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Lymphland International Lymphedema Online
| Healing Honey for Wounds WASHINGTON, D.C. (Ivanhoe Newswire) -- Some people suffer wounds that just won't heal. To solve the problem, doctors are going back in time to find a solution that helps heal everything from diabetic sores to burns. Josh Pennington has mowed the lawn more times in his 63 years than he can count, but the routine chore nearly killed him when he hit a stone that wounded his leg. That wound just wouldn't heal. "I do a lot of hunting and fishing outdoors where I could possibly get it infected, so that was always on my mind," Pennington told Ivanhoe. His wound was so deep, it exposed his bone -- and nothing he tried for three years would fix it. To solve the problem, doctors at Georgetown University tried a new bandage infused with honey. "As long as it's clean and it's healthy and it's showing progress, I'm with the program," Pennington said. Medi-Honey is a highly-absorbent, seaweed-based bandage soaked with a special kind of honey produced only in Australia and New Zealand. The honey is concentrated and provides an ideal environment for wound healing. "It kills bacteria with some of the enzymes it has in it," Christopher Attinger, M.D., Chairman of the Division of Wound Healing at Georgetown University Hospital in Washington, D.C., told Ivanhoe. The acid in the bandage also helps lower the pH level in chronic wounds for better healing. Unlike antibiotics, the honey poses no toxic effects or risks of resistance. "We're starting to use manuka honey as a first-line drug as opposed to waiting to see whether other dressings work, because we've had excellent success with it," Dr. Attinger said. In just months, Pennington's wound shrunk 95 percent. "Power to the bees," Pennington said. He couldn't be happier that this sweet new treatment gave him his life and use of his leg back. Researchers believe the Medi-Honey bandage may also protect wounds from infections like MRSA. A box of the bandages costs $50. FOR MORE INFORMATION, PLEASE CONTACT: Division of Wound Healing Georgetown University Hospital Washington, D.C. (202) 444-3059 http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=20176 ----------------------------------------------------------- Zapping Migraines COLUMBUS, Ohio (Ivanhoe Newswire) -- About 28 million Americans suffer from migraines. The debilitating headaches disrupt lives and force many to rely on powerful pain medications. Now a new technique zaps away pain before it starts using a migraine magnet. It happens at the worst times. "Migraines are pretty inconvenient for me," Richard Higgins told Ivanhoe. Higgins has suffered from migraines since he was a kid. Now the biomedical engineer often gets them at work. "My first symptoms are auras, which are small blind spots in my vision, and over the course of 10 to 15 minutes that blind spot grows so much so that I can't read or I can't drive safely," Higgins described. There may be a way to relieve his pain without medication. "This is a very exciting and important option," Yousef Mohammad, M.D., M.Sc., a professor of neurology at Ohio State University Medical Center in Columbus, told Ivanhoe. It's called a transcranial magnetic stimulator or TMS. "They'll put it at the back of their head and they'll receive two pulses," Dr. Mohammad explained. The device sends magnetic pulses during the aura phase -- the warning period before the migraine hits. It's often described as an electrical storm. "We're interrupting this electrical storm or current in the brain before it leads to the headache," Dr. Mohammad said. Research shows 39 percent of patients were pain-free two hours after the treatment compared to twenty- two percent who got sham pulses. Higgins eagerly joined the TMS trial, hoping to find a replacement for pain killers. "Using a device that can disrupt my migraine without taking medicine, I think is for me a much safer way to deal with the symptoms," he said. With a job that requires his full attention, Higgins can't afford to let his migraines win. According to Dr. Mohammad, the TMS device could approved in the next few months. If approved, it will probably be much smaller than the one used in the research trials. Women are three times more likely to suffer from migraines than men. FOR MORE INFORMATION, PLEASE CONTACT: Ohio State University Medical Center Sheri Kirk, Medical Center Communications (614) 293-3737 Sheri.Kirk@osumc.edu http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=20233 ------------------------------------------------------ http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=20237 Medicine's Next Big Thing: Growing New Cartilage for Knees? PROVIDENCE, R.I. (Ivanhoe Newswire) -- Bending down or getting up can be a painful chore for someone with knee problems. Doctors say many times the loud creaking in a person's bones can be blamed on a loss of cartilage, but researchers are close to finding a permanent solution. They're helping the body heal itself by naturally re-growing cartilage. Getting down to her granddaughter's level is difficult for 60-year-old Kathleen Haberstroh. "It hurts," she described to Ivanhoe. "It shoots up and down my leg and I can actually hear the bones grinding." Thomas Webster, Ph.D., a biomedical engineer at Brown University in Providence, R.I., developed a solution that could soon help people like Haberstroh naturally regenerate cartilage in their own bodies. "We developed a material that serves as a band-aid that can be put in the place of the degenerated cartilage," Dr. Webster explained to Ivanhoe. He created molecular-scale tubes made of carbon that would be implanted in a person's knee. The tubes' rough surfaces are similar to natural tissue, which attracts cartilage-growing cells. "We're more or less tricking the body into thinking we're implanting part of itself," Dr. Webster said. Every time a person takes a step, the pressure on the tubes generates electricity. That current triggers the cells to grow cartilage. "Cells which are residing on the material can feel and sense and grow much more effectively than without that electrical property," Dr. Webster said. The goal: produce new cartilage and help Haberstroh play without pain. "It would make things a lot happier because I wouldn't be left out a lot," Haberstroh said. It could be a permanent solution for those who don't want to miss a moment of the action. Dr. Webster and his team are still testing the cartilage regeneration procedure. Right now doctors inject an artificial gel to imitate cartilage in the knee, but that's only a temporary solution requiring follow-up injections. FOR MORE INFORMATION, PLEASE CONTACT: Thomas Webster, Brown University (401) 863-2318 Thomas_Webster@brown.edu ----------------------------------------------------------------------------------------- stress and your immune system, quiz on how emotions affect your immunity Stress: Your Body Under Attack by Anita Harris Having trouble sleeping? Popping more antacids than usual? Or maybe you've had more colds this winter. Maybe these symptoms are related to stress. Just about everyone has experienced a pounding heart, tense muscles, and sweaty palms—the body's evolutionary "fight or flight" response when facing a threat. It's a well-known phenomenon that a certain amount of stress can sharpen your mental prowess, and new research suggests that brief exposures to certain stressors may enhance the body's immune response. However, responses designed by evolution to protect us from predators may sometimes be useful, says Richard Sloan, PhD, director of the Department of Behavioral Medicine at the Columbia Presbyterian Medical Center in New York. They are counterproductive in many situations today. Your Body Under Stress When you experience stress, Sloan explains, your blood clots more readily so you bleed less, and blood flows to your muscles so you can fight back with strength. This would be very helpful if you were being attacked by a lion, he says, "but it's not useful when your boss yells at you." According to some studies, prolonged or frequent exposure to stressful events might increase our vulnerability to illnesses like depression, heart attacks, and the common cold. Scientists are only just beginning to understand how this works, according to Firdaus Dhabhar, PhD, an assistant professor and