Journal Watch April 2017

CHRONIC PAIN

• Pregabalin (Lyrica) No Better Than Placebo for Lower Back, Leg Pain: The study, published March 22 in the New England Journal of Medicine, found that sciatica patients improved to the same degree whether they were given pregabalin or placebo capsules. 

• PT as Good as Surgery for Carpal Tunnel Syndrome: Researchers found that physical therapy -- particularly so-called manual therapy -- improved hand and wrist function and reduced pain as effectively as a standard operation for the condition. Moreover, after one month, physical therapy patients reported better results than those who underwent surgery. Journal of Orthopaedic & Sports Physical Therapy 

• What Drugs Work Best for Diabetic Nerve Pain: A  review of106 studies on pain relief for diabetic neuropathy found "moderate" evidence that the antidepressants duloxetine (Cymbalta) and venlafaxine (Effexor) reduce diabetic nerve pain. However, they only found "weak" evidence that botulinum toxin (Botox), the anti-seizure drugs pregabalin (Lyrica) and oxcarbazepine (Trileptal), and drugs called tricyclic antidepressants and atypical opioids (drugs such as Tramadol) may help reduce pain. The researchers also noted that gabapentin (Neurontin, Gralise) works in a similar manner to pregabalin, and the review found gabapentin no more effective than a placebo. "Unfortunately, more research is still needed, as the current treatments have substantial risk of side effects, and few studies have been done on the long-term effects of these drugs." Neurology 

• Chondroitin Sulphate Similar to Celecoxib in Improving Pain, Function in Knee Osteoarthritis: Chondroitin sulphate offers greater pain reduction and function than placebo and benefits similar to celecoxib in patients with knee osteoarthritis, according to results of a phase 3 trial presented at the 2017 World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO). 

• Injections of Platelet-Rich Plasma Improve Severe Knee Osteoarthritis: Injections of platelet-rich plasma can provide significantly improved clinical status and quality of life for patients with severe knee osteoarthritis, according to results of a prospective study presented at the 2017 World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO). 

• Obese people have lower pain threshold: An extra layer of fat won’t provide a cushion against pain – in fact, obese people are more sensitive to pressure pain than those who are not overweight, and they are equally susceptible to extremes of hot and cold. European Journal of Pain 

• Healthier Weight May Mean Fewer Migraines: Those with migraine and [their] doctors need to be aware that excessive weight and extreme weight loss are not good for [migraine sufferers], and that maintaining a healthy weight can decrease the risk of migraine.” Neurology 

• Spinal Manipulation Treatment for Low Back Pain Associated with Modest Improvement: Among patients with acute low back pain, spinal manipulation therapy was associated with modest improvements in pain and function at up to six weeks, with temporary minor musculoskeletal harms, according to a study. JAMA 

• Real-world massage is effective treatment for low back pain: In the first study of its kind, researchers found real-world massage therapy to be an effective treatment for chronic low back pain. More than 50 percent of those who participated in the study experienced clinically meaningful improvements in their low back pain with disability. Pain Medicine 

COMPLEMENTARY & ALTERNATIVE MEDICINE

• Music therapy reduces pain in spine surgery patients Music therapy has been found to decrease pain in patients recovering from spine surgery, compared to a control group of patients who received standard postoperative care alone. American Journal of Orthopedics 

• Stress a common seizure trigger in epilepsy:  The relationship between stress and seizures has been well documented over the last 50 years. A recent review article looks at the stress-seizure relationship and how adopting stress reduction techniques may provide benefit as a low risk form of treatment. Seizure 

• Yoga for Prostate Cancer Patients: New research suggests yoga may help men deal with the side effects of prostate cancer therapy. Novice yoga practitioners had renewed energy and fewer of the sexual and urinary symptoms tied to radiation treatment, compared with men who didn't use the technique, the study found. International Journal of Radiation Oncology, Biology, and Physics 

FDA ACTION

• Approved Bravencio for rare skin cancer

• Approved 23 and Me’s personal genetic test for some diseases, including Alzheimer’s, Parkinson’s and celiac disease.

