Life with Chronic Disease: Alternatives to Opioids

Recently headlines have been announcing that even though prescriptions for opioids are down, they are still way over prescribed. According to Anne Schuchat, the Centers for Disease Control (CDC) acting director, the prescription rate is still triple the level it was in 1999 and four times what it is in some European countries. Even at the reduced prescribing rate, enough opioids were ordered in 2015 to keep every American medicated round-the-clock for three weeks.

There is much discussion about cutting back on how many pills can be obtained for an acute episode as well as the CDC saying that people with chronic pain should seek alternatives.

Keep in mind that Americans don’t like to be in pain and have gotten use to being prescribed a pill for whatever ails them. Opioids do have their place, particular for acute painful episodes, or when someone is dealing with end stage cancer pain.  However , there are a variety of modalities that can be used to replace them.

There is no one measure that works for everyone all of the time. Some of the treatments listed below may not be covered by insurance since the practice can be an “off label” use-such as hyperbaric medicine for the treatment of fibromyalgia.  There are many options to consider and it’s worth exploring them in order to avoid addiction.

Acetaminophen: The generic version of Tylenol. Combining acetaminophen with ibuprofen can provide better pain relief for dental pain than opioids and in Europe there are pills that combine the two. However, they can have side effects, so be sure to talk to your provider before taking them. Do not exceed 1,000 mg to 2,000 of acetaminophen in a 24-hour period and  use as low a dose of ibuprofen as possible.

Acupuncture: Research shows it can benefit those with back and neck pain, osteoarthritis, chronic headache and shoulder pain.

Anticonvulsants: Effective in treating neuropathic pain conditions

Antidepressants: Tricyclic antidepressants, such as Amitriptyline, Imipramine and Clomipramine, are particularly effective in treating neuropathic pain.

Breathing: This is now a common practice for women to use in childbirth and many emergency room and first aid staff are trained in coaching patients with acute pain. This is a good relaxation technique that can help with various types of pain management. Just concentrating on taking deep breaths helps to distract the mind from pain.

Chiropractic Care: This is a field that is expanding. Check out Chiropractic Care for Pain Relief from Harvard Health

Cognitive Behavioral Therapy: A form of talk therapy that helps people identify and develop skills to change negative thoughts and behaviors. CBT is often combined with other pain management including medications, physical therapy, massage or even surgery.

Exercise: Doctors recommend exercise to all patients, but research has shown that it is especially important for those with chronic pain. Low-impact exercise helps improve mobility and functionality. Studies have shown that chronic back pain, joint pain, arthritis, and fibromyalgia can all be improved with yoga and tai chi.

Gait retraining: A person's normal pattern of standing, walking, or running may invite joint problems. A physical therapist can analyze your gait and help you learn to move more efficiently.

Hypnosis: Research shows that medical hypnosis can help with both sudden (acute) and long-term (chronic) pain from cancer, burns, and rheumatoid arthritis. Researchers at Mount Sinai School of Medicine in New York analyzed 18 studies and found moderate to large pain-relieving effects from hypnosis, supporting its use for pain management. Note that patients with post traumatic stress disorder or who are vulnerable to false memories can experience a worsening of their conditions due to hypnosis

Hyperbaric Medicine: Hyperbaric oxygen treatment has been effectively used to reduce chronic pain, especially fibromyalgia syndrome, complex regional pain syndrome, myofascial pain syndrome, migraine, and cluster headaches. Hyperbaric Oxygen Therapy A New Treatment for Chronic Pain? 

Ice & Heat (cryotherapy and thermotherapy): Both have a role for acute and chronic pain. Check out The Great Ice vs. Heat Confusion Debacle  to learn which one to use and for how long.