neuroimmunologist at Ohio State University. As he explains it, when our sensory organs encounter a potential threat, they transmit signals to the brain which, in turn, releases chemicals that stimulate nerves and glands throughout the body. In the adrenal glands—which are located near the kidneys—the brain chemicals induce the secretion of the hormones corticosterone and epinephrine, which stimulate the organs to act in various ways. The result is what Dhabhar calls "the typical stress response": The heart beats faster. The muscles tense. Sweat glands are activated. Blood flow is diverted from the intestines to other parts of the body. Immune cells move from the blood to other organs. Ordinarily, Dhabhar says, within three hours following the threat, "Everything goes back to normal." The Dangers of Chronic Stress Under conditions of ongoing or repeated stress—such as continual worry and anxiety, a bad work situation, or medical illness—the body's "fight or flight" system gets "hammered," Dhabhar says. Constant stimulation might lead to overproduction of stress-related hormones and "the systems begin to break down." This, in time, could negatively affect the immune system. According to Herbert Benson, MD, chief of the Division of Behavioral Medicine at Beth Israel Deaconess Medical Center in Boston, chronic stress can lead to the following: Depression Anger High blood pressure Cardiac arrhythmia Insomnia Atherosclerosis Infertility Chronic stress might also increase the risk of heart attacks and make premenstrual syndrome and hot flashes more severe. Recent research suggests that high levels of stress might speed up the progression of AIDS and multiple sclerosis, and hinder the effects of medication. Crying Wolf Repeated or constant exposure to stressors may also impair the brain's ability to evaluate whether a stress response is warranted and make it less able to regulate the response, according to a 1998 article in the New England Journal of Medicine by Bruce McEwen, PhD, of the Rockefeller Institute. This could be problematic at several levels—from the day-to-day management of average stressors to suddenly being faced with a situation that would normally call up the fight or flight response. Recognizing There's a Problem To begin with, it's important to recognize the presence of stress-induced symptoms. The signs may include the following: Excess anxiety Stomachaches Headaches Diarrhea Temper outbursts Unexplained anger or crying spells Nightmares or insomnia Personality changes Impatience Reducing the Stress Change your situation Do what you can to change stressful conditions, Benson advises. If they involve a relationship or workplace situation, he says, "more often than not, this is difficult to do." Learn to relax Benson advocates invoking what he calls "the relaxation response". This well-known technique, based on the principles of transcendental meditation, involves repeating a word, sound, prayer or phrase or performing a repetitive muscular activity. "When other thoughts come into your mind, let them go passively, and come back to repetition." According to Benson, who is the founder of the Mind/Body Medical Institute, these activities have been shown to quiet the brain and to decrease blood pressure, heart rate, and the rate of breathing. Change your outlook Sloan suggests learning relaxation techniques such as biofeedback, and what he terms "cognitive restructuring," a method that involves questioning whether the physiologic reaction you are experiencing is rationally justified. "You may learn that your office is being moved and think 'that's the worst news I've had in years,'" he explains. By "reforming" the issue, you may decide it's not so bad—and your body will respond accordingly. Practice remaining calm Sloan also suggests rehearsing in advance how you will respond to a stressful situation. For example, if you need to deal with a difficult person, "figure out how you will address your concerns without yelling or provoking an angry attack and then practice these behaviors." Seek help Others suggest developing a network of family and friends to avoid social isolation, and seeking professional counseling if needed. Keep it simple In Dhabhar's view, "Grandma's advice still stands." You should "eat good, wholesome food; exercise moderately and get enough sleep." This may seem "too simple," he says, but being in a state of healthy equilibrium helps you minimize the impact of stress and makes your body better able to fend off any immune challenges that arise. RESOURCES: American Institute of Stress http://www.stress.org Mind/Body Medical Institute http://www.mbmi.org/Default.asp Stress Management Briefs from the University of Minnesota http://www.extension.umn.edu/distribution/familydevelopment/DE7269.html ======================================================== Basal Body Temperature and Thyroid Function Thyroid hormone is secreted from a gland in the area of the “Adam's apple” and helps regulate the entire body's activity level (metabolism). Low body temperatures can be a sign of decreased metabolism. This can be caused by thyroid imbalances as well as other hormonal and nutritional problems. Lab studies often miss thyroid problems that aren't immediately life-threatening. By checking your axillary temperature (under the arm) every morning you can see if your metabolism is running at its peak. Shake your mercury thermometer down in the evening within arm's reach of your bed. Upon awakening in the morning (before getting out of bed) place the thermometer under your armpit. Remain very still and read the temperature at 10 minutes. Record the temperature for 10 different days. At the completion of your 10-day cycle add all the temperatures and divide by 10. If your average temperature is below 97.5 degrees Fahrenheit it is probable that you will benefit from thyroid evaluation and treatment. This type of evaluation is best understood by doctors who specialize in functional, holistic, alternative or integrative medicine. More information on this concept is available at www.brodabarnes.org ============================================================ What is irritable bowel syndrome (IBS)? Irritable bowel syndrome is a disorder characterized most commonly by cramping, abdominal pain, bloating, constipation, and diarrhea. IBS causes a great deal of discomfort and distress, but it does not permanently harm the intestines and does not lead to a serious disease, such as cancer. Most people can control their symptoms with diet, stress management, and prescribed medications. For some people, however, IBS can be disabling. They may be unable to work, attend social events, or even travel short distances. What are the symptoms of IBS? Abdominal pain, bloating, and discomfort are the main symptoms of IBS. However, symptoms can vary from person to person. Some people have constipation, which means hard, difficult-to-pass, or infrequent bowel movements. Often these people report straining and cramping when trying to have a bowel movement but cannot eliminate any stool, or they are able to eliminate only a small amount. If they are able to have a bowel movement, there may be mucus in it, which is a fluid that moistens and protect passages in the digestive system. Some people with IBS experience diarrhea, which is frequent, loose, watery, stools. People with diarrhea frequently feel an urgent and uncontrollable need to have a bowel movement. Other people with IBS alternate between constipation and diarrhea. Sometimes people find that their symptoms subside for a few months and then return, while others report a constant worsening of symptoms over time. What causes IBS? Researchers have yet to discover any specific cause for IBS. One theory is that people who suffer from IBS have a colon, or large intestine, that is particularly sensitive and reactive to certain foods and stress. The immune system, which fights infection, may also be involved. Normal motility, or movement, may not be present in the colon of a person who has IBS. It can be spasmodic or can even stop working temporarily. Spasms are sudden strong muscle contractions that come and go. The lining of the colon called the epithelium, which is affected by the immune and nervous systems, regulates the flow of fluids in and out of the colon. In IBS, the epithelium appears to work properly. However, when the contents inside the