Health Education

A Better Colon Cancer Screen - and I try not to be cynical

I am NOT cynical about the alternative cancer screen - only about its near absence in any of the literature we see in the USA about preventing colon cancer. A study that was printed in the journal Lancet this past week, involves the use of a flexible sigmoidoscope, in screening for polyps which often precede colon cancer. In the UK, the standard colon cancer screen is a fecal blood test every other year - at home -this is for persons between the ages of 60 and 74. I recall writing about the use of the blood test in the USA several years ago and that it IS effective in reducing incidence of colon cancer. In the research study, which I have read, nearly 200,000 people were randomly assigned to a control or intervention group. Years later, the groups were compared for colon cancer outcomes. The intervention group (when complying) had the sigmoidoscopy and the control group did not. There was a significant difference in the number of persons who got cancer and who died from cancer between these two groups, but NOT between men and women. During the screening, small polyps could be removed, if larger ones were discovered, a colonoscopy was ordered. The study conclusion is this: Flexible sigmoidoscopy is a safe and practical test and, when offered only once between ages 55 and 64 years, confers a substantial and longlasting benefit. The test or screening used in this study is much less invasive and expensive that the more common colonoscopy used in the USA after the age of 50. It is certainly safer than the CT scan - which exposes the person to radiation. There are additional studies on the effectiveness of this test, both published and on going. In a news story about the research, it was noted that the American Cancer Society does recommend several different options for colon cancer screening, including the blood fecal test and this flexible sigmoidoscopy - but to tell you the truth, I have never heard of it and I READ ALOT. I will tell you also that in the news story I read, it was stated that the US hardly ever uses this test in deference to the colonoscopy which the reporter noted lasted 20 minutes and was conducted under sedation. The reporter went on to say that there was NO RESEARCH to prove that this procedure was best for screening. In other words, the procedure removes polyps best, but maybe a lot of people are going through it that do NOT need to have polyps removed. Also, the researchers for the study I am addressing today stated that this test only needs to be completed once and that if polyps have not formed by ones 60s they won't. I can assure you that this information is informing my decision about colon cancer screening and that, as no one in my family has had this disease, I will likely wait until age 60 and opt for this flexible sigmoidoscopy test. I cannot link you to the complete study as I accessed it through a secure site, but <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60551-X/abstract">here is the summary </a>which tells you about the study and has the proper citation.

A Better Colon Cancer Screen - and I try not to be cynical

I am NOT cynical about the alternative cancer screen - only about its near absence in any of the literature we see in the USA about preventi...

4:47 PM

Cape Wind Approval

Not too long ago I <a href="http://yourhealtheducator.blogspot.com/2010/04/environmental-health-it-is-earth-day.html">posted</a> about wind farming "off shore". In that piece I noted that Europe had more of both on and off shore wind farms then the US. I had found only one mention of a US off shore farm - in the Nantucket Sound - at least a proposed one. <div align="left">As it turns out - it has not yet been created and only today received the go ahead from the US Interior Secretary. It looks like many legislators in Massachusetts are in support of the wind farm, but it could still be a long way from actual development. There are many other approvals that Cape Wind Associates will have to receive and then there is the financing. Still, today was monumental for some. </div><div align="left"> </div><div align="left">The official approval also means that those opposed to the wind farm can file lawsuits. As I read about the decision, in print and on line - I again was hard pressed to find the environmental risk factors, as I know that they exist. People were NOT complaining about that however. Residents in the area are upset about the view and the obstruction of view and some people are upset about how the structures will impact boating and other water activities, and a few local Indian tribes are concerned about rituals and burial grounds, but very little is said about how it will harm the marine environment - which is my concern.</div><div align="left"> </div><div align="left">I did find information eventually and there is a coalition against the offshore farm. There are several organizations working together to bring attention and perhaps suit with regard to this development. There is an umbrella group called the Alliance to Protect Nantucket Sound. They address the aesthetic and financial impact the project could have, but they also discuss environmental impact. BTW, wind turbines use oil and could also leak. Anyway, if you are interested in how this alternative energy solution can create problems itself you can read about it<a href="http://www.saveoursound.org/site/PageServer?pagename=CapeWind_Threats_Environment"> here.</a> </div><div align="left"> </div><div align="left">Again, I am in support of alternative energy and fuels and even wind farms, but not in our oceans.</div>

Cape Wind Approval

Not too long ago I posted about wind farming "off shore". In that piece I noted that Europe had more of both on and off shore w...

4:56 PM

I Cannot Tolerate That

For the sake of brevity, tonight I will offer an observation/opinion. It appears to me that the companies which sell psychotropic or mood altering prescription drugs have done such a fine job in marketing them, that a mind shift has occurred in the USA and elsewhere. The mind set of many people and young people are included - seems to be this - I can't tolerate any discomfort, I won't tolerate any discomfort and I DO NOT HAVE To... These very powerful medications are meant to be used when a true neurotransmitter problem is evident. This could mean that chemicals are not being released or that chemicals are not having the effect that they should - but to take medications to override the natural circuits of the brain because life is difficult this week is NOT the smartest response. In other words, being anxious because a job or relationship is changing does not mean you are mentally ill - isn't that a relief! Indeed, sometimes having to being uncomfortable - and learning that you can be uncomfortable - is the best thing that can happen to a person.

I Cannot Tolerate That

For the sake of brevity, tonight I will offer an observation/opinion. It appears to me that the companies which sell psychotropic or mood a...

5:00 PM

Vitamin D - the sun - the good, the bad, the extra

Yesterday afternoon, my coworkers and I were taking a little stroll and along the way we discussed Vitamin D benefits, the sun and the risks to our health from sun exposure. I told them that I was very careful now to also cover my head to keep the sun from frying my hair and my scalp. We reminisced about putting lemon juice and oil treatments in our hair and I shared that I used to be excited about the red highlights that I would gain each summer. One of the women I work with who was not walking with us yesterday actually had a biopsy taken recently because of a suspicious area on the top of her head. The other day at the pool, she had on a visor NOT a hat - and she is one of the reasons I wear a hat. I have been keeping sunscreen on my face as well, since a wise, older running buddy pretty much besought me to do so – for wrinkle prevention! That got my attention the most. In the last year I can say that I have been paying more attention to other people’s habits and how they are aging – both internally or physically and externally – meaning their looks. I live in Florida so there are a lot of people to observe! Smoking and sun exposure are clearly the biggest age accelerators with regard to skin. Inactivity is the greatest ager with regard to functional ability. About a year ago, I blogged about sun exposure and that the FDA was looking at labeling changes for sun screens – I expect that the label rules will be finalized during this year, 2010. I believe that they will be as previously suggested – 50 SPF cap and removal of the phrases sun block and water proof. The benefits of Vitamin D also remain constant in the literature. They are bone health, heart health, mood enhancement and reduced risk of some cancers. It is said that 15-30 minutes of sun exposure two to three times a week would generate the right amount of vitamin D for health. There is a raging debate within the field of dermatology however and very few will ever recommend that one gets Vitamin D from the sun. The irony is this – my friends and I discussed this Monday and the WSJ had a feature piece on it Tuesday. In that article there is a good explanation of UVA and UVB rays. It is the UVA that DO accelerate aging by penetrating the skin and damaging the tissue enough to cause sagging – OM GOSH – and the UVB is more often the cause of skin cancer. Tanning booths, which I have been 100% in favor of banning since 2006 – have a lot of the UVA – want to tell those 20 something girls that they will look old before their time – they will likely be more worried, just as I am, about looking old than getting skin cancer. There are many factors involved with regard to sun exposure – the individual complexion, the geographical location – etc. Burning is certainly the biggest concern for the DNA damage that precedes skin cancer, but to be clear – the browning of the skin is also a symptom of damage. Finally, Vitamin D is available in supplement form and many people would benefit from taking it. Next time you are at the doctor’s office you might inquire about this. The extra for you is <a href="http://www.aad.org/media/background/news/Releases/New_Research_Finds_Six_Factors_Predictive_of_Melan/">this link </a>to another article which lists some factors that seem to be the most serious risks for melanoma. Melanoma is the rarer skin cancer, but the lethal one. The dermatologist who is featured here is a professor at NYU.

Vitamin D - the sun - the good, the bad, the extra

Yesterday afternoon, my coworkers and I were taking a little stroll and along the way we discussed Vitamin D benefits, the sun and the risks...

