Showing posts with label Anemia. Show all posts
Showing posts with label Anemia. Show all posts

Monday, March 24, 2008

A Bone Marrow Disease With a Brighter Prognosis

(HealthDay News) -- Blood is life. And the rare disease known as aplastic anemia robs the body of life by robbing the body of blood.

The aplastic anemia patient's blood thins as the bone marrow slows its production of blood cells. The results can range from chronic fatigue to heart disease or from endless infections to cuts that won't clot, depending on the type of blood cells that are lacking.

But there's hope: Considered fatal as recently as two decades ago, aplastic anemia is becoming a far more manageable disease. Advances in drug therapies and improvements in the field of transplantation have slashed the death toll, allowing patients to live longer, fuller lives.

"We are getting better at treating aplastic anemia, either in getting rid of it or treating its symptoms," said Dr. Jaroslaw P. Maciejewski, with the Cleveland Clinic's Department of Hematologic Oncology and Blood Disorders.

And those advances are helping doctors gain greater insights into other, more prevalent, health conditions, such as heart disease and leukemia.

An estimated 50,000 people develop aplastic anemia in the United States each year, according to the U.S. National Institutes of Health. (A related blood disorder, myelodysplastic syndrome, or MDS, occurs when the bone marrow begins to produce poorly functioning or immature blood cells. About 20,000 to 30,000 new cases of MDS occur each year.)

It's important to note that many symptoms of aplastic anemia, such as fatigue and infection, can also be caused by other diseases, said Dr. Ronald Paquette, a blood disease researcher with the University of California, Los Angeles' Jonsson Comprehensive Cancer Center.

"If everyone who was fatigued thought they had aplastic anemia, we'd be swamped," Paquette said.

Bone marrow -- the spongy material inside bones -- produces stem cells that normally develop into the three main types of blood cells -- red blood cells, white blood cells, and platelets.

"Essentially, the bone marrow is a factory of blood," Maciejewski said.

In patients with aplastic anemia, the stem cells have been damaged, slowing or stopping the production of all blood cells.

The cause of the damage to stem cells remains unknown in more than half of people with aplastic anemia. Some research has suggested that stem cell damage occurs when the immune system attacks the body's own cells by mistake, according to the National Institutes of Health.

Aplastic anemia has also been linked to exposure to toxins such as pesticides, arsenic and benzene. Some infectious diseases also can cause the disorder, including hepatitis, Epstein-Barr virus, cytomegalovirus, parvovirus B19, and HIV, as well as autoimmune diseases like lupus and rheumatoid arthritis. Finally, some genetic disorders have been linked to it.

Symptoms vary depending on the type of blood cells in shortage:

  • Too few red blood cells can mean not enough oxygen is carried to the body, according to the NIH. People who have a low red blood cell count often feel tired. Because the heart has to work harder to pump blood to get enough oxygen to the body's organs and tissues, heart disease can develop over time.
  • Too few white blood cells weaken the body's defense against infection. The patient may become ill more often, and the illness can be severe.
  • Too few platelets hamper the blood's ability to clot. Patients with a low platelet count may bruise or bleed easily, and their bleeding may be hard to stop.
  • Once aplastic anemia is detected, swift treatment is essential, Paquette said. "Because it's a rare disease, it's important to be treated at a specialized center," he said. "The most important thing is to be seen by someone with a lot of experience treating the disease early on."

For patients younger than 30, stem cell transplantation is often the preferred treatment. For those with a matched sibling donor, stem cell transplantation replaces the defective bone marrow with healthy cells, and as many as 80 percent of patients enjoy a complete recovery, according to the Aplastic Anemia & MDS International Foundation Inc.

Advances in stem cell research and anti-rejection drugs have meant that transplantations from unrelated donors also are becoming more successful, Paquette said.

One promising avenue of treatment involves transplantation using stem cells harvested from the umbilical cord of new mothers. "The cells can be cryopreserved [frozen] and saved, then given to unrelated donors," Paquette said. "It's quite encouraging."

For these patients, again, speed is of the essence. "The data show the earlier you do a transplant, the better the outcome," Paquette said.

Patients whose transplants fail, or for whom transplantation is not an option, often receive successful immunosuppressive therapy with agents like anti-thymocyte globulin and cyclosporine. Response rates typically range from 70 percent to 80 percent, according to the Aplastic Anemia & MDS International Foundation Inc.

Blood transfusions from matched donors also are used to keep blood counts high and help relieve symptoms, although they are not an effective long-term treatment.

"Whether we cure the disease or not, patients are getting better across the board," Maciejewski said. "We now can maintain life, keep these patients alive longer."

More information
To learn more, visit the Aplastic Anemia & MDS International Foundation Inc.

Thursday, October 25, 2007

Doctor-Patient Bond Frays After Medical Mistake

(HealthDay News) -- Serious medical errors don't just affect the health of the patient, they can quickly destroy the patient's relationship with his or her doctor, too, experts say.

Too often, a health care mistake causes shame and fear in the physician responsible, leading to stilted, unsatisfying conversations with -- or avoidance of -- the affected patient, say the authors of an article in the Oct. 25 New England Journal of Medicine.

All of this can quickly move patient and doctor into an adversarial or litigious position.

But that's not always necessary, said one of the article's co-authors.

"Trust is an enormously important part of medicine -- if people aren't straight with you, you do not trust them," said Dr. Tom DelBanco, a professor of general medicine and primary care at Harvard Medical School.

"So, being upfront and honest, indicating that you want to do something about what happened, makes all the difference in the world," said Delbanco, who co-wrote the article with Harvard colleague Dr. Sigall Bell.

In many cases, doctors who frankly admitted their mistake and told patients how they would safeguard against future errors avoided litigation by doing so, Delbanco said. Those doctors also maintained strong, long-lasting bonds with the patient and the patient's family.

According to Delbanco, several patients interviewed for the article (and a related film) said that, " 'We don't expect you to be perfect, everybody makes mistakes. We just want you to be honest when it happens. We can deal with that.' "

In fact, "There are now some malpractice [insurance] companies that teach doctors to be honest and open," Delbanco noted. "There is slowly growing evidence that it may actually prevent lawsuits."

Medical errors have gotten a lot more attention recently, ever since the U.S. Institute of Medicine issued its 1999 report, To Err is Human. That report estimated that the deaths of more than 100,000 Americans each year are tied to some form of medical mistake.

In the wake of such errors, doctors often feel shame and guilt, as well as fear linked to the looming threat of lawsuits. For legal reasons, "I think that doctors are very confused about what they can and cannot say" to patients after an error comes to light, Delbanco said. That includes the use of simple words such as "mistake," "error," or even "I'm sorry."

"It depends on their institutions' views, it depends on the lawyers that they may or may not talk to," Delbanco said. "Very often, they are not only confused, but depressed, because they feel like they cannot say what they really feel like saying."

People who care deeply for a patient affected by a medical mistake often shoulder their own level of guilt after the incident. "Family members, in particular, can feel extraordinary guilt," Delbanco said, and often berate themselves, thinking, " 'If I had done this, this wouldn't have happened,' 'If I had been there, I would have prevented it,' 'If only I had been more forceful, the doctor wouldn't have done this.' "

Such was the case for those close to a young man with sickle cell anemia, mentioned in the NEJM article. The unnamed patient received morphine while in the hospital -- despite a well-documented allergy to the painkiller. He slipped into kidney failure and coma soon after, and his sister said she felt as if she "failed her family in terms of 'I should have been there.' That's a guilt that everyone shares."

Doctors who acknowledge that a mistake has happened, and outline steps to prevent such mistakes going forward, can ease a lot of distress for themselves and the patient, experts say.

But, in many cases, physicians have "a lack of confidence in their communication skills -- they just aren't sure how to have these conversations," said Dr. Thomas Gallagher, associate professor of medicine at the University of Washington School of Medicine, in Seattle.