colon move too quickly, the colon loses its ability to absorb fluids. The result is too much fluid in the stool. In other people, the movement inside the colon is too slow, which causes extra fluid to be absorbed. As a result, a person develops constipation. A person’s colon may respond strongly to stimuli such as certain foods or stress that would not bother most people. Recent research has reported that serotonin is linked with normal gastrointestinal (GI) functioning. Serotonin is a neurotransmitter, or chemical, that delivers messages from one part of your body to another. Ninety-five percent of the serotonin in your body is located in the GI tract, and the other 5 percent is found in the brain. Cells that line the inside of the bowel work as transporters and carry the serotonin out of the GI tract. People with IBS, however, have diminished receptor activity, causing abnormal levels of serotonin to exist in the GI tract. As a result, they experience problems with bowel movement, motility, and sensation—having more sensitive pain receptors in their GI tract. Researchers have reported that IBS may be caused by a bacterial infection in the gastrointestinal tract. Studies show that people who have had gastroenteritis sometimes develop IBS, otherwise called post- infectious IBS. Researchers have also found very mild celiac disease in some people with symptoms similar to IBS. People with celiac disease cannot digest gluten, a substance found in wheat, rye, and barley. People with celiac disease cannot eat these foods without becoming very sick because their immune system responds by damaging the small intestine. A blood test can determine whether celiac disease may be present. (For information about celiac disease, see the NIDDK’s Celiac Disease fact sheet.) How is IBS diagnosed? If you think you have IBS, seeing your doctor is the first step. IBS is generally diagnosed on the basis of a complete medical history that includes a careful description of symptoms and a physical examination. There is no specific test for IBS, although diagnostic tests may be performed to rule out other problems. These tests may include stool sample testing, blood tests, and x rays. Typically, a doctor will perform a sigmoidoscopy, or colonoscopy, which allows the doctor to look inside the colon. This is done by inserting a small, flexible tube with a camera on the end of it through the anus. The camera then transfers the images of your colon onto a large screen for the doctor to see better. If your test results are negative, the doctor may diagnose IBS based on your symptoms, including how often you have had abdominal pain or discomfort during the past year, when the pain starts and stops in relation to bowel function, and how your bowel frequency and stool consistency have changed. Many doctors refer to a list of specific symptoms that must be present to make a diagnosis of IBS. Symptoms include Abdominal pain or discomfort for at least 12 weeks out of the previous 12 months. These 12 weeks do not have to be consecutive. The abdominal pain or discomfort has two of the following three features: It is relieved by having a bowel movement. When it starts, there is a change in how often you have a bowel movement. When it starts, there is a change in the form of the stool or the way it looks. Certain symptoms must also be present, such as a change in frequency of bowel movements a change in appearance of bowel movements feelings of uncontrollable urgency to have a bowel movement difficulty or inability to pass stool mucus in the stool bloating Bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS and may indicate other problems such as inflammation, or rarely, cancer. The following have been associated with a worsening of IBS symptoms large meals bloating from gas in the colon medicines wheat, rye, barley, chocolate, milk products, or alcohol drinks with caffeine, such as coffee, tea, or colas stress, conflict, or emotional upsets Researchers have found that women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can worsen IBS problems. In addition, people with IBS frequently suffer from depression and anxiety, which can worsen symptoms. Similarly, the symptoms associated with IBS can cause a person to feel depressed and anxious. What is the treatment for IBS? Unfortunately, many people suffer from IBS for a long time before seeking medical treatment. Up to 70 percent of people suffering from IBS are not receiving medical care for their symptoms. No cure has been found for IBS, but many options are available to treat the symptoms. Your doctor will give you the best treatments for your particular symptoms and encourage you to manage stress and make changes to your diet. Medications are an important part of relieving symptoms. Your doctor may suggest fiber supplements or laxatives for constipation or medicines to decrease diarrhea, such as Lomotil or loperamide (Imodium). An antispasmodic is commonly prescribed, which helps to control colon muscle spasms and reduce abdominal pain. Antidepressants may relieve some symptoms. However, both antispasmodics and antidepressants can worsen constipation, so some doctors will also prescribe medications that relax muscles in the bladder and intestines, such as Donnapine and Librax. These medications contain a mild sedative, which can be habit forming, so they need to be used under the guidance of a physician. A medication available specifically to treat IBS is alosetron hydrochloride (Lotronex). Lotronex has been reapproved with significant restrictions by the U.S. Food and Drug Administration (FDA) for women with severe IBS who have not responded to conventional therapy and whose primary symptom is diarrhea. However, even in these patients, Lotronex should be used with great caution because it can have serious side effects such as severe constipation or decreased blood flow to the colon. With any medication, even over-the-counter medications such as laxatives and fiber supplements, it is important to follow your doctor’s instructions. Some people report a worsening in abdominal bloating and gas from increased fiber intake, and laxatives can be habit forming if they are used too frequently. Medications affect people differently, and no one medication or combination of medications will work for everyone with IBS. You will need to work with your doctor to find the best combination of medicine, diet, counseling, and support to control your symptoms. How does stress affect IBS? Stress—feeling mentally or emotionally tense, troubled, angry, or overwhelmed—can stimulate colon spasms in people with IBS. The colon has many nerves that connect it to the brain. Like the heart and the lungs, the colon is partly controlled by the autonomic nervous system, which responds to stress. These nerves control the normal contractions of the colon and cause abdominal discomfort at stressful times. People often experience cramps or “butterflies” when they are nervous or upset. In people with IBS, the colon can be overly responsive to even slight conflict or stress. Stress makes the mind more aware of the sensations that arise in the colon, making the person perceive these sensations as unpleasant. Some evidence suggests that IBS is affected by the immune system, which fights infection in the body. The immune system is affected by stress. For all these reasons, stress management is an important part of treatment for IBS. Stress management options include stress reduction (relaxation) training and relaxation therapies such as meditation counseling and support regular exercise such as walking or yoga changes to the stressful situations in your life adequate sleep What does the colon do? The colon, which is about 5 feet long, connects the small intestine to the rectum and anus. The major function of the colon is to absorb water, nutrients, and salts from the partially digested food that enters from the small intestine. Two pints of liquid matter enter the colon from the small intestine each day. Stool volume is a third of a pint. The difference between the amount of fluid entering the colon from the small intestine and the amount of stool in the colon is what the colon absorbs each day. Colon motility—the contraction of the colon muscles and the movement of its contents—is controlled by nerves, hormones, and impulses in the colon muscles. These contractions move the contents inside