Archive for February, 2009
The most recent of several studies involving women who had breast cancer and who also take drugs to strengthen bone shows encouraging results. The study of 1,800 women, published recently in the New England Journal of Medicine, involved those who took hormonal therapy to block estrogen production that fuels growth in certain breast cancers. Half of the group was also given zoledronic acid, or Zometa, intravenously twice a year for three years. Women given Zometa showed a 36 percent reduction in cancer recurrences and metastases, compared to half the group who didn’t get it.
 Four years later, 54 women receiving zoledronic acid and 83 who didn’t get the bone drug had a recurrence, a new cancer in the second breast, or a spreading of cancer to the bone. The question is, shouldn’t all women on hormonal therapy for breast cancer receive Zometa or a similar bone drug? Before prescribing these drugs as standard therapy, researchers plan to examine results from two other large studies now nearing completion. Women taking hormonal therapy are blocking estrogen production, which in turn can cause thinning of bones. Why not add the bone-building drugs to their anti-cancer therapies?
 Cancer cells are known to interact with a type of bone cell called osteoclasts, whose role is to break down bone. Breast cancer cells sometimes migrate to the bones and stimulate osteoclasts, which in turn stimulate cancer cells. It’s a vicious cycle. But what if the cycle can be interrupted?
 Drugs used to treat the bone-thinning disease osteoporosis have been shown to stop osteoclasts from releasing substances that cause bone loss. As osteoclasts stop working, they die. Other studies of bisphosphonates to prevent osteoporosis have shown in lab studies that they might have other anticancer effects. Bisphosphonates affected the ability of cancer cells to stick to surrounding tissue, to invade and grow in numbers. One of the new study’s lead researchers believes that bisphosphonates could squelch the cells that migrate to the bones and hide in marrow, thus affecting the ability of breast cancer to recur.
 Researchers are also investigating whether bisphosphonates could treat cancer that has already metastasized to bone. After determining that they could, zoledronic acid and other bisphosphonates were approved for women with bone metastasis. These therapies were shown in one study to prevent further spread of cancer in bones. Zometa is approved only for bone complications of cancer and is not an official drug for osteoporosis. There is a rare but quite serious side effect, osteonecrosis of the jaw, which has been seen with bisphosphonate use. No instances have been seen in study participants, however.
 Studies are still in progress to investigate whether these bone drugs used in high doses to treat cancer can prevent breast cancer from initially spreading. Results have been mixed. In research now ongoing, there is hope that zoledronic acid could add a benefit to existing breast cancer therapy to the same degree as the magnitude from chemo or hormonal therapy alone. Scientists and physicians are waiting for data from other studies. Clinical trials may have the answers in the near future.
 Source: Gina Kolata; New York Times; Feb. 11, 2009
http://www.nytimes.com/2009/02/12/health/research/12bone.html?th&emc=th
blog article by Anna Dabney
February 16th, 2009
Pain and weakness in the shoulder joint is often described medically as “impingement syndrome.†This condition results when tendons of the rotator cuff are pinched as they pass between the top of the upper arm and the tip of the shoulder. A group of four muscles and bones, the “rotator cuff,†share a common tendon. “Tendonitis†of the shoulder joint is another frequently used term.
Impingement syndrome of the shoulder joint occurs when muscles and tendons don’t slide easily and normally. Tendons and bursae, fluid-filled sacs that protect the tendons, become irritated and swollen. Typical symptoms of this syndrome are pain, tenderness and the inability to move the shoulder joint fully and normally. An injury or repetitive motions over many years may result in the onset of a cycle of inflammation, swelling, and misery.
Other symptoms can include pain or weakness in raising the arm above your head or away from the side of the body; a grating or catching of muscles when you rotate or raise your arm; and inability to sleep on the affected side due to pain.