Gallagher said Delbanco's and Bell's article echoes the findings of studies he has led, which revealed profound differences in the ways doctors and patients communicated after a serious medical error.

But he also believes the landscape around medical errors is changing. Already, about 30 states have enacted so-called "I'm sorry" laws, which, to a certain degree, make a doctor's apology for an error inadmissible in a court of law.

That should help ease patient-doctor conversations. But Gallagher said many of these laws still "provide very little protection for clinicians. They allow you to say 'I'm sorry,' but they don't allow you to make any expression that a mistake happened or to admit liability."

And, he said, it's not entirely clear that admitting to mistakes always wards off a lawsuit. "It's not a magic bullet," Gallagher said. "There will clearly be some cases where disclosure is what precipitates a lawsuit."

So, work remains to be done in finding strategies that allow patients and doctors to remain close even after a mistake occurs.

For his part, Delbanco said he is currently screening his film for third-year students at Harvard Medical School -- at the request of the school's dean -- to help them become better physicians. "Traditionally, there's been little coaching in this area," he said. "That's changing."

His advice to patients: If a serious medical error occurs, "be very aggressive in asking for communication. Patients should not be afraid of opening their mouths." And if that communication is not forthcoming, "Ask why and with whom can they speak?" he said.

And a hasty "I'm sorry" from a physician may not always be adequate, Delbanco added.

"Apology only means something when you show what you are going to do for that person -- and for the next person," he said. "Otherwise, they are just words."

More information
There's more on preventing medical errors at the U.S. Agency for Healthcare Research and Quality.

Sunday, December 17, 2006

Penicilliosis and HIV

HIV InSite Knowledge Base ChapterMarch 2006
Woraphot Tantisiriwat, MD, Srinakharinwirot University, Bangkok, Thailand Judith A. Aberg, MD, New York University, New York

Introduction

Penicilliosis is an infection caused by Penicillium marneffei, a dimorphic fungus endemic to Southeast Asia and the southern part of China.(1) Rarely noted before the AIDS epidemic, P marneffei infections have become more prevalent in the endemic areas in conjunction with the AIDS epidemic.(2,3)

Persons affected by penicilliosis usually have AIDS with low CD4 lymphocyte counts, typically <100 href="javascript:openWindow(" page="kb-05-02-07&rf=2,4','References')">2,4) Patients with penicilliosis occasionally are seen outside endemic areas, but most have a history of travel to an endemic area.(5-8)

The most common presentation is a disseminated infection manifested by fever, skin lesions, anemia, generalized lymphadenopathy, and hepatomegaly.(2) Localized infection such as pneumonia also has been reported.(7)

Patients with penicilliosis have a poor prognosis without treatment.(2) P marneffei demonstrates in vitro susceptibility to multiple antifungal agents including ketoconazole, itraconazole, miconazole, flucytosine, and amphotericin B.(9)

Response rates of up to 97% have been reported with amphotericin B therapy for the first 2 weeks followed by 10 weeks of itraconazole.(4) Relapse occurs in the absence of prophylaxis in approximately 50% of patients after discontinuation of successful therapy.(10,11) Maintenance therapy with itraconazole is effective for prevention of relapse.(11)

Microbiology and Epidemiology

P marneffei appears in tissue as a unicellular yeastlike organism that reproduces by planate division.(12) The fungus is a mold at room temperature and it coverts to the yeast form if incubated at 37° C. This dimorphism is not found in other known members of the genus Penicillium.

In the mycelial form on culture, the mold grows relatively fast, producing a grayish-white and downy or woolly colony in 2-3 days. The underside of the fungus appears either pink or red due to the production of a characteristic soluble red pigment that diffuses into the agar. Over time, the colony becomes more rugose while the aerial mycelia become pink.

The color of the colony changes from white to light brown to light green after 10 days. The yeastlike cells are oval or cylindrical and are about 3-6 microns in length. Unlike the mold, the colonies of yeast do not produce a red pigment. The organism can be cultured from various clinical specimens including blood, bone marrow, skin, sputum, bronchoalveolar lavage fluid, and lymph nodes.

P marneffei is endemic to Southeast Asia and the southern part of China, where it has been isolated from 4 species of bamboo rats and from soil.(1,13,14)

Infection seems to be more frequent in the rainy season.(15) Recent history of occupational or other exposure to a potential environmental reservoir of organisms in the soil has been shown to be the predominant risk factor for infection in susceptible persons.(16)

Infection rarely was documented before the AIDS epidemic. The first report of natural infection with P marneffei was in a person with Hodgkin lymphoma who had lived in Southeast Asia.(17) Only 8 cases of infection with P marneffei were reported between 1964 and 1983.(18)

The prevalence of infection has increased substantially, especially in persons who are infected with HIV.(2) There were 92 cases diagnosed from 1987 to 1992 in Chiang Mai University Hospital, involving 86 patients who also were infected with HIV.

Currently, this infection is the third most common opportunistic pathogen in patients with AIDS in Thailand, after tuberculosis and cryptococcosis, despite the fact that it is endemic only to the northern part of Thailand.(3)

Infections with P marneffei occasionally are seen outside the endemic area. Sporadic cases have been reported, all of which involved patients with a history connected to the endemic area.(5-8) The diagnosis should be considered in HIV-infected patients with fever, compatible clinical manifestations, and a history of travel to an endemic area.

Clinical Presentation
The clinical features of infection with P marneffei are shown in Table 1.(2) The most common presentation is fever and weight loss, occurring in more than 75% of patients. The average duration of symptoms prior to presentation is 4 weeks.(1,2)

Other common manifestations include skin lesions, anemia, lymphadenopathy, and hepatomegaly with or without splenomegaly. Skin lesions are present in approximately two thirds of cases and can be varied in appearance. Generalized papular eruptions, central umbilicated papules resembling those of molluscum contagiosum, acnelike lesions and folliculitis all may occur. Skin lesions commonly occur on the face, trunk, and extremities.

Pharyngeal and palatal lesions also can be seen.(19) Subcutaneous nodules occasionally can be seen.(2) Pulmonary symptoms (such as cough and dyspnea) occur in about 50% of cases. Chest radiographic abnormalities typically manifest as diffuse reticulonodular infiltrates, though 50% of cases have normal chest radiographs.

Cavitary lesions also have been reported, particularly in patients with hemoptysis.(20) Laboratory findings include anemia, elevated transaminases (alanine and aspartate aminotransferase), and elevated alkaline phosphatase levels. Fungemia is observed in >50% of cases.

Diagnosis
Diagnosis usually is made by identification of fungi from clinical specimens. Biopsies of skin lesions, lymph nodes, and bone marrow demonstrate the presence of organisms on histopathology.(2) The fungi are spherical or oval in shape with basophilic intracellular or extracellular yeastlike appearance on Wright stain, often with clear central septation.

The organism also can be identified on peripheral blood smear or bone marrow aspirate.(21) Blood cultures are positive frequently, while bone marrow culture is positive in nearly all cases.(2) The lysis centrifugation culture system may improve the yield of blood cultures.

Histopathologic features include granulomatous, suppurative, or necrotizing inflammation.(22) Immunologic techniques to identify organisms on tissue samples are under evaluation with promising results.(23-30)

A specific polymerase chain reaction (PCR) assay is under evaluation and might be useful as an alternative test for rapid diagnosis of P marneffei infection.(31-32)

Therapy and Prevention

Patients with penicilliosis have poor prognosis without treatment.(2) Even with treatment, mortality is approximately 20%. Treatment with amphotericin B with or without flucytosine, or itraconazole, is the treatment of choice.(10,33)

P marneffei demonstrates in vitro susceptibility to many of the currently available antifungal agents, including ketoconazole, itraconazole, miconazole, flucytosine, and amphotericin B.(9,34) Fluconazole appears to be less active in vitro.(9)

Clinical failure is more common in treatment with fluconazole (63.8%) compared with amphotericin B (22.8%) or itraconazole (25%).(9) Newer azoles (posaconazole, ravuconazole, and voriconazole) have demonstrated good in vitro activity against P marneffei.(35)
There are no randomized, controlled trials of the treatment of penicilliosis.