the colon toward the rectum. During this passage, water and nutrients are absorbed into the body, and what is left over is stool. A few times each day contractions push the stool down the colon, resulting in a bowel movement. However, if the muscles of the colon, sphincters, and pelvis do not contract in the right way, the contents inside the colon do not move correctly, resulting in abdominal pain, cramps, constipation, a sense of incomplete stool movement, or diarrhea. Can changes in diet help IBS? For many people, careful eating reduces IBS symptoms. Before changing your diet, keep a journal noting the foods that seem to cause distress. Then discuss your findings with your doctor. You may want to consult a registered dietitian who can help you make changes to your diet. For instance, if dairy products cause your symptoms to flare up, you can try eating less of those foods. You might be able to tolerate yogurt better than other dairy products because it contains bacteria that supply the enzyme needed to digest lactose, the sugar found in milk products. Dairy products are an important source of calcium and other nutrients. If you need to avoid dairy products, be sure to get adequate nutrients in the foods you substitute, or take supplements. In many cases, dietary fiber may lessen IBS symptoms, particularly constipation. However, it may not help with lowering pain or decreasing diarrhea. Whole grain breads and cereals, fruits, and vegetables are good sources of fiber. High-fiber diets keep the colon mildly distended, which may help prevent spasms. Some forms of fiber keep water in the stool, thereby preventing hard stools that are difficult to pass. Doctors usually recommend a diet with enough fiber to produce soft, painless bowel movements. High-fiber diets may cause gas and bloating, although some people report that these symptoms go away within a few weeks. (For information about diets for people with celiac disease, please see the NIDDK’s Celiac Disease fact sheet.) Increasing fiber intake by 2 to 3 grams per day will help reduce the risk of increased gas and bloating. Drinking six to eight glasses of plain water a day is important, especially if you have diarrhea. Drinking carbonated beverages, such as sodas, may result in gas and cause discomfort. Chewing gum and eating too quickly can lead to swallowing air, which also leads to gas. Large meals can cause cramping and diarrhea, so eating smaller meals more often, or eating smaller portions, may help IBS symptoms. Eating meals that are low in fat and high in carbohydrates such as pasta, rice, whole-grain breads and cereals (unless you have celiac disease), fruits, and vegetables may help. Is IBS linked to other health problems? As its name indicates, IBS is a syndrome—a combination of signs and symptoms. IBS has not been shown to lead to a serious disease, including cancer. Through the years, IBS has been called by many names, among them colitis, mucous colitis, spastic colon, or spastic bowel. However, no link has been established between IBS and inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. Points to Remember IBS is a disorder that interferes with the normal functions of the colon. The symptoms are crampy abdominal pain, bloating, constipation, and diarrhea. IBS is a common disorder found more often in women than men. People with IBS have colons that are more sensitive and reactive to things that might not bother other people, such as stress, large meals, gas, medicines, certain foods, caffeine, or alcohol. IBS is diagnosed by its signs and symptoms and by the absence of other diseases. Most people can control their symptoms by taking medicines such as laxatives, antidiarrhea medicines, antispasmodics, or antidepressants; reducing stress; and changing their diet. IBS does not harm the intestines and does not lead to cancer. It is not related to Crohn’s disease or ulcerative colitis. Hope through Research The NIDDK conducts and supports research into many kinds of digestive disorders including IBS. Researchers are studying gastrointestinal motility and sensitivity to find possible treatments for IBS. These studies include the structure and contraction of gastrointestinal muscles, as well as the mechanics of fluid movement through the intestines. Understanding the influence of the nerves, hormones, and inflammation in IBS may lead to new treatments to better control the symptoms. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory. For More Information International Foundation for Functional Gastrointestinal Disorders P.O. Box 170864 Milwaukee, WI 53217–8076 Phone: 1–888–964–2001 Fax: 414–964–7176 Email: iffgd@iffgd.org Internet: www.iffgd.org ============================================================ What is Peripheral Neuropathy? Peripheral neuropathy describes damage to the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body. More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis. Impaired function and symptoms depend on the type of nerves -- motor, sensory, or autonomic -- that are damaged. Some people may experience temporary numbness, tingling, and pricking sensations, sensitivity to touch, or muscle weakness. Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction. Peripheral neuropathy may be either inherited or acquired. Causes of acquired peripheral neuropathy include physical injury (trauma) to a nerve, tumors, toxins, autoimmune responses, nutritional deficiencies, alcoholism, and vascular and metabolic disorders. Acquired peripheral neuropathies are caused by systemic disease, trauma from external agents, or infections or autoimmune disorders affecting nerve tissue. Inherited forms of peripheral neuropathy are caused by inborn mistakes in the genetic code or by new genetic mutations. Is there any treatment? No medical treatments exist that can cure inherited peripheral neuropathy. However, there are therapies for many other forms. In general, adopting healthy habits -- such as maintaining optimal weight, avoiding exposure to toxins, following a physician-supervised exercise program, eating a balanced diet, correcting vitamin deficiencies, and limiting or avoiding alcohol consumption -- can reduce the physical and emotional effects of peripheral neuropathy. Systemic diseases frequently require more complex treatments. What is the prognosis? In acute neuropathies, such as Guillain-Barré syndrome, symptoms appear suddenly, progress rapidly, and resolve slowly as damaged nerves heal. In chronic forms, symptoms begin subtly and progress slowly. Some people may have periods of relief followed by relapse. Others may reach a plateau stage where symptoms stay the same for many months or years. Some chronic neuropathies worsen over time, but very few forms prove fatal unless complicated by other diseases. Occasionally the neuropathy is a symptom of another disorder. What research is being done? The National Institute of Neurological Disorders and Stroke (NINDS) and other institutes of the National Institutes of Health (NIH) conduct research related to peripheral neuropathies in laboratories at the NIH and also support additional research through grants to major medical institutions across the country. Current research projects funded by the NINDS involve investigations of genetic factors associated with hereditary neuropathies, studies of biological mechanisms involved in diabetes-associated neuropathies, and investigations exploring how the immune system contributes to peripheral nerve damage. Neuropathic pain is a primary target of NINDS-sponsored studies aimed at developing more effective therapies for symptoms of peripheral neuropathy. Some scientists hope to identify substances that will block the brain chemicals that generate pain signals, while others are investigating the pathways by which pain signals reach the brain. Select this link to view a list of studies currently seeking patients. Organizations American Chronic Pain Association (ACPA) P.O. Box 850 Rocklin, CA 95677-0850 ACPA@pacbell.net http://www.theacpa.org Tel: 916-632-0922 800-533-3231 Fax: 916-632-3208 Neuropathy Association 60 East 42nd Street Suite 942 New York, NY 10165-0999 http://www.neuropathy.org Tel: 212-692-0662 Fax: 212-692-0668 National Foundation for the Treatment of Pain P.O. Box 70045 Houston, TX 77270 http://www.paincare.org Tel: 713-862-9332 Fax: 713-862-9346 American Pain Foundation 201 North