Archive | February, 2011

ED May Predict Earlier Death

Researchers have recently found an association between erectile dysfunction (ED) and a greater risk for cardiovascular events.  Patients with ED who were treated with telmisartan, ramipril, or both were at greater risk for cardiovascular events than other patients on the same medications.

Study results revealed that men with baseline ED experienced a doubled rate of all-cause mortality during a 4 year follow-up.  This rate is in comparison to men who had mild or no ED, according to a study published online in Circulation.

“The present data clearly show that ED is closely associated with an increased risk for all-cause deaths, as well as the primary composite outcome of cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure,” said Michael Bohm, MD, of the University of the Saarland, Saarbrucken, Germany, and colleagues.

“The evaluation of ED in the medical history as an early symptom of endothelial dysfunction and atherosclerosis and as a predictor of death and future cardiovascular events might be relevant to identify patients at particularly high risk of experiencing a cardiovascular event.”

The study evaluated a subgroup of 1,549 men  who had participated in either the ONTARGET study, which looked at the effectiveness of a ramipril/telmisartan combination in patients with cardiovascular disease, or the TRANSCEND study, which examined the effects of telmisartan in patients who were intolerant of ACE inhibitors.

An ED questionnaire was used for the study and contained the five-item short form of the International Index of Erectile Function (IIEF) and the Kolner (Cologne) Evaluation of Erectile Dysfunction scores.  Questionnaires were obtained from all patients at baseline, at year two, and at the next-to-last follow-up visit.

The results showed that patients with ED at baseline were more likely to die of cardiovascular causes or MI and tended to have higher risks for heart failure and stroke, “but the observed trends toward increased risk were not significantly different,” noted the authors.

The researchers also looked at the effects of the study drugs on ED.

“There were no significant differences in IIEF scores or the changes in scores at the run-in, two-year, and penultimate visits among the treatment groups in either ONTARGET or TRANSCEND,” they said.  In addition, “over time, there were also no differences in onset of new ED due to either treatment.”

“It is likely that the presence of ED identifies individuals whose cardiovascular disease might be far more advanced than evaluated by other clinic parameters alone,” concluded the authors.

They added that the association was particularly close with regard to all-cause and cardiovascular death:  “According to the IIEF scores in the present study, there was an increased risk in patients with mild to severe ED, and we observed a stepwise increase in risk depending on the severity of ED.”

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New Test Better Predicts Kidney Disease

A recent study conducted by researchers at the San Francisco VA Medical Center and the University of California, San Francisco, revealed that cystatin C, a blood marker of kidney function, proved significantly more accurate than the standard blood marker, creatinine, in predicting serious complications of kidney disease.

Researchers found that only patients with chronic kidney disease who have both high levels of creatinine levels and cystatin C are at high risk for death, cardiovascular disease, heart failure, or kidney failure.  Those patients with only high creatinine but normal cystatin C levels had risks similar to those with normal creatinine levels.

“A small but important segment” of the study population was missed by creatinine but identified by cystatin C as being at significant risk of serious complications, said lead author Carmen A. Peralta, MD, MAS, an SFVAMC researcher and an assistant professor of medicine in residence in the division of nephrology at UCSF.

The study included 11,909 participants and was published on December 16, 2010, in the JASN Express section of the Journal of the American Society of Nephrology.  The Multi-Ethnic Study of Atherosclerosis and the Cardiovascular Health Study provided the patient data for the researchers.

Principal investigator Michael G. Shlipak, MD, MPH, chief of general internal medicine at SFVAMC, explains that the study reveals a clinical use for cystatin C as a method for confirming a diagnosis of chronic kidney disease.  Shlipak has long proclaimed the benefits of identifying cystatin C levels, and believes it to be an alternative, accurate, and reliable marker of kidney function.

Both cystatin C and creatinine are substances made in the body and filtered by the kidneys.  If the body contains high levels of either, then it may mean the kidneys are losing the ability to filter these substances and kidney function has been altered.

“However, creatinine is a byproduct made in muscles, so it is affected by what you eat and especially by how much muscle you have.  Thus, a bodybuilder with healthy kidneys might have an elevated creatinine level because of high muscle mass, whereas a frail elderly person might have normal or even low levels of creatinine, but in fact this person’s kidneys are not working well—it’s just that there’s not much creatinine because there’s not much muscle,” explains Peralta.

On the other hand, cystatin C is a protein made in cells throughout the body.  “In studies so far, it does not seem to be that affected by age or muscle mass or diet,” said Shlipak, who is also a professor in residence of medicine and epidemiology and biostatistics at UCSF.