One open-label study of amphotericin B 0.6 mg/kg/day intravenously for 2 weeks followed by 10 weeks of itraconazole 400 mg/day showed excellent results.(4) This regimen was effective in 97% of 74 HIV-infected patients treated. All patients had cleared fungemia by the end of their second week of treatment. Patients tolerated the regimen without any major adverse reactions.

After completing initial treatment, patients with P marneffei infection should receive secondary prophylaxis to prevent relapse of infection. A randomized controlled trial demonstrated that secondary prophylaxis with itraconazole 200 mg daily is effective.(11)

None of the patients receiving itraconazole had a relapse, whereas 57% of those in the placebo group had a relapse within 1 year after completing initial treatment. Although this study was not powered to detect a survival difference, 15% of the patients who had a relapse died.

Primary prophylaxis can prevent the occurrence of penicilliosis. A randomized placebo-controlled study from Chiang Mai University suggests that primary prophylaxis with itraconazole 200 mg daily can prevent the occurrence of penicilliosis among patients with AIDS and CD4 counts <200>36)

Of 129 patients enrolled, penicilliosis occurred in only 1 case in the itraconazole arm compared with 11 cases in the placebo arm, a statistically significant difference (p = .008 in those who had CD4 counts <100 name="S6X">References
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Sobottka I, Albrecht H, Mack D, Stellbrink HJ, van Lunzen J, Tintelnot K, Laufs R. Systemic Penicillium marneffei infection in a German AIDS patient. Eur J Clin Microbiol Infect Dis 1996; 15:256-9.
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Sekhon AS, Stein L, Garg AK, Black WA, Glezos JD, Wong C. Pulmonary penicillosis marneffei: report of the first imported case in Canada. Mycopathologia 1994; 128:3-7.
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Supparatpinyo K, Chiewchanvit S, Hirunsri P, Baosoung V, Uthammachai C, Chaimongkol B, Sirisanthana T. An efficacy study of itraconazole in the treatment of Penicillium marneffei infection. J Med Assoc Thai 1992; 75:688-91.
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Chariyalertsak S, Sirisanthana T, Supparatpinyo K, Praparattanapan J, Nelson KE. Case-control study of risk factors for Penicillium marneffei infection in human immunodeficiency virus-infected patients in northern Thailand. Clin Infect Dis 1997; 24:1080-6.
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DiSalvo AF, Fickling AM, Ajello L. Infection caused by Penicillium marneffei: description of first natural infection in man. Am J Clin Pathol 1973; 60:259-63.
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Deng ZL, Connor DH. Progressive disseminated penicilliosis caused by Penicillium marneffei. Report of eight cases and differentiation of the causative organism from Histoplasma capsulatum. Am J Clin Pathol 1985; 84:323-7.
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Deng Z, Ribas JL, Gibson DW, Connor DH. Infections caused by Penicillium marneffei in China and Southeast Asia: review of eighteen published cases and report of four more Chinese cases. Rev Infect Dis 1988; 10:640-52.
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Panichakul T, Chawengkirttikul R, Chaiyaroj SC, Sirisinha S. Development of a monoclonal antibody-based enzyme-linked immunosorbent assay for the diagnosis of Penicillium marneffei infection. Am J Trop Med Hyg 2002; 67:443-7.
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Prariyachatigul C, Chaiprasert A, Geenkajorn K, Kappe R, Chuchottaworn C, Termsetjaroen S, Srimuang S. Development and evaluation of a one-tube seminested PCR assay for the detection and identification of Penicillium marneffei. Mycoses 2003; 46:447-54.
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Drouhet E. Penicilliosis due to Penicillium marneffei: A new emerging systemic mycosis in AIDS patients traveling or living in Southeast Asia. Review of 44 cases reported in HIV infected patients during the last 5 years compared to 44 cases of non AIDS patients reported over 20 years. J Mycol Med. 1993;4:195-224.
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Pfaller MA, Messer SA, Hollis RJ, Jones RN. Antifungal activities of posaconazole, ravuconazole, and voriconazole compared to those of itraconazole and amphotericin B against 239 clinical isolates of Aspergillus spp. and other filamentous fungi: report from SENTRY Antimicrobial Surveillance Program, 2000. Antimicrob Agents Chemother 2002; 46:1032-7.
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Tuesday, October 03, 2006

HAIR TISSUE MINERAL ANALYSIS (HTMA)

Hair

Hair is the ideal biopsy material for determining the body's levels of nutrient and toxic minerals. Hair analysis is an extremely precise analytical test, which is used to measure the mineral content of hair. Research studies have shown that this test, performed under very strict laboratory conditions, is able to determine the body's current mineral levels.

Blood

The blood and serum do contain minerals, but they may not be completely representative of the body’s mineral storage. In many cases, the serum level of minerals is maintained at the expense of tissue concentration (homeostatic mechanisms).

Serum concentrations may fluctuate with emotional changes, the time of day the blood is drawn, or foods eaten prior to taking a sample.

For example:
· Serum magnesium can fluctuate depending upon the blood drawing technique. The longer the tourniquet is applied, the higher the magnesium rises as a result of tissue hypoxia.
· Symptoms of iron deficiency can be present long before low serum levels can be detected, as iron deficiency symptoms before anemia is very common.

Excess accumulation of minerals in the body are often undetected in the serum due to their removal from the blood for deposition into the tissues. When this occurs, the mineral may fail to be excreted through the urine or intestinal tract. Thirty to forty days following an acute exposure to the toxic metal lead, for instance, elevated serum levels may be undetectable as a result of the body’s removing the lead from the serum as a protective measure and depositing the metal into such tissues as the liver, bones, teeth, and hair.

Minerals may fluctuate between the serum and tissues in acute or chronic conditions. This is seen with copper and iron during infections, inflammatory disorders, and certain malignancies. Also, calcium loss from the body can become so advanced that severe osteoporosis develops without any appreciable changes noted in the blood levels of calcium.

Urine

Minerals found in the urine indicates what is being removed from the body. It does not indicate the current level of minerals in the body. Hence it is not a good tool to detect mineral and heavy element status. However, urine analysis is good for testing organic acids and peptides.

Toxic minerals and substances

The Environmental Protection Agency or EPA of the USA has identified hair as the tissue of choice for biological monitoring of toxic heavy metals. In situations where one is continuously exposed to low levels of toxic metals, blood and urine tests are poor indicators. The body will remove these toxins from circulation and sequestrate them to storage depots such as the hair and nails. Hair is thus a good indicator of whole-body accumulation, while blood and urine are not.

However, for acute poisoning where one ingest a large amount of toxic substances, blood and urine test will show high levels of the toxins immediately. Over time, when these toxic substances get stored in various tissues and bones in the body, the amount circulating in the blood and those excreted through the urine will be undetectable.

Time-Average Characteristic of Hair Analysis

In a hair analysis, about one and a half inches of hair close to the scalp is sampled. This length of hair contains approximately six to eight weeks of information about the body's internal metabolism. Thus the result is actually averaged over this period of growth, making it more reflective of one's lifestyle and dietary habits.

Instantaneous Characteristic of Blood Test

Blood mineral analysis will tell which minerals are circulating extra-cellularly at the time the blood is sampled. If you have just eaten a banana, your blood test can indicate that you are high is potassium, even though you may actually need potassium supplementation. On the other hand, hair analysis will indicate your overall level of potassium - your actual storage levels over a period of time, not just what you ate that day or even that week. So a blood test will only accurately report what is being transported in your blood at the time of the test.