• Warns against bogus Autism “Cures” 

• Approved Ingrezza (valbenazine), the first drug to treat adults with the neurological disorder tardive dyskinesia

PREVENTION

• Lifestyle intervention leads to 10-point drop in systolic blood pressure: In the first randomized, double-blinded trial of an online behavioral intervention for high blood pressure, participants in web-based lifestyle counseling reduced their systolic blood pressure (the higher number in a blood-pressure reading) by 10 mmHg, compared with a 6 mmHg reduction for those taking part in a web-based control intervention, a statistically significant difference. American College of Cardiology 

• Weight-bearing exercises promote bone formation in men: Human hormone, protein linked to bone mass are impacted by 12 months of targeted exercise Osteoporosis affects more than 200 million people worldwide and is a serious public health concern, according to research. Now, newly published work is the first in men to show that long-term, weight-bearing exercises decrease sclerostin, a protein made in the bone, and increase IGF-1, a hormone associated with bone growth. These changes promote bone formation, increasing bone density. Bone 

• Exercise a Great Prescription to Help Older Hearts: Regular exercise is potent medicine for older adults with heart disease, a new American Heart Association scientific statement says. Daily walking and tackling more chores at home also can be helpful. Resistance training and balance training can help prevent falls. Tai chi and yoga employ strength, balance and aerobic features. Circulation 

• Gum Disease, Tooth Loss May Increase Postmenopausal Women’s Risk of Death: Gum disease and tooth loss may be associated with a higher risk of death in postmenopausal women but not increased cardiovascular disease risk, according to a study published in the Journal of the American Heart Association. Loss of all natural teeth also was linked with an increased risk of death in postmenopausal women.

• Fitness, Not Fat, Is Key to Post-Stroke Recovery: People who were active and exercised regularly before their stroke were less likely to face disability after the attack, researchers say. But the amount of body fat a person had did not seem to be tied to post-stroke disability, the study found. Neurology 

• Good Sleep Gets Tougher With Age: Most people see their sleep habits shift as they age, but a new review suggests that some seniors lose the ability to get deep, restorative rest. And that can come with health consequences. Sleep "fragmentation" has been linked to a number of medical conditions, including depression and dementia. People with fragmented sleep wake up multiple times during the night, and miss out on the deep stages of sleep. Neuron 

• Exercisers May Have Better Shot of Surviving Heart Attack: Researchers compared exercise levels among 1,664 heart attack patients in Denmark, including 425 who died immediately. Those who had been physically active were less likely to die, and the risk of death decreased as exercise levels rose. Patients who had light or moderate/high physical activity levels were 32 percent and 47 percent less likely to die from their heart attack, respectively, than the sedentary patients. European Journal of Preventive Cardiology 

NUTRITION/SUPPLEMENTS/VITAMINS

• Daily consumption of tea protects the elderly from cognitive decline: Tea drinking reduces the risk of cognitive impairment in older persons by 50 per cent and as much as 86 per cent for those who are genetically at risk of Alzheimer’s, new research concludes. The research team also discovered that the neuroprotective role of tea consumption on cognitive function is not limited to a particular type of tea -- so long as the tea is brewed from tea leaves, such as green, black or oolong tea. The Journal of Nutrition, Health & Aging 

• Daily Glass of Beer, Wine Might be Good for the Heart: Researchers tracked more than 1.9 million healthy British adults and found that having the occasional drink was tied to reductions in the risk of heart attack, sudden heart death, heart failure and stroke, compared to non-drinkers. In the study, "moderate" drinking was defined as 7 pints of regular beer or 1.5 bottles of wine in one week. British Medical Journal 

• Probiotics benefit tin Schizophrenia shaped by yeast infections: In a small pilot study of men with schizophrenia, researchers say they have evidence that adding probiotics -- microorganisms, such as bacteria found in yogurts -- to the patients' diets may help treat yeast infections and ease bowel problems. Probiotics may also decrease delusions and hallucinations, but in the study, these psychiatric benefits mostly affected those without a history of yeast infections. Brain, Behavior, and Immunity 