Charles Street Suite 710 Baltimore, MD 21201-4111 http://www.painfoundation.org Tel: 888-615-PAIN (7246) Fax: 410-385-1832 National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC) 3 Information Way Bethesda, MD 20892-3580 http://www.niddk.nih.gov Tel: 301-654-4415 800-891-5390 Charcot-Marie-Tooth Association (CMTA) 2700 Chestnut Parkway Chester, PA 19013-4867 http://www.charcot-marie-tooth.org Tel: 610-499-9264 800-606-CMTA (2682) Fax: 610-499-9267 Muscular Dystrophy Association 3300 East Sunrise Drive Tucson, AZ 85718-3208 http://www.mda.org Tel: 520-529-2000 800-344-4863 Fax: 520-529-5300 American Diabetes Association 1701 North Beauregard Street Alexandria, VA 22311 http://www.diabetes.org Tel: 800-DIABETES (342-2383) 703-549-1500 National Diabetes Information Clearinghouse (NDIC) 1 Information Way Bethesda, MD 20892-3560 http://www.diabetes.niddk.nih.gov Tel: 301-654-3327 800-860-8747 Prepared by: Office of Communications and Public Liaison National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda, MD 20892 NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history. All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated. http://www.ninds.nih.gov/disorders/peripheralneuropathy/peripheralneuropathy.htm Peripheral Neuropathy: Tingling or Numbness of the Hands and/or Feet Presented by: Nessa Coyle, NP, PhD, FAAN and K. Simon Yeung, PhamD, LAc August 7, 2007 Treatment for cancer may be followed by numbness, tingling, or weakness in some parts of the body. These symptoms may range from distressing to disabling and can affect quality of life. Please join us for an in-depth discussion of this troubling disorder. http://www.mskcc.org/mskcc/html/75594.cfm#395441 ============================================================== COMPLEX REGIONAL PAIN SYNDROME (CRPS) aka REFLEX SYMPATHETIC DYSTROPHY (RSDS) RSD is also known as Complex Regional Pain Syndrome (CRPS) type 1. CRPS type 2 is causalgia which is identical to type 1 except that it is caused by a nerve lesion. Recent evidence suggests that CRPS1 is also from nerve damage.(Please see "Evidence of Nerve Damage in CRPS1" on WHAT'S NEW? page). Other names: causalgia algodystrophy postraumatic dystrophy Sudeck's atrophy shoulder-hand syndrome RSD/CRPS has existed since the American Civil War (1861-5) where Dr. Silas Weir Mitchell documented cases of causalgia in Civil War soldiers. RSD/CRPS is a multi-system syndrome with diverse symptoms characterized by chronic pain. Usually it affects one or more extremities but it can affect any part of the body. Due to dilation or constriction of the blood vessels, the blood supply to the limb (hand, foot, hip, shoulder) is affected. The nerves, skin, muscle and bone are also involved. RSD is a debilitating disease which can impair the ability of the limb to function or function can be lost. How do you get RSD/CRPS? a soft tissue injury due to minor trauma in 65% of cases e.g. sprain, twisted ankle etc. fracture surgery certain cervical spine or spinal cord disorders infections, stroke, heart attack, repetitive motion disorder, or cumulative trauma e.g.. carpal tunnel. certain medications or venipuncture in rare cases What are the symptoms? PAIN usually burning, severe, constant and in an area other than the primary injury site SWELLING usually localized but can involve entire limb SKIN CHANGES: TEMPERATURE or COLOUR: E.G. dystrophy, dryness, tissue atrophy e.g.. can be cool and pallid or mottled; or warm and red with increased sweating. LIMITED AROM (active range of motion) in the affected part INCREASE OF ABOVE COMPLAINTS after exercise What other symptoms are there? motor dysfunction e.g. tremor, weakness, dystonia, spasms dystrophy e.g. muscle wasting limbic system dysfunction e.g.. insomnia, agitation, anxiety, depression, poor memory or judgment hair and nail changes bone changes e.g.. osteoporosis joint tenderness and swelling How is it diagnosed? There is NO SINGLE TEST available to diagnose RSD/CRPS. thorough medical history noting sign and symptoms examination by a qualified expert physician thermography which measures the heat emitted from the body and senses skin temperature differences (may help) DO YOU SUSPECT RSD? "If the pain is out of proportion to the injury, there is stiffness and inflammation following a seemingly minor trauma e.g. twisted ankle, dropping item on foot, sprain , suspect RSD. The pain is described as burning, shooting, stabbing or a "hot poker". If the pain persists longer than the expected healing time of the injury, suspect RSD." (from: Hooshmand, H MD CRPS: Diagnosis and Management Pain Digest Spring Verlager 1999). --------------------------------------------------------------------------------- TREATMENT IS CRUCIAL WITHIN THE FIRST THREE TO SIX MONTHS when the disease responds best. It is essential that the person be referred to the proper specialist for treatment as soon as possible. After 6 months you can still receive treatment however avoid delays and see a specialist as soon as possible for best results. DELAY IN TREATMENT COULD MEAN A LIFETIME OF CHRONIC PAIN for the patient. Without treatment, the disease could eventually become resistant to treatment. --------------------------------------------------------------------------------- Who can get RSD/CRPS? Anyone can get RSD, but it is more prevalent among women 3-1 to men; typically it is a women ages 40-60 who is most affected. However, children and teenagers can have RSD as well. For them, the prognosis is more favourable. What can I do? "Early diagnosis brings the best prognosis" In RSD/CRPS the best response to treatment is within the first three to six months of the disease. If after reading this, you suspect that you or a friend may have RSD, get treatment as soon as possible. For doctor referrals in your area, please contact us. TREATMENT The following is a list of treatments for RSD/CRPS: Drug therapy: a) local or systemic corticosteroids b) muscle relaxants c) alpha-adrenergic and beta blockers d) analgesics e) anti-inflammatories f) tricyclics and related compounds g) tranquillizers h) calcium channel blockers i) membrane stabilizers j) opiods Blocks: a) focal b) sympathetic blockade c) intravenous regional blocks d) epidural e)plexus catheter blocks Physical therapy: land PT or aqua therapy Transcutaneous electrical nerve stimulator (TENS) Sympathectomy: a) surgical b) chemical in selected cases Implantable devices: a) dorsal column stimulator b) peripheral nerve stimulator c) morphine infusion pump (intrathecal drug delivery e.g. baclofen) CURRENT RECOMMENDATIONS FOR TREATMENT UPDATE 2006: Please contact PARC for current recommendations for treatment. UPDATE 2004: From the San Diego Conference Sept. 11-2, 2004, are the "revised therapeutic algorithm for CRPS with emphasis on therapeutic options in response to patient's clinical progress in the rehabilitation pathway".(1) Abstract: The goal of treatment in patients with complex regional pain syndrome (CRPS) is to improve function, relieve pain and achieve remission. Current guidelines recommend interdisciplinary management, emphasizing 3 core treatment elements: pain management, rehabilitation, and psychological therapy. Although the best therapeutic regimen or the ideal progression through these has not yet been established, increasing evidence suggest that some cases are refractory to conservative measures and require flexible application of the various treatments as well as earlier consideration of such interventions such as a spinal cord stimulator(SCS). While existing treatment guidelines have attempted to address the comprehensive management of CRPS, all fail to provide for contingent management in response to a sudden change in the patient’s medical status. This paper reviews the current pathophysiology as it is known, the purported treatments, and provides a modified clinical pathway (guideline) that attempts to expand the scope of previous guidelines.