Urine analysis will tell which minerals have been excreted, not necessarily what has been absorbed and utilized by the body.

Preventive Health

Our body has a homeostasis control which regulates the blood contents of the body within narrow high-low limits. When a mineral intake is very high, the body will remove or eliminate it as quickly as possible. If the mineral is not eliminated, it will be stored in the body tissues, such a hair or nails. If a mineral intake is very low, the body will draw from storage areas to maintain blood levels. Only when the storage areas are markedly depleted, then the blood will reflect a deficiency.

Unlike blood, hair is a metabolic by-product and is not regulated by the homeostasis mechanism. It is a tissue storage site. Any mineral deficiency or trend towards deficiency will show up in a hair analysis first. This makes hair analysis a very good tool for preventive health programs.

Blood test and urine analysis are like snapshots of what's going on in the body. Only hair analysis will reveal the unique mineral absorption during a very specific period of time. This analysis allows for exact recommendations of only those supplements that are actually needed. This is important knowledge to have for those concerned about maintaining good health and discovering the body's toxic metal levels.

ADVANTAGES OF HAIR ANALYSIS
Hair specimen can be collected more quickly and easily than blood, urine, or any other tissue, using a non-invasive method.
Hair analysis is more cost-effective than mineral testing through other means.
Unlike blood, hair is less susceptible to the homeostatic mechanisms that quickly affect trace element levels.
Long-term deviations of mineral retention or losses are more easily detected in hair than blood.
Concentrations of most elements in the hair are significantly higher than found in the blood and other tissues.
Hair provides a record of past as well as present trace element levels, i.e. biological activity.
Hair provides information of substances entering the hair from the blood serum as well as from external sources.
Hair is invaluable in the assessment of toxic metal levels.



Monday, September 11, 2006

Children's Health

Children's Health
In this section many common questions related to children’s health are explored.

Contrary to popular belief, children are not "little adults," and the approaches to their health conditions are often markedly different than those used for grown-ups.

The rapid changes that occur during growth and development require special consideration in choosing both treatments and medications.

In some cases, specific treatments have not been well studied in children, but the majority of childhood health concerns are those that parents have been asking about for many generations, and the solutions are tried and true. Information on other childhood conditions can be found in the QA archives.

  • Acupuncture
  • Attention Deficit Disorder
  • Asthma from Exercise
  • Bedwetting
  • Broken Bones
  • Carsickness
  • Colicky Babies
  • Constipation
  • Ear Infections
  • Early Puberty
  • Fluoride
  • Food Coloring
  • Head Lice
  • Overweight Kids
  • Sore Throat
  • Teething
  • Toy Safety
  • Vitamins

Acupuncture
In the United States, acupuncture hasn’t often been used to treat children, mainly because youngsters tend to be afraid of needles.

But several recent studies have suggested that this fear can be overcome and that children can benefit from acupuncture treatment for certain conditions.

The latest study on this subject was conducted at the Harvard-affiliated Children’s Hospital in Boston by Yuan-Chi Lin, MD, an anesthesiologist who specializes in pain management in children. Dr. Lin’s study included 243 youngsters ranging in age from six months to 18 years who were being treated for headaches, stomachaches, back pain and other chronic complaints that often caused them to miss school.

When the study began, the young patients rated their pain as an "8" on a scale of 1 to 10. (One of Dr. Lin’s methods of demonstrating to the kids that the needles won’t hurt is by inserting them first in the children’s parents.)

When the year-long study was over, the average pain rating among the youngsters was a "3." The kids also reported missing less school, sleeping better, and being more able to participate in extracurricular activities as a result of treatment.

In an earlier study at the same hospital, 70 percent of the 47 youngsters participating reported that acupuncture helped relieve their pain and 59 percent of their parents agreed.

The conditions for which these patients were treated included migraines, endometriosis in teenage girls, and reflex sympathetic dystrophy (a syndrome in which pain becomes chronic after an injury).

In this study, 15 children were age 12 or under while 32 were between 13 and 20 years old. Other studies have looked at acupuncture as a treatment for attention deficit hyperactivity disorder and cerebral palsy in children.

While not many acupuncturists specialize in treating children, Dr. Lin estimates that about a third of pediatric pain centers nationwide now offer acupuncture to their young patients.

Acupuncture is best used for pain reduction as part of comprehensive treatment that includes relaxation techniques, clinical hypnosis and various forms of bodywork.

Attention Deficit Disorder
Ritalin, a stimulant, remains the most common treatment for Attention Deficit Disorder (ADD), also called Attention Deficit Hyperactivity Disorder (ADHD). Paradoxically, with ADHD the drug has a calming effect, apparently because it stimulates parts of the brain that regulate activity and attention.

While it can have excellent results in some cases, it is greatly over-prescribed.
There currently is no herbal treatment for ADHD, except possibly coffee, which may work like Ritalin for some patients.

Pediatrician Sandy Newmark, M.D., of Tucson, Ariz., confirms that no herbs have been found effective for treating the main or "core" symptoms of ADHD — that is, lack of focused attention that often leads to poor school performance. And he doesn’t think coffee is a good long-term solution. However, Dr. Newmark notes that herbs can help with some of the associated symptoms. For example, valerian tea can help youngsters with sleeping problems and St. John's wort can help relieve depression. For children under 12, use half the adult dosage.

Dr. Newmark does recommend a dietary supplement, omega-3 fatty acids, for all children with ADHD because levels of omega-3s in the plasma and red blood cells of children with ADHD are lower than in normal children. He also recommends that youngsters with ADHD take a quality multivitamin as well as a good probiotic, a product that contains "friendly" bacteria that can stabilize the digestive tract. You can find milk-free brands in health-food stores.

Make certain that the underlying cause of your child’s disruptive behavior really is ADHD, and that he or she isn’t acting out difficulties at home or expressing frustration with a learning disability. Be sure to rule out hearing or vision problems, allergies, depression or even boredom in a gifted child.

As far as foods are concerned, while there’s no evidence that a dietary approach helps in all cases, a 1993 Cornell University study found that eliminating dairy products, wheat, corn, yeast, soy, citrus, eggs, chocolate, peanuts, artificial colors and preservatives seemed to decrease ADHD symptoms. An even earlier study showed that a low-allergen diet supplemented with calcium, magnesium, zinc and vitamins produced favorable results.

Asthma from Exercise
Exercise can trigger asthma symptoms in children and adults – even those who don't otherwise suffer from the condition - and can aggravate the problem in up to 80 percent of those who do have asthma.

The symptoms – coughing, wheezing, shortness of breath or tightness in the chest – usually come on after exercise, although they can occur soon after exercise has begun. It can be treated with medication and by taking precautions to prevent or minimize symptoms. Here’s a rundown of medication options, provided by pediatrician John Mark, MD, an assistant professor of pediatrics at the University of Arizona who treats asthma in both adults and children.

Albuterol – A short-acting bronchodilator that’s inhaled 15 to 20 minutes prior to exercise and that protects against symptoms for about four to six hours.

Salmeterol – A long-acting bronchodilator that’s inhaled twice a day which offers protection for up to 12 hours. You can also use salmeterol as a preventive before you work out.

Montelukast (Singulair) – A drug that blocks the action of leukotrienes in the lungs, resulting in less constriction of bronchial tissue and less inflammation. Leukotrienes are one of several classes of chemical messengers produced in the body that can trigger bronchial constriction and inflammation. Montelukast is available in pill form and is taken the night before you exercise.

Cromolyn (Intal) – An anti-inflammatory drug inhaled 15 to 20 minutes before exercising that prevents the release of histamines and leukotrienes. It’s most useful in asthma when an allergic component is present.