LumiWave/Infrared Energy: Developed in 2005 by the Colorado-based company BioCare Systems Inc., the device is a chain of four black discs, each of which contains 50 infrared LEDs. When placed on painful areas, such as a strained bicep or an inflamed lower back, the device sends pulses of light that induce the release of nitric oxide in the body, which promotes healing on a cellular level. The device supposedly outperforms ice or heat to eliminate sourness. The device was cleared by the FDA as a Class II medical device “for temporary relief of minor muscle pain and spasms and minor joint pain and stiffness.” There is research  that does support applying infrared energy to reduce chronic low back, which also found no adverse effects.

Kinesiology Tape: Used by physical therapists and sports trainers, this treatment benefits those who have a variety of musculoskeletal ailments and pain by providing support and stability to muscles and joints without restricting the body’s range of motion. There isn’t a lot of research on the use of this tape, let alone its effectiveness, but it does appear that taping is helpful for certain injuries, such as patella tendonitis. See a licensed therapist who can show you the proper way to tape if you want to try it.

Massage: There are various reasons why massage is helpful in reducing pain-it aids in sleep, reduces stress and releases serotonin in the brain-a natural production of anti pain chemicals. Be sure to check with your medical provider about any possible adverse effects from massage and inform your therapist accordingly. 

Meditation: See Mindfulness Based Stress Reduction

Mindfulness Based Stress Reduction: There is a great deal of research now that supports the use MBSR for chronic pain.  Learn more about it at the UMass Medical School’s Center for Mindfulness website and check with your provider about local programs. If there isn’t a program near you or finances are an issue, there is a free option online.  However, part of what helps is the group interaction, so it’s best if you can be part of an MBSR group.

Neurostimulators: This treatment uses implanted electrodes to interrupt nerve signals. This does not cure what is causing the pain, but stops the pain signals before they reach the brain. It can be used for back, neck, arm, or leg pain.

NSAIDs (Non-Steroidal anti-inflammatory drugs): This includes aspirin, ibuprofen. See information for acetaminophen above about combing the two for pain relief.

Tens Units: Transcutaneous electrical nerve stimulation has been a physical therapy and chronic pain clinic staple for decades. There are many consumer TENS units available and many swear by them. Effectiveness is based more on an individual experience than scientific evidence. Check out Zapped! Does TENS Work for Pain?

Therapeutic Ultrasound: Relaxes muscle spasms and aids healing

Therapeutic exercise: Can strengthened muscles and reduce stress on joints, knees and hips.

For more ideas about what might work, check out PainScience: Sensible Advice for aches, pains & injuries

 

Take a Break: Try canning

With fruits and vegetables now ready for picking, this is a good time to consider canning. As much as I like having a pantry full of peaches, apple sauce etc. that I’ve canned, there are wonderful recipes for refrigerator pickles, onions etc. that will last for weeks up to several months.

Below are some links to try:

A Beginner’s Guide to Canning 

 10 Easy Jams and Pickles for Canning 

Easiest Fridge Dill Pickles: Love Smitten Kitchen recipes.

 Quick Pickled Red Onions

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Living with Lyme Disease

Vermont has one of the highest incidences of Lyme Disease (LD in the country and in my small town, at least four people have been learned of the diagnosis only after being tested in an effort to understand symptoms such as pain and fatigue. They had no recollection of having been bitten by a tick.

With the spread of LD all over the country, thought a post on LD might be useful. This post has been designed for people living with Lyme Disease (PLWLD)-sometimes referred to as chronic, persistent or post treatment. To learn about preventing LD, go to TakeTicks Seriously.

The black-legged tick is responsible for the infection, a bacterium called Borrelia burgdorferi.

Though there is evidence that LD has been around for thousands of years in the US, it was  “discovered” 40 years ago. It is a complex and puzzling health condition for multiple reasons:

•  The Infectious Diseases Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS)  — the two medical associations associated with LD, have issued competing and controversial care guidelines for Lyme There is a growing group of LD “literate” providers who are outside IDSA and ILAD. While some are doing outstanding work, others are taking advantage of patients who are desperate for relief. 

•  LD is often called the “great imitator” because of the broad range of symptoms, such as digestive problems, joint conditions and cognitive issues. Some people develop lingering symptoms after initial treatment and there are others, that haven’t felt well for a long period of time and are surprised to learn they are infected. It’s important to note that 25% of those with LD don’t recall a tick bite.

