The Medicine Chest

GLOMUS TUMOR

2006-05-24T14:47:00.000-07:00

Have you ever heard of a glomus tumor? Probably not since it is very rare. However, if you have, please send me your story or medical info.
For approximately 5 years, I was experiencing a throbbing burning pain in my left thumb. It got to the point where it was so painful I sought out a hand specialist. After three MRI's she diagnosed a glomus tumor under my thumb nail. She stated the only way to relieve the pain was to have it removed. This would be done by putting me under anesthesia, removing my nail and cutting out the tumor. Three weeks ago, I had the surgery performed. I woke up in excruciating pain. She stated "You should not be in any pain because I have removed the tumor." I was given morphine and a prescription for pain and sent home.
I was scheduled for a follow-up exam in ten days. The pain did not let up during this time. I went for my appointment. I was seen by the doctors' assistant. I told her how much pain I was in (although it was quite obvious.) She took out the stitches, put a band-aid on it, and a splint. The doctor never examined or even looked at my thumb. She stood in the doorway, told me there was no explanation for my pain and suggested I get a second opinion. Four days later, I called her office and left a message saying I was in excruciating pain. I waited all morning for a call back. No one called. I went to the emergency room. I was seen by a doctor who diagnosed me with a bacterial infection called cellulites. I was given prescriptions for antibiotics, an anti-inflammatory and pain.
It is now five days later. My thumb is still very swollen, red and I'm still in a lot of pain. I can not find another hand specialist who will see me. I am now at my wits end as to what to do next.
Help! If any one has any suggestions as to what I can do, or if anyone has had a glomos tumor, please respond. I would really like to hear about your experience. Thanks for any help you can give me.
Pedro

Grapefruit and Drugs

2005-04-11T12:02:00.000-07:00

Food and other nutrients can impact the effectiveness of prescription and over the counter drugs. IN the 1980s, scientist discovered that grapefruit juice inhibits the CYP3A4 enzyme. which metabolizes cretin drugs and may enhance the body absorption of the drugs, causing side effects. The Web site at www.DruginteractionCenter.org contains a database of grapefruit-drug interactions along with the supporting scientific literature. Consumers will information about specific drugs under the section labeled "Professionals," or they can search for a specific drug by name.

Bextra Suspension

2005-04-07T15:57:00.000-07:00

The FDA and European regulators agreed that Bextra's risks outweigh its benefits. Both groups asked drug maker, Pfizer Inc. to remove Bextra from the market.

The FDA asked Pfizer to add a "black box" warning to the label of its painkiller Celebrex. Bextra and Celebrex are in a class of drugs known as COX-2 inhibitors that also includes Vioxx, which was pulled last year because of an increased risk of stroke and heart attack.

The FDA singled out Bextra for suspension because it gives no added advantage as a painkiller and can cause a potentially life-threatening skin condition called Stevens-Johnson syndrome, a reaction that usually begins as a blistering of the mouth and lips and can spread to to the rest of the body.

Teething

2005-04-06T20:43:00.000-07:00

Teething occasionally may cause mild irritability, crying, low-grade temperature (but not more than 100 degrees Fahrenheit), excessive drooling, and a desire to chew on something hard. Usually, the gums around new teeth will be tender and swell.
To ease your baby's discomfort, the American Academy of Pediatrics recommends that you try gently rubbing or massaging the gums with one of your fingers. Teething rings are helpful, too, but they should be made of firm rubber.
Pain relievers and medications that you rub on the gums usually aren't useful, since they wash out of the baby's mouth within minutes. If your child seems particularly miserable or has a fever higher than 100 degrees, teething probably isn't the cause. You should consult your pediatrician as soon as possible.

Asthma inhalers banned in 2009

2005-04-02T12:59:00.000-08:00

Albuterol metered-dose inhalers that contain CFCs, which asthma patients use to help open air passages and ease breathing, will be banned in the U.S. starting in 2009.

Glaxo Smith Kline and Ivax Corp. are some makers of albuterol inhalers that do not contain CFCs, unfortunately they cost about $20.00 more than older, generic inhalers.

CFC-containing albuterol inhalers had been exempted from a general ban on CFC production because they were given "essential use" status.CFCs deplete the earth's protective ozone layer.