In addition to medication, the following approaches can help prevent or minimize symptoms:
A very slow warmup. Even to the point that your child reports the beginning feelings of the "tightness" associated with exercise-induced asthma.

Then your child should stop and stretch, or slow down if exercising vigorously. By taking this break, the development of asthmatic symptoms can often be blocked and a normal pace can be resumed. This may take some getting used to, but can sometimes eliminate the need for medication.

Try breath work. The most effective approaches are pranayama techniques – breath control exercises taught in some yoga classes for adults. You can have your child do these after the initial warm-up, again, when the symptoms are almost felt. For most children, you can start with Dr. Weil’s technique for "The Relaxing Breath."

Find a form of physical activity that minimizes exercise-induced symptoms. Sports or activities that have intermittent rest periods (such as tennis, softball and golf) can allow your child to regain control of his or her breathing. Swimming may be better than running outdoors in cold weather, but no type of exercise is off-limits with proper treatment. In fact, some of the world’s top athletes have exercise-induced asthma, and they’re still able to compete successfully in Olympic-level events.

Bedwetting
Although by age 8 most youngsters have outgrown bedwetting, a sizeable minority still haven’t. As a matter of fact, 5 to 10 percent of boys still have enuresis (the medical term for bedwetting) by age 10. Enuresis tends to run in families and, when this is the case, children usually outgrow it at the same age as the parent, sibling or other relative who had the problem did.

No one knows what causes bedwetting, although it is sometimes associated with constipation. If so, simple dietary changes such as eating more fruits and vegetables and drinking more water early in the day can help resolve matters. Pediatrician Sandy Newmark, MD, of Tucson, Ariz., suggests making sure that children aren’t drinking any beverages that contain caffeine (such as some sodas) and trying to limit (within reason) the amount of fluids they drink in the evening.

Dr. Newmark explains that an "enuresis alarm" is the most simple and effective intervention for youngsters. This device is a wristwatch with a sensor that is attached to pajamas so that the alarm sounds at the first sign of wetness.

This system eventually conditions a child to wake when the bladder is full. Dr. Newmark says that the alarms work in about 70 to 80 percent of children. They are available at most drugstores and cost about $50. Be patient with this system since it can take weeks, and sometimes months, to see results.

If the alarm doesn’t help, Dr. Newmark suggests trying hypnosis as a safe and effective treatment. While some pediatricians prescribe drugs for children who wet the bed, using medication is controversial and should be viewed as a last resort. Homeopathic remedies also may be effective; consult a homeopathic practitioner if you want to try this approach.

Broken Bones
Results of a recent study at the Mayo Clinic in Rochester, Minn., suggest that the rate of wrist and forearm fractures among young girls has increased dramatically in the last 30 years. The study results, published in the Sept. 17, 2003, issue of the Journal of the American Medical Association showed that the fracture rate for young girls increased 56 percent from 1969-1971 and 1999-2001.

Boys still suffer more fractures, but the rate of increase among young boys was only 32 percent. Overall, the Mayo Clinic researchers found that the fracture rate among young people had increased 42 percent over three decades.

The researchers had no answers for why this is happening. It is unlikely that youngsters are breaking more bones because they’ve become more physically active. One possibility is that kids may not be getting enough calcium during a period when their bones are growing rapidly.

If so, their bones may never become as dense as they should, which raises the possibility that affected youngsters may be more vulnerable later in life to osteoporosis and hip and vertebral fractures.

The researchers noted that government surveys have shown a decrease in milk consumption among older girls and an increase in consumption of carbonated drinks. The phosphates in carbonated beverages interfere with calcium absorption.

The RDA for calcium is 1,300 mg for young people age 9 to 18. This translates to 4-5 servings of dairy per day, but kids don’t have to drink milk to get their calcium. Other good sources include yogurt, cheese, sea vegetables, collard and mustard greens, kale, bok choy, broccoli, canned salmon and sardines, tofu that has been coagulated with a calcium compound, calcium-fortified soy milk, fruit juice and blackstrap molasses.

Other experts have noted instances of vitamin D deficiency that could contribute to weakened bones. Our bodies make vitamin D with exposure to sunlight, and youngsters who spend too much time indoors may not produce optimal amounts of vitamin D. Spending 10 minutes in the sun without sunscreen a few days each week will do the trick, but it is not a bad idea for kids 12 and older to take a multivitamin supplement that includes 400 IU of vitamin D.

Carsickness
Carsickness, like all types of motion sickness, occurs when the brain receives conflicting signals from the inner ears, eyes, and other parts of the body that sense motion. A child sitting in the back seat of a car may sense movement – her inner ear perceives the motion – but she may not be able to see out the window to see that she is moving. At the same time, her perception is that her body isn’t moving at all. In some children, these conflicting messages can result in very distressing nausea.

One effective remedy for motion sickness comes from an old Chinese fisherman’s remedy of stimulating the acupressure points that control nausea. The updated version of this treatment is done with wristbands equipped with a plastic peg that presses on acupressure points on the inner surfaces of the wrists. The wristbands are available at most drug and health-food stores. Follow package directions carefully – proper placement of the wristbands is critical.

Motion sickness can also be prevented (and treated) with ginger. Mix a half teaspoon of ginger powder in a glass of water and give it to your child 20 minutes before you get in the car. Or give your child two capsules of powdered ginger.

This remedy has proved more effective than Dramamine – with none of the drowsiness that can occur as a side effect of the drug. Ginger snaps, ginger ale and candied ginger can all help with mild nausea, so keep some in the car should someone develop symptoms during the trip. You also could explore homeopathic remedies – and possibly hypnosis – as a long-term solution.

The American Academy of Pediatrics suggests trying to deal with carsickness in children by focusing youngsters’ attention away from their queasiness. Listen to the radio or tapes, sing or talk. Also, direct their attention at things outside the car, not at books or games. Make sure that they look out the front windows, where apparent motion of objects is less.

Colicky Babies
First, exclude other reasons for the baby’s crying. Make sure the infant isn’t running a fever, isn’t lethargic, is eating normally and isn’t having any trouble breathing. Your pediatrician will also want to exclude GERD (gastroesophageal reflux disease), which can occur among babies (although it is much more common among adults).

The good news about colic is that what you see is what you get – a fussy, crying but otherwise perfectly healthy baby. Some doctors think that this irritating phase may be part of normal development. Between 5 and 28 percent of infants develop colic between when they are two to six weeks old, and usually outgrow it by the time they’re three to four months old.

Here are Dr. Russell Greenfield’s suggestions for dealing with colic – and with the frustration it can breed among parents:

  • Try massage therapy, a great way to enhance bonding between parent and child at a time when colic may be interfering with the bonding process.
  • Rock your baby rhythmically.
  • Turn on music or try the clothes dryer or vacuum cleaner. Sometimes the white noise they produce helps.
  • Try cranial osteopathy or homeopathy; both may help and are safe forms of treatment.
  • Try herbal remedies such as cooled chamomile or fennel tea. You can get tea bags at the health food store and give the baby one to two ounces at a time, no more than three to four ounces per day.
  • Switch to a cow’s milk-free formula, or, if breast feeding, change the mother’s diet to affect what is entering her breast milk (in some cases, a food sensitivity may play a role).
    Swaddle your baby – it provides a nice snug feeling.
  • Chill – find a way to relax; try breathing exercises or other relaxation techniques to lower your frustration level.

By the way, the latest international report on colic comes from a Canadian study that found that mothers don’t appear to sustain any lasting psychological effects as a result of dealing with a colicky infant.

Constipation
Constipation is a common problem for children and usually is temporary. Strictly speaking, a child is constipated if he or she has fewer than three bowel movements per week or if the stools are hard, dry, and unusually large or difficult to pass. Because constipation can make bowel movements painful, youngsters may try to avoid having them. (In addition, about 60 percent of constipated children experience recurrent abdominal pain, a common stress-related condition in youngsters.)

