement in pain and disability in three months, compared with those who adhered to a standard regimen of pulling toes toward the shins several times daily. When performing that exercise, it is best to roll a hand towel and place it under the toes to increase the amount of flexion.
In addition to therapy, other conservative measures are recommended initially, including:
- avoid flat shoes and barefoot walking
- cut back on activities that may aggravate the
- condition (running, dancing, jumping)
- over-the-counter silicone heel shoe inserts
- short-term trial of anti-inflammatory drugs
Plantar fasciitis can persist, however, and additional treatment may include:
- single glucocorticoid (cortisone) injection
- molded shoe inserts (orthotics) or arch supporting shoes
- night splints
- cushioned walking boot
Fancy Footwork: Expert Advice to Keep You on Your Toes
Preventive stretching. Add conditioning exercises to your daily routine, such as rolling your foot over a golf ball for a few minutes to work the plantar fascia ligament, or tracing the letters of the alphabet with your feet. Wrap a TheraBand (a resistance tool) around the sole of your foot while sitting on the floor with your legs straight out in front, and flex and point.
Size check. The size of your foot can change over time, especially in women whose feet become longer and wider after pregnancy. Ask for a professional measurement the next time you shoe shop.
Find the right fit. Too-tight shoes weaken the muscles in the ball of the foot and the ligaments that hold the toes straight, causing corns, ingrown nails and bunions. Make sure your shoe is roomy enough to provide a finger’s breadth between its tip and your big toe.
Stand tall, naturally. High heels are the most common cause of foot pain among women, leading to corns, calluses, bunions and neuromas (pinched nerve or nerve tumor). Choose shoes broad in the toes, with a low wedge and shock absorbent sole.
The good news: almost 90 percent of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods, say experts.
The post Thinking on Your Feet: The Latest on Warning Signs from Below appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Healthy Aging, Patient News
While exercise has an undisputed key role in maintaining brain health throughout our lives, promising new research points to a number of other factors that can spell the difference between thriving or just surviving the senior years. We checked in with Eric Terman, MD, personal physician and Assistant Professor of Internal Medicine and Geriatrics at Northwestern University for an informed view of the latest thinking on this topic…important not just for current seniors, but also for aging Baby Boomers and for younger 40-somethings just beginning the “aging” process.
What are some of the key findings of current studies into how the mind ages?
Research shows that the brain continues to form new connections throughout life. This process, called adult neurogenesis, shows how plastic or structurally adaptable the brain is, even as we age. A combination of exercise, diet and stimulating environments can increase adult neurogenesis and improve cognitive functioning in young and old individuals. This has been documented in animals and we are seeing increasing evidence this occurs with humans too.
What role does exercise play?
We know exercise appears to increase the neurogenerative properties. While the cause is not clearly proven yet, there is little doubt that exercise benefits both body and mind in many ways. It is associated with reduced risk of dementia, and may actually be preventive. For these reasons, I almost always recommend a form of regular activity to my patients.
Do you advise your older patients to consider retirement for reduced stress, more time for leisure activities, etc?
It’s critical to stay engaged in something you care about, whether or not you’re earning a significant salary. The brain stays sharp if you continually grapple with problems, find solutions and achieve positive outcomes.
Wouldn’t lifelong learning classes and lectures fill that void?
Sometimes listening to a lecturer can be barely better than watching TV in terms of passive versus active involvement of your brain. Unless you’re reading textbooks and writing papers, you’re better off with the type of engagement you receive from working. It’s the same reason the benefits of brain training games are unclear – problem solving for real world issues results in better cognitive capacity.
Can you explain mindfulness-based interventions and how these work to reduce the severity or risk of diseases such as Parkinson’s and Alzheimer’s?
High levels of stress are associated with increased risk of these diseases, and with mild cognitive impairment. Mindfulness-based interventions such as meditation and yoga are non-invasive stress reducers, and proven effective complements to treatments for anxiety, hypertension, chronic pain and insomnia too. Preliminary research is also showing that mindfulness-based interventions reduce atrophy of the hippocampus (a critical site of episodic memory), increase gray matter and improve functional connectivity in the neural networks of the brain most affected by the disease process of Parkinson’s and Alzheimer’s.
What is the best way to get started with this kind of program?
There are formal meditation programs and yoga training activities, as well as some excellent apps that take you through the process, such as Headspace.
What advice would you give seniors looking for ways to keep their brain and spirit vigorous as they age?
Find something to pursue that keeps you actively engaged and that you love to do if you formally stop working. Definitely, keep moving – I have patients who have started exercise programs in their 70s and they see significant differences in the way they feel. Modify your sleep behaviors if needed to ensure a good refreshing sleep, every night. And while the effect of a strong social network may be somewhat of a chicken-egg conundrum, there is increasing evidence that social and mental stimulation strengthen connections between nerve cells in the brain.