4:54 PM

Alcohol and Breast Cancer Recurrence

I learned from a family member that women who have been diagnosed and treated for breast cancer are advised by their oncologists to limit alcohol intake as it could increase the risk for recurrence of the cancer. Breast cancer can be related to genetics but there are also several lifestyle factors that increase risk. These risk factors are the same for recurrence. They include but may not be limited to being overweight, not exercising and consuming alcohol in excess. For those of us who do not have breast cancer, the recommendation for alcohol consumption includes no more than one drink a day or seven per week. I have said it before and it is important enough to repeat - one drink is 12 oz of beer, 4 oz of wine or 1.5 oz of liquor. I have found several references to one research study in regards to alcohol consumption AFTER treatment for breast cancer and in that study the threshold for risk was much lower. The final recommendation after the nearly 2000 breast cancer survivors were followed for eight years, was that more than three glasses a week was harmful. The women in the study were mostly wine drinkers, but experts suggest that the same would hold true for beer or liquor. In the study, over a third of the women who drank more than three glasses of wine a week did have a recurrence of their cancer and over 50% of those women died from the disease. WHY? Probably because alcohol can increase the levels of estrogen in the body and estrogen fuels many types of breast cancer. In a Web MD article, oncologist Jeffrey Peppercorn from Duke University states that it is not clear that ANY amount of alcohol is safe and so it should be limited to rare occasions in this population.

Alcohol and Breast Cancer Recurrence

I learned from a family member that women who have been diagnosed and treated for breast cancer are advised by their oncologists to limit al...

4:47 PM

Odds and Ends

Tobacco News - First quarter results were released this week for both Phillip Morris and Reynolds American. In spite of a national tobacco tax increase last year and a nearly universal state tax increase that followed - both companies are reporting profits. According to a WSJ piece, PM made over a billion in profit from last year and Reynolds, the second biggest of the two, made about 82 million. At the same time, sales of smokeless tobacco products are showing an increase while cigarette sales are down, but less than one percent. Tobacco control experts continue to argue on whether or not smokeless tobacco, including the new non traditional Orbs, Strips and Sticks, have a place as reduced harm products. NOP- This stands for National Organic Program. If you live in the USA where labeling of organic products is a little less strict than in some other countries, I encourage you to look for the words <a href="http://www.usda.gov/wps/portal/usda/usdahome?navid=ORGANIC_CERTIFICATIO&navtype=RT&parentnav=AGRICULTURE">USDA /Organic </a>on the product, if you are choosing to buy organic. At this time, there is not substantial evidence to support that organic foods provide a health benefit over non organic, though some produce have been deemed to be the type of food that is worth the extra cost. Green - If the organic standard is lax, the eco friendly one is almost non existent. Currently the Federal Trade Commission is evaluating some companies for labeling that seems to imply environmentally safe or friendly products which aren't There are also some law suits pending over misleading advertising on products. Stay tuned for more - or research the company before you spend the extra dollar. Drug Trials - I believe that I have shared here that drugs that are sold in the USA must first be approved by the FDA which can occur after a certain number of drug trial PHASES. Phase 1 involves testing the drug on generally healthy people to see if it is tolerated. Phase 2 and 3 are used for efficacy, dosing and more intense side effect evaluation. Though I had told you that drugs can only be advertised and marketed for that which was approved, I did not realize that the studies that provide new indications are Phase 4 trials. An example of a drug that went through a Phase 4 study is wellbutrin or buproprion. This is an anti depressant that is also sold as Zyban to treat tobacco dependence. French Fries - I usually talk with my Aunt Lyna on the weekend. She is my father's only living first degree relative (he isn't living either). I think I said that right. My dad used to call her every Sunday. Now I think our talking together helps us to both feel close to him and to each other. My Aunt is nearly 85 years old and the opposite of my 81 mother who continues to waitress five days a week. My aunt is one of the frail elderly. She is in significant pain from rheumatoid arthritis, is a breast cancer survivor, has osteoporosis, takes more pills that I can count and is a recent widow. She does still live independently however and meets all her own needs, including transpiration and shopping. Oh, she is in CT and I am in FL. She may weigh 110 pounds. When I called her today, she said her dinner was almost ready. I asked what she was having and she said, slowly - w/ martini induced speech ( :)) Lamb chop..... Asparagus.... French Fries. I laughed out loud. She said, " I knew you would laugh." I am sure they are baked fries, but you know what? If anyone gets to eat french fries, it is my Aunt Lyna. good night - hope your week starts well...

Odds and Ends

Tobacco News - First quarter results were released this week for both Phillip Morris and Reynolds American. In spite of a national tobacco ...

5:01 PM

Who Knew? (omega 3)

In previous posts I have talked about the proven and suspected benefits of 0mega-3 fatty acids. I have also noted the best sources for this great anti inflammatory substance – namely fatty fish and fish oil supplements. At the same time, I have tried to steer you away from processed foods that say they have omega- 3s in them – foods that have been fortified. I tell you this because the amount in the more expensive product is in milligrams and the amount that improves health is in grams. Meanwhile, I have come across a grain/legume that is one of the few plant based sources of ALA (the right kind of omega 3) that does provide benefits similar to marine derived omega-3s. I had not heard of this before I saw a little note on it in a Runner’s World article and then – after fact checking through the website of Dr. Andrew Weil – I realized I had heard of it. I am referring to chia seeds – as in the “ch ch ch chia” pet! You may have heard of flax seed or flax seed oil – I had even tried some for a while, but the benefits to health were much lower than from fish oil so I switched to that – until deciding that my eating fish once or twice a week was okay – as I do not have any risk factors for heart disease. Oh – now that was tangential. Anyways, flax seed seemed to be all the range a few years back. What many people did not know is that unless it was ground flax seed, the omega three benefit, though slight anyway, was nonexistent in the whole seeds. Chia seeds are superior for two reasons then. They have more antioxidant value and have it whether they are ground or not. They also swell and make a little gel when they get wet, in a dish or in your stomach. For this reason, they are great to stabilize glucose levels which keep you feeling full longer and prevent blood sugar spikes. They are sort of an anti Twinkie. Both flax seeds and chia seeds are high in fiber – something salmon lacks! Chia seeds are similar to peanuts with regard to calorie content – a little less per ounce than the flax seed. If you do decide to add them to your yogurt, for instance, just remember that you are adding (good) calories as well and if you do not want to gain weight, you will have to subtract those calories somewhere else. In fact, you can read all the nutrient info at the <a href="http://www.nal.usda.gov/fnic/foodcomp/cgi-bin/list_nut_edit.pl">USDA website</a> – as you will see, 1 oz has about 140 calories. From Dr. Weill I learned another interesting thing – which goes back to the first part of this blog. Remember that some foods, like eggs and other non marine foods, have label claims of omega 3 fatty acids – I wasn’t exactly sure how the foods became rich in omega 3s but assumed some fortification was taking place like our flour and cereals are embellished. I do think that I had also been aware on some level that animals are given supplements. Dr. Weill notes that chickens are fed CHIA SEEDS and thus make eggs with omega 3s, oand cows are fed the seeds and TADA 0mega 3 milk. Food manufacturers also add the seeds to their already made products. Well – I would bet that it would be cheaper to just add them yourself! My suggestion is to add them yourself. I wonder if chickens who are fed chia seeds feel fuller and have good blood sugar control.

Who Knew? (omega 3)

In previous posts I have talked about the proven and suspected benefits of 0mega-3 fatty acids. I have also noted the best sources for this...

5:59 PM

Accountability

The Council of Medical Specialty Societies which contains 32 separate organizations has come out with a joint statement regarding the use of pharmaceutical company funding. As you might expect, the drug industry has direct and indirect influence on clinical practice by paying scientists and practicing physicians in various ways. Research studies can be fully or partially funded, universities can receive endowments, clinicians can be paid to speak to others about certain drugs or medical devices, dinners can be provided to offer a nice setting to present new research and products. On the lower end, offices can receive products to use everyday – which come with the drug or drug company logos. What is especially disconcerting is how the drug industry can influence best practice guidelines. In other words, their funding and kick backs can lead to a protocol for treating disease which may turn out to be - well – not best. Some practice guidelines that are prescription heavy – and may or may not be examples of influence – involve the treatment of heart disease (cholesterol), osteoporosis (osteopenia) and tobacco dependence. Just last week I read a brief on a study that showed that the more aggressive use of medicines to lower cholesterol was NOT more effective than moderate changes in diet and exercise. This is the type of post market comparative research we need. We have gotten to the point of thinking that drug benefit managers who limit our use of prescriptions are the enemy – when in fact, it may be drug companies who are manipulating us. With respect and reservation – as the research and development that goes into drug creation can indeed lead to life saving chemical interventions and for that I do offer deference. I applaud any industry, as the one mentioned above, that strives towards openness and independence in regards to the delivery of health care.

