Archive for April, 2008
The FDA is re-evaluating its position as to the safety and effectiveness of LASIK surgery. Millions of Americans have had successful outcomes from LASIK, in which a laser reshapes the eye’s cornea and reduces or eliminates dependence on glasses or contact lenses. However, members of the U.S. regulatory agency on healthcare issues are currently considering the testimony of 140 patients who are complaining of serious side effects. These individuals had LASIK procedures performed between 1998 and 2006.
Approximately 700,000 Americans elect to undergo laser surgery for vision correction each year. The majority who are selected as appropriate candidates can see with 20-20 vision or better after vision correction surgery. Unfortunately, about 25 percent of those who consult LASIK surgeons for the procedure are not appropriate patients. Those persons should clearly understand the risks they are taking if they decide to proceed with LASIK, which generally costs about $2,000 per eye.
With the LASIK procedure, doctors cut a flap in the cornea, the eye’s clear covering, and aim a laser underneath it. The laser quickly and painlessly zaps and reshapes the cornea to achieve sharper vision. Cutting the corneal flap severs the nerves responsible for tear production. If these nerves heal well, dry eye is only temporary. Some individuals endure long-lasting dry eye and intense pain which can sometimes be improved by additional surgery to help the eyes retain moisture.
Those with overly large pupils, thin corneas, severe nearsightedness, or who have difficulty with dry eyes should not be considered good candidates for LASIK. Some surgeons can be faulted for not giving adequate information on potential problems and for not ruling out those who do not meet appropriate criteria for the surgery.
About 95 percent of patients who undergo LASIK are satisfied with their outcome. In the 5 percent or less who have poorer outcomes, it is unknown how many suffer with troublesome daily side effects. It is estimated that less than 1 percent have severe complications that leave them with poor vision.
Among the complaints aired at the hearings are reports of unremitting eye pain, blurred or double vision, painful dry eyes, and poor vision even using glasses. For others, their problems leave them unable to drive at night due to glare or fuzzy vision. Headlights from approaching cars may look like huge “starbursts” of light. In extreme cases, an individual may become despondent and resort to suicide. In one testimony, a father told of his son’s suicide note in which he described his deep depression over his reduced vision and years of intolerable side effects.
Among the suggestions the FDA is hearing: (1) use photographs to illustrate the effects of poor outcomes; (2) explain how often patients suffer from side effects such as dry eyes (almost half experience this condition even months after LASIK); (3) communicate clearly the conditions that should disqualify someone from having the eye surgery; (4) explain to young persons with extreme nearsightedness that they would be guaranteed to need reading glasses in middle age if they have the eye surgery. Without LASIK, they might avoid the need for glasses in later life, as eyes become more far-sighted with age.
Although the FDA agrees with eye surgeons’ studies indicating that only about 5 percent of patients are dissatisfied, they do not yet know how many individuals suffer lasting severe problems and how many simply didn’t have the degree of vision correction they expected.
Sources: San Francisco Chronicle, AP reporter Lauran Neergaard, 4/26/08;
Yahoo News, 4/25/08; Susan Heavey,
New York Times
April 27th, 2008
According to the Center for Health Statistics, deaths from Methadone nationwide are increasing at a faster rate than other deaths related to drug use. The number of Methadone deaths nationwide rose from 786 in 1999 to 4,462, a nearly six-fold increase. As a comparison, fatal cocaine overdoes rose 63 percent.
Most cocaine users realize they are dealing with a drug with potentially lethal consequences. In contrast, Methadone is not widely perceived as being especially hazardous. Substance abusers are often given Methadone as a heroin substitute, but generally under tight controls. In addition, chronic pain clinics are increasingly prescribing Methadone for pain relief. Because methadone is slow-acting and patients seek immediate relief, they may take a pill or more than the prescribed dose. Methadone does not give a high and is sometimes dangerously combined with other drugs or alcohol.
Some chronic pain patients obtain multiple prescriptions for Methadone from different medical providers. These prescriptions are difficult to track. Other persons get their prescriptions illegally from friends or buy them from individuals. Those who take Methadone without appropriate medical supervision may be unaware of its potential risks. The drug oxycodone, or OxyContin, belongs to the same class of drugs as Methadone. In states such as Vermont, OxyContin is the leading cause of 80 drug-related deaths last year.
For someone with a low tolerance for certain drugs, even low doses of Methadone or OxyContin can be dangerous. While the Northeast is seeing Methadone as the street drug of choice, methamphetamines are the predominant street drugs in other parts of the U.S. Deaths from Methadone are beginning to drop in New England and the Eastern Seaboard where educational campaigns are emphasizing the potential hazards of its use.
Source: San Francisco Chronicle; April 18, 2008; Holly Ramer, A.P.