• Ticks are known to carry many pathogens and will often pass on more than one co-infection with a single bite. These co-infections can increase the severity of the Lyme symptoms or cause entirely different symptoms. They also do not all respond to antibiotics, complicating diagnosis, treatment, and management of symptoms.

• Testing, while available is not always accurate.

For more on this topic read US News May 20, 2017 article Lyme Disease on Rise Amid Diagnosis, Treatment and Controversy.

THE BASICS

Symptoms of early Lyme disease: Can be flu-like (fever, chills, sweats, muscle aches, fatigue, nausea and joint pain) and may be accompanied by a rash (bull’s eye or other types) or facial drooping. If you develop a rash, take a photo, and see a doctor immediately. Your primary care provider should be able to provide a test. At this stage of infection, the Lyme test can be negative so treatment should not be delayed if there is suspicion of LD (tick bite, rash, fever etc.). Please note that LD isn’t the only condition you can get from a tick bite and locally at least one person has contracted anaplasmosis from a tick bite.

Symptoms of PLWLD: People who have unresolved LD, whether they’ve been treated or not, experience symptoms such as fatigue, restless sleep, pain, aching joints or muscles, pain or swelling in the knees, shoulders, elbows and other large joints, decrease short-term memory or ability to concentrate and/or speech problems.

Use the Lyme Disease Symptom Checker to help you understand your possible risk for LD. 

Testing: The most common diagnostic tests for Lyme disease are indirect ones. They measure the patient’s antibody response to the infection, not the infection itself. The two most-used antibody tests are the enzyme-linked immunosorbent assay (ELISA) and the Western blot. The CDC recommends that doctors first order an ELISA to screen for the disease and then confirm the disease with a Western blot. As noted above, testing within the first four-6 weeks of Lyme infection is unreliable as the person will not have developed the antibody response.

TREATMENT

 The earlier you are treated, the better the outcome. Depending on your doctor and presenting symptoms will dictate length of antibiotic treatment. Some people’s symptoms do not resolve after six months and develop what is called Post Treatment LD.

The ideal antibiotics, route of administration and duration of treatment for persistent Lyme disease are not established. No single antibiotic or combination of antibiotics appears to be capable of completely eradicating the infection, and treatment failures or relapses are reported with all current regimens, although they are less common with early aggressive treatment.

There are medical providers that are now specializing in LD and are trying a variety of treatments, some of which are controversial. However, some are trying treatments, which have been approved for other conditions, “off label” just not LD.

One such “off label” use is hyperbaric oxygen treatment (HBOT).  An approved therapy for 14 different conditions, there has been at least one study that has shown its efficacy for PLWLDs. In May, Seven Days ran a story Is Hyperbaric Oxygen a MiracleCure?,  which describes how a VT chiropractor is using HBOT for PLWLD.

WHAT ABOUT A VACCINE?

In 1998, the FDA approved a Lyme vaccine, LYMErix, which reduced new cases of the disease by nearly 80 percent. Yet, in 2001, manufacturer SmithKline Beecham voluntarily withdrew LYMErix from the market amidst problems with sales and reports by some who were vaccinated that as a result, they developed musculoskeletal ailments including arthritis. A class-action suit was brought against the company, even though data gathered did not support that claim. While there is interest in a vaccine, given the experience of SmithKline Beecham, it’s unlikely to expect one in the near future. However, there is a vaccine for dogs, which is administered yearly.

LIVING WITH LYME DISEASE

While the physical symptoms of LD are bad enough, the disease can cause emotional, financial, logistical and work difficulties. Because there are no clear treatment guidelines, let alone a cure, PLWLDs are subject to scams and it’s not uncommon to rack up enormous bills for treatments and tests that lead nowhere. Check out If it Sounds to Good to Be True: Scams, Frauds, and Quacks.  Therefore it’s important to find a medical provider that you can work with, as well as connect with other PLWLDs.