Accountability

The Council of Medical Specialty Societies which contains 32 separate organizations has come out with a joint statement regarding the use of...

7:28 PM

Environmental Health (it is Earth Day)

I recently heard someone speaking about wind farms in regards to an option for generating energy. The person was on CNBC I believe and when she was asked for a final comment, she said that the only negative about wind farms were NOT having them. I did not find anything wrong with that statement. More recently, I came across a story about a big expansion in wind farming - I believe it was a Swedish proposal - and I had to do a double take when I was reading - as it said offshore wind farming. Offshore? Off shore - as in off shore oil drilling - as in "in the ocean?" I was (am) very concerned to hear about this. Certainly there is not the risk of oil spill or the pollution that is associated with other fossil fuel production - even on shore, but here again - we are exploiting an ecosystem. There is no way that building a structure and embedding it in the ocean floor will not disrupt the life cycles of countless species of marine life. I am surprised that I had not caught this before - as offshore wind farms are not a future plan, but a past, present AND future one. There are many off the coast of the UK and also off land from France, Portugal, Spain- Sweden make have the biggest off shore wind farm in Europe and in the USA one is planned, if not begun, in the Nantucket Sound. WOW. Yes the turbines generate a great deal of clean energy - I LOVE that part - but what of their adverse environmental impact? In fact, there is a term for what I am referring - EIA - or an Environmental Impact Assessment. Some countries require that the EIA be completed before a permit will be granted. In some cases, the studies are ongoing - and occur while the wind farms are created and used. In other words, well, let us build it and see what happens. It is less invasive to US (people) - it is not something we see or hear in our backyards - but it is certainly not neutral. At this time - looking into the matter just briefly, I see more reports on how to do an EIA than I can find results of one. Instead, there are guidelines on what to look for and examples of how it is less harmful than some other measures. A report that reports ocean based wind farming as nearly risk free comes from the Ocean Energy Council, but that is a group that wants to use the ocean for energy. I would like an independent source. Don't think for one minute that the brilliant scientists across the globe do not already know exactly what could happen - I just don't want something positive to cause something catastrophic for the aquatic world. And yes, it is a personal issue. We take things out (oil, orcas and more), we put things in(fuel,trash, emissions, ourselves) - we need to leave it alone....

Environmental Health (it is Earth Day)

I recently heard someone speaking about wind farms in regards to an option for generating energy. The person was on CNBC I believe and when...

4:29 PM

A Drug Maker's Dream

I am appalled to think that thousands of women will begin to take one of two medications that have a significant risk profile with the intent of preventing a certain type of invasive breast cancer. (which is a current news story) Research exists to suggest that tamoxifen and Evista are both able to prevent some cases of breast cancer. The newest research involves a head to head study of the two. In the study from Pittsburgh, it is reported that 50% of the women on the medications did not get invasive breast cancer during the study. Evista was somewhat more effective than the older tamoxifen. Both drugs carry the risk of clotting, stroke and uterine cancer. I would like to see a study that compares the same group of women and includes weight loss and exercise as preventative measures. I cannot imagine taking one of these medicines as a preventative measure when the chances of getting the disease are not that high and the chances of dying from it are even lower. This is similar in my mind to the osteopenia situation. Taking a drug to treat a condition that is pre pre risk factor or some such thing. Now if the tens of thousands of women with a genetic or familial risk for breast cancer( like myself) were to go on these medicines, the drug companies that own them would see a substantial growth in profits.

A Drug Maker's Dream

I am appalled to think that thousands of women will begin to take one of two medications that have a significant risk profile with the inten...

6:02 PM

Headline Misspeak

I don't know if these articles I read make me smarter or completely boggle my senses. In any case, I saw a news story by a Julie Steenhuysen, a Reuters reporter, with the title, Gene makes people fat, raises Alzheimer's risk. She was reporting on a study that has been published that links a variation in the FTO or fat mass and obesity gene with brain tissue loss. Her article then provides statements attributed to the study author, Paul Thompson who specifically did NOT say that the gene makes anyone fat. But let us back up a little first. The gene in question is part of all of our make ups and is found on a certain chromosome. Scientists are studying the FTO for all the reasons you might imagine. Obesity is a real and significant health and economic concern for several countries AND anyone that can come up with diagnostic tools and pharmaceutical treatments to address it is going to make billions. Several variants to the gene have already been identified and associated with certain outcomes. Some information is available at the <a href="http://www.universityofcalifornia.edu/news/article/23228">UC - LA website</a>. People with variations in this gene - (and ethnicity is a factor) tend to weigh more than people without the variant (all other things controlled). The extra weight on average is LESS than ten pounds. This is not "gene makes you fat." Scientists like Paul Thompson have been consistent and clear - people who have this particular obesity related allele are NOT advised to throw up their hands and ignore the exercise and weight management recommendations. Other studies have shown that people who moderate their calories and exercise daily, but have this variation, are NOT obese. The newer research however, is showing that some persons with the FTO variant also have brain tissue loss - or shrinkage. This puts them at risk for a dementia related disease. Whether or not a person has the genetic predisposition, exercise is recommended to prevent loss of cognitive functioning, so again, ALL persons should engage in near daily exercise. Being at risk for something because of a gene is not the same thing as being destined for that outcome. No matter what metabolic condition occurs, in 99.9% of us - the problem is too much energy in. Additionally, lack of exercise is disease promoting whether one is overweight or not. In fact, Dr. Thompson's study found that very thing. The people with the variant FTO had less brain mass whether fat or not. It has already been found that obese persons have accelerated cognitive losses - so, the answer in this new group is EXERCISE. On the UC Newsroom website - this quote is attributed to Thompson: "Half of the world carries this dangerous gene. But a healthy lifestyle will counteract the risk of brain loss, whether you carry the gene or not. So it's vital to boost your brain health by being physically active and eating a balanced diet."

Headline Misspeak

I don't know if these articles I read make me smarter or completely boggle my senses. In any case, I saw a news story by a Julie Steenhu...

4:24 PM

Tumor Analysis

This morning I read a brief news statement about a lung cancer clinical trial referred to as<a href="http://clinicaltrials.gov/ct2/show/NCT00409968"> BATTLE </a>that is underway at the M.D. Anderson Cancer Center in Texas. I have since contacted the reporter, reviewed the study website, read the study particulars on the US Institute of Health website for clinical trials, skimmed over several scholarly articles and then, read an article by another reporter which HAD the piece of information I needed in order to proceed with this post. The study is a promising one which is addressing the treatment of the deadliest cancer - cancer of the lung. In the Anderson study, persons who have late or end stage non small cell lung cancer (nsclc) and who meet certain inclusion criteria - including having been through one course of first line treatment - (FDA approved medication for lung cancer treatment) - which did not slow or stop the progression of their cancer are entered into part one of the study, or the umbrella phase. All of the persons have tumors ( small cell lung cancer, the most common one for smokers, tends to be diffuse) and these tumors are biopsied. Each tumor has characteristics and based on those characteristics, the volunteers are placed into one of four groups for part two of the study. This is a Phase II drug trial. They are put on a study medication for 8 weeks and then the tumor characteristics are reviewed again. A successful outcome is when the disease does not progress and people do not die. If progression has occurred, the person is taken out of the study and allowed to go on to receive standard treatment through their own provider. I understand that tumors can have different fuels and expression - we often hear a distinction between estrogen receptor positive or negative breast cancer. That is what I was trying to find out with regard to this study. So yes, lung cancer tumors can be fueled by different proteins, can be a result of expressions of certain genes, or be caused by a mutation on a certain gene. It is this distinction that the scientists make before putting the patient on one of the study drugs. Some success has been noted already with certain medications and tumor types. The study is not complete and full disclosure is pending. I wonder if the tumor histories are used to tell what type of nsclc a person has. I also wonder if tobacco use is allowed during the study and if the patients were tobacco users. I did not see tobacco use as an exclusion for the study, but I did see this statement: Any condition that is unstable or could jeopardize the safety of the patient and its compliance in the study, in the investigator's judgment. I would consider smoking during treatment of lung cancer something that could jeopardize safety - wouldn't you? This is a promising study - but to be clear, most persons with advanced stages of lung cancer do not live past a year. In the second article I read, it was noted that of the people in the study receiving this personalized approach to care, 38% survived to one year. I read that as 58% died. And nsclc is supposed to have a better survival rate that small cell lung cancer. I would like to know if the type of nsclc was determined, as there are three - adenocarcinoma, squamous cell carcinoma and large cell carcinoma. Do the proteins, mutations,or expressions determine that categorization or are their various biomarkers within disease type as well? Perhaps this will be answered when the study is published - if not - I will seek answers from a cancer organization. Over 80% of lung cancer is caused by tobacco smoke - the most common nonsmoker lung cancer is the nsclc described here - however, even that type is most often caused by smoking.

