Sunday, November 15, 2009

Distal biceps tendon tear more than likely leads to surgery

As if the Colts secondary has not been tormented by enough injuries this season, we recently learned that safety Bob Sanders will be out with a distal biceps tendon rupture at the elbow which will require season-ending surgery. The surgery was performed by the renowned orthopaedist Dr. James Andrews earlier this week.

The biceps muscle is an important muscle in the upper arm. The distal tendon of the biceps muscle transmits all of the forces of the muscle to the forearm at its insertion (radial or bicipital tuberosity), thereby contributing to an athlete's ability to forcefully flex the elbow as well as rotate their forearm in turning the palm upward (supination).

The distal biceps tendon can tear, preventing the transmission of forces from the muscle to the forearm bones. While it can happen from repetitive injury in athletes, it more commonly results from a single traumatic event in which the flexed elbow is resisted or even traumatically extended as in Sander's case. The event is usually accompanied by a "popping sensation" and sense of sharp tearing around the elbow crease.

Once a distal biceps tendon is ruptured, it unfortunately will not heal on its own. Rather, the tendon will continue to retract away from the bone and slide up the arm as the muscle contracts without resistance. Over time, the tendon will be come stiff and scarred as well. This loss of biceps muscle function results in a loss of elbow flexion (bending the elbow) and forearm rotation strength.

Usually the presentation of a distal biceps tendon is not subtle in the athlete. When compared to the normal arm, the tendon can no longer be palpated at the elbow flexion crease. Frequently, there is swelling and bruising around the elbow flexion crease.

The diagnosis can be made by taking a history from the patient and performing a physical exam. An MRI often can confirm a complete tear of the tendon as well as to assess any potential retraction of the tendon. Over the past few years, surgical techniques and implants have improved, which, when combined with people trying to stay more active, has led to an increasing number of distal bicep tendon repairs being performed.

In the past, 2 incisions were typically needed to repair the tendon whereas now 1 is often used. Patients are protected in a brace for the first 6 weeks after surgery after which they progressively work on strengthening exercises before returning to sports. The best results are achieved when surgery is done within three weeks of the initial injury.

Wednesday, November 4, 2009

H1N1 fears cause boom in natural medicine

New Brunswick's natural medicine industry is seeing a boost in popularity as people look for alternative ways to ward off the swine flu virus.

With more H1N1 vaccine clinics being cancelled and those clinics that are running facing queues that stretch for hours, people like Pam Temple are offering natural ways to stay healthy.

Temple, the owner of Healthy Start in Rothesay, said she has a steady stream of new customers coming through her doors. Almost all of those customers are looking for alternative ways to fight the swine flu.

"We have parents that are looking for immune boosters for their children that are under two years old up to senior citizens," Temple said.

"Everyone is concerned about getting their immunity built up."
Naturopath fielding more calls

Blossom Bitting, a naturopath in Dieppe, said she is swamped with calls about H1N1.

However, Bitting said she doesn't have all the answers people want to hear about natural ways to prevent the contraction of the H1N1 virus.

"Because the H1N1 virus is so new, we don't know of anything in the natural realm that is specific against it," Bitting said.

Bitting said there are many supplements that can help fight influenza generally, such as ginger tea, garlic, multivitamins and extra vitamin C.

Bitting said alternative medicines are best used in combination with conventional medicine to stay healthy this flu season.

"I think the combination is going to be stronger than one on its own," she said.

Wednesday, October 28, 2009

Antipsychotic Drugs in Kids Linked to Weight Gain

Children and teens who took antipsychotic medicines in a study gained weight and developed increased blood-fat levels, possibly harming their future health, researchers in New York State said.

The subjects, taking the antipsychotic drugs for the first time, gained from 9.7 to 18.7 pounds (4.4 to 8.5 kilograms) after about 11 weeks of treatment, depending on which medicine they were given, the scientists said today in the Journal of the American Medical Association. Fifteen patients who didn’t stick with drugs or who declined to participate in the research gained less than half a pound on average.

The study was the largest to show how antipsychotic medicines affect the bodies of children taking the drugs for the first time, the researchers wrote. Many past studies of the drugs involved patients who had also used other treatments -- methodology that may have masked the extent of weight gain, according to an editorial published with the study.