Cystatin C is a low cost, as little as $17 per test, addition that should be made to the current method for confirming or staging chronic kidney disease, proposes Shlipak.  “It’s vital that we have an accurate diagnostic test, because kidney disease does not show symptoms until it’s too late, when your kidneys have almost failed completely,” he added.

“Being missed by creatinine is an important limitation in our current method of diagnosing kidney disease,” said Peralta.  And being incorrectly diagnosed with kidney disease by using inaccurate test results can also decrease the quality of life for patients.  “There is a fear and psychological stress, particularly in communities of color, where people have a lot of friends and family members who are on dialysis,” noted Peralta.  “You can also be subjected to unnecessary and expensive tests and medications.”

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Aspirin May Do More For Men Than Relieve Minor Aches and Pains

Aspirin has long been known to reduce inflammation and relieve minor aches and pains.  But promising evidence has surfaced suggesting that aspirin can help drastically cut deaths among prostate cancer patients.

Dr. Kevin Choe of the University of Texas Southwestern Medical School in Dallas says men with prostate cancer who take anti-coagulants such as aspirin in addition to radiation therapy or surgery may be able to cut their risk of dying of cancer by more than half.

“Findings from this study—involving 5,275 men with localized prostate cancer—are promising, but, further studies are necessary before the addition of aspirin to prostate cancer therapy becomes standard treatment,” Choe, the study author, said.

Other studies have been conducted to test similar predictions, but many have had mixed results with anti-coagulants.

“If the cancer has already metastasized, then anti-coagulants may not be as beneficial,” explains Choe.

This study also found that aspirin led to the greatest benefits, when compared to other anti-coagulants.  In addition, aspirin had the most benefit for those patients with the most aggressive form of cancer.

“This is exciting news as patients with high-risk disease have the most aggressive cancer, with a high likelihood of dying from the disease, and the treatment options are currently limited,” Choe notes.

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Americans Are Vastly Under-Screened for Colorectal and Prostate Cancer

Two recent studies from the journal Cancer have revealed that, alarmingly, the majority of Americans who should be screened for colorectal and prostate cancer (a cancer only found in men) have not. Both men and women over the age of 50 should be screened for these diseases, but according to research, only 25.4% of people eligible for Medicare were screened. Additionally, only 50% of all Americans age 50 and over have received a colonoscopy screening.

“These numbers are very discouraging and, unfortunately they confirm previous studies that show not enough people are getting screened for colorectal and prostate cancer. These diseases are preventable and treatable when caught in its early stages, and screening is a covered benefit for those eligible for Medicare,” said Grace Elta, MD, president of the American Society for Gastrointestinal Endoscopy (ASGE). “We know that screening works. According to a recent study by leading cancer groups, including the American Cancer Society and the CDC, deaths from colorectal and prostate cancer dropped nearly 5 percent between 2002 and 2004. ASGE encourages all people age 50 and older to talk to their doctor about getting screened for colorectal or prostate cancer.”

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The Natural Choice for Male Infertility

With sperm counts falling almost 50% since the 1930s, according to the most recent research reports, new ways to address male infertility are constantly being introduced into the medical field.  One option is the naturopathic treatment.  This path focuses on improving sperm quantity, sperm quality, and overall male reproductive health.  Researchers have found that the environment, diet, and lifestyle all effect a man’s sperm production.  Improving diet and making healthy lifestyle choices should positively impact male reproductive health.

In order to function properly, the reproductive system requires proper vitamins and minerals.  Nutritional deficiencies can impair hormone function, inhibit sperm production, and contribute to the production of abnormal sperm.  In order to improve and maintain a healthy diet, try these recommendations:

  1. Eat a natural foods diet that focuses on fresh vegetables, fruits, whole grains, fish, poultry, legumes, nuts, and seeds
  2. Drink 50% of body weight in ounces of water daily.  For example, a 150 lb man should drink 75 oz of water.
  3. Eliminate processed and refined foods like white flour, junk foods, sugars, alcohol, and caffeine.
  4. Avoid saturated fats and hydrogenated oils like margarine; use olive oil instead.
  5. Incorporate pumpkin seeds into your diet.  Pumpkin seeds are naturally high in zinc and essential fatty acids which are vital to healthy functioning of the male reproductive system.