Tumor Analysis

This morning I read a brief news statement about a lung cancer clinical trial referred to as BATTLE that is underway at the M.D. Anderson C...

5:06 PM

Odds and Ends

Wow that was a fast week! Kudos! I have noticed an older woman walking in the mornings when I go out to run or ride my bicycle (yes - warm enough to bring out the bike, not yet warm enough for my morning swims). Just the other day, I saw this same woman walking when I got home from work. I said, "Wow - two a day - that is awesome!" I said this because people need to be caught doing RIGHT things. She then explained to me that she had arthritis and she had bad circulation and was stiff. Her doctor told her that she needed to walk often. I was stunned. "Wow! You actually listen - that is very, very smart." Kudos Number Two: I was at the grocery store today and as I was coming down the condiment aisle, two teen aged girls, appearing to be sisters, were choosing a salad dressing. A woman who appeared to be their Mom was standing by. The girls were looking at Ranch dressings and one was trying to convince the other that they should get the fat free one. One sister was NOT in favor of this, but the other held out the dressings and said 80 calories - 30 calories. She was doing her best to point out that 50 calories was a significant difference. As I walked by, I said, "don't give up!" [personally I buy the Walden Farms near calorie free dressings, but all stores do not carry that brand] A Billion Dollar Industry: I read a bit of a medical update in regards to diagnostic testing for Alzheimer's disease. More than one company has a test in clinical trials that is meant to give a definitive diagnoses of this brain wasting disease - prior to death and autopsy. The idea is to have a test that can light up a PET scan or functional MRI . The areas in the brain that light up would be those with the plaque that many scientists say are the cause of the brain destruction. In the studies, the tests are done on a person with a tentative or suggested Alzheimer's diagnosis and then when the volunteer dies, the autopsy is compared. Because so many cases of Alzheimer's Disease (AD) are expected in the coming years, the company that has the most sensitive test is going to bring in billions of dollars. There is some evidence to suggest that <a href="http://www.alzheimersprevention.org/intro_4_pillars.htm">AD is preventable </a>- I suggest looking into THAT! And that my friends, is all the odds and ends I have this time!

Odds and Ends

Wow that was a fast week! Kudos! I have noticed an older woman walking in the mornings when I go out to run or ride my bicycle (yes - warm ...

5:00 PM

YUMMY !!

Let me share three new products with you - though one of them may just be new to me, the other two really are new. First, a vegetarian protein option - a new "burger" from Morning Star, found in the frozen food section - often near the waffles. This one is called Grillers California Turk'y and has 90 calories, 5 grams of PUFA (good fat) and 9 g of protein. It is a pattie that actually tastes good without any embellishment. I had mine along side roasted green beans and cauliflower - just a few minutes ago. You can check this product out on line <a href="http://www.morningstarfarms.com/product_detail.aspx?family=363&id=19371">here.</a> The next two items are snacks. The first is called Pirate's Booty and it is a popcorn product that is very low in calories and nonetheless, quite flavorful. I had a little package in a race packet recently. I have tried the cheddar and pizza flavors. You can buy the individual bags which have 130 calories or so each - or buy the bigger bag for less money and then measure our the exact calories YOU want. These snacks are NOT at Wal-Mart and can be hard to find, but the <a href="http://www.piratesbooty.com/products/piratesbooty/agedwhitecheddar">website</a> can direct you. You may have to give the page a few minutes to load. This last one I only tried yesterday. I was delighted. In fact it is basically a potato chip - I have not had any of those since those Olestra ones - the kind that give everybody gas if they eat any amount at all. Good news guys, none of that fake stuff is in these <a href="http://www.popchips.com/nutrition-information/">Popchips</a>. They have the same type of calorie content as the above snack. Buy a large bag and measure out the serving size that is best for you. They can be found at Target stores. Now with any of this stuff - they are only calorie controlled if you control yourself! The first product I discovered in the grocery aisle, the second, because of a race and a third from a web news story about the CEO. I think you might be surprised by how good all three of them are.

YUMMY !!

Let me share three new products with you - though one of them may just be new to me, the other two really are new. First, a vegetarian prote...

5:21 PM

Sabotage

Do you have a saboteur? An inner voice that seeks to weaken you and prevent you from accomplishing your goals? You know - the one that tells you that you need to eat the brownie because there may never be another brownie to eat? Or that you do not need to go for a walk because it is going to be painful and pain is bad? Or that you cannot get lab tests because blood work makes you faint? The voice keeps you from succeeding by preventing action - action that could improve your health - physically and or emotionally. The saboteur has a purpose and really it could be considered noble if it weren't so limiting. The purpose is to keep you from getting hurt and from failing. Funny thing about this is - No try - no failure and oh, NO SUCCESS either. It is time to make that voice work FOR you instead of against you. Let it protect you but control it - use it. If you are overcome with an intense sense of dread, fear, anticipation - or do not feel those things directly, but engage in procrastination, avoidance, denial or defensiveness (no one is going to tell me what to eat)- then it is time to take control. Yes, you might get hurt, feel pain, fail - but then again you might not. So address the fear. Acknowledge that it is there and play out the worst case scenario option in your mind or on paper. If the worst case scenario happens, how can you pull a positive out of it? Name it, explore it, challenge it, overcome it - or as I like to say - Do IT Anyway! You can eat less than you are now (if you need to) you can exercise more, you can lift weights, you can get a physical, you can go to a new place, you can stop smoking, you CAN .... fill in the blank, friend. Use the voice to tell yourself what you ARE capable of doing and then well, to borrow a phrase, Just Do It. It doesn't take willpower to make a move you know. It takes confidence and faith. Confidence in yourself and confidence in the behavior. I used to faint every time I had my blood taken - the fear from having that happen kept me from getting blood work for a few years. The first time I managed to have a blood draw without fainting, well it wasn't long ago - maybe 2001. I had to talk myself out of fainting - I had to do it on FAITH. I told myself, "I do not have time to be sick all day." "I want to run later." "I am going to call my Dad after this and say, I did NOT faint, Daddy." I used faith in myself and motivation. Now, I still am scared. I still have to lie down and use self talk, the difference is, I have confidence I will not faint because I have experiences where the worst case scenario did NOT happen. To learn more about defense mechanisms and how to overcome them, I recommend a book by Drs. C. Cortman and H. Shinitzky titled, Your Mind.

Sabotage

Do you have a saboteur? An inner voice that seeks to weaken you and prevent you from accomplishing your goals? You know - the one that tell...

4:51 PM

Alcohol Defense - iveness

WebMD has a website called Medscape which is used to educate health care professionals on current research and best practices in medicine. It often has CME programs to earn credits for licensure renewal etc. I went to the website recently in order to print my CME credits and while I was there I saw a piece about the health promoting aspects of alcohol. The specific recommendation on alcohol is as follows: women - no more than one glass of wine/beer/liquor ( as measured in serving sizes of 4oz, 12oz, 1.5oz respectively) per day and men no more than 2. The science states that this moderate amount of alcohol could reduce adverse cardiovascular outcomes compared to persons who consume NO alcohol and those who consume too much. A primary care physician noted that even as this evidence was nearing conclusiveness, he did not recommend that his abstainers begin drinking and he wondered if he should. He asked the Medscape community if they recommended alcohol consumption to their patients. He received many responses. I am personally in support of the alcohol and health connection. I am also aware that some persons are alcoholics and cannot drink any amount of alcohol because they cannot keep it at the health promoting level. Comments were varied and for and against, but one was especially aggressive and anti alcohol. This response was from a man who was in AA and had been sober for many years. He felt that there was absolutely NO place for alcohol, No amount, in any one's life. Which leads me to this response: Unlike tobacco, there is a health promoting way to use alcohol for some persons. Because alcohol is a poison to alcoholics does not mean it is a poison to others. I would ask that particular person if he would make the same declaration about peanuts if he happened to be allergic to them? Just because something is bad for one person doesn't mean we all have to avoid it. Some things are bad for all people - period - pollution, inactivity, mercury, tobacco, processed foods - etc.... This is an exception then. Research does show us a positive use for alcohol and in case you are wondering -caffeine. And for both, over consumption, just like over consumption of food, is deleterious.