“We were able to show all of these agents can cause quite a bit of body weight changes and body composition changes that are not beneficial to the health,” said Christoph Correll, the study’s lead author, in a telephone interview on Oct. 23.

“What we need to figure out is what are the long-term consequences in the lives of children,” Correll, who is a medical director at Zucker Hillside Hospital in New York City’s Queens borough and an associate professor of psychiatry at Yeshiva University’s Albert Einstein College of Medicine in the Bronx.

Metabolic Syndrome

Gaining weight and changes in blood sugars and fats can be precursors to metabolic syndrome, a group of risk factors linked to heart disease and diabetes, according to the research article. Weight gain, obesity and increases in cholesterol in children are linked to their adult risk of cardiovascular problems and cancer.

Patients in the study had been diagnosed with mood disorders, schizophrenia and disruptive or aggressive behavior. Their doctors had prescribed Abilify, made by New York-based Bristol-Myers Squibb Co.; Zyprexa, made by Indianapolis-based Eli Lilly & Co.; Seroquel, made by London-based AstraZeneca Plc, or Risperdal made by New Brunswick, New Jersey-based Johnson & Johnson.

Risperdal and Abilify are the only two antipsychotics approved for pediatric use. A panel of outside advisers to the U.S. Food and Drug Administration recommended in June that Seroquel, Zyprexa and New York-based Pfizer Inc.’s Geodon be cleared for pediatric use.

Impact in Children

The medicines, so-called atypical antipsychotics, were introduced for adults in the mid-1990s and marketed as having fewer neurological side effects than older drugs. The FDA has grappled with pediatric use for years because of concerns that weight gain, sleepiness and movement disorders reported as side effects in adults may be more pronounced in children.

U.S. sales of antipsychotic drugs reached $14.6 billion last year, the most for any class of medicines, according to IMS Health Inc. in Norwalk, Connecticut. Use of antipsychotic medicines by people younger than 20 years old has more than doubled since 2001, according to data compiled by Medco Health Solutions Inc. of Franklin Lakes, New Jersey.

The study reported today was conducted to determine if weight gain and other changes to the body were related to the start of a psychiatric illness or hospital admission, or to the medicines.

Prescribed for Behavior

Researchers at Zucker Hillside, and at the Feinstein Institute for Medical Research in Manhasset, New York, studied 272 people ages 4 to 19 who were prescribed the antipsychotic medicines for behavioral, mood or psychosis-related problems. The patients were followed for the first 12 weeks.

At about 11 weeks, those taking Zyprexa gained 18.7 pounds on average, compared with 13.4 for Seroquel, 11.7 for Risperdal and 9.7 for Abilify, the study showed.

“The extent and the rate of weight gain is remarkable,” said Christopher Varley, a professor in the psychiatry and behavioral sciences department at the University of Washington in Seattle, in a telephone interview on Oct. 23. “Realistically the kids were exposed to 11 or 12 weeks of medication. Some of them gained over 20 pounds.” Varley co-wrote the editorial in the journal that was published with the study.

Ten percent to 36 percent of the patients in the study became overweight or obese within 11 weeks of starting the medicine, the researchers said.

Cholesterol Increases

Those on Zyprexa had larger increases in cholesterol and blood sugars, according to the study. Those on Risperdal had rises in their levels of triglyceride, a type of fat found in the blood, without affecting their blood sugar, the researchers wrote. Those on Seroquel also had an increase in total cholesterol and triglycerides, and patients on Abilify didn’t have any significant worsening in their blood fats or blood sugars, according to the scientists.

Correll recommended that parents monitor their children’s weight and make sure the kids are eating healthy food and exercising.

Doctors in some cases should consider counseling and behavior therapy, as well as parental training, before prescribing the drugs, Correll said. Once the medicines are given to children and adolescents, doctors need to frequently monitor the weight gain and the patients’ blood sugars and blood fats, he said.

In the editorial accompanying the study, Varley wrote, “Given the risk for weight gain and long-term risk for cardiovascular and metabolic problems, the widespread and increasing use of atypical antipsychotic medications in children and adolescents should be reconsidered.”