• High Dose Vitamin D Failed to Curb Heart Disease in Study:  Taking high doses of vitamin D once a month won't lower your risk for heart disease, new research indicates. But, even though the vitamin came up short in this study of more than 5,000 adults, the researchers aren't ready to scrap hopes for vitamin D supplementation altogether. "Our study only rules out monthly dosing," said study lead author Dr. Robert Scragg. His team did not explore whether daily vitamin D supplementation might prove more protective of heart health. JAMA Cardiology 

• Vitamin D, calcium supplementation among older women does not significantly reduce risk of cancer: Among postmenopausal women, supplementation with vitamin D3 and calcium compared with placebo did not result in a significantly lower risk of cancer after four years, according to a study. The JAMA Network Journals 

• Yo Yo Dieting Does No favors to the Heart: People who experience regular weight fluctuations of 8 to 10 pounds are much more likely to suffer from heart disease, heart attack, stroke and other heart-related maladies than people who only experienced shifts of 2 pounds or less. NEJM 

• Trans Fat Bans May Have Cut Heart Attack, Stroke Rate: A new study that found lower rates of heart attack and stroke in communities that restrict trans fats in foods. The study found a 6 percent decline in hospitalizations for heart attack and stroke in areas with trans fat restrictions compared to those without within three years of implementing no trans fat policies. JAMA Cardiology 

• Larger doses of vitamin C may lead to a greater reduction in common cold duration: The relationship between vitamin C dosage and its effects on the duration of the common cold symptoms may extend to 6-8 grams per day. Nutrients 

• High doses of vitamin C to improve cancer treatment passes human safety trial: Clinical trials found that it is safe to regularly infuse brain and lung cancer patients with 800-1,000 times the daily recommended amount of vitamin C as a potential strategy to improve outcomes of standard cancer treatments. The researchers also show pathways by which altered iron metabolism in cancer cells, and not normal cells, lead to increased sensitivity to cancer cell killing caused by high dose vitamin C. Cancer Cell 

TREATMENT

• Current jellyfish sting recommendations can worsen stings: Researchers investigated whether commonly recommended first aid actions such as rinsing with seawater or scraping away tentacles lessen the severity of stings from two dangerous box jellyfish species. Their results reveal that some of the most commonly recommended practices actually worsen stings. Instead of rinsing with seawater or scraping, the team found that rinsing with vinegar -- which irreversibly prevents the stinging cells from firing -- or even simply plucking tentacles off with tweezers led to less venom injection. And after the sting, applying heat actively decreased venom activity. Toxins 

• Surgery reverses pseudoparalysis in patients with rotator cuff tears:Arthroscopic superior capsule reconstruction (SCR), a surgical approach to treat irreparable rotator cuff tears, may eliminate pseudoparalysis and significantly improve shoulder function, new research shows. American Orthopaedic Society for Sports Medicine's (AOSSM) Specialty Day 

• Deep brain stimulation provides long-term relief from severe depressions: Doctors have produced the first evidence of deep brain stimulation's lasting effectiveness in a four-year study. The method could serve in the future as an optional therapy for critically ill patients, suggests a new report. Brain Stimulation 

• Evolocumab significantly reduces risk of cardiovascular events: Evolocumab, one of the new targeted PCSK9 inhibitor drugs that has been shown to dramatically lower levels of low-density lipoprotein (LDL), or “bad” cholesterol, also significantly lowers the risk of cardiovascular events in patients with existing heart or vascular disease already on statin therapy, according to new research. NEJM

• Shingles Vaccine Cuts Chronic Pain, Hospitalizations: Vaccination greatly reduces the risk of serious complications from shingles, a new study finds. Protection lasts years after immunization, researchers found. The new study showed the vaccine was 74 percent effective in preventing hospitalizations for shingles during the three years after vaccination. That number dropped to 55 percent effective after four or more years. Clinical Infectious Diseases 