Alcohol Defense - iveness

WebMD has a website called Medscape which is used to educate health care professionals on current research and best practices in medicine. I...

5:04 PM

The Power of Brown

Those crazy scientists - always up to something. Back in 2009 I mentioned a story about the different types of fat that we have in our body. In <a href="http://yourhealtheducator.blogspot.com/2009/04/wellness-weekly_17.html">this wellness weekly</a>, I explained a little of what was being discovered and noted that the issue didn't get as much press as I'd expect. I did think that some company would continue to diligently work to somehow make the finding into an obesity treatment. Really, I said that and you can check by clicking the highlighted link. The body does have two types of fat cells. They are usually simply referred to as brown and white. They are very different. Without delving into too much biology, our body is made up of cells, tissues and organs. The cells have engines that require energy in order to divide, reproduce, secrete substances, etc. That energy for us is ATP which is created in the cell with oxygen. (Exercise can improve ATP production). The engines are actually mitochondria. Every cell has at least one, and as you might guess, the more mitochondria a cell has, the more energy it will need to keep those engines running or working. Researchers at Harvard and elsewhere, have found that the brown fat cells have an abundance of mitochondria where as white fat cells do not. Thus, the brown fat burns calories or uses energy and the white fat stores it. Most of us understand that too much energy in, in the form of food, can lead to an increase in white fat cells. What researchers what to do is figure out a way to get more brown fat cells. So far it seems that babies have the most brown fat but as babies become more able to do things, like move around to create energy and body heat, they have less and less brown fat. If they eat too much, well, then they have too much white fat. A specific protein in our body is the trigger for brown fat cell production. This protein can also stimulate the transformation of white fat cells TO brown fat cells. Holy Cows, now that would be something. Scientists are exploring ways to make the body create more of the protein (through gene expression), or find a chemical that will mimic the protein, or find a way to make the protein more powerful - all to get more brown fat cells in the body. In a WSJ article on this same topic, a Netherlands researcher cautioned that increasing energy burn in a person might also increase appetite. He was concerned that people who still eat too much. Another idea on the minds of researchers is exposing people to cold temperatures. Apparently, being in cold air can stimulate brown cell activity. Unfortunately, in the two or three experiments testing this hypothesis, it only worked with the lean people. Obese people have more insulation - as they have more white fat cells, and the job of the white cell is to conserve energy and insulate the person. White fat cells are very good at their job. My coworkers keep the air condition blowing cold most of the day at work so I have now started to accuse them of making me lose weight. Recently I wrote a piece about the need to stay dynamic in your weight control - weight maintenance. This was in regards to the research on middle age weight gain and needing to modify exercise AND calorie programs to make up for plateaus. It is clear from this Harvard research that pills do not change any of that. It is always going to be a matter of energy in and energy out. I am beginning to think, however, that some persons who have over consumed and over consumed the worst foods (processed) may really have irreversibly damaged some of the intricate chemical and hormonal workings of their metabolic systems. They may need more than diet and exercise, but that is a very small group of people and always always, pills and surgeries should be the last effort not the first.

The Power of Brown

Those crazy scientists - always up to something. Back in 2009 I mentioned a story about the different types of fat that we have in our body...

4:48 PM

Brief O&E Update

Throughout the day I pondered over a topic - I thought, I do not want to think so hard tonight. I have begun reading an article that I think might be good for tomorrow, but tonight I am just going to share a couple of thoughts I have had since Sunday when I posted <a href="http://yourhealtheducator.blogspot.com/2010/04/odds-and-ends_11.html">this</a> entry. I want to say first that I messed up the info on my generation and obesity. I kind of felt like I had it wrong, but by notes were in the car and oh my gosh, I was too lazy to go down and get them - I know, hard to believe. Funny though that the notes were on this little notepad I keep on the visor. Why do I have a pad stuck in my visor? To take notes when I hear a news story that I want to explore further in order to share on the blog! So what I meant to say was that people born in the 1960s and 1970s tended to gain weight up until their 20s where the numbers peaked. This generation then tended to lose some of that extra weight. One fifth of the them were said to be obese. Now, I can say that I personally weighed more in my twenties than I do in my forties, so there, research experiment of one! I think I did get the second part of the statement correct last Sunday, which is that later generations are obese at higher rates and they do not peak but appear to continue to gain weight indefinitely. Currently we have an obesity rate of 33% in the USA. Also in the last O&E I mentioned the concept of behavior placement as an extension of product placement. Since then I saw two blatant examples of both - in fact, they both occurred in TV shows that I was watching simultaneously last night! On Damages, (FX Mondays at 10), a character was at a laptop computer and wanted to look something up. VERY clearly the search engine he used was the lesser known Bing. On the show I was really watching, Saving Grace on TNT , the phenomenal Holly Hunter (whose character smokes all the time :() Stomped out a cigarette in the sand and then picked up the butt and either put it in her pocket or in the trash. Either way, she did not LITTER or cause a fire with her discarded smoke. It is against the law to throw out cigarettes in Florida, where I live - If you have ever seen a wilderness on fire, even on the news, you will understand why. That's all then - tomorrow I will tell you more about brown fat, as I believe I have mentioned it at least once in the past.

Brief O&E Update

Throughout the day I pondered over a topic - I thought, I do not want to think so hard tonight. I have begun reading an article that I thin...

5:00 PM

A Choice Environment

There is a new book out about how we make choices, <a href="http://www.twelvebooks.com/books/how_we_choose.asp?page=desc">The Art of Choosing</a> by Sheena Iyengar. In her <a href="http://www.whyy.org/91FM/voices.html">Voices of the Family interview</a>, she discusses sex/gender differences and states "women have different choice environments than men" in that they have more social implications put upon them (and accepted by them) for their choices ("This blouse or that one?") and usually consider more variables when arriving at a decision. "I want" is answering the question easy or hard? Granted I want is a little different than I pick this or that. Here's sticky chart entitled "I want" from Dave Gray at <a href="http://images.google.com/imgres?imgurl=http://farm3.static.flickr.com/2178/1973297621_b09b65c11f.jpg&imgrefurl=http://communicationnation.blogspot.com/2007_11_01_archive.html&usg=__GjDCoiCXgBb1X7pE4MQ0ZhHC5IA=&h=500&w=500&sz=214&hl=en&start=2&sig2=zMPGNhZiVmMJxuR7ldfbCA&itbs=1&tbnid=R_snDd0t4opeUM:&tbnh=130&tbnw=130&prev=/images%3Fq%3Dwhat%2Bdo%2Byou%2Bwant%253F%26hl%3Den%26gbv%3D2%26tbs%3Disch:1&ei=m77ES8q7KIij_ga4uKGODg">Communication Nation</a> - in his blog he has an interesting listing of 'wants' from a trainings he does. <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgot5vj3Xkt84BLUUGvVmJZ88vENjxxMGuoDrhX5HmQ6i5yxQdQGRRfEX9cDRkQof5TXaJtcRdXOCG1-Uxwu-MI76aBbamY_ZUx6vjpYUC6C-VI5zkkexHGxaeX_CGD-q92h_Yn-Il5mEPV/s1600/stickypadiwant.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200px" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgot5vj3Xkt84BLUUGvVmJZ88vENjxxMGuoDrhX5HmQ6i5yxQdQGRRfEX9cDRkQof5TXaJtcRdXOCG1-Uxwu-MI76aBbamY_ZUx6vjpYUC6C-VI5zkkexHGxaeX_CGD-q92h_Yn-Il5mEPV/s200/stickypadiwant.jpg" width="200px" wt="true" /></a></div>In medicine, we ask people to make choices every day (and usually pretty quickly.) How can we best help others priorities and how can we motivate them to make their health a priority?Apparently, in Iyengar's book (haven't read it yet) she recommends focusing upon priorities and eliminating the extraneous. Easier said than done, I think! What are the implications of decisionmaking and anxiety? BTW - Number of women with disability poll answer is 1 in 5!!

A Choice Environment

There is a new book out about how we make choices, The Art of Choosing by Sheena Iyengar. In her Voices of the Family interview , she discu...