The causes of constipation in kids usually are simple and relatively easy to correct: not enough fiber in their diets, not drinking enough liquids or not getting enough exercise. Then, too, constipation can occur when youngsters ignore the urge to have a bowel movement, which they can do for reasons ranging from not wanting to take a break from playing to embarrassment at using a public bathroom or because a parent isn’t around to help when the urge occurs.

Medication can also be a factor. Those that can cause constipation include aspirin and codeine, vitamins with high doses of iron, the bismuth in Pepto-Bismol, as well as some chemotherapy agents (vincristine) and some psychiatric drugs (imipramine).

Sandy Newmark, MD, a pediatrician at the University of Arizona Program in Integrative Medicine, recommends the best ways to deal with constipation in young children, listed here:
Decrease dairy products: They can be constipating. Provide your child with an alternative source of calcium such as soy milk fortified with calcium or a calcium-fortified breakfast cereal.
Increase fluids: Encourage your child to drink lots of water.

Increase fiber: Give your child lots of high-fiber fruits and vegetables as well as high-fiber cereals, whole-grain breads and beans.

Although these measures probably will do the trick, if a child’s episodes of constipation last longer than three weeks and prevent him or her from participating in normal activities, you might want to consult a pediatrician. Don’t be tempted to administer the over-the-counter laxatives designed for children. They can be dangerous to youngsters and should be given only under the direction of a pediatrician.

Ear Infections
Recurrent ear infections can be troublesome during early childhood. Here are two strategies:
Eliminate milk and milk products from your child’s diet for at least two months. This means avoiding all dairy products as well as other foods containing milk in any form. Soy, rice, and nut milks such as almond milk are all right. The protein in milk, casein, is often associated with recurrent ear infections in early life as well as with sinus conditions, eczema, chronic bronchitis, and asthma.

Try cranial osteopathy. It is another good treatment for recurrent ear infections. When performed by a skilled practitioner, this technique can often end cycles of ear infections, sometimes with a single treatment.

The late Bob Fulford, D.O., a leading practitioner of cranial osteopathy, had great success curing recurring infections in young children. He believed that fluid stagnation in the middle ear – caused by restricted breathing – was at the root of the trouble.

Gentle manual manipulation (and sometimes application of a vibrating instrument known as a percussion hammer) opens up breathing, which in turn helps fluid drain from the middle ear. To find a practitioner of cranial osteopathy, send a self-addressed stamped envelope to the Cranial Academy, 8202 Clearvista Parkway, #9D, Indianapolis IN 46256. At the University of Arizona, researchers are now concluding a study funded by the National Institutes of Health's National Center for Complementary and Alternative Medicine on the use of both cranial therapy and Echinacea to break cycles of recurrent childhood ear infections.

Early Puberty
In the United States, there's a virtual epidemic of precocious puberty these days – the onset of puberty at very young ages in both boys and girls. Among Caucasian girls today, 1 in 7 starts to develop breasts or pubic hair before she is 8 years old. Among African-American girls, the number is 1 out of 2! Unfortunately, no one knows why this is happening, although there's plenty of speculation. Precocious puberty can be triggered by tumors in the pituitary gland, hypothalamus, ovaries, or testicles, but these cases are rare. Environmental factors are more likely to blame for the upsurge in cases today. The theory with the most scientific support is that obesity is responsible. I think this may be true, since we've long known that overweight girls mature physically earlier than thin ones.

Research also has suggested that environmental pollution may play a small role. In the spring of 2000, results of a study reported in the Journal of Pediatrics showed that boys exposed to DDE (a breakdown product of DDT) were heavier than their peers, while girls exposed to PCBs were heavier than their peers and tended to reach puberty a bit sooner, even though the actual numbers involved in the study were not deemed statistically significant. (Both DDT and PCBs are chemicals that appear to interfere with the body's own hormones.) Researchers are also looking at other environmental chemicals – among them Bisphenol A (BPA), used in manufacturing plastic – but so far haven't found a definitive link.

Unfortunately, there's not a lot to offer in terms of treatment and no natural remedy that I can suggest. Since it's occurring so often these days, some physicians believe that precocious puberty in girls between the ages of 6 and 8 should be seen as normal and not treated at all. (We do know that the risk of breast cancer later in life increases with an earlier onset of puberty.) The only approved allopathic treatments are two drugs: Gonadotropin-Releasing Hormone, GnRH, and Luteinizing Hormone-Releasing Hormone, LHRH, both given by daily injections or at intervals of every three to four weeks. These drugs interfere with the hormonal changes responsible for precocious puberty, in effect putting them on "hold" until the child reaches a more appropriate age (typically between the ages of 11 and 13 in girls). The drugs may also reverse the changes that already have taken place.

The physical changes are only one aspect of what girls must contend with as a result of precocious puberty. Because they look like young women, they're often treated as if they were much older than they are by boys (or men who should know better) and may also be teased by friends and at school. If you are a parent with a child in the midst of precocious puberty, you must keep the parent-child lines of communication open. Make sure that your child understands that despite the change in her appearance, he or she is still a child.

Fluoride
The only children who need fluoride supplements of any type are those who live in communities without fluoridated water supplies or in homes with water purifiers that remove minerals. The easiest, most efficient and most cost-effective means of making sure that children have adequate fluoride to protect against tooth decay is to support fluoridation of your area's water supply.

If your community's water is not fluoridated, your child will need dietary fluoride supplements which are available only by prescription from your dentist or physician. To protect against tooth decay, children need fluoride on a daily basis from the age of 6 months to 16 years. (Pregnant women take fluoride supplements beginning in the sixth month of gestation to ensure strong tooth development in the fetus – check with your obstetrician about this.) The correct dosage for your child must be calculated on the basis of the natural fluoride concentration of your local drinking water as well as your child's age, and the extent of his or her exposure (if any) to other sources of fluoride, such as toothpaste or commercial products.

Some fluoride is present in all water sources, but according to the American Dental Association, most bottled waters don't contain enough to prevent tooth decay. Fluoridation of community water supplies involves adjusting the fluoride content to the optimal level for dental health, 0.7 to 1.2 parts fluoride per million parts water. Too much fluoride can be bad for children's teeth, just as too little is bad. An excess of fluoride can lead to mottled, chalky, white spots on the teeth. Other health risks include weight loss, brittle bones, anemia and weakness. Be aware that there are conflicting reports that continue to fuel the controversy over fluoridation. Yet at proper levels, fluoride is of immeasurable benefit to the teeth – during childhood and throughout life.

Food Coloring
We are seeing more and more strangely colored foods and snacks, but as a precaution, keep children – and adults – away from foods with artificial colorings. The danger is that the chemicals used to create color are energetic molecules, many of which are capable of interacting with and damaging DNA. Anything that damages DNA can injure the immune system, accelerate aging, and increase the risk of cancer. Indeed, many synthetic food dyes once considered safe have turned out to be carcinogenic. Some approved for use in Europe are considered unsafe in the United States, and vice versa.

Dyes are added to foods for the convenience of the manufacturer, not for the health of the consumer. Luckily, these are among the easiest types of food additives to avoid. Try to convey to your children that garishly colored snack foods are weird and unhealthy – rather than attractive – and make it a rule not to buy them. Watch out for labels that list any of the following terms: "color added," "artificial color added," "U.S.-certified color added," or "FD&C red No. 3" (or green or blue or yellow followed by any number; these are FDA-approved food drug and cosmetic dyes).

There is nothing wrong with foods dyed with natural colors obtained from plants. The most common, annatto, is from the reddish seed of a tropical tree. It is widely used in Latin American cooking to make yellow rice and breads, and is also commonly added to butter and cheese to make them yellow or orange. Other safe food colorings are a red pigment obtained from beets, a green one from chlorella (freshwater algae), caramel, and carotene from carrots.
Definitely keep your kids away from bright green ketchup, a product designed specifically to appeal to youngsters.