Local Resources: The easiest way to find out what type of resources exist in your state is to Google your state name with “lyme resourses.” Infectious Disease and Internal Medicine are the two medical specialties that treat LD.

Learn about your condition: Knowledge is power. Using the links in the Resource Section below, keep tabs on the latest research. Be careful of the sites you use-those sites that end in.org, edu and .gov are generally going to be more reliable. Be wary of sites trying to sell you a product.

Share your data: Incredible strides are being made in all fields of medicine as people are now sharing their data thanks to the Internet. Some sites, such as Patients Like Me, are running clinical trials to help find out what works and what doesn’t. Sites to consider

• Patients Like Me

• MyLymeData

Connect with Others: Check with providers and others with LD about where a local support group might be. If there isn’t one, check out:

• Lyme Disease Support Network

• Tired of Lyme

• Top 25 Websites & Blogs for People with Lyme Disease

Check out Healing the Whole Person: Ways to Increase Well-Being When Living with a Chronic Condition and Getting What You Need Checklist 

RESOURCES

American Lyme Disease Foundation 

Bay Area Lyme Association: Currently funding the development of therapies for later stage Lyme with enhanced efficacy and reduced side effects relative to antibiotics.  

Centers for Disease Control and Prevention

Children’s Lyme Disease Network

Lyme Disease Association: Offers a Doctor Referral site. 

Lyme and Tick Borne Diseases Research from Columbia University Medical Center 

Take a Break: Soar Over Pluto

So it’s been reduced to “dwarf planet” status but all the same it’s pretty amazing to see the continuing videos released by NASA in celebration of the two year anniversary of New Horizons Pluto flyby. 

Below are links to check out the amazing views of Pluto and its moon Charon thanks to the nine year journey of “New Horizons," which continues into the outer reaches of space. 

NASA Videos Taking you on a personal tour of Pluto 

Flyover Reveals Bizarre Terrain from National Geographic

 Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Journal Watch July 2017

CHRONIC PAIN

• Applying electric current to nerve for chronic low back pain does not provide clinically important improvement: Treatment of chronic low back pain with radiofrequency denervation, a procedure that can be performed with different techniques including the application of an electric current to the pain-conducting nerve, resulted in either no improvement or no clinically important improvement in chronic low back pain, according to a study. JAMA Network Journals

• Reaching Beyond the Prescription Pad to Treat Pain: Teaching coping skills may help reduce the risk that patients with chronic pain will become addicted to opioid painkillers, a new study suggests. Canadian Journal of Pain

• Cognitive behavioral therapy improves functioning for people with chronic pain, study shows: Cognitive Behavioral Therapy (CBT) is the most frequently used psychological intervention for people with chronic pain, and new approaches for improving CBT outcomes may be found in the psychological flexibility model and Acceptance and Commitment therapy (ACT), according to research. The Journal of Pain

• New, oral treatment option for rheumatoid arthritis: Patients suffering from rheumatoid arthritis are treated for around six months with the standard anti-rheumatic agent methotrexate, to which many patients respond very well. However, if they do not respond and no remission or at least reduction in the activity of the disease can be achieved, they are given a combined treatment of methotrexate and a biologic agent if risk factors are present. An international research group has now shown that there is another, equally effective oral treatment option. The Lancet

• Controlled temperature change inside ear can prevent migraines: The application of gentle cooling and warming currents inside the ear canal can provide relief for migraine sufferers, new research has shown. The Journal of Head and Face Pain

COMPLEMENTARY & ALTERNATIVE MEDICINE

• Yoga Designed for Back Pain Effective as PT: New research finds that a yoga class designed specifically for back pain can be as safe and effective as physical therapy in easing pain. Researchers at Boston Medical Center developed the yoga protocol with input from yoga teachers, doctors and physical therapists. During the class, trained instructors guide participants through gentle poses, including cat-cow, triangle pose and child's pose. Simple relaxation techniques are part of the class as well. More difficult poses, such as inversions, are avoided. A guidebook that details the poses taught during the class is freely available, as is a teacher training manual. Annals of Internal Medicine  