12:25 PM

The Down Side of FDA Regulation

I was not familiar with the history of the FDA before today. I know it now because I looked it up. I was inspired to look it up after reading an article in today's WSJ about a drug that has been used for years to treat gout. You may recall from an earlier post that gout is a form of arthritis - one of the inflammatory types. Gout flare ups can be very painful. The drug name is colchicine and several generic versions exist. The pill has been relatively cheap over the years, and I mean YEARS. It has always been prescribed off label because it was never tested or approved for use by the FDA. <div align="justify">This blog consistently discusses the FDAs rules on drug testing. A company that wishes to put a drug on the market has to get an application from the FDA for a new drug and must conduct experiments and clinical trials to prove that the drug is safe, that it is effective and often, that it is safer or more effective than a drug already on the market. The drug can then be marketed for the specific condition the company made its FDA request. The drug can be used for whatever a clinician chooses. So the second part of that has been happening with cholchicine - and it only costs five or ten dollars a month. At least until now.</div> One of the companies that makes the drug decided that they did want to market it for treatment of gout - or the painful episodes that gout can produce. They did their trials and completed all their paperwork, learning a few things about this drug that are indeed helpful to know. For example, it interacts with certain other drugs and certain doses are more effective than others. It did indeed get approval to market the drug for gout treatment. So what do you think happened? It now has a brand name, Colcrys, and costs nearly ten times as much. Whats more? The company that did their due diligence, URl Pharma, wants all the other versions of this drug taken off the market - as it has the new drug patent rights. (interestingly, in February of 2008 another form of this same drug, which was taken as an injection, was banned by the FDA) In reading Jonathan Rockoff's article I learned that the FDA did not start regulating drugs until this one was already being used and that it was grandfathered in. That peaked my interest. In case you are equally intrigued, here is a <a href="http://www.fda.gov/AboutFDA/WhatWeDo/History/Milestones/ucm128305.htm">time line on the FDA </a>website of how it came into existence and the amendments and findings that were monumental over the years. It was not until 1962 that drugs had to be found safe and effective, approved by the FDA and were than allowed to be marketed. Drugs already on the market at the time were not really grandfathered in, as I can tell, but were expected to be reviewed in a timely manner. There just was not a systematic protocol for doing so - and as oft happens, it did not get done. I read and AP article by Ricardo Alonso-Zaldivar and Frank Bass as well. They noted some statements by one of my favorite congress persons, Charles Grassley. In that piece, there was some discussion on how these unapproved medications are paid for with our tax dollars in the Medicaid and Medicare programs. I have no idea if the Patient Protection and Affordable Care Act (Health Care Reform) has a provision to address this issue or not, but it is clear that unapproved drugs need to be identified, evaluated for safe use and in some cases banned. Sen. Grassley had considered introducing legislation to mandate disclosure - meaning, if you were prescribed a drug that was unapproved, you'd have to be told. Another suggestion was that the FDA compile a master list of the unapproved drugs - and then of course, target them for review. I do not know where these matters stand today - but you could probably find out by viewing Charles Grassley's web page.

The Down Side of FDA Regulation

I was not familiar with the history of the FDA before today. I know it now because I looked it up. I was inspired to look it up after read...

4:56 PM

Odds and Ends

Instead of listening to the news or radio at the moment, I have the windows open and can hear the sound of the rain. It is cathartic - it calms my soul - not that my soul is agitated, but I think you understand. So another week ends and a few notes have been set aside for comment. SCAMS: GRRRR you can just imagine me pulling my hair out okay?! I was listening to Pandora today (free music over the Internet) and an ad played for an "all natural" weight loss program that guarantees 1-2 pounds a day of healthy weight loss. Just because the company uses a supplement that is an herbal does not mean it is safe and nor does it mean it is healthy. At the website they clarify that the 1-2 pounds per day is just in the first week - oh really - as in WATER weight. It is 70$ for fifteen days, but experts recommend at least thirty days. It is a supplement combined with a very low calorie diet (you think?). Supplements are not regulated by the FDA and may have any amount of the active ingredient claimed along with others that could be harmful If you buy this product, I WILL know and you will be in big trouble. Just refer to yesterday's blog and change your life in a way this actually IS safe. Elevators: I work in a complex that is two stories. All the offices open outside. There is an elevator in the middle of the complex and stairs at either end. The whole thing is slightly larger than a football field. I only take the elevator if I have a roller cart with equipment, etc. I paid attention to the people getting on the elevator the other day - remember, what matters to us is what gets our attention. I only saw overweight people getting on. A flight a day can make a difference - if we stop navigating stairs, we are going to be unable to navigate stairs as we age. Old age is no place for the frail. Drink Up: I didn't know that there was an employer who allowed drinking on the job until an uproar crossed The Continents because the employer was limiting it! In Denmark, the brewer, Carlsberg has long allowed employees to drink on the job from conveniently placed coolers- as long as they did not become inebriated. (drivers have the special ignition locks to prevent drunk driving). I am not sure why the company is trying to curtail the drinking to only 1-3 beers during lunch breaks, but the employees WALKED off the job in protest. Too damn funny. I was a bartender once and a waitress in a diner that served alcohol - goodness no, we could not drink a drop on the job, but I really think that was more about inventory and cost than anything else. Behavior Placement: How very cool an idea this is and I have to say NBC-U is the group making it happen. Most of us have heard of product placement which involves having an actress or TV personality "subtly" drink, wear, or use a brand name product on camera. But behavior placement is having that same person DO something that we want others to do. In the past and in the negative - the behavior was tobacco use. Now, we have people recycling, exercising, driving hybrids. I learned from reading a WSJ article that NBCU makes this happen on its shows at least twice a year - THAT will get them my loyalty - I am impressed. Talking Bout My Generation: Heard on the news this week - one fifth of the people born in the 1960s are overweight or obese. Also heard was that in my generation, those currently in their 40s, the weight stabilizes but in younger generations it seems that the weight continues to increase across their lifespan and thus the concern that today's children, with very early cases of diabetes and hypertension, will be the first to reverse the trend in our increasing life expectancy. I do want to take this time to remind of the other problem which is the great number of people who are simply dieing longer as opposed to living longer. Think about it. Races: I ran another short distance race this morning. Though it wasn't my fastest 10K (six miler) it was my second fastest and I won a little medal for out running the other 11 women in my age group. The total number of racers was 242 and I finished 118 overall. I mention this in reference to the <a href="http://yourhealtheducator.blogspot.com/2010/03/saga-ends-and-new-goal-is-born.html">previous posts </a>on the saga of a failed marathon and the new goals I embraced. Oh , if you want to see the map of the race, it is under my links with the heading My Garmin Activity. POOP! Oh yes, my friends, the very best for last. I hope you have not left the blog just yet. This is the best thing I heard all week. I arrived home from work one evening, and a man and woman were having a conversation across the way, in the grass. They each had a dog on a leash. As the man was walking away, the woman said, "Oh - someone left their poop." Seriously? My "greatest generation" Dad, he never picked up our dog's poop - I wonder what he would think of this - crating and poop scooping - what has the world come to?

Odds and Ends

Instead of listening to the news or radio at the moment, I have the windows open and can hear the sound of the rain. It is cathartic - it c...

4:40 PM

Don't Be a Kirstie

Or an Oprah for that matter. I first remember Ms. Alley from the TV miniseries, North and South. I was struck by her eyes and thought to myself that she was a beautiful woman. She continued to impress me with her acting and her comedic skills for many years, though I watched in dismay as the tabloids presented the other side of Kirstie Alley. I have watched her struggle with her weight and lose. I have no doubt that both she and Ms. Winfrey struggle with inner demons. In fact, I see them as being battered by them - maybe more so for Kirstie. I know those demons by name - which stokes my empathy even more. What is far worse however, is that the media exploits her. I think she is currently "staring" in her second weight loss show. No that is wrong. The first was the commercials for a diet food/program. Now she has a show. I do not want you to be a Kirstie. Diets and celebrity workouts will NOT change a person any longer than they are able to follow them (which is usually only when the cameras are rolling and the person is being paid). Never have these women taken something away from the "plan of the month" that has changed their lifestyles - and thus their health. Whatever battle that Kirstie has - it is deep and destructive and not going to be solved by a "diet." Her health however, will be adversely affected by these gimmicks and her pride, oh my, I cannot bear it for her. Do not be a Kirstie - Everywhere I go; work, gym, running with friends - I explain Volumetrics - it is a way to eat the most healthy foods, in abundance, but not in caloric density. The video below is made for my YouTube channel, but I have not posted it yet. So enjoy the premiere. BTW, Volumetrics is a concept and there are no foods or things to buy. The idea comes from a college professor and no one pays me a cent to promote it. (if you are an email subscriber, you will have to click on the link at the bottom of your email to access the video on the blog website) <iframe allowfullscreen="allowfullscreen" class="b-hbp-video b-uploaded" frameborder="0" height="288" id="BLOGGER-video-9077a704da2cda2c-15703" mozallowfullscreen="mozallowfullscreen" src="https://www.blogger.com/video.g?token=AD6v5dyfEyRCx2of7GhbrSzdSZh46bPCeiEAMxUaLrM8Mx2TmjDdLinrt61qxlRYmde1XGl-98xwnWBQNz5BwPCIBvJyoZgQs_xeUbNZoTavcfuctC7b-oDcV9d4vwWRdYFWh6wesTWs" webkitallowfullscreen="webkitallowfullscreen" width="409"></iframe>

Don't Be a Kirstie

Or an Oprah for that matter. I first remember Ms. Alley from the TV miniseries, North and South. I was struck by her eyes and thought to mys...