• Trial of new triple inhaler shows 20 percent reduction in COPD flare-ups: Flare-ups in chronic obstructive pulmonary disease can be reduced by 20 percent by a combined triple inhaler, according to the results of a trial of more than 2,000 people. As well as reduced exacerbations, the trial also found that the new inhaler helped to improve lung function more generally and resulted in fewer overall symptoms. The trial is also the first study to prospectively study a biomarker for individualising treatment better. The Lancet 

• Prolonged Antibiotic Use Linked to Precancerous Colon Growths: Women who took antibiotics for two weeks or more in their 20s through their 50s were more likely to have colon lesions in their 60s than women who didn't take the drugs for an extended period, researchers found. If not removed, these lesions -- called polyps or adenomas -- can lead to colon cancer. Gut 

• Ditropan Link to Dementia Risk Over prescribed to Seniors: More than one-quarter of patients with the urinary problem had been prescribed the drug oxybutynin (Ditropan), an international team of investigators found. Yet, "oxybutynin is a particularly poor drug for overactive bladder in elderly patients.” Prior studies have linked the drug to thinking problems and increased risk of dementia in older people, possibly because of the way it affects brain chemicals. European Association of Urology conference

OTHER

• Drugs that Work in Mice Often Fail When Tried in People: Most potential new drugs fail when they're tested in people. These failures are not only a major disappointment – they sharply drive up the cost of developing new drugs. A major reason for these failures is that most new drugs are first tested out in mice, rats or other animals. Often those animal studies show great promise. But mice aren't simply furry little people, so these studies often lead science astray. Some scientists are now rethinking animal studies to make them more effective for human health. NPR 

Take a Break: Peeps 2017

Just a few days before Easter, so time for what’s new to do with Peeps. This year it’s about making Peep Play Dough. What you do after you’ve made this from left over or new Peeps is up to you. Follow the directions from Play, Learn, Grow.

Past Peep activities:

2012:Peep novelties-peepshi, peep pelting, s’mores etc. 

2013:Make a Peep 

2014:Peep trees and topiary 

2016:Peep Videos 

Not interested in today’s activity? Check out the Take a Break Pinterest for lots of Take a Break ideas. 

Living with Chronic Disease: Phone Scams-Don’t Say Yes!

Because those affected by chronic disease are often at home, particularly during the day, they are more likely to be subjected to phone scams. On March 27, the FCC (Federal Communications Commission) issued a consumer alert :Can You Hear Me” Scams. What is most troubling about this scam is that by the time many people realize what’s going on, it’s too late. They start off by saying, “Can you hear me?” which is not an uncommon question for those calling from a medical office or hospital to ask.

 The goal of the caller is to get you to say “yes.” This will be recorded and then used to authorize unwanted charges on your utility or credit card account. The fraudulent callers impersonate representatives from organizations that provide a service and may be familiar to the person receiving the call, such as a mortgage lender or utility.

If you receive this type of call, immediately hang up. If you have already responded, review all of your statements such as those from your bank, credit card lender, or telephone company for unauthorized charges. If you notice unauthorized charges on these and other types of statements, you have likely been a victim of “cramming”.

The following tips can help ward off unwanted calls and scams:

• Don’t answer calls from unknown numbers. Let them go to voicemail.

• If you do answer, don’t reply to any questions that seem to be fishing for a quick “yes” or no” answers.

• If you answer and the caller (often a recording) asks you to hit a button to stop receiving calls,  just hang up. Scammers often use these tricks to identify, and then target, live respondents.

• If you day say yes, keep an eye on your accounts for any authorized charges.

• If you receive a scam call, write down the number and file a complaint with the FCC so they can help identify and take appropriate action to help consumers targeted by illegal callers.

• Ask your phone service provider if it offers a robocall blocking service. If not, encourage your provider to offer one. You can also visit the FCC’s website for information and resources on available Robocall blocking tools to help reduce unwanted calls.

