Archive for March, 2007
For women with very dense breasts or a strong family history of breast or ovarian cancer, MRI can yield much greater detail than mammography. MRI is so sensitive that it can reveal many types of suspicious growths in the breast. For this reason, there may be more false-positive findings leading to some unnecessary biopsies and additional scans. But for women at high risk for the disease, MRI can find tumors when they are most treatable.
Breast MRI requires special equipment, software and trained radiologists, and the expense can be 10 times the cost of mammography. In addition, breast MRI may not be available outside large cities.
Women at high risk are defined as having at least a 20 to 25% chance of developing breast cancer over their lifetime. Most U.S. women have about a 9% lifetime risk. Those who inherited defective BRCA1 or BRCA2 genes – a condition involved in only 10 percent of breast cancers – have a lifetime risk ranging from 36 to 85% of getting the disease. Especially at risk are those whose mothers, sisters or daughters carry those mutations, even if the woman herself has not been tested.
Using MRI for breast scans is especially useful for women who have been diagnosed with cancer in one breast and who need to know the status of the other breast. This sensitive technology can find tiny tumors that mammograms have missed. If an early cancer is detected in the other breast, both can be treated at the same time. Studies have shown that 10% of women with cancer in one breast over time will also develop it in the second breast.
MRI scans are most useful in younger women with cancer diagnosed in one breast and those with dense tissue that mammograms do not clearly image. Older, post-menopausal women with early tumors and clear mammograms are less likely to need MRI imaging.
Breast MRI can cost between $1,000 and $2,000. It may not always be covered by medical insurance. Figuring out just who needs MRI scans in addition to mammography can be difficult and much will depend on having a knowledgeable referring physician. A simple risk calculator is available online at http://www.cancer.gov/bcrisktool/. Genetic counseling can also be valuable in determining a woman’s level of risk.
Sources: New York Times ; MSNBC
Â
March 31st, 2007
Since the last estimate five years ago from the Alzheimer’s Association, another 10% increase in the disease has occurred in this country. More than 5 million Americans are now living with Alzheimer’s. By the year 2030, some 7.7 million may be affected.
This alarming trend is expected to accelerate, as baby boomers begin turning 65 in 2011. The largest risk factor is age. Currently, 1 in 8 persons over age 65 has the mind-destroying disease. Over age 85, almost half have Alzheimer’s or another type of dementia.
While small drops in the death rates from heart disease and cancer make headlines, Alzheimer’s-related deaths have increased by 33%. Even more disturbing is the trend toward early-onset Alzheimer’s. The disease in those under age 65 is vastly underreported and is often difficult to recognize in its early stages, before full-scale memory problems are involved.
Despite years of research, the causes of Alzheimer’s progressive brain deterioration are still largely unknown, and there is no cure. Medications on the market only temporarily alleviate symptoms. The disease that gradually robs memories and the ability to provide self-care eventually kills Alzheimer’s sufferers.
Medicare spends nearly three times as much for dementia patients’ care as is does on the average beneficiary — $13,207 a year for Alzheimer’s patients compared to $4,454 annually for others. Medicare expenditures do not add in the expense of families and friends proving round-the-clock care, as most Alzheimer’s patients live at home. However, a new report indicates that close to $83 billion is spent annually on nursing home costs for patients in advanced stages of the disease.
Nine drugs for Alzheimer’s are in the final stages of clinical trials. If some of these drugs are successful in slowing or delaying the onset of Alzheimer’s symptoms by even a few years, millions of dollars could be saved in health care costs in future decades. The toll in human suffering could also be greatly alleviated. Experiencing “the long good-bye†in those you love can be excruciating.
Source:Â Yahoo News
March 22nd, 2007
The FDA warned in mid-March that all prescription sleeping pills have the potential to cause bizarre behaviors, such as “sleep-driving.†In extremely rare instances, patients have been known to get up in the night and drive, with no later memory of the event.
About one out of 1,000 persons on these medications has experienced unusual behaviors such as sleep driving, preparing and eating food, making phone calls, or even having sex while asleep. More common than middle-of-the-night excursions is driving while still feeling dangerously drowsy, for example, during an early morning commute.
Although extremely rare, another reported risk is a life-threatening allergic reaction and severe facial swelling. This side effect can occur with first use or anytime thereafter when the pills are taken. Seek immediate emergency treatment for such an occurrence.
Later this year, pharmaceutical companies that manufacture 13 prescription sleep medications will include new, extensive warnings in a special “medication guide†brochure. Some insomnia drugs may be riskier than others. The FDA has recommended clinical trials to compare their complications and frequencies with which they occur.
Ambien and a second drug Phenergan were implicated in sleep-driving headlines last year when Rep. Patrick Kennedy crashed into a barrier outside the U.S. Capitol building. Kennedy stated that he did not recall being behind the wheel.
To lower the risk of sleep-driving and other risky behaviors, patients are advised never to take any prescription insomnia drug with alcohol or another sedating drug. Also, never exceed the recommended dosage.