Breakthrough research sheds new light on Alzheimer’s disease
Numerous studies of Alzheimer’s disease, the leading cause of dementia that gradually erodes a person’s memory, thinking and ability to perform everyday tasks, are beginning to provide answers as to causes and possible targets for treatment. For instance, the link with cardiovascular disease has become increasingly evident. Several conditions known to raise the risk of cardiovascular disease, including high blood pressure, diabetes and high cholesterol, also increase the risk of developing Alzheimer’s – as many as 80 percent of individuals with Alzheimer’s disease also have cardiovascular disease, according to the Alzheimer’s Association. Experts have noted that while some people develop brain plaques and tangles seen in the disease, they do not suffer from the symptoms of Alzheimer’s unless vascular disease is also present.
Other new research is focused on the blood-brain barrier (BBB), a protective filter of the brain that becomes more damaged in patients with Alzheimer’s disease. At University of Southern California, neuroscientist Berislav Zlokovic and team found that the BBB becomes leaky with age, starting in the hippocampus, an area that is affected before the symptoms of Alzheimer’s disease are seen. He noted that specialized brain scans might help doctors diagnose the condition earlier. “Dr. Zlokovic’s advances bring us that much closer to a cure,” reports the chairman of the Cure Alzheimer’s Fund.
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by Specialdocs Consultants, LLC | Nov 20, 2017 | Nutrition, Patient News
Let food be thy medicine and medicine be thy food. – Hippocrates
Food’s healing properties is a concept that stems back to the earliest days of medicine, but has taken on new significance as a natural way to prevent or manage today’s most devastating illnesses, from dementia to heart disease. The regimens presented below are not ‘diets’ in the traditional sense, but rather represent a shift to eating habits that preserve wellness.
DASH (Dietary Approaches to Stop Hypertension), a low-sodium diet that encourages consumption of foods rich in nutrients such as potassium and calcium magnesium that help lower blood pressure, prevent diabetes and support heart health.
The Mediterranean diet emphasizes fish, fruits, and vegetables, with olive oil as the main source of fat, has gained prominence for its link to stronger bones, a healthier heart and reduced blood pressure.
Combining both of the above, the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, from Rush University Medical Center, shows real promise in helping patients maintain cognition and reduce the risk of dementia. Seniors who rigorously adhered to the recommended foods lowered their risk for Alzheimer’s disease by 53 percent, but even those who followed it only moderately well experienced a 35 percent reduction, according to newly published research from the Health and Retirement Study. The focus is on eating ‘brain-healthy’ foods, including:
Green leafy vegetables, such as spinach or kale – at least six servings weekly
- Other vegetables – at least one serving daily
- Nuts
- Berries – at least twice weekly
- Beans – at least three servings weekly
- Whole grains – three servings daily
- Fish – at least once weekly
- Poultry – at least twice weekly
- Olive oil
- Wine – once daily, if desired
Excluded: red meat, butter, margarine, cheese, pastries, sweets, refined sugar or flour, and fried or fast food. Eggs and dairy are included but in small portions.
Additional research points to the role of a high quality diet in preserving brain health and maintaining cognition. However, MIND study lead author and nutritional epidemiologist Claire McEvoy, Phd, cautions that to conclusively prove the connection between diet and dementia risk, the next step is to conduct clinical trials. In the meantime, experts say there’s no harm in incorporating these foods into your daily diet, as they provide antioxidants, assist with maintenance of normal blood pressure levels and help keep chronic inflammation in check.
Other plans worth considering:
Weight Watchers: still a smart, effective diet after 54 years. It’s rated high by dietitians for ease of adherence, nutritional soundness, emphasis on group support, abundance of fruits and vegetables, and allowance for occasional indulgences.
Mayo Clinic Diet: consisting of a two-week jump start for weight loss, followed by a lifelong approach to diet and health, with information on food choices, portion sizes, menu planning and physical activity. The emphasis is on generous amounts of low-energy-dense foods that help you lose weight by feeling full on fewer calories, and includes whole-grain carbohydrates, lean sources of protein and unsaturated fats. At least 30 minutes of exercise is recommended daily. A typical 1200-calorie-a-day menu includes:
- Breakfast: 1/2 cup cooked oatmeal with 1 cup milk and 2 tablespoons raisins, 1/4 cup mango, calorie-free beverage
- Lunch: Quinoa and sweet potato cakes, tossed salad with fat-free dressing, calorie-free beverage
- Dinner: 1 pita pizza, 3/4 cup mixed fruit, calorie-free beverage
- Snack: 1 cup sliced bell peppers and 2 tablespoons hummus
The post MIND Your Diet appeared first on Specialdocs Consultants.
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.
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