Fish oil holds promise in Alzheimer's fight

2005-03-27T20:02:00.000-08:00

Senior author Greg M. Cole, Ph.D., a neuroscientist at the Greater Los Angeles VA Healthcare System and UCLA, said that unlike many studies with mice, this one points to the benefits of a therapy that is easily available and already touted for other medical conditions. DHA--either from food sources such as fish and soy, or in fish-oil supplements--is recommended by many cardiologists for heart health, based on scores of previous studies. "The good news from this study is that we can buy the therapy at a supermarket or drug store," said Cole. "DHA has a tremendous safety profile--essentially no side effects--and clinical trial evidence supports giving DHA supplements to people at risk for cardiovascular disease." The new study involved older mice genetically altered to develop Alzheimer's disease. The researchers fed one group of the mice DHA-fortified chow. The control mice ate a normal or DHA-depleted diet. After three to five months--the equivalent of several years in human biology--the high-DHA group had 70-percent less buildup of amyloid protein in the brain. This sticky protein makes up the plaques, or patches, that are a hallmark of Alzheimer's. A similar study by Cole's group published in Neuron last fall showed that DHA protected against damage to the "synaptic" areas where brain cells communicate and enabled mice to perform better on memory tests. The studies, say the scientists, suggest that even people who are genetically predisposed to the disease may be able to delay it by boosting their DHA intake. Omega-3 fatty acids, typically deficient in the American diet, are essential for human health. DHA in particular is vital to proper brain function, as well as eye health and other body processes. In recent years epidemiologists have tied fish-rich diets to a lower incidence of Alzheimer's disease and homed in on DHA as the preventive factor. Omega-3 fatty acid supplements are now being tested in clinical trials with early-stage Alzheimer's patients in the United States, Canada and Sweden to see if the therapy really slows the disease. Food sources of omega-3 fatty acids include fish such as salmon, halibut, mackerel and sardines, as well as almonds, walnuts, soy, and DHA-enriched eggs. Concerns about mercury contamination in fish have helped popularize purified DHA supplements based on fish oil or algae. Last year, Cole's team identified another nutrient that appears to combat Alzheimer's plaques in mice: curcumin, the yellow pigment in turmeric, one of the spices that make up curry powder. Researchers became interested in curcumin's potential to prevent or treat Alzheimer's disease after noting the low prevalence of dementia among the elderly in India, where curry is a staple. Cole is the associate director for research at VA's Los Angeles-based Geriatric Research, Education and Clinical Center, and a professor of medicine and neurology professor of medicine and neurology at the David Geffen School of Medicine at UCLA. Lead author for the new study was Giselle P. Lim, PhD, a UCLA postgraduate researcher in Cole's group. Working with them were colleagues from VA, UCLA and the National Institutes of Health. The study was supported by the National Institute on Aging, VA, the Alzheimer's Association, and the Canadian Institutes of Health Research. People wishing to receive e-mail from VA with the latest news releases and updated fact sheets can subscribe at the following Internet address: va.gov/opa/pressrel/opalist_listserv.cfm

Salmon have high levels of poisons

2005-03-22T19:45:00.000-08:00

Rich in heart protective fats, salmon has become a favorite of the health conscious, there is such a high demand that they are being farmed around the world. The problem here is fish farms also breed toxins, a recent study the largest of its kind, revealed farmed salmon have high levels of poisons like PCBs and dioxins.
Scientist have studied more then 700 salmon, both wild and farmed from North America, South America, and Europe, looking for 14 organochliorines thought to cause cancer and birth defects. All 14 were found in North American and European farmed salmon and in higher amounts than in wild specimens.
The source of the toxins seems to be the food they feed them on the farms. Salmon are carnivorous and thus are fed meal and oil derived from smaller fish. Organochliorines are fat soluble, so trivial amounts in small plant-nibbling fish become concentrated in the fatty tissue of salmon.
To protect their children, women should avoid eating farmed salmon at all from the day they are born through menopause. Men on the other hand can safely eat wild salmon as often as eight times a month, but farmed salmon only once or twice a month. Salmon from farms in Scotland and the faeroe Islands are so contaminated; they should not be eaten more then three times a year.
This story was written on information gathered by Dr. David O. Carpenter Professor at the Environmental Health and Toxicology Division, School of Public Health at the University of Albany in New York.