April 20th, 2008
For those who have experienced chemotherapy, or watched their loved ones go through it, the idea of an effective cancer treatment with NO side effects seems like a dream come true. Dreams can be a long time in coming, however. The brain child of American inventor John Kanzius may one day be the answer to the prayers of cancer patients. First, his Kanzius Machine must be rigorously tested in laboratory animals before clinical trials are approved for cancer patients. Preliminary lab testing has shown great promise.
The potential new treatment that Kanzius envisioned was featured on CBS’ “Sixty Minutes” (April 13, 2008). In theory, it involves gold or carbon nanoparticles injected into the bloodstream or into a cancerous tumor. These metallic-laced nanoparticles, already FDA-approved, attract radio waves. Once the diseased cells are properly targeted, radio waves would heat them to an optimal temperature to eradicate them. The idea is to destroy cancer cells, leaving healthy cells undamaged. Nanoparticles are so tiny that trillions of them can be contained in a test tube. The chief problem is finding a delivery system in which the nanoparticles would bind only to cancer cells.
How did a man without a medical degree or credentials as a lab scientist come up with a revolutionary idea to treat cancer? Diagnosed with liver cancer six years ago, John Kanzius had endured thirty-six rounds of chemotherapy. During his treatments at a renowned cancer center, he was touched by the faces of young cancer patients, children with teddy bears, fighting for their lives. It was then that he vowed to try to find a better way to fight cancer.
One sleepless night, the retired radio and TV executive envisioned using radio waves to treat cancer. In his childhood, he had built radio sets. He understood that radio waves could harmlessly pass through a living organism but were attracted by metal. Once his primitive tests showed promise, the senior citizen built radio-wave equipment and conducted experiments in his garage. He invested $200,000 of his own money to build prototypes of his radio frequency (RF) equipment. Support and funding for his efforts have since materialized from many sources. His Kanzius RF Machines are now selectively placed in laboratories at the University of Pittsburgh and at MD Anderson Cancer Center in Houston, Texas.
At MD Anderson, Dr. Steven Curley, a surgical oncologist, began to work closely with Kanzius on his invention. Dr. Curley believes the potential treatment to be the most exciting new development he has seen in twenty years of working in oncology. Like an “ultimate weed killer” able to kill weeds without harming grass, the treatment is designed to destroy only the cancer cells. The ability to eliminate solid tumors injected with gold nanoparticles has already been demonstrated in rats and rabbits. The ultimate goal is to be able to target microscopic cancer cells that have circulated throughout the body. Curing metastatic cancers would not be possible without such a selective delivery system. If a way is found to precisely target and destroy only cancer cells, then the potential to cure many types of cancers is tremendous – and with no pain and distress.
John Kanzius is working with the Lee Memorial Health System in southwest Florida to coordinate tentative clinical trials after approval is granted. He hopes to live to see his dream realized some three or four years down the road.
Sources:
http://en.wikipedia.org/wiki/Kanzius machine; http://60minutes.yahoo.com/segment/159/the_kanzius_machine
April 17th, 2008
A hip fracture, one of the most dreaded injuries, can be devastating and complicated. This medical emergency is a painful, stressful and life-changing event. One in five persons over age 50 who breaks a hip will die within a year. Forty percent of hip-fracture patients over age 65 move to a nursing home after hospitalization.
The risk of a hip fracture rises with age. Those with brittle bones (osteopenia or osteoporosis) are most likely to suffer a hip fracture from falling, or in some cases, just the stress of walking can cause the femur to snap. Protective reflexes in older adults are slower and make it more difficult to avoid falling directly on a hip. In addition, certain medications, such as SSRIs and oral corticosteroids, may increase fracture risk.
A few people are “fortunate” enough to have stable fractures so that they are able to avoid surgery and move around after a few days of rest. The majority of hip fracture patients undergo surgery within 24 hours of being admitted to the hospital. Hip fractures can sometimes heal without surgery after up to three months of bed rest. However, prolonged immobility can lead to complications such as pressure sores, deep vain thrombosis (DVT), and muscle loss. The risk of DVT can be reduced with pressure stockings and blood-thinners, but the best protection involves getting up and moving around as soon as possible after surgery. Any unusual heat, pain and swelling in the leg can indicate that DVT has developed, during which a clot can travel to the lung or brain.
Recovering the ability to walk is unlikely following several months of bed rest. Because urinary catheters must be used when the patient is confined to bed, urinary tract infections are an additional risk. Catheters should be removed as soon as possible. If the patient is immobilized for long periods, pneumonia may set in. Delirium can be another complication to watch for, including delusions, agitation and hallucinations. Less subtle symptoms and more commonly seen are impaired ability to focus, disorientation, and memory and language problems. These symptoms may be overlooked due to heavy sedation for pain and in those suffering from dementia.
The prognosis for recovery is best in cases where hip surgery is an option. The type of hip surgery is determined by the location of the fracture. Surgery is the beginning of the long road to recovery. Only the patient can do the painful and difficult work of rehabilitation, which starts as soon as possible after the operation. Physical therapists help the patient to walk to a chair and use the bathroom. Therapy progresses to include exercises to strengthen muscles and learning to use a walker and a cane.