12:35 PM

The High Cost of Valor

An article has been published in the current issue of the New England Journal of Medicine titled, <a href="http://content.nejm.org/cgi/reprint/362/14/1263.pdf">Lung Function in Rescue Workers at the World Trade Center after 7 years</a>. The first author is Thomas Aldrich and I did make contact with him this afternoon. (He responded to two of my emails in great detail and I appreciate his time.) The article is available on line, in full (linked above). The researchers are from the Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center,and worked in collaboration with FDNY and The Office of Health Services of NYC. The senior author is David Prezant. The research goal was to evaluate the lung functioning of emergency response workers after the World Trade Center collapsed on September 11 2011. The study did include a great number of fire fighters and emergency medical service or EMS workers. The study included those individuals for whom prior medical or health records existed and who were employed and working at the disaster site between September 11 and September 24. The men and women were followed for six additional years. Over 12,000 persons were included. The test for lung function involves a spirometer. The person blows into the device and a measure of Forced Expiratory Volume or FEV is determined. This is the same type of test given to determine a person's lung age. It has been used in previous research to show that smoker's lungs age at significantly faster rates than non smokers. Still everyone loses some amount of lung capacity or function as they age. In this study, the scientists looked at normal FEV levels AND predicted FEV values - I am pretty certain that the predicted value is a measure of lung age based on normal situations. (If you ever had a bone mineral density test, think of the tscore and zscore - one compares you to a young person and the other compares you to people your same age). Data existed on several variables, including FEV prior to September 11, height, weight, BMI, smoking status, sex, race, time arrived at crash site, duration of time spent at crash site. I have got to say that the sample was overwhelmingly male - but around 25% of EMS workers were female. The smoking status is somewhat skewed, which is something I asked Dr. Aldrich about in my email. It appeared at first as though thousands of workers quit smoking after the event - which would make sense in response to the amount of lung damage they experienced but then that would be offset by the amount of stress the workers experienced. Instead, the data indicates whether or not the respondents smoked at ANY time prior to 9/11 - not only if they were smokers ON 9/11. (The purpose for asking about forming smoking status would be that the lungs would already have some damage) The results however, do note current smoking status, and of course, the decline in lung function is worse in smokers. The other variable factor that turned my head - BMIs. Remember the characterization of the workers is divided by time of arrival or time at site and then by fire fighter or EMS status. At each time period the BMI average was 28 to 30. In case you have forgotten, the normal weight BMI is 18.5 to 24.9. Yes, the BMI can be skewed by brawny men, and I imagine their would be some brawny firefighters, but some of this is overweight. Lung function is affected by weight as well. So - back to the study. The responders, especially the firefighters, had significant decline in lung function over the first year after 9-11. In the past, workers exposed to such chemicals as found in smoke have also been tested and the loss of function in those cases appears to have reversed in a relatively short amount of time. In this situation, seven years after the fact, the 10% loss of lung function did not reverse. In my speaking with Dr. Aldrich I noted that this reminded me of how a smoker can stop the accelerated lung decline through smoking cessation but cannot reverse it. (i.e I quit smoking at age 32ish - my lungs were probably ten years older than that - now I am 44 and they are probably 54 - but would have been much older had I kept smoking) He said that he had thought something similar. He said that the responders did in fact have symptoms similar to a person who had been smoking for 8 to 10 years. He described these symptoms as coughing, shortness of breath and lack of response to medications that help to relax bronchial tubes. It is too soon to know if these brave persons will have higher cases of COPD or Lung Cancer, but from reading the information provided in this study, I expect that they will.

The High Cost of Valor

An article has been published in the current issue of the New England Journal of Medicine titled, Lung Function in Rescue Workers at the Wor...

4:29 PM

FDA Steps Up

I promise that I understand the desire to get an easy fix to things that do not please us. I promise too, that I am not going to age gracefully as I already fret about sagging eyelids and wrinkles above my lip. I do not know what I will do about these things - and I only share my concern to let you know that I GET IT... I do believe in the idea of controlling the things that you can, however and am not at all afraid to work very hard to maintain a fit and healthy body. I was once overweight with a BMI of 27.3 - three little points away from obesity - and now that my BMI is closer to 18 - I am so much more comfortable in my skin. I am getting off topic I think - but I wanted you to know that I do not talk without experience and empathy. I am grateful really, that I had to work to lose weight and keep it off because I am now very physically active (agile) and confident. I do not think I would have gained any fitness points if I had just been able to take some pill to shed my pounds. But you know, I did try various things over the years - wanting to believe that the latest gimmick was going to change my life. ( In the 80s I took Dexatrim while taking dance classes at an arts school. During one of my classes I felt certain that my heart was going to burst, I was so unbelievably scared. I went back to the dorm and slept for 24 hours. Later, in my late 20s I took these pills I ordered from the TV. They had some fancy schmancy name, but they were fiber pills. Three a day, three times a day - craziness. When the pills ran out, the hunger returned!) These days the big spin is on a fat dissolving injection. It is supposed to do what liposuction does, but without surgery. I can't even begin to wrap my mind around liposuction itself - so I won't. The current trend is something that is occurring in spas around the world. In the US it is marketed with several different names. Liposissolve, mesotherapy, lipozap and lipotherpay. I did a search and found spas offering it just a few minutes from my home. The FDA has sent out warning letters to at least 7 businesses, unfortunately, the one I just noted is not on the list. (SO I of course, alerted them!) The drug that the companies use is a combination of two FDA approved medicines. However, the medicines are approved for something different. A clinician can request that the drugs be compounded at a pharmacy and then the clinician is able to use them in practice, as they see fit. It is similar to using a medicine off label. Unfortunately, the FDA does not regulate compounding and that is another issue. Remember from past blogs, a company cannot market a medicine to treat a condition for which it was not tested and is not FDA approved. That is exactly what these spas are doing. They are making false and undocumented claims. Before this lipodissolve can be advertised for use in fat reduction, the FDA must approve it, and that would require clinical testing for efficacy and safety. The FDA has received complaints of side effects, including disfigurement, and lack of effect. You can read the <a href="http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM207620.pdf">letter to consumers </a>here.

FDA Steps Up

I promise that I understand the desire to get an easy fix to things that do not please us. I promise too, that I am not going to age gracefu...