Head Lice
Head lice are a common nuisance of childhood. Kids pick them up from someone who already has them by wearing each other’s hats, scarves, hair ribbons and other clothes; sharing combs, brushes or towels; or lying on a bed, couch, pillow or even cuddling a stuffed animal that belongs to a child who has lice. Try to discourage this kind of sharing, particularly if you hear that there’s an infestation at school, at a day care center, or wherever your children spend time.

The conventional treatment is one-percent lindane, sold as Kwell lotion. Yet lindane is a cousin of DDT and can harm the nervous system. Natural and safer alternatives include one-percent permethrin cream rinse, sold as Nix and Neem, which is derived from a tree in India. Lice can develop resistance to permethrin products, and they can aggravate asthma in some children, but both are relatively nontoxic. (Neem is sold in garden shops.)

Some California school systems are using a new product called Lice B Gone, a non-toxic, multi-enzyme shampoo made from plant sources that seems to get rid of lice in a single application. It works by softening the glue that holds the nits (lice eggs) to the hair shaft and also dissolves the exoskeletons of adult lice. Since it contains no pesticides, Lice B Gone is considered safe for pregnant women, nursing mothers, young children and people with asthma.

Overweight Kids
You'll probably be happy to hear that not all children who are heavy grow up to be overweight adults. However, we do have an epidemic of childhood obesity in the U.S., and all parents should be aware that for every year that a child remains overweight, his or her chances of growing into an overweight adult increase.

Aside from eliminating sodas or junk food at home, look to physical activity as a way to help your child lose weight. Try for at least half an hour of physical activity each day. Unfortunately, only 25 percent of school-aged children now take physical education classes. If your child doesn't get any exercise at school, it's up to you to make sure he or she does some type of physical activity at home.

Here are some approaches to add exercise to your child's life as well as foods that will help control his or her weight:
Curb screen time. Limit the time your child spends watching television, sitting at the computer or playing video games.
Set a good example. Studies have found that children are more likely to be physically active if their parents and siblings are active, and if they're encouraged to take part in physical activities. Take family walks, hikes or bike rides on a daily basis, if possible.
Emphasize nutritious foods. Don't limit the amount your child eats, but make sure the foods he does eat are low in fat and high in fiber. When making these changes, say that you're doing it for the entire family to avoid drawing attention to your child's need to lose weight.
Eat meals together. Family breakfasts and dinners give you more control over what your child eats and allow you to make sure that everyone gets at least two nutritious meals per day.
Think about drinks. Cut back on fruit juices, sodas and whole milk. Drinks can provide a surprisingly large number of calories per day.
Teach a relaxation technique. If your child eats in response to stress, you might show him how a relaxation technique such as deep breathing can help to calm him.

Sore Throat
The most important thing parents can do when children develop sore throats is to make sure that the problem isn’t strep, a bacterial infection that requires antibiotic treatment. Strep is diagnosed via a throat culture. (Or a rapid strep test, which takes only 10 minutes but is not as accurate.) While the results may not be available for a few days, a doctor often can tell on the basis of observation whether strep is the likely problem and begin immediate treatment with penicillin. The sore throat usually eases in 24 to 48 hours.
Besides a very sore throat, symptoms of strep often include fever, swollen and tender lymph glands under the jaw, and a swollen and marked redness at the back of the throat that may have white dots. Those symptoms don’t always mean strep, but they often do. (Another clue: suspect strep when there are none of the typical symptoms of a viral infection such as a cough, runny nose, hoarseness and eye irritation.)
It is very important to treat strep throat with antibiotics as soon as possible, because in rare cases it can lead to an autoimmune reaction – rheumatic fever – that can affect the joints, heart and kidneys.
To reduce your child’s susceptibility to sore throat, try to build up his or her immune system by administering a course of the Chinese herb astragalus (Astragalus membranaceous) during cold and flu season. You can get astragalus in tincture form or in capsules at the health-food store. Administer one half the adult dose. This herb is safe for regular use.
If your child can gargle, give her a mixture of half hot water and half hydrogen peroxide to use several times a day. Gargling with warm salt water (one-quarter teaspoon salt to one cup of warm water) is also soothing.

Teething
In many infants, the process of teething is painless, causing only some increased drooling and a desire to chew. However, some infants develop tender, swollen gums, may not sleep or eat well, and may run a low fever (under 100 degrees). A fever above 100 degrees or diarrhea suggests problems unrelated to teething.
Here are some recommendations to keep a teething baby comfortable:
Wipe the drool off your baby’s face with a soft cloth (to prevent rashes).
Rub the baby’s gums with a clean finger.
Let your baby chew on a wet washcloth that has been placed in the freezer for 30 minutes (wash it after each use). Alternatively, use a cool spoon or rubber teething ring (take it out of the freezer before it gets so hard that it bruises the tender gums).
Never tie a teething ring around a baby’s neck – it could get caught on something and strangle the child.
Homeopathic teething tablets are a good option. Many parents tell me they have used them successfully to relieve the minor discomforts of teething in their babies.

Toy Safety
Look over the toys you have at home to see if they are age-appropriate for your children. In general, this means making sure they aren't too advanced for the youngest child, but sufficiently sophisticated for the older ones. Homes with infants or toddlers should make sure all toys (and their removable parts) are large enough so they can't be put into a child's mouth and become a choking hazard. (An easy test: A child can choke on any object that fits inside the tube from a roll of toilet paper.)
Parents or grandparents should also be aware that over the last two years toy manufacturers have recalled teethers, rattles, and other products that contain a cancer-causing chemical called diisononyl phthalate (DINP) from the market. Phthalates are used to soften plastics, but high doses have been linked to cancer in mice and rats. The U.S. Consumer Product Safety Commission has said the amounts that might have been ingested by small children are not high enough to pose a risk, but it does make sense to toss any soft plastic rattles and teethers that you’ve had more than a year – that's when most toy manufacturers agreed to phase out use of the additive.
The following guidelines for toy safety are from the American Academy of Pediatrics and the Consumer Products Safety Commission:
Check the surface and edges of wooden toys. Sandpaper sharp corners and splinters.
Don't give hobby kits, such as chemistry sets, to children younger than 12.
Don't permit children to play with adult darts or other hobby or sporting equipment that have sharp points.
Examine all outdoor toys regularly for rust or weak parts that could become hazardous.
Discard all plastic wrappings on toys before they become deadly playthings.
New toys intended for children under age 8 should be free of glass and metal edges.
Toys with long strings or cords may be dangerous around infants and very young children. Never hang toys with long strings, cords, loops, or ribbons in cribs or playpens where children can become entangled.
Keep toys designed for older children out of the hands of little ones.

Vitamins
Yes, children should take vitamins, mostly because so many kids don’t eat enough fruits and vegetables, and because their diets are often full of processed and refined foods. However, vitamin supplements shouldn’t be substitutes for whole foods, especially fruits and vegetables.
Teach children of any age to enjoy healthy food by involving them in its preparation, even if they’re only in the kitchen to observe. In "The Healthy Kitchen," Rosie Daley and I give a number of ideas for recipes and snacks that kids will like. Also, try to discourage your children from eating too much fast food, processed food, sugar and caffeine (in cola and other soft drinks). There’s no harm in the occasional ice cream, pizza or candy bar in the context of a well-balanced diet, but try to encourage snacking on healthier foods – fresh or dried fruit; a small handful of raw, unsalted nuts such as cashews and walnuts; a piece of flavorful, natural cheese; or a piece of dark chocolate.
As far as supplements are concerned, give children a complete antioxidant formula as well as multiminerals. Be sure to keep the vitamins out of the reach of young children – some supplements for kids taste and look like candy and there is a danger of overdosing, especially when supplements contain iron.