The patient may go to a rehab center for two weeks, followed by several months of outpatient therapy. Not everyone is able to return home after rehabilitation is completed. Some go to a nursing home and continue their physical therapy before they are able to return home. Others may need to stay there permanently to receive the support the need.
Living at home after a hip fracture can be complicated and difficult for all concerned. Pain and setbacks can impede the recovery process. The home environment should be modified in order to make it easier for the patient to function and remain active while minimizing pain. Soreness can persist for a month or longer, and the individual can quickly lose strength if not strongly motivated to continue exercises learned in rehab. Depression can also sap the desire to continue rehabilitation.
Caregivers should understand that the hip fracture patient has a high risk of a second fracture. In many cases where thin bones are involved, the physician will prescribe life-long osteoporosis therapy to strengthen bones and reduce risks of future falls and fractures. It is vital that the patient also gets adequate calcium intake – 1,200 to 1,500 mg daily for people over 50 and vitamin D of 800 IU daily. Calcium and vitamin D strengthen bones and lower the risk of falling again.
Seniors can do a great deal to avoid the pitfalls of a hip fracture. For those with thinning bones, osteoporosis therapy and Calcium can help as preventive measures. Getting adequate exercise, using hand-held weights to build bone, and working on balance are also useful. Those who are unsteady on their feet should have a walking companion and use a cane. Obstacles such as loose throw rugs should be removed from the home. When exercising outdoors, walking on an even surface can help to prevent tripping and falling.
Johns Hopkins Medical Letter: Health After 50; August 2007
April 9th, 2008
Some women in their 40s can still get pregnant without assistance from fertility clinics. That’s good news for those who have postponed motherhood, but for women who have completed their family, continuing fertility can be problematic. Today, the Pill and the IUD (intra-uterine devices) are both considered good options for some women in their fourth decade. These two methods are much safer than, for example, in the 1960s and 1970s. In the past, most women over age 40 underwent a tubal ligation (a fallopian tube-tying procedure), or relied on condoms or vasectomy with their male partner.
Sterilization is now easier for women, thanks to a non-surgical method of tubal treatment called Essure. The new technique was approved by the U.S. government in 2002. No cutting of the abdomen or tying of the tubes is involved. Instead, the doctor works through the cervix, using a thin tube to insert small devices into the ends of the fallopian tubes. These “plugs” in about three months produce scarring to block the woman’s tubes, thus preventing ovulated eggs from reaching the uterus.
Women over 40 should continue to use birth control until well into menopause. This age group has been shown to have high abortion rates, similar to those of adolescents. Under certain conditions, the Pill is now safe for “older” women. The dosage of estrogen in today’s Pill is greatly reduced and considered by many physicians to be a good alternative for lean, healthy women over 40. The Pill has other benefits besides contraception for appropriate women. It can help to control irregular menstrual bleeding and hot flashes, reduce hip fractures and cases of ovarian cancer. Yet, some physicians urge caution even in lean and healthy women who are approaching menopause.
If a woman over 40 is significantly overweight, has high blood pressure or diabetes, the Pill would not be a good option. For them, the chances of dangerous blood clots rise sharply. Middle-aged women who are obese, who smoke, have migraine headaches or other identified risk factors might instead consider IUDs or progestin-only treatments termed “mini-pills.” Although higher breast cancer rates have been found in older women taking estrogen-progestin pills to control menopausal symptoms, women 35 and older taking oral contraceptives have not shown an increase in breast cancers.
Another birth control product called Implanon, FDA-approved in 2006, is a matchstick-sized plastic rod that is implanted under the skin of the upper arm. Implanon is similar to the earlier Norplant and can last up to three years.
Today’s IUDs are safer and more effective than those used by women in the 1970s. The earlier Dalkon Shield version resulted in a number of serious medical problems due to its defective design. A large class-action lawsuit was filed and millions in payouts were made over the years. American women and their physicians are again considering the IUD as a simple and effective method of birth control.
Women should discuss with their OB-GYN physician their preferences for contraception, the appropriateness for their age group and their individual health risks. New options in birth control methods and technologies greatly reduce the risk of an unwanted pregnancy.
San Francisco Chronicle, Mike Stobbe, AP story, April 5, 2008
http://www.msnbc.msn.com/id/23954260/
April 8th, 2008
Over the past six months, I took a breather from writing blog articles for Healthcareupdates.com. During that period, I put more effort into my personal writing which includes poetry and my autobiography in progress. I also served as chief copy editor for my daughter, who just completed her doctoral dissertation.
For relaxation, I took three special trips. I attended my high school reunion out of state, celebrated my birthday with my grown children, and took a cruise to Mexico’s Yucatan Peninsula. I’m now back and looking forward to again summarizing the latest trends in healthcare, as I see them. I encourage comments or questions from my readers.
April 8th, 2008