The study was funded partly by the U.S. National Institutes of Health, based in Bethesda, Maryland.

Friday, October 23, 2009

U.S. drug labels omit vital data

In a shocking revelation, two prominent doctors have revealed that most of the times key information telling about the extent of side-effects or the effectiveness of the medicines is excluded from the drug labels in the country.

Because of the omission of important information, the drug ultimately is presented in a way that makes it seem safer and more effective than it actually is. This was written by the doctors in a commentary in the New England Journal of Medicine.

Drs. Lisa Schwartz and Steven Woloshin of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire, wrote, “Much critical information that the Food and Drug Administration (FDA) has at the time of approval may fail to make its way into the drug label and relevant journal articles.”

The labels on various medicines are actually written by the manufacturers and the FDA finally gives a stamp of approval after discussing the wording.

However, some relevant information might be missing, said Woloshin. He questioned, “How can I decide if the potential harms of this drug are worth the risk if I don’t know how well the drug works, and vice versa?”

Examples of drug labels where key information was missing
Citing one of the numerous examples, the doctors quoted the case of Sepracor’s four-year-old sleep drug Lunesta that was promoted with an advertising campaign that cost a whopping $750,000 per day in 2007.

The company benefited very much and generated sales of $600 million last year. It even became a wholly-owned subsidiary of Dainippon Sumitomo Pharma Co Tuesday.

The label on the drug only said that Lunesta was superior to a placebo and nothing else was specified.

However, when the tests were conducted and the results were given to the FDA, it came to light that “Lunesta patients still met criteria for insomnia and reported no clinically meaningful improvements in next-day alertness or functioning,” wrote Schwartz and Woloshin.

Another such case in point is that of Takeda Pharmaceutical Co’s insomnia drug Rozerem. The label on the drug did not mention that laboratory statistics have revealed that it still took 31 minutes for adults above 64 years of age, and 24 minutes for younger adults to fall asleep once they consumed the drug.

Not only this, when clinical trials were conducted, the volunteers reported “no subjective improvements in total sleep time, sleep quality, or the time it took to fall asleep.” But all this information was not mentioned on the drug label, the researchers said.

Schwartz and Woloshin stressed in their commentary, “Sometimes what gets lost is data on harms.”

New system to make drug labels clearer in content
Woloshin believes that he and his colleagues have found a better system that can help in clarifying the extent of the dangers and benefits of the drugs to the consumers.

The FDA’s Risk Advisory Committee is also in favor of the new system and the matter will be further discussed next month.

As genetic medicine races ahead, docs are left behind

Genetic tests that can help predict and refine a patient's response to drug therapy may be the first big thing in personalized medicine. But the vast majority of physicians don't know how to use them, a new survey finds.

Individual genetic variations can affect how a patient will respond to many antidepressants, pain medications, cardiovascular medicines and certain drugs that treat cancers and gastrointestinal ailments. In all, roughly one in four American patients take medications whose effectiveness could be tweaked or predicted by a pharmacogenetic test. And purveyors of genomic testing services and devices are rushing to provide tests for them all.

A survey of more than 10,000 U.S. physicians undertaken by the American Medical Assn. and the pharmacy benefits manager Medco Healthcare Solutions Inc. found that just more than one in four had had any type of education in the use of genetic testing to guide medication decisions. And only 1 in 10 felt he or she had the necessary training and knowledge to put pharmacogenetic testing to good use in treating patients. Some 13% had ordered or recommended a genetic test for a patient in the last six months. But twice that many said they would do so in the next six months.

Genes that regulate liver enzymes can have a particularly powerful influence on a patient's response to a medication. Scientists believe that one such enzyme may be responsible for governing the way patients respond to some 30% of all drugs used today. In oncology, a test can help predict if breast cancer patients will respond to the drug tamoxifen. And cancer drugs in the development pipeline are expected overwhelmingly to be administered with the guidance of genetic tests. Genetic tests also can help reduce unwanted side effects; the blood thinner warfarin, for instance, can cause blood clots or serious bleeds in some patients with an identified genetic variance, and physicians are increasingly testing those on a blood-thinning regimen in an effort reduce such risks.