(2) A review of this article will appear in the PARC PEARL newsletter. Please contact PARC. (1,.2) Stanton-Hicks, Michael MD BS, DR med et al An Updated Interdisciplinary Clinical Pathway for CRPS: Report of an Expert Panel World Institute of Pain Pain Practice Vol. 2 No.1; 2002 1-16. --------------------------------------------------------------------------------- 2002 The doctors at the Tampa CRPS/RSD Conference in Feb. 2002 discussed the following: Physiotherapy is the number one treatment modality which will return function to the limb, range of motion, flexibility and strength. It is imperative that PT is part of the treatment program. Aqua therapy is also recommended in 92-93 degree water. It is moist heat which is good for most RSD patients, it is non-weight bearing. it supports weak muscles, and the amount of resistance can be controlled. Warm water is also soothing. Psychological support is also recommended e.g.. counselling, cognitive behaviour techniques, biofeedback, visualization, relaxation techniques, hypnosis. Any of these modalities can help. Medications that control pain are essential and will facilitate the progress made in physiotherapy. CONSENSUS REPORT According to the 1998 Consensus Report compiled by Michael Stanton-Hicks et al, "CRPS:Guidelines for Therapy" states that a three pronged approach is best. The treatment algorithm has the following three elements: A) Medical Interventions: NSAIDS, Opioids, Tricyclics, Alpha 2 Agonists, Calcium channel Blockers. The next phase is blocks (focal, sympathetic, regional,epidural and pumps.). Then Neurostimulation (SCS, PNS) and medications. B) Physical Therapy: It is essential that early intervention occur here. Progress is contingent upon the degree of pain and successful treatment of pain. "It is critical to progress slowly and within patient defined limits.... adequate and liberal analgesia should be used to facilitate these steps.". Steps include gentle reactivation: contrast baths, desensitization. Flexibility, edema control, peripheral E-Stim, isometric strengthening, and most importantly diagnosis and treatment of secondary myofascial pain. Gentle ROM (range of motion exercises), stress loading, isotonic strengthening, general aerobic conditioning, postural normalization and balanced use can also be done. Next is ergonomics, movement therapies, normalization of use and vocational and functional rehabilitation. Any of these methods can be used to facilitate progress in an individual with RSD/CRPS. C) Psychological Interventions: Various methods include counselling (expectations, motivation, control, family, diary) behaviour therapy,relaxation techniques, imagery, hypnosis and coping skills. Any of these methods can be used. Methods A. B. and C are designed to work simultaneously in order to facilitate the return of function and good pain control for the patient. ( Source: Stanton-Hicks M et al "Consensus Report: CRPS: Guidelines for Therapy" Clin Jour Pain 1998: 14; 155-66.) PROBLEMS If treatment is delayed, many RSD/CRPS patients can face the following: a lifetime of chronic pain. not being believed or misdiagnosed receiving inappropriate treatments dealing with doctors who are inexperienced in diagnosing and treating RSD/CRPS Unfortunately, these situations are all too common. Most of the time, reliable information about RSD/CRPS is the key to being believed and diagnosed properly. Receiving inappropriate treatment would not happen if the patient and doctor were better informed. Unnecessary surgery to "correct RSD" would also not occur. As the patient, it is possible to take on the responsibility of informing the doctor . Perhaps then, some of these problems could be avoided. Giving the doctor as much information as you can so that he can better treat you will certainly promote a healthy doctor-patient relationship. Working together with your doctor is a win-win situation. WAYS TO HELP YOUR DOCTOR Prioritize a list of your complaints. Whatever is bothering you the most, list it first. e.g.. be specific about where your pain is. e.g.. Before and after the visit, record pain levels throughout the day to help determine the overall pattern of how the disease affects you. Keep a journal of your medications. e.g. effective and non-effective medications, side effects, etc. Be sure to take someone with you. Take notes so that you are clear as to what transpired. Another point of view is often helpful. Prepare a list of questions. Your spouse/friend can record the answers. Keep a record of your past treatments and medications. Record how they affected you. For new patients, bring your test results, scans, x-rays etc. Make a brief summary of your medical history thus far. OPQRST If you are experiencing pain and are having difficulty describing it, this is a device that doctors use to diagnose pain. It could help prepare you for your next doctor’s visit. Answers should be as clear and brief as possible: • ONSET: When did the pain start? • PROVOKES: What makes it better and/or worse? • QUALITY: What does the pain feel like? e.g. burning, throbbing • RADIATES: Does the pain travel or stay in one place? • SITE:Where do you feel the pain? • TIMING: When do you get the pain? (e.g. morning, evening,) and how long does it last? PAIN DIARY Keep a pain diary with recorded pain levels three times per day. Divide the seven days into three parts and record levels by assigning number to your pain: 0 = no pain 5 = moderate pain 10 = worst pain you ever had Take this pain diary along with your other materials to your doctor. WHY DO WE GET RSD? There are several theories as to why we get RSD. Most of the current theories cannot fully explain all the processes going on in the body e.g.. signs and symptoms vary from patient to patient and can be inflammatory e.g.. pain, edema, skin and temperature changes and neurological e.g.. hyperesthesia, hyperpathy or motor dysfunction (tremor). The psychosocial theory states that various predisposing factors such as emotional instability, nervousness, depression, anxiety and life events contribute to a person developing RSD. There is no evidence thus far, in the literature to support this theory. Inactivity has also been suggested to contribute to edema and muscle atrophy in RSD. In chronic RSD, atrophy and edema are present. However, inactivity cannot explain the skin discoloration, altered temperature or pain. Quite popular even still, is the sympathetic theory which states that an hyperactive sympathetic nervous system is responsible for RSD. Since sweating and vasomotor instability are present and a sympathectomy reduces pain, this theory was thought to hold water. However, it did not explain why some sympathectomies did not work. None fully explained the enigma of RSD. The causalgia theory stated that the burning sensations in RSD were caused by a nerve injury. However, not all RSD had an nerve injury as the cause. In many cases, fracture, or soft tissue injury was the trigger for RSD and no definable nerve lesion could be found. Based on Sudeck's exaggerated inflammatory response theory, the signs and symptoms of inflammation and acute RSD have similarities: "rubor (redness), calor (warmth), dolor (pain), tumor (swelling) and functio laesa (limited function)". Based on Sudeck's theory Dr. Veldman, Dr L van der Laan and numerous other Dutch doctors have done extensive studies with RSD/CRPS patients in Holland. They hypothesize that after an injury or surgery there is an exaggerated inflammatory reaction process which begins in the body. Based on a 1993 study of 829 patients over 8 years, Dr Veldman found that the most common signs and symptoms of pain (92%), swelling (86%), difference in skin temperature (98%), difference in skin colour (97%), limited active range of motion (90%), increase of complaints after exercise (89%) were inflammatory in nature. There is evidence that free radicals are also involved in this inflammatory process since they can damage tissue or membranes in the body. Further evidence, is that free radical scavengers like DMSO (dimethyl sulfoxide), N-Acetyl-cysteine,or IV Mannitol are used successfully in treatment of early cases in Holland. ========================================================== New Guidelines Issued for Management of Hip and Knee Osteoarthritis CME/CE News Author: Laurie Barclay, MD CME Author: Charles Vega, MD posted 2/2008 Release Date: February 28, 2008; Valid for credit through February 28, 2009 Credits Available Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians; Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians; Nurses - 0.25 nursing contact hours (None of these credits is in the area of pharmacology) To participate in this internet activity: (1) review the target audience, learning objectives, and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation; (4) view/print