 

• Acupuncture relieves pain in emergency patients: The world's largest randomized controlled trial of acupuncture in emergency departments has found the treatment is a safe and effective alternative to pain-relieving drugs for some patients. The study found acupuncture was as effective as pain medicine in providing long-term relief for patients who came to emergency in considerable pain. But the trial, conducted in the emergency departments of four hospitals, showed pain management remains a critical issue. he Medical Journal of Australia

• Antibiotic Resistance Linked to Common Household disinfectant triclosan: Scientists have discovered a link between a major mechanism of antibiotic resistance and resistance to the disinfectant triclosan which is commonly found in domestic products. Journal of Antimicrobial Chemotherapy

 

• Closing medical marijuana dispensaries increases crime, according to new study: Contrary to popular belief, medical marijuana dispensaries (MMDs) reduce crime in their immediate areas, suggests a new report. Journal of Urban Economics

 

• Yoga more risky for causing musculoskeletal pain than you might think: Yoga causes musculoskeletal pain in 10 percent of people and exacerbates 21 percent of existing injuries, research shows. The findings come from the first prospective study to investigate injuries caused from recreational participation in yoga. The injury rate is up to 10 times higher than has previously been reported. Journal of Bodywork and Movement Therapies

 

• Guided self-help approach to graded exercise program is safe, may reduce fatigue for patients with chronic fatigue syndrome: A self-help approach to a graded exercise program, supervised by a specialist physiotherapist, is safe and may reduce fatigue for some people with chronic fatigue syndrome (CFS), according to a new trial of 200 people. The Lancet

 FDA ACTION

• Warns diabetics against use of secondhand test strips

• Approves new Sickle Cell Drug Endari (L-glutamine oral powder)

• Advisory Committee Approves CAR-T cell immunotherapy (CTL019 or tisagenlecleucel) “living drug” approach for children and youth with a common form of leukemia

PREVENTION

• Interventions to prevent cognitive decline, dementia: Evidence supporting three interventions-cognitive training, blood pressure management, and increased physical activity- that might slow cognitive decline and the onset of dementia is encouraging but insufficient to justify a public health campaign focused on their adoption. National Academies of Sciences, Engineering, and Medicine

Breast-Feeding Tied to Lower Heart, Stroke Risk for Mom:Women who breast-feed their babies may have a slightly lower risk of suffering a heart attack or stroke decades later, a large new study suggests. The study pointed out that women who breast-feed for a longer time tend to have lower odds of high blood pressure and diabetes. Journal of the American Heart Association

• Frequent sexual activity can boost brain power in older adults: More frequent sexual activity has been linked to improved brain function in older adults, according to a new study. Researchers found that people who engaged in more regular sexual activity scored higher on tests that measured their verbal fluency and their ability to visually perceive objects and the spaces between them. The Journals of Gerontology, Series B: Psychological and Social Science h

 

• Regular brisk walks and a daily longer one help lower office workers' blood lipids: Taking 2-minute brisk walks every 30 minutes and a half-hour walk each day reduces blood lipid levels when measured in response to a meal consumed around 24 hours after starting the activity, research shows for the first time. Journal of Clinical Lipidology

• For Many, Friends Are Key to Happiness in Old Age: These relationships may even outstrip family when it comes to well-being, study suggests. Personal Relationships 

• Sinus disease symptoms improve 10 years after patients quit smoking: Patients with chronic rhinosinusitis (CRS) who quit smoking will see their condition improve over a period of about 10 years, according to the results of a new study. Otolaryngology-Head and Neck Surgery 

• Elderly yoginis have greater cortical thickness: Scientists in Brazil have imaged elderly female yoga practitioners' brains and found they have greater cortical thickness in the left prefrontal cortex, in brain areas associated with cognitive functions like attention and memory. The results suggest that yoga could be a way to protect against cognitive decline in old age. Frontiers in Aging Neuroscience

NUTRITION/SUPPLEMENTS/VITAMINS

• Fish Eaters Report Less Rheumatoid Arthritis Pain: Eating fish at least twice a week may significantly reduce the pain and swelling associated with rheumatoid arthritis, a new study says. Arthritis Care & Research

• Many Americans May Be Taking Too Much Vitamin D: Study finds more people are exceeding the upper daily limit of what is considered safe. The recommended daily amount of vitamin D is only 600 IUs for adults aged 70 and younger. For those over 70, the recommendation is 800 IUs a day.