Corticosteroid Treatment Effective for Children's Asthma

2005-03-20T15:51:00.000-08:00

New studies are confirming the benefit of treating young asthmatic children with inhaled corticosteroids.

"It's not new information, but it backs up what we know," said allergy expert Dr. Clifford Bassett, a clinical assistant professor of medicine at the State University of New York. "It's viable as a long-term treatment." A pharmacological corticosteroid is a hormone similar to those produced by the adrenal cortex, such as cortisol and aldosterone. These hormones have been shown to be effective in combatting asthma.

The studies were presented Saturday at the annual meeting of the American Academy of Allergy, Asthma and Immunology in San Antonio.

According to background information, the proportion of American children with asthma has grown from 3.6 percent to 6.2 percent. Children under the age of 5 have the highest rate of hospitalization from the disease.

"Asthma in young children results in significant morbidity," said Dr. Kevin Murphy, lead author of one of the studies and a clinical professor of pediatrics at the University of Nebraska Medical Center in Omaha. "It's the No. 1 chronic disease in children."

Murphy's study was a retrospective analysis of 11,407 children under 5 years old who had been diagnosed with asthma and were taking medication for their condition.

Those who were given inhaled corticosteroids first (before any other medication) had fewer emergency room visits than those who were prescribed the therapy first or second: 25 percent of the kids who got inhaled corticosteroids first had an emergency room visit or a hospital stay at least once during a year vs. 29 percent of those who had the drug prescribed second and 41 percent of those who had it prescribed third.

"The earlier you get it, the better," Murphy said. "This should encourage people to think about early intervention."

A second study looked at 1,974 children 5 to 10 years old who were randomized to receive either budesonide, an inhaled corticosteroid, once a day or a placebo. All the participants also took their regular asthma medications.

Use of budesonide earlier reduced the risk of an exacerbation by 40 percent. These children also had less of a need to use their other mediation (12 percent versus 23 percent).

"When we added budesonide, we saw a significant decrease in asthma," said Dr. Albert Sheffer, chairman of the study safety committee and a clinical professor of medicine at Harvard Medical School in Boston.

Children taking budesonide, however, did have slowed growth, Sheffer added, but they caught up after five years.

The frequency of other side effects was similar in both groups

Exercise can help depression

2005-03-17T20:12:00.000-08:00

The idea is to do something active to trigger the mechanisms that reduce negative moods and improve positive moods.

How exercise reduces symptoms isn't clear. There are plenty of theories, about both the physiological and psychological pathways that can improve symptoms related to depression including sadness, anxiety, stress, fatigue, anger, self-doubt and hopelessness.

The physiological mechanisms that may be at work is an increase in levels of certain mood-enhancing neurotransmitters in the brain. In addition, exercise may boost endorphins, release tension in muscles, diminish sleep abnormalities, reduce levels of the stress hormone cortisol and even increase body temperature, which has calming effects.

Help with Pain relief

2005-03-15T12:25:00.000-08:00

International group of pain specialists meets to develop recommendations for the treatment of chronic moderate-to-severe pain in the wake of the global withdrawal of rofecoxib (Vioxx(R)) and concerns regarding use of other COX-2 inhibitors.

Given uncertainty over the continuing safety and utility of coxibs, and the lack of clear interim guidance from national and international regulatory agencies, societies and organizations, physicians and their patients face a dilemma. Should they revert to the use of traditional NSAIDS, with their associated serious side-effect profiles (a cause of 16,500 deaths each year in the USA alone), or should they be looking to adopt more flexible approaches? An expert panel of pain specialists met in UK to discuss this issue and to attempt to formulate guidance for physicians.

After discussing the safety data for both NSAIDs and the COX-2 inhibitors, the group endorsed an expanded role for weak opioids, which are more effective in moderate-to-severe pain than NSAIDs, and possess other significant advantages included titratability, reversibility and lack of prostaglandin-associated side effects. The role of combinations of weak opioids and other analgesic agents - in particular, tramadol plus paracetamol - merits particular attention.