In addition to keeping your diet healthy, you may also try adding natural supplements to your daily routine.  You must remain on these supplements for 3 to 4 months before you experience the maximum benefits.  Try these supplements to increase your sperm count and/or motility:

  1. Arginine—Take 4 grams daily.  Needed to produce sperm.  If the sperm count is below 10 million per mL, arginine probably will not provide any benefit.
  2. Coenzyme Q10—Take 10 mg daily.  Increases sperm count and motility.
  3. Flaxseed oil—Take 1 tbsp daily.  Is a source of essential fatty acids.
  4. L-carnitine—Take 3-4 grams daily.  Required for normal sperm function.
  5. Multivitamin mineral—Buy a high-quality product and take one serving size.
  6. Selenium—Take 200 mcg daily.  Improves sperm motility.
  7. Vitamin B-12—Take 1000 mcg daily.  A B-12 deficiency reduces sperm motility and sperm count.  Even if no deficiency exists, B-12 supplementation may help men with a sperm count of less than 20 million per milliliter or a motility rate of less than 50%.
  8. Vitamin C—Take 500 mg 2 times daily.  Is an antioxidant.
  9. Vitamin E—Take 400 IUs 2 times daily.  Is an antioxidant and improves sperms’ ability to impregnate
  10. Zinc—Take 30 mg 2 times daily.  Required for a healthy male reproductive system and sperm production

Herbal medicine is often used in naturopathic medicine.  These remedies usually do not have side effects when used appropriately and at suggested doses.  If nausea or headache occur after taking the recommended dose of an herb, then it may be a reflection of the purity of the preparation or added ingredients.  To avoid these side effects, use only high-quality products.  Be sure not to overdose as serious illness and/or death may occur.  Try these herbs to treat male infertility:

  1. Ginseng (Panax ginseng)—This is known as male tonic and is used to increase testosterone levels and sperm count.  Siberian ginseng (Eleutherococcus senticosus) may also be used.
  2. Astragalus (Astragalus membranaceus)—Increases sperm motility.
  3. Sarsaparilla (Smilax spp.)—Known a male (and female) tonic.
  4. Saw palmetto (Serenoa repens)—Used for overall male reproductive health.

A few lifestyle choices are also beneficial.  First, avoid alcohol.  Alcohol consumption is associated with an increased number of defective sperm.  Second, consider acupuncture.  And finally, do not smoke.  There is an association between smoking and low sperm count, poor sperm motility, and abnormal sperm.

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Does Viagra Hurt Women?

With the advent of Viagra, sexual virility was saved for millions of middle-aged men and women.  Or was it?

When a man has difficulty engaging in sex, pills are thrown at him to help ease the situation.  Specifically, the little blue pill, Viagra, has been the go-to for aging men looking to reverse the effects of time.  But for post-menopausal women, the drug may actually be harming their health, according to Evelyn Resh, director of sexuality services and programming for Miraval Resorts.

Resh explains that women experience many physical changes after the onset of menopause that may affect their sexual encounters.  She says, “These changes include decreased elasticity and lubrication, thinning of the tissue, and constriction of the vaginal opening.  Without reparative therapy, these changes can make intercourse about as comfortable as chewing glass…Pfizer and the practitioners who were writing prescriptions for Viagra forgot:  women have health issues and needs too when it comes to aging, vaginal penetration, and their genital preparedness.”

In her column on the Huffington Post, Resh blames this mishap on what she calls the “Pharmaceutical Industrial Complex,” suggesting that doctors disregard the well-being of women as they rush to prescribe Viagra to their “flaccid and forlorn male patients.”

“When it comes to women’s genital health, the sorry facts are this; fewer than 25 percent of post-menopausal women who experience significant genital changes receive the care they need to live more comfortably with these changes.  They’re often essentially disregarded in the decision of whether or not her husband’s restored ability for intercourse was something she could accommodate.”

Viagra sells itself as an amend to an otherwise failed, aged sexual relationship.  But Resh doesn’t buy the quick-fix theory of romantic relationships that bolsters Viagra sales.  Nor are other sexual health professionals, like Abraham Morgentaler.

“As I listened to my patients, I came to see that our culture had taken Viagra and created a legend out of it that went far beyond its actual pharmacological properties.  People had come to expect that taking a little blue pill could solve their personal and relationship problems, no matter how complex those difficulties were,” said Morgentaler in his book, The Viagra Myth.

Before running to a pill to solve all of our problems, perhaps we need to take a little more time to consider the drug’s physical and emotional impact.