• Extra-virgin olive oil preserves memory, protects brain against Alzheimer's: The Mediterranean diet is associated with a variety of health benefits, including a lower incidence of dementia. Now, researchers have identified a specific ingredient that protects against cognitive decline: extra-virgin olive oil. In a new study, the researchers show that consumption of extra-virgin olive oil protects memory and learning ability and reduces the formation of amyloid-beta plaques and neurofibrillary tangles in the brain -- classic markers of Alzheimer's disease. Annals of Clinical and Translational Neurology

• Zoning in on specifics of Mediterranean diet for colorectal health: The benefits of a "Mediterranean diet" (MD) are well-known when it comes to colorectal protection, but it's hard to know specifically what elements of the diet are the healthiest. Now a new study, presented today at the ESMO 19th World Congress on Gastrointestinal Cancer suggests loading up on fish and fruit, and cutting back on soft drinks are the three most important things. 

• Imprecise iron supplementation can spur increase in Salmonella: Individuals who do not produce enough iron are anemic, and often experience fatigue. One common remedy is for physicians to prescribe an iron infusion to their anemic patients. This makes sense, but can lead to unexpected consequences like increasing the risk of food poisons such as Salmonella. These types of poisons depend on abundant access to iron. Physicians should be attuned to this dynamic when determining the strength of iron infusions for their anemic patients. Frontiers

• With health care cuts looming, low-cost magnesium a welcome option for treating depression: The cost of depression is great -- 350 million people worldwide suffer from this disorder and costs for traditional SSRI treatments are high. New clinical research results show magnesium is effective at addressing symptoms and is safer and easier on the wallet than prescription therapies. Science Daily

 • High fat diet reduces gut bacteria, Crohn's disease symptoms: A high fat diet may lead to specific changes in gut bacteria that could fight harmful inflammation -- a major discovery for patients suffering from Crohn's disease, research indicates. Crohn's disease, a type of inflammatory bowel syndrome, causes debilitating intestinal swelling, cramping, and diarrhea. The disease affects half a million people in the United States, but its cause is yet unclear. Science Daily

• Drinking coffee could lead to a longer life, scientist says: Whether it's caffeinated or decaffeinated, coffee is associated with lower mortality, which suggests the association is not tied to caffeine Scientists have found that people who drink coffee appear to live longer. Drinking coffee was associated with lower risk of death due to heart disease, cancer, stroke, diabetes, and kidney disease. People who consumed a cup of coffee a day were 12 percent less likely to die compared to those who didn't drink coffee. This association was even stronger for those who drank two to three cups a day -- 18 percent reduced chance of death. Annals of Internal Medicine 

• Better Diet, Longer Life: Study is the first to show that sustained diet changes -- even later in life -- might extend people's lives. NEJM

 TREATMENT

• NSAIDs improve survival for certain colorectal cancer patients, study shows: Among long-term colorectal cancer survivors, use of nonsteroidal anti-inflammatory drugs, or NSAIDs, is associated with about a 25 percent reduction in all-cause mortality. The study further suggests that NSAIDs such as aspirin, ibuprofen and naproxen have a particularly advantageous effect when taken after diagnosis by colorectal, or CRC, patients without tumor mutation in the KRAS gene (KRAS wild-type tumors): The study shows that NSAID use by this group is associated with a survival benefit of 40 percent.  Journal of Clinical Oncology