4:40 PM

April - Women with Disabilities Awareness Month

<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9jH366e5ml7jxEyjc4X_sM_dPgPtGUnX2mayuiI6hv8J87lxMw2VwAf25GoOReKCIp16FLMioZgau34PCCOKZLEVWZnGrRG3fhQAMdSUgTjgqQ286WBtcwUdmEM5Ea-u4z2hFNcYAQEq9/s1600/women_disabilities.jpg" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200px" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9jH366e5ml7jxEyjc4X_sM_dPgPtGUnX2mayuiI6hv8J87lxMw2VwAf25GoOReKCIp16FLMioZgau34PCCOKZLEVWZnGrRG3fhQAMdSUgTjgqQ286WBtcwUdmEM5Ea-u4z2hFNcYAQEq9/s200/women_disabilities.jpg" width="120px" wt="true" /></a>Within sex and gender health disparities, there can be another layer preventing optimal health outcomes - disabled status. Many of your patients will have disabilities (even if they aren't visually apparent.) Be aware of bias - women living with disabilities often work; want excellent health care; are interested in sexual health; (based upon their age) are interested in family planning options; lead productive and happy lives and live with their limitations but aren't defined by them. Here's some <a href="http://www.womenshealth.gov/statistics/#a563">stats </a>and from our <a href="http://dawn.thot.net/fact.html">Canadian friends</a> here's some more. Dr. Lisa Iezzoni has a <a href="http://www.womenwithdisabilities.org/video/lisaintro.html">video </a>(long but useful video presentation) and information about barriers for women <a href="http://www.womenwithdisabilities.org/video/videos/wwd_barriers_and_solutions/player.html">including tips on communication resources</a>. Also, some <a href="http://www.womenwithdisabilities.org/modules/ppt/Introduction_Women_with_Disabilities.ppt">powerpoints here</a> and for <a href="http://www.google.com/url?q=http://www.hhs.gov/od/documents/NLS0601Hefner.ppt&ei=7E6-S423IpiWlAfwrO2IDg&sa=X&oi=nshc&resnum=1&ct=result&cd=2&ved=0CAgQzgQoAQ&usg=AFQjCNEAcZpfwZ1ZsnGwri_h7-dchWYeCA">women of color</a> with disabilities.</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwEdzn8YpXLBmIAfejnGib-oCYoOx3MlCJdQMpmc7qRqcNtxRxV7c7nKnVSd75wN0IqBcBqLAQM7sAXHxDxGiWDloauQXTrukEcBRJ4lt4DkEQSlIjfpMtWl43uPKkPZkGk3agERbAAaF2/s1600/color_contrast_01.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="148px" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwEdzn8YpXLBmIAfejnGib-oCYoOx3MlCJdQMpmc7qRqcNtxRxV7c7nKnVSd75wN0IqBcBqLAQM7sAXHxDxGiWDloauQXTrukEcBRJ4lt4DkEQSlIjfpMtWl43uPKkPZkGk3agERbAAaF2/s200/color_contrast_01.jpg" width="200px" wt="true" /></a>Here's a cool resource on <a href="http://www.lighthouse.org/accessibility/design/accessible-print-design/effective-color-contrast">color limitation</a> and disabilities. Here's information from the <a href="http://www.cdc.gov/ncbddd/women/default.htm">CDC</a>, other resources about <a href="http://www.disability.gov/health/specific_populations/women">abuse awareness</a>, also a general <a href="http://www.bcm.edu/crowd/">listing of topics for women with disabilities</a> and <a href="http://www.hhs.gov/od/topics/healthandhumanservices/healthandhumanservices.html">here.</a> This CDC resource gives <a href="http://www.cdc.gov/ncbddd/dh/accessibilityguides.htm">guidelines and criteria to assess accessibility.</a> Lastly, a <a href="http://www.proyectovision.net/english/resources/index.html">Latino youth with disabilities resource.</a></div> Stay tuned for the answer to the poll!

April - Women with Disabilities Awareness Month

Within sex and gender health disparities, there can be another layer preventing optimal health outcomes - disabled status. Many of your pati...

2:11 PM

Black Lung

Of course I have been thinking of coal mines. Several incidents have occurred in China in the last few weeks, including in the province of Henan, the Shanxi’s Wangjialing coal mine, a coal mine in the north-western region of Xinjiang and lastly a fire in Shaanxi province’s Quanzigou mine. In the United States, rescue workers are still hoping to save men from a West Virginia collapse. The US incident is said to be the worst stateside disaster in 25 years. I do hope that the same excoriation faces the American company as is customary towards China, which has the worst coal mine disaster record in the world. Coal miners risk their lives every time they go into a mine. The risk of explosion s high, especially as we are learning, due to methane gas. Coal mining is also a physically demanding job and my expectation is that there would be high incidence of arthritis and back injury in this population. Coal miners spend much of their work time walking hunched over because they cannot stand erect in the low altitude. And then there is the consequence of breathing the air that contains coal dust, day after day, on the "jobsite". The occupational lung hazard for coal miners is a disease or condition called pneumoconiosis - it has two categories, simple and complicated. We often refer to it as black lung disease because the lungs of coal miners are not usually the healthy pink shade of people who do not work in coal mines and who do not smoke. Though a person with either form of black lung may also be diagnosed with emphysema or chronic bronchitis as the disease progresses, they are separate illnesses. The coal dust irritates the lungs, causes inflammation and scarring. Some cases involve lung nodules that can create blockages - this would be the complicated coal worker's pneumoconiosis - also called progressive massive fibrosis or PMF. The incidence of black lung and its lethality has decreased over the years. There is much to learn about the disease and compensation from the Black Lung Disability Trust. It is not easy to receive compensation from that fund at this time, but billions were paid out after coal mining safety legislation was passed in 1969. One cannot be diagnosed with coal worker's pneumoconiosis if they have not inhaled coal dust. Smoking does not increase the risk of CWP (SimpleCWP or ComplicatedCWP) - but does increase the risk of emphysema and chronic bronchitis. There is no cure for any of these and simple CWP can progress to the more complicated and disabling type. The only way to prevent this pneumoconiosis is to never breathe coal dust. Beyond the significant risks to the health of miners, coal itself can have a negative impact on our environment and has much to do with mercury contamination from coal fired power plant emissions.

Black Lung

Of course I have been thinking of coal mines. Several incidents have occurred in China in the last few weeks, including in the province of ...

4:55 PM

FUBAR

I do not know if you have ever heard of a radio show that airs on NPR from the BBC, it is called World Have Your Say and I enjoy the show very much. The idea of the show is to present a popular news item or event that has a global impact and get the opinions and thoughts of people throughout the world. It gives a great perspective outside of ones own box. Today the show discussed a video that has been released from Wikileaks that is on You Tube and has been seen be a great many people. During the live show, which you can hear yourself, the person who released the video and several guests discussed the events, which are hard to hear and see. It was during this that I heard the following and decided to mention it on my blog tonight. A retired Navy commander, named Sal, was one of those guests and what he had to say led me to mention this on the blog tonight. He said this, "I do not see that as enjoying what you are doing, or enthusiasm. I see that, I see some young men under a lot of stress under a lot of adrenalin ,realizing that their actions ...can directly or indirectly result in the death of their countrymen... And yes the video is horrifying, war is horrifying... What you hear, it is not enthusiasm, it is not pleasure. It is not happiness. It is adrenalin. These are 18, 19, 20, 21- 25 year olds who see war every single day who have seconds to make a decision...Mistakes happen, these things happen in war, but these things you hear on the video, it is not pleasure it is not happiness, it is adrenalin. They are not college professors, they are not at a poetry reading, they are not playing cricket . They are at war every single day so they are not going to have the language of someone at a horse race..." I tried to capture his words exactly, but it was hard.. please listen to the podcast for exact verbiage - what he said is not on the video, but the podcast. His point is well made - they are, in my mind, children. So young - and I think (I hope) - before military training, completely naive to this type of behavior. How could they possibly wrap their minds around it. Of course, as someone suggested, they look like they are playing video games - would it not be unconscionable to them to engage in such brutal acts as war demands of them? So yes, SAL - they are not college professors and it is likely that they NEVER will be. Instead they will suffer incredibly high rates of mental illness and post traumatic stress disorder and in my opinion, they will be FUBAR - I imagine you know what the F stands for - Fd Up Beyond All Repair - that is the future for these brave, but forced to be brutal, young men and possibly women. Here is an article to support the <a href="http://www.tarleton.edu/Faculty/lapierre/Lapierre%2CSchwegler%2CLaBauve%2C2007.pdf">mental health claims </a>that I made. Also you can find the <a href="http://wikileaks.org/">video</a> here and the podcast to the show is <a href="http://www.bbc.co.uk/podcasts/series/whys/">here</a> . .

FUBAR

I do not know if you have ever heard of a radio show that airs on NPR from the BBC, it is called World Have Your Say and I enjoy the show ve...

5:13 PM

Health Education

A Better Colon Cancer Screen - and I try not to be cynical

Cape Wind Approval

I Cannot Tolerate That

Vitamin D - the sun - the good, the bad, the extra

Alcohol and Breast Cancer Recurrence

Odds and Ends

Who Knew? (omega 3)

Accountability

Environmental Health (it is Earth Day)

A Drug Maker's Dream

Headline Misspeak

Tumor Analysis

Odds and Ends

YUMMY !!

Sabotage

Alcohol Defense - iveness

The Power of Brown

Brief O&E Update

A Choice Environment

The Down Side of FDA Regulation

Odds and Ends

Don't Be a Kirstie

The High Cost of Valor

FDA Steps Up

April - Women with Disabilities Awareness Month

Black Lung

FUBAR

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