The group considered that tramadol and tramadol combinations offered a useful advantage in that they were 'NSAID-sparing'; i.e., they could be used in combination with lower-than-usual doses of NSAIDs. Use of tramadol is recommended by medical societies.

Hurdles to proper utilisation of weak opioids were also addressed by the panel. Side-effects are a common reason given for non-compliance. The panel agreed that a policy of 'go low, go slow' - starting with a low dose and increasing it gradually - should be used to achieve good analgesia without intolerable side-effects.

The meeting concluded with a discussion on the importance of communicating clear guidance to physicians on appropriate prescribing of analgesics in this new climate of uncertainty regarding the continuing use of COX-2 inhibitors.

In light of the recent decision of the NIH to suspend use of the COX-2 inhibitor celecoxib in the Adenoma Prevention with Celecoxib (APC) trial - and the likelihood that elevated cardiovascular risk may indeed be a class effect - physicians and other healthcare providers are now faced with significant treatment and ethical challenges. The need for prompt and clear guidance to physicians is immediate and urgent.

The discussions at the meeting and recommendations of the panel will be written up and submitted for publication in the peer-reviewed literature.
Source: Medicdirect

Schizophrenia

2005-03-15T11:00:00.000-08:00

A UK survey of psychiatrists has revealed that they believe more than 50% of people with schizophrenia forget to take their treatment, increasing the risk of the return of psychotic symptoms – relapse. Almost 90% of psychiatrists agreed that taking treatment as prescribed is the key to reducing the risk of relapse.

1 As many as 82% of people with schizophrenia and schizoaffective disorder will relapse within the first five years of recovery from a first episode.

2 The return of symptoms (relapse) is often traumatic and debilitating, and may result in hospitalisation or even more tragically, suicide.

3 Urgent action is needed to help people with schizophrenia benefit from advances in treatment and care. The survey captured data for nearly 2,000 patients and is endorsed by SANE - one of the leading mental health charities.

Marjorie Wallace, Chief Executive of SANE said, “People with schizophrenia often find it difficult to continue with treatment due to the intolerable side effects of older treatments and complicated treatment regimes.” She continued, “According to psychiatrists, almost two out of three patients rely on their family, carer or doctor to remind them to take their treatment. This can be distressing for the person with schizophrenia as well as increasing the burden on carers, often ending in conflict within the family, who are usually the main source of support. We therefore need to devise strategies to help people continue with treatment, whilst also ensuring this is part of a package of care to help people get better and carry on with everyday life.”

Psychiatrists in the survey reported that 53% of people with schizophrenia often felt embarrassed or upset at having to take tablets everyday for their illness1. This reinforces the need for support and education of people with schizophrenia in order to encourage them to take treatment as prescribed. They should be involved in decisions about their medication and be well-informed about the benefits, possible side effects, and importance of taking treatment long-term in order for them to get better and remain well.

Dr Martin Turner, Consultant Psychiatrist, from Glasgow says, “With atypical antipsychotic medications we have an excellent opportunity to help people with schizophrenia manage their illness. Since many patients with schizophrenia do not recognise that they have an illness, the very fact that atypical medications work so well and have a low level of side effects compared to the older antipsychotics, means that many patients will not take them as prescribed and often stop them altogether once they feel well.” The survey showed that as many as 65% of psychiatrists believed their patient had chosen to stop medication because they felt better.1 He continued, “If people stop their medication for any reason, they become increasingly vulnerable to the return of symptoms and hence relapse. It’s our role as psychiatrists’ to ensure that patients and their carers know that the potential consequences of discontinuing treatment can be devastating.” source: Medicdirect

THE DOCTOR IS INgreat medical help

2005-03-13T17:57:00.000-08:00

Self-diagnosis is the new cool. MedicDirect is the name behind many of the health channels on popular ISP portals. Medicdirect provides a complete health information resource for both consumers and medical practitioners.

Medicdirect recognize the need for a comprehensive medical information website which supplements the medical information supplied by patients’ own doctors but avoids the hazards of self-diagnosis used in other websites.

The medical information is written in plain simple English, and provides comprehensive and authoritative information online. The patient’s awareness of health issues is enhanced by the use of multimedia including videos and both supplements and complements the advice provided by doctors to their patients.