The thirteen drugs for insomnia, so-called “sedative-hypnotics,†which will carry the new warnings are: Ambien, Butisol sodium; Carbrital; Dalmane; Doral; Halcion; Lunesta; Placidyl; Prosom; Restoril; Rozerem; Seconal; and Sonata.
Source:Â CNN.comÂ
March 17th, 2007
If you’ve ever experienced chronic pain (lasting more than six months), you were probably depressed. Pain and depression can form a vicious cycle, with one fueling the other. When your quality of life takes a big nosedive, you generally get depressed. If a significant disability is also involved, your chances of depression are even greater.
Most physicians who treat patients with chronic pain also treat the depression that usually accompanies it. Your internist may wish to give you a prescription or refer you to a psychiatrist. Sometimes you may be referred to a licensed “behavioral medicine†specialist. So-called cognitive therapy classes may be especially useful in helping you find new ways of thinking and thus reduce your pain levels.
Talk therapy usually takes a back seat to prescription antidepressants these days. In fact, sometimes talking about your pain can actually make it worse because you focus on it more. Antidepressant medications are often a primary treatment for depression, especially when chronic pain syndromes or nerve-related disorders are involved.
The earlier your depression is treated, the better the outcome can be. Early diagnosis and appropriate medications can reduce distress and even prevent suicide, in many cases. Those receiving treatment for depression that takes place while experiencing chronic pain often have an improvement in their overall medical condition.
Antidepressants work by altering certain chemical levels in the brain. It may take a while to find a particular antidepressant with minimal side-effects that works well for you. Every person experiences pain and reacts to medications differently. Among the antidepressants which are commonly prescribed today are the following:
- Celexa
- Prozac
- Zoloft
- Elavil
- Norpramin
- Effexor
- Serzone
- Wellbutrin
- Cymbalta
- Paxil
- Remeron
If you are depressed about a serious, life-changing event or due to severe, unremitting pain and disability, you should consult a physician about treating your depression.
Source: WebMD
March 11th, 2007
Epidural steroid injections to treat chronic back pain and sciatica do little to give lasting relief, according to medical researchers in the field of neurology. Back pain is often accompanied with leg pain along the path of the sciatic nerve. Depending on which vertebral disks are involved, sciatica runs down the back or the side of the leg and can be excruciating.
Based on findings of four studies, a group of neurology professionals is advising against use of epidural injections for long-term back pain relief, improving back function, or avoiding surgery.
Patients who received epidural shots had mild improvement in pain for two to six weeks after their injections. Compared with patients who got epidural shots with no medications (placebo injections), the steroids failed to relieve back pain more than the placebo at 24 hours, three months or six months after the treatments.
The neurologists agreed that some pain relief is positive, but they concluded that the results fell short of expectations and are not “clinically meaningful.†Not only did the shots fail to give significant pain relief, they also did not improve the patients’ average back function or help to avoid back surgery.
Study results were recently published in a news release from the American Academy of Neurology. The report indicates that the team of neurologists did not have enough data to evaluate the use of epidural steroid shots for neck pain. Researchers call for more studies of these types of injections for neck and back pain.
Source:Â WebMD
March 8th, 2007
Results of recent studies have revived the controversy over circumcision in infants. The U.S. leads the way in holding to this practice, although in the past decade or so, the surgical procedure has declined. A 1999 survey of hospital records found circumcision rates varying widely by region — 81% in the Midwest, 66% in the Northeast, 64% in the South and 37% in the West.
In Europe, Asia, and Latin America, baby boys are not routinely circumcised, however Jewish and Muslim faiths traditionally subscribe to circumcision. Recent international studies have cast new light on the subject. Two trials held in Africa involving more than 7,500 men were stopped early because results showed that circumcised adult males had a 51% to 60% lower rate of contracting HIV, the AIDS virus, than their uncircumcised counterparts.
Researchers believe that the warm, moist area under foreskins of uncircumcised men can breed infections. Lifestyle and personal cleaning habits may have more impact on health, however, than the surgical removal of foreskin. In some areas of the world, clean water and soap may not be widely available, and in these areas, circumcision may make sense.
Doctors in the U.S. are split in their opinions on the potential benefits of circumcision. Those opposed believe that circumcision does unnecessary violence to the infant’s genitals, and that the decision should be left to the male in adulthood. Furthermore, they believe that removing a baby boy’s foreskin might diminish his sexual pleasure when he becomes sexually active.
Doctors who favor the procedure point out that studies over the years have shown circumcised males to have lower rates of urinary tract infections, penile cancer (a rare condition), and a variety of sexually transmitted diseases (STDs). Circumcised baby boys have fewer urinary tract infections and possibly other problems, but these can be treated with antibiotics or other strategies if needed.
Tradition, religion and philosophical beliefs will continue to be factors involved in the emotional choice involving circumcision. In the final analysis, it is up to the parents, guided by information from their baby’s doctor, to make the decision.
Whatever parents decide for their newborn sons will probably be fine, as there appear to be advantages and disadvantages either way. When in doubt, why not leave the penis intact and let the individual decide as an adult?
Source:Â MSNBC
March 5th, 2007