"It's clear there's wide acceptance" on physicians' part for the role that genetic testing can play in guiding medication decisions, said Dr. Robert Epstein, Medco's chief medical officer, who briefed physicians and researchers on the survey at the annual meeting of the American Society for Human Genetics on Thursday. But the AMA and other groups must step up efforts to educate physicians in the use of these tests, added Epstein. "With the number of new drugs coming to market with a companion diagnostic, it's paramount that this education takes place."

Sunday, October 11, 2009

Promising Pre-Med Wins Nobel Prize in Medicine

The Nobel Prize Committee announced today that it is awarding the Prize in Medicine to Jimmy Duncan, a senior at Horace Greeley High School in Chappaqua, New York, for getting a 97 on his bio-chem final.

“The Committee felt that Master Duncan has shown great promise with his outstanding grades,” said Dr. Leif Quisling, chairperson of the Nobel Prize Committee. “It is our fervent hope that this award encourages him to do great things in the future, such as find a cure for cancer.”

The committee was first alerted to Jimmy Duncan when they came across a YouTube clip of Duncan’s class presentation on his career goals.

“We were particularly struck by his unbridled optimism,” said Dr. Quisling. “Duncan closed his passionate talk with these inspiring words: ’And we can end cancer in our lifetimes if we all work together really, really hard!’ It is exactly those kind of empty platitudes that impress this committee. Far more so than anything so gauche as actual achievement.”

Mr. Duncan was somewhat blase’ about the news. “I was lying in bed playing a little X-Box before heading off to school when my mom yelled, ‘Jimmy, you’ve got a phone call from Stockholm!’ It was pretty cool, yeah.”

Dr. Quisling acknowledged that the committee was inspired to award prizes prematurely after giving President Barack Obama a Nobel Peace Prize the year before, despite the fact that nominations had been closed only 11 days after he entered office.

“In Barack Obama’s case, we figured that if the American people were willing to hand over the U.S. presidency to someone who hasn’t accomplished much, why not give him the Nobel Peace Prize before he’s done anything, either?” Dr. Quisling said.

As for Jimmy Duncan, 17, he says he’s “psyched” about the Nobel Prize. “I should be a shoo-in now to get into Harvard,” he said.

“By the way, I’m not going pre-med anymore,” Duncan volunteered. ”Now that I’ve got the Nobel in Medicine, why bother? I’ll just invest my prize money in a diversified fund and I never have to work another day in my life. In fact, I may just skip Harvard and go to a party school. Arizona State, here I come!”

We contacted Dr. Quisling’s office for a comment on Duncan’s change in plans. Nobody returned our calls by press time.

Thursday, October 8, 2009

Babies Born to Childhood Cancer Survivors Do Well

Cancer treatments can compromise fertility, but new research suggests that when survivors of childhood cancer are able to have children, their babies do not face an increased risk of birth defects.

Women who survived childhood cancer were more likely to have premature or low birth weight babies compared with women who had never had cancer, one study found. But the survivors’ newborns were no more likely to have malformations or die, nor were the mothers at greater risk for pregnancy complications over all.

A companion study of men who had survived childhood cancer found that their offspring were slightly more likely to be of low birth weight (less than five and a half pounds), but they were not at greater risk for birth defects or prematurity than children born to men who had not had cancer.

The two studies, done by researchers at the Fred Hutchinson Cancer Research Center in Seattle, were published in The Archives of Pediatrics and Adolescent Medicine.

The researchers used national cancer registry data from 1973 to 2000 in four regions — Seattle, Detroit, Salt Lake City and Atlanta — to identify boys and girls who had cancer before age 20. They then linked the data to birth records to identify the first children born to cancer survivors after their diagnosis.

They were able to compare the outcomes of babies born to 1,898 female cancer survivors with 14,278 controls, also identified from birth records, and to compare the outcomes of 470 babies of male survivors with 4,150 controls.

“The main take-home message is that most kids born to childhood cancer survivors did very well,” said Dr. Eric J. Chow, an author on both papers and a research associate at the cancer center.

The study was limited because it was only able to count birth defects that were obvious upon delivery, he said. Still, he added, “Most people can feel reassured.”