• Study Hints at Link Between Some Statins, Parkinson's Risk: People on cholesterol-lowering statins may have a slightly increased risk of developing Parkinson's disease, a new study suggests. Researchers said the finding doesn't prove statins are to blame. But, they added, the findings undercut the notion that statins might help protect against Parkinson's. Movement Disorders

• Transcranial stimulation and/or physical therapy improves walking speed in Parkinson's disease: Noninvasive brain stimulation and physical therapy -- alone or in combination -- improve some measures of walking ability in patients with Parkinson's disease (PD), concludes a clinical trial. American Journal of Physical Medicine & Rehabilitation

• Combining antibiotics proves more effective against common infection: The common and highly resistant Pseudomonas aeruginosa bacterium is a fatal threat to weakened and ill patients. A new study now shows that a combination treatment using two different types of antibiotics can reduce mortality up to five times. Science Daily

• 'Brain training' app found to improve memory in people with mild cognitive impairment: A 'brain training' game could help improve the memory of patients in the very earliest stages of dementia, suggests a new study. The International Journal of Neuropsychopharmacology

• Readily available drug cocktail can help prevent sepsis shock and death Vitamin C, corticosteroids, and thiamine administered together may help prevent progressive organ failure caused by sepsis, according to a new study. Chest 

• Popular Heartburn Drugs Linked to Higher Early Death Risk: Popular heartburn drugs called proton pump inhibitors (PPIs)- Prevacid, Prilosec and Nexium- have been linked to a variety of health problems, including serious kidney damage, bone fractures and dementia. Now, a new study from Washington University School of Medicine in St. Louis shows that longtime use of the drugs also is associated with an increased risk of death. BMJ

•  Repurposed asthma drug shows blood sugar improvement among some diabetics: After 12 weeks of taking an anti-asthma drug, a subset of patients with type 2 diabetes showed a clinically significant reduction in blood glucose during a randomized, double blind, placebo-controlled clinical trial, report researchers. Cell Metabolism  

• Steroids may do more harm than good in some cases of severe asthma: Corticosteroids, the main treatment for asthma, may worsen the disease in this group of patients, new findings suggest. This will have important clinical implications, say the researchers. JCI Insight 

• Observation Best Option for Most Low-Risk Prostate Cancer: Men with early stage prostate cancer who have surgery to remove their tumor do not live longer than those who receive no treatment at all, a 20 year clinical trial has concluded. At the same time, nearly one in three men who had the surgery wound up with long-term complications, such as urinary incontinence and erectile dysfunction, NEJM

• CPAP Mask Not a Prescription for Heart Troubles: Using a breathing device to treat sleep apnea may help you get a good night's rest, but it might not lower your risk of dying from a stroke or heart condition, a new analysis suggests. JAMA

CAREGIVING

• Depression May Worsen Health for Cancer Caregivers: Depression is known to be linked to worsening physical health, and a new study finds this may be especially true for cancer caregivers. American Cancer Society

OTHER

• Many Chronic Illnesses Linked to Suicide: People with chronic health problems seem to have a higher risk of suicide, a new study suggests. The investigators identified 17 medical conditions linked to increased odds of suicide including asthma, back pain, brain injury, cancer, congestive heart failure, chronic obstructive pulmonary disease, diabetes, epilepsy, HIV/AIDS, heart disease, high blood pressure, kidney disorder, migraine, Parkinson's disease, psychogenic pain, sleep disorders and stroke. The risk was nine times higher among people with a traumatic brain injury and two times higher among those with sleep disorders and HIV/AIDS. American Journal of Preventive Medicine 

• Older Americans Struggling with Drug Costs: A national poll of more than 2,100 adults aged 50 to 80 found that 27 percent said their prescription drug costs were a financial burden. Among the respondents who said their medication costs were a burden, 49 percent had not talked to their doctors about the issue. But doing so was effective, because 67 percent of those who talked to their doctor received a recommendation for a less expensive drug, as did 37 percent of those who talked to their pharmacists. Health Day