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Have chronic pelvic pain? Here are 5 keys for pain management

Chronic pain is never easy to combat, but it is an exciting time for pain management in general.  Pain management is a relatively young specialty compared to others.  Here are five areas of opportunities and ways to successfully take charge of the pain.

1. Read up on high-quality research.  Pain management, as a field of medical practice and research, has exploded since it first came onto the stage only a couple decades ago.  Even though the pain management field is a young one compared to most other specialties, pain management-related research continues to spur the emergence of higher-quality procedures.

“Especially in the past few years, the research has really been able to validate the efficacy of many commonly performed procedures,” says Jonathann Kuo, MD, a board-certified anesthesiologist and pain management specialist.  “In the past, there was a lack of good quality data, but there are now more recent studies and meta-analysis published by both academics and physicians in private practice that validate what we do.”

2. Understand expanded use of neurostimulation.  Dr. Kuo says the field of neurostimulation has increased dramatically over the past several years.  Pain management physicians can now use neurostimulation for other chronic pain conditions, such as complex regional pain syndromes, pelvic pain, angina, pacreatitis, phantom limb pain, occipital, chest wall, and other painful neuropathies.

“The whole point is that pain physicians can utilize neurostimulation not only in the spinal cord, but also on the peripheral nerves.  There is an expanded use of peripheral nerve or peripheral field stimulation and now physicians can place the electrodes anywhere in the body,” says Dr. Kuo.  “It’s no longer only limited to the spinal cord.”

3. Watch for more minimally invasive procedures.  Pain management is a specialty that has made a large shift from inpatient to outpatient settings, such as office-based procedure suites and ambulatory surgery centers.  The shift has implications for your pain management physician who can now better control healthcare costs and reduce in-patient therapy and recovery times for pain management procedures.  Minimally invasive pain procedures also mean fewer complications and require little anesthesia.

“Traditionally, pain management procedures took place in the hospital setting and involved significant administrative work and lack of efficiency.  The trend now is that many procedures…can be done in an outpatient setting without a hospital stay,” Dr. Kuo says.

4. Stay connected on pain management issues.  The pain management field is still young.  New role players are rapidly emerging into the picture, thus forcing the field to evolve at an accelerated rate.  Both you and your physician need to stay up-to-date on relevant news and trends in the pain management field, constantly evaluating what bit of news applies to your own situation.

5. Know the device market.  Another driving force behind the explosion of pain management is the medical device market.  Medical technology is a main reason many of the pain management procedures have been able to shift from the inpatient to outpatient setting.  Increased attention toward delivering high quality patient care in a cost-efficient manner has driven IT innovators to come out with new tools and equipment to help physicians reach that same goal.  Although it is an exciting time for pain management, extra care must be taken when choosing a new device to try.

These are 5 tips are for you to become more educated on your chronic pain and cutting-edge ways to control it.  But you cannot do this on your own.  You must consult your doctor to better evaluate what procedure and method of pain control works best for you.

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Dogs Detect Colon Cancer

A study published Monday in the digestive health journal, Gut, reveals that Japanese researchers have successfully trained an 8 year old female Labrador Retriever to sniff out colon cancer on the breath of a patient.

Previous research has suggested that dogs may be useful for the early detection of cancer.  Several studies show that dogs are able to detect melanoma, bladder, lung, ovarian, and breast cancer at very early stages due to their amazing sense of smell.  Dogs can identify chemicals diluted as low as a few parts per trillion, which is why they are also used for sniffing out bombs and drugs at airports.

In the most recent study with the Labrador Retriever, the dog sniffed 33 breath samples belonging to colon cancer patients and 132 samples from health controls, half of whom had benign colon polyps.  Each group contained five samples, and the dog was trained to sit in front of the sample determined to be from a cancer patient.

She was able to identify those samples with cancer 91% of the time and could distinguish between cancerous and benign polyps.  Further, she was able to exclude healthy samples 99% of the time.

Even when the dog was given watery stool samples to sniff, she was able to sniff out cancers 97% of the time with a specificity rate of 99%.  The researchers determined the dog also had a 70% success rate when using fecal occult blood tests, which is another routine colon cancer screening method for checking blood in the stool.

Given the large costs associated with preventative medicine and yearly examinations, using dogs to detect early stages of cancer could save the medical field millions of dollars.  The usage of dogs may also help those elderly patients who cannot make it to examinations or who may quickly begin developing the cancer between visits.  But despite its promise, the dog-sniffing method will have to be accompanied with colonoscopy because of the expense and time required for training the dogs.

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