certificate View details. Learning Objectives Upon completion of this activity, participants will be able to: List recommended nonpharmacologic treatments of osteoarthritis of the hip and knee. Identify recommended first-line pharmacologic treatment of osteoarthritis of the hip and knee. Authors and Disclosures Laurie Barclay, MD Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships. Charles Vega, MD Disclosure: Charles Vega, MD, has disclosed an advisor/consultant relationship to Novartis, Inc. Brande Nicole Martin Disclosure: Brande Nicole Martin has disclosed no relevant financial information. February 27, 2008 — The Osteoarthritis Research Society International (OARSI) has issued 25 evidence- based, expert consensus recommendations for the management of osteoarthritis (OA) of the hip and knee. These guidelines, which are published in the February issue of Osteoarthritis and Cartilage, were intended to be adapted for use in different countries or regions according to the availability of treatment modalities and strength of recommendation (SOR) for each modality of therapy. "Osteoarthritis (OA) is the most common type of arthritis and the major cause of chronic musculoskeletal pain and mobility disability in elderly populations worldwide," write W. Zhang, PhD, from the University of Edinburgh, Osteoarticular Research Group, Queen's Medical Research Institute, Edinburgh, United Kingdom. "Knee and hip pain are the major causes of difficulty in walking and climbing stairs in the elderly in Europe and the USA and as many as 40% of people over the age of 65 in the community in the United Kingdom suffer symptoms associated with knee or hip OA." The objective of these guidelines was to develop concise, current, patient-centered, evidence-based, expert consensus recommendations for the management of hip and knee OA. The panel intended these guidelines to be adaptable and designed them as an aid to clinicians and allied healthcare professionals in general and specialist practice throughout the world. Goals of treatment of knee and hip OA include decreasing joint pain and stiffness, stabilizing and increasing joint mobility, reducing physical limitations and disability, improving health-related quality of life, limiting the progression of joint damage, and providing patient education regarding the nature and management of OA. The medical literature has described more than 50 modalities of nonpharmacologic, pharmacologic, and surgical therapy for knee and hip OA. Despite the development of several National and Regional Guidelines to guide clinicians, allied healthcare professionals, and patients in their choice of treatment to manage knee and hip OA, there have been no internationally agreed-on and universally applicable guidelines for management. In September 2005, OARSI convened a meeting of an international, multidisciplinary committee of experts to critically review all existing evidence-based and consensus guidelines as well as the recent research evidence and to develop up-to-date, evidence-based, globally relevant consensus recommendations for management of knee and hip OA in 2007. The guidelines development team consisted of 16 experts in primary care, rheumatology, orthopaedics, and evidence-based medicine from the United States, the United Kingdom, France, the Netherlands, Sweden, and Canada. Using the validated appraisal of guidelines research and evaluation instrument, the team reviewed 23 existing guidelines published between 1945 and January 2006 and generated a core set of management modalities based on the agreement between guidelines. Evidence before 2002 was based on a systematic review by the European League Against Rheumatism, and subsequent evidence was updated with use of MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library, and health technology assessment reports. Whenever feasible, effect size (ES), number needed to treat, relative risk or odds ratio, and cost per quality-adjusted life years gained were estimated. A Delphi exercise was used to produce consensus recommendations, and a visual analog scale was used to determine the SOR for propositions relating to each modality. Of 51 treatment modalities addressed by the identified guidelines, 20 were universally recommended. Although ES for pain relief varied among treatments, overall there was no statistically significant difference between nonpharmacologic (0.25; 95% confidence interval [CI], 0.16 - 0.34) and pharmacologic (ES, 0.39; 95% CI, 0.31 - 0.47) modalities. The team reached a consensus on 25 carefully worded recommendations and provided SORs and 95% CIs for each. Their overall conclusion was that optimal management of patients with hip or knee OA requires a combination of nonpharmacologic and pharmacologic treatment modalities. Twelve recommendations describe the use of nonpharmacologic treatment modalities: education and self- management; regular telephone contact with healthcare providers; physical therapy referral with provision of canes or walkers when appropriate; aerobic, muscle-strengthening, and water-based exercises; weight loss in overweight patients; assistive devices including walking aids, knee braces, footwear, and insoles; thermal modalities; transcutaneous electrical nerve stimulation for short-term pain control; and acupuncture, which may help relieve symptoms in some patients. Eight of the recommendations discuss pharmacotherapeutic agents including acetaminophen (up to 4 g/day); cyclooxygenase-2 (COX-2) nonselective and selective oral nonsteroidal anti-inflammatory drugs (NSAIDs) used at the lowest effective dose, with avoidance of long-term use; topical preparations of NSAIDs and capsaicin; intra-articular injections of corticosteroids and hyaluronates; symptomatic relief with glucosamine and chondroitin sulphate supplementation; possible structure-modifying effects associated with glucosamine sulphate, chondroitin sulphate, and diacerein; and indications for use of weak opioids and narcotic analgesics to treat refractory pain. Five recommendations focus on surgical modalities, including total joint replacements, unicompartmental knee replacement, osteotomy and joint-preserving surgical procedures, joint lavage and arthroscopic debridement for knee OA, and joint fusion used as a salvage procedure when joint replacement has failed. "Patients with hip or knee OA who are not obtaining adequate pain relief and functional improvement from a combination of non-pharmacological and pharmacological treatment should be considered for joint replacement surgery," the authors of the guidelines write. "Replacement arthroplasties are effective, and cost- effective interventions for patients with significant symptoms, and/or functional limitations associated with a reduced health-related quality of life, despite conservative therapy." OARSI provided financial support for development of these guidelines. The authors of the guidelines have disclosed various financial relationships with such industrial entities as Abbott, AstraZeneca, Merck, Bristol- Meyers Squibb, GlaxoSmithKline, and Novartis. The complete list of disclosures is available in the original article. Osteoarthr Cartil. 