Risk factors for impingement syndrome:
* Injuries to the shoulder joint
* Age 50 or older
* Athletes engaging in activities such as tennis, swimming, baseball, and football     that involve repetitive movements of arm and shoulder
* Persons who develop bone spurs or rough spots on bone that can irritate surrounding tissue and cause swelling
* Those whose bones are shaped in a manner that allows less space between the joint than the average person
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Treating Impingement Syndrome:
Treatments may be as simple as taking aspirin and resting the arm, or it may ultimately involve surgery, depending on the severity of the condition. Some treatments that may be effective in resolving the condition are the following:
* Conservative care:Â rest the joint and use ice packs for up to 20 minutes at a time, as needed, up to three or four times a day.
* Take anti-inflammatory drugs such as aspirin or ibuprofen.
* Avoid activities that cause pain such as lifting something heavy or stretching to reach past your comfort zone.
* Physical therapy, including exercises or stretching to strengthen, preserve or extend your range of motion; faithfully perform exercises at home.
* Cortisone or steroid injections given if other approaches don’t eliminate the symptoms; some doctors give a cortisone injection early in the syndrome to reduce pain and swelling.
* Surgery, the last resort
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Impingement syndrome may take many months or even a couple of years to heal. This is especially true when it is complicated by the “frozen shoulder†syndrome, where one cannot raise the arm overhead. Patience, your doctor’s guidance, physical therapy, and prescribed home exercises should help to ultimately resolve the condition.
Sources: Cedars-Sinai Medical Web site and personal experience; blog article by Anna Dabney
           http://www.cedars-sinai.edu/9837.html
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February 11th, 2009
For over 50 years, Darvon or Darvocet has been prescribed to treat pain. Recently, an advisory panel of the Food and Drug Administration (FDA) recommended that the risks and benefits of the drug be re-examined. Problems such as addiction and suicide have been associated with its long-term use.
First approved in 1957, Darvon was one of the few drugs at that time for treating pain. The alternatives were aspirin or powerful narcotics. Today, it continues to be marketed as Darvocet and it is one of the top 25 most commonly prescribed medications. Over 20 million prescriptions of the Darvon/Tylenol combination are written annually.
Dr. Sidney Wolfe, a drug safety expert with Public Citizen, is spearheading the drive to ban Darvon. He first spoke out and proposed a ban against the painkiller in the 1970s. It is Dr. Wolfe’s opinion that Darvocet offers weak pain relief and poses a risk of overdose and potential for use in suicide.
The two companies that market Darvocet say that the medication is safe and effective when used as directed. They argue that physicians need a range of medications for use in treating pain. Some company representatives point out that many other painkillers have become drugs of abuse, and with considerably worse consequences.
A professor of medicine at Harvard and critic of the pharmaceutical industry commended FDA advisers for looking hard at Darvon. His point, that it is not the most dangerous drug in its class, but that doesn’t mean that Darvon is a good drug.
The United Kingdom banned its version of Darvon in 2005. If the FDA decides to take the advisory panel recommendations, it could mandate stiffer warning labels, safety studies, and more efforts to educate doctors and patients about its shortcomings and potential risks.
In the U.S., Davon-related deaths in 2007 rose to 503 from the 446 that occurred the previous year. In both years, about 20 percent of these emergency room visits and deaths were considered suicides. Only about one-third of the U.S. population is tracked in these reported statistics from emergency rooms.
On a personal note: I took Darvocet for chronic pain for many years as prescribed by my physician, and I believe it can become a problem with long-term use. It is, in my opinion, a good drug to ease pain following surgery – especially for those who can’t tolerate a more powerful pain reliever such as Vicodin or Percocet. Chronic pain in itself is a debilitating and depressing condition. Few options are available that have no risks or undesirable side-effects. I eventually tried the strategies urged by Dr. Dean Edell, who recommends that persons taking drugs for chronic pain over long periods try phasing off painkillers. They might find, as I did, that their pain can be managed without them. Sometimes the drug itself can be responsible for recurrent cycles of pain and depression. I have felt much better since gradually phasing off Darvocet.
Source:Â Associated Press story; January 31, 2009; and, personal experience.
Written by Anna Dabney
February 4th, 2009