• Consider registering all of your telephone numbers in the National Do Not Call Registry.

NEVER GIVE OUT PERSONAL INFORMATION IF YOU DON’T KNOW THE CALLER.

Take a Break: Make Paper Tulips

Easter is less than two weeks away and the only sign of spring in Vermont is maple syrup houses in full swing. While the smell is wonderful, and we’re all laying in our supplies for the year, I need some color other than white. So it’s a good day to make tulips (wont see them until May at the rate we’re going) out of paper:

• Free Printable 3 D Tulips 

• Origami Tulips (Beginner level) 

• Crepe Paper Tulips 

                             Really good tutorial. Could use straws for the stems instead of rolled paper. 

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

Living with Chronic Conditions: Protecting your Internet Privacy

Since I’ve been writing this blog, I’ve discussed the importance of Being an E Patient and Sharing Data. This past week, Congress took an action that will give many people with chronic conditions pause. All your private online data—the websites you visit, the content of your chats and emails, your health info, and your location—just became suddenly less secure. Not because of hackers, but because Congress just blocked crucial privacy regulations. This will allow your Internet service provider to collect all your data and sell that info to the highest bidder without asking you first. Welcome to a brave new world..... This doesn't just mean that sharing that information without your explicit permission will be fine and dandy. Since the rules were rolled back through the Congressional Review Act, the FCC is also barred from creating any "substantially similar" rules down the line. Popular Mechanics 

The average consumer isn’t going to notice a whole lot of difference, because every site you visit is already sharing data in order to generate targeted ads. Pretty much anyone in the ad business-which is how most websites and the Internet in general are paid for-ends up using Google Analytics or some other basic tool.

The price of free Internet is advertisements, and that is ultimately what the companies are out to obtain. The good news is that an increasing amount of the activity online is encrypted, due to lots of advocacy. ... Increasingly, much of what you do is shielded from third parties because of encryption in place. The ISPs typically — in their efforts to use this data even before this (FCC) rule — have been providing consumers with ISP-level opt-outs. ... People should look for emails — typically they do push out an announcement when they roll out an ad-targeting program. NPR 

That noted, once the data is gathered, how and who uses the data remains to be seen. While the FCC and FTC have historically protected privacy, with the new chairs and administration, this becomes a concerning question.

This is incredibly concerning for the public in general, but more so for those who wish to keep their health concerns private. There is no two ways about it, major advances in the treatment of chronic conditions are coming for people who are E-patients because they are sharing their data and participating in sites like Patients Like Me. But are their risks?

If you are an E Patient, be sure an read the security and privacy parts of the website. Patients Like Me has clear guidelines on what they collect and share and what they are doing to protect confidentiality. 

Consider the following Opt Out Options:

Your ISP (Internet Service Provider): Time Warner/Spectrum customers can find their privacy dashboard here. Comcast customers can opt out of some targeted programs using these instructions. Verizon customers can find opt out options here. Remember, your phone company is technically an ISP too, so look up your options on that front as well.

Some smaller ISPs, which survive on small and satisfied customer bases as opposed to a large and captive audience, are more incentivized to protect your privacy with gusto. In fact, a whole host of small ISPs wrote a letter to Congress opposing this move. If you're lucky enough to have the option of switching to one, now might be a good time.

Triangle “i”: If you go to a website and there is a triangle “i” on your banner ad, that means that the company is tailoring ads based on your Web surfing and is offering you an opt-out. Keep in mind that while they wont be bothering you with advertisements, they’re probably still collecting data.

Mobile Devices: My iPhone lets you clear ad ID if you don’t want your apps to be tracked or work with their ad network partners. Apple lets you wipe that out. Google lets you reset it. Use of location, is also an opt-out.

Do-Not-Track: This appears in your browser and while only a small number of companies respect it. Choosing encrypted tools when you use email or make decisions about what sites and services (to use) — far less information about what you do during the day is going to be available.