2008;16:137-162. Clinical Context OA is the most common form of arthritis, and as many as 40% of community-dwelling adults older than 65 years in the United Kingdom have symptoms associated with OA of the hip or knee. Despite the widespread prevalence of OA, there remains controversy regarding the best management of this condition. To address this issue, the OARSI convened 16 experts in 4 medical disciplines to review current guidelines for the management of OA of the hip and knee. Researchers focused on guidelines published between 1945 and January 2006, and they emphasized the quality of evidence in the guidelines as well as ES, number need to treat, and cost per quality-adjusted life years. Consensus among the expert panel was achieved following a specific algorithm, and all current recommendations were assigned an SOR based on a scale of 0 to 100, with a higher assigned value indicating a stronger recommendation. The individual recommendations with their SOR values are summarized in the Study Highlights. Study Highlights The optimal management of OA of the hip and knee combines both nonpharmacologic and pharmacologic treatment modalities (SOR, 96%). The initial treatment of OA should focus on patient empowerment and self-driven therapies. All patients should receive education on lifestyle changes, exercise, pacing of activities, and weight reduction (SOR, 97%). Monthly telephone contact, even by lay personnel, can improve the clinical status of patients with OA (SOR, 66%). A physical therapy consultation focusing on appropriate exercises may benefit patients with OA, although this recommendation is largely based on expert opinion. The physical therapy visit may also include advice regarding assistive devices for ambulation (SOR, 89%). Weight loss is encouraged and can relieve pain and stiffness and improve function (SOR, 96%). Assistive devices for ambulation can reduce pain associated with OA. Frames or wheeled walkers are preferable for patients with bilateral disease (SOR, 90%). Among patients with knee OA and mild or moderate valgus or varus instability, a knee brace can reduce pain, improve stability, and reduce the risk of falling (SOR, 76%). Insoles can also reduce pain among patients with knee OA (SOR, 77%). Thermal modalities may improve knee OA, but there is less evidence that ice may be effective (SOR, 64%). Transcutaneous electrical nerve stimulation can help with short-term pain control among patients with hip or knee OA (SOR, 58%). Acupuncture can relieve symptoms of knee OA (SOR, 59%). Acetaminophen is the first choice for pharmacologic treatment of OA. Doses up to 4 g/day may be initiated before the use of other medications (SOR, 92%). NSAIDs may be used at their lowest effective dose, and long-term use should be avoided if possible. Among patients at an increased risk for gastrointestinal tract bleeding, clinicians should prescribe either a COX-2 selective agent or a nonselective NSAID with co-prescription of a proton pump inhibitor or misoprostol. NSAIDs should be used with caution among patients with cardiovascular risk factors (SOR, 93%). Topical NSAIDs and capsaicin can be effective as monotherapy or adjunctive treatment for OA of the knee (SOR, 85%). Patients with moderate to severe pain associated with knee OA that is not responding to oral therapy can be treated with intra-articular injections (SOR, 78%). Intra-articular injections of hyaluronate are associated with delayed onset of analgesia but a prolonged duration of action vs injections of corticosteroids (SOR, 64%). Treatment with glucosamine and chondroitin may relieve symptoms of OA, but treatment should be discontinued if there is no relief after 6 months of therapy (SOR, 63%). Unicompartmental knee replacement is effective among patients with knee OA restricted to a single compartment (SOR, 76%). Osteotomy may be considered for young adults with symptomatic hip OA, whereas high tibial osteotomy may reduce the need for joint replacement among young adults with knee OA (SOR, 75%). Joint fusion of the knee can be performed to salvage a failed joint replacement (SOR, 69%). Pearls for Practice The current recommendations for nonpharmacologic treatment of OA of the hip and knee include regular telephone calls from the clinician's office; self-driven therapies; and education on lifestyle changes, exercise, and weight reduction. For patients with knee OA, a knee brace for varus or valgus instability, insoles for appropriate patients, acupuncture, and thermal therapy are recommended. However, the topical application of ice is less proved. The current guidelines for pharmacologic treatment of OA of the hip and knee recommend acetaminophen as the first choice. Other treatments include NSAIDs and glucosamine and chondroitin, but long-term use of these medications should be avoided. ====================================================== VITAMIN D (OT) Scientists have developed a vitamin D pill Exposure to Vitamin D from sunlight is known to improve the prognosis of certain cancers. US drug company Novacea has produced a pill which delivers a concentrated dose of the vitamin without running the risk of side- effects from an overdose. Chemistry and Industry magazine reports that if clinical trials of the drug - Asentar (DN-101) - are successful it could be available by 2009. The drug would be given to patients in the advanced stages of the disease, along with chemotherapy drugs. Professor Nick James, a cancer expert at the University of Birmingham, said the drug had produced impressive results in preliminary phase two trials. He said patients taking the drug lived for an average of an extra nine months longer than those taking another chemotherapy drug - taxotere - alone. Professor James said: "On average, patients in the advanced stage of the disease survive about 18 months, so an extension of nine months would be very significant in my view." Asentar provides levels of vitamin D 50 to 100 times higher than normal. Patients would be expected to take one tablet once a week with their weekly regime of taxotere for three weeks out of every four. No guarantees However, Professor James said it was far from certain that the phase three trials would repeat the success of the earlier tests. The phase II trial used a less than optimal taxotere regime so the survival rate may have been artificially inflated. Professor James said vitamin D was known to play a key role in the regulation of several tissues, including the prostate and breast. He said laboratory work had shown that cancer cells had lost the ability to respond in the normal way to vitamin D, and carried on dividing in an uncontrolled fashion. Data shows that rates of prostate cancer are higher in countries further away from the equator, where there is less exposure to sunlight. Professor James said it was possible that the new drug helped to increase the sensitivity of cancer cells to the effect of other chemotherapy drugs. Dr Julie Sharp, of the charity Cancer Research UK, said: "We would welcome any improvements in the treatment for men with advanced prostate cancer and this drug has shown potential in early trials. "But the results of the much larger study are needed to fully establish if this treatment is both effective and safe." Prostate cancer is the second leading cause of cancer death in men. It kills one man every hour in the UK. Source: http://news.bbc.co.uk/2/hi/health/6264533.stm =========================================================== VARICOSE VEINS: Reported March 7, 2008 New Help for Varicose Veins ORLANDO, Fla. (Ivanhoe Newswire) -- Twenty-five-million Americans -- or half of all men and women over age 50 -- have varicose veins -- veins that become damaged and fail to regulate blood flow from the legs to the heart. They're bulging and unsightly and can lead to fatigue and pain. Now, there's a quick new treatment for varicose veins that gets patients back to their routine faster than ever. Lately it's been Amelia the dog doing all the dancing at Dave Schwartzman's house. He says his left leg often feels tired and heavy. The reason: varicose veins. Schwartzman is undergoing a new procedure to treat the problem. It's all done under local anesthesia. Vascular surgeon Dr. Ken Adcock uses ultrasound to go inside the vein with a catheter, then a radio frequency probe. Radio frequency energy is used to heat the vein from inside, causing the vein wall to contract and close. This redirects the blood to other healthy veins. The treatment takes just a few minutes and Dr. Adcock says it's also easier on the patient. "It's a lot less traumatic to surrounding tissues a lot better as far as patient comfort," says G. Kendrix Adcock, M.D., a vascular surgeon at Florida Vascular Consultants in Orlando, Fla. Other varicose vein treatments, like laser or vein stripping, can leave bruises that can last for days. But with this procedure, Dr. Adcock says there's virtually no bruising or pain, and patients can return to regular activities in just 48 hours. "I've been performing vascular surgeries for almost 25 years now and this is a quantum leap forward," Dr. Adcock says. "I was surprised at how quick it took, and really pain free and that's not an exaggeration it was pain free," Schwartzman says. Doctors aren't sure what causes varicose veins. They do know the condition runs in families, and is more common in women and men. Also varicose veins seem to occur more often in people who spend many hours a day on their feet. FOR MORE INFORMATION, PLEASE CONTACT: VNUS ClosureFAST http://www.vnus.com Florida Vascular Consultants http://www.flvascular.com |