Andrew Weil, M.D.–Author of:
Eight Weeks to Optimum Health
Spontaneous Healing
The Natural Mind
The Marriage of the Sun and Moon
Health and Healing
Natural Health, Natural Medicine
From Chocolate to Morphine (with Winifred Rosen)

Saturday, July 22, 2006

Health Highlights: May 23, 2006

Here are some of the latest health and medical news developments, compiled by editors of HealthDay: NSAIDs Increase Risk of 1st Hospital Admission for Heart Failure

Commonly used nonsteroidal anti-inflammatory drug (NSAID) painkillers, such as ibuprofen, are associated with a slightly increased risk of first hospital admission for heart failure, says a study in the journal Heart.

The study of more than 228,660 patients concluded that there would be one extra first hospital admission for heart failure for every 1,000 people ages 60 to 84 who take NSAIDs, United Press International reported.

However, the researchers said this could increase to three additional cases per 1,000 among patients 70 and older who have chronic conditions such as high blood pressure, diabetes, or kidney failure.

Overall, 14 percent of patients were taking NSAIDs at the time of their first hospital admission for heart failure, compared with 10 percent of a comparison group of randomly selected people. Half of those admitted to hospital were ages 70 to 79.

The data used in the study came from the General Practice Research Database, which contains the medical records of millions of patients of family doctors in Britain, UPI reported.
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Prince Charles, British Docs Differ Over Alternative Medicine
Just hours after a group of Britain's leading doctors and scientists urged the National Health Service (NHS) to stop paying for complementary health therapies, Prince Charles told a meeting of the World Health Organization in Geneva that alternative medicine should be given more prominence in mainstream health care.

In an open letter, the British doctors and scientists criticized public funding of "unproven or disproved treatments" such as homeopathy and reflexology at a time when large deficits are leading to the firing of nurses and to limited patient access to life-saving drugs, The Times of London reported.

They demanded that the NHS pay only for evidence-based therapies.
In his speech, the Prince of Wales said that an integrated, holistic approach was the best way to tackle chronic disease, rather than a "dangerously fragmented" approach that relies on what he referred to as a bio-physical treatment model, The Times reported.
He did note that modern medicine has served humanity well but he said excessive reliance on it had upset natural harmony.

"I believe there is now a desperately urgent need to address the fragile but vital balance between man and nature, through a more integrated approach where the best of the ancient is blended with the best of the modern, and I am convinced this is particularly vital when it comes to the collective health of people in all countries," Prince Charles told delegates from 192 nations.
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No Difference Between 2 Anemia Drugs for Cancer Patients: Report
There is no clinically significant difference in effectiveness between two drugs -- epoetin and darbepoetin -- used to manage anemia in cancer patients undergoing chemotherapy or radiation treatment, says a report released Tuesday by the U.S. Agency for Healthcare Research and Quality (AHRQ).

The report said the two drugs show no difference in improving hemoglobin concentration or in reducing the need for transfusion. Both drugs do reduce the need for transfusion by about 20 percent, but there is no evidence that either drug, when added to cancer treatment, improves patient survival.

In addition, there are many unanswered questions about the safety and best use of both drugs, the report said.

"This report is a synthesis of studies performed so far regarding epoetin and darbepoetin, including unpublished findings as well as published reports," Dr. Carolyn M. Clancy, AHRQ director, said in a prepared statement.

"The authors have analyzed and weighed all of the evidence available in order to obtain the fairest possible understanding of these two alternative treatments for managing anemia in cancer patients. In addition, an important role for our comparative-effectiveness reviews is to identify research gaps where new evidence is needed. Their report finds that significant questions remain unanswered about both of these drugs," Clancy said.
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U.S. Soldiers With PTSD More Likely to Suffer Poor Health

A year after leaving Iraq, American combat soldiers with post-traumatic stress disorder (PTSD) are more likely to be in worse physical health, experience more pain, and are more likely to miss work than those who don't have PTSD, says a U.S. military survey of nearly 3,000 Iraq war veterans.

The survey found that about 17 percent of the respondents had PTSD symptoms and they were more likely than those without symptoms to report various kinds of pain -- from backaches to headaches -- and gastrointestinal problems such as indigestion and nausea, USA Today reported.

Anxiety may contribute to these physical symptoms, said Dr. Charles Hoge, chief of psychiatry and neuroscience at the Walter Reed Army Institute of Research in Washington, D.C.
He also noted that nightmares, flashbacks and other symptoms of PTSD can interfere with sleep, resulting in a negative impact on health. About 50 percent of the soldiers who reported PTSD symptoms rated their health as fair to poor, compared with about 20 percent of soldiers with no PTSD symptoms, USA Today reported.
The findings were released Monday at an American Psychiatric Association meeting.
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FDA Approves Generic Version of Lexapro
The first generic version of Lexapro (escitalopram oxalate), one of the most popular prescription antidepressants, has been approved by the U.S. Food and Drug Administration.
The approval, announced Monday, gives permission to Ivax Corp. of Miami to market 5, 10, and 20 milligram doses of the drug for major depression, The Associated Press reported.
Ivax is part of Teva Pharmaceutical Industries Ltd. of Israel.

The brand name Lexapro is made by New York-based Forest Laboratories Inc. Last year, Lexapro was the No. 2 antidepressant in the United States, with 29.6 million prescriptions filled and sales of $2.1 billion. The drug Zoloft was the leading antidepressant, the AP reported.
Last reviewed: 05/23/2006 Last updated: 05/23/2006

Monday, June 19, 2006

Iron or Vitamin Deficiency and Fingernail Health

Provided by: DrDonnica.com

Q: Lately I've noticed that my fingernails are much paler in color than normal, plus they've started curving up on the sides. I've heard that nutritional deficiencies can show up in your nails: Could there be something missing in my diet?

A: Just as the eyes are said to be the window to the soul, the fingernails may be a window to certain nutritional deficiencies. But don't read too much into your self-diagnoses. Spoon-shaped nails, as you've described, may be a clue to a thyroid deficiency or iron deficiency anemia, or just an inherited trait. Pallor is consistent with iron deficiency, a very common problem in menstruating women, especially if they have heavy periods (e.g. with fibroids). Thin, brittle nails without a white crescent (moon) at the base may also indicate hypothyroidism.

Many women report that their nails were never as strong or healthy as when they were pregnant and this is probably because most pregnant women in the US take prenatal vitamins. While eating a well-balanced healthy diet is optimal, most American women benefit from taking a daily multivitamin even when they're not pregnant! Menstruating women should consider a supplement that includes iron, unless their physicians have instructed them otherwise. Most daily multivitamins will contain vitamins, A, C, B6, niacin and iron, but women should be aware that most daily multivitamins do not contain an adequate amount of calcium. Adequate calcium supplementation requires taking a separate pill or liquid. Calcium supplementation is essential for optimal bone health, but can also benefit fingernail strength.

Tuesday, June 13, 2006

How Can You Reduce Your Risk of Getting Gallstones?

Provided by: DrDonnica.com
Gallstones are very common and tend to run in families. They account for more than 800,000 hospitalizations annually in the US and are believed to affect more than 20 million Americans. Women are twice as likely as men to be affected, in large part because of several additional risk factors: birth control pills, multiple pregnancies, obesity, and rapid weight loss diets. The good news is that there are several steps you can take to reduce your risk.

When I was in medical school, we learned that the typical gallstone patient is female, fat, fertile, and forty. In fact, gallstones can be found in anyone. The other known risk factors include blood diseases with rapid breakdown of red blood cells (e.g. sickle cell anemia or hereditary spherocytosis), cirrhosis, Crohn's disease, diabetes, pancreatic disease, and hyperparathyroidism. If you have any of these conditions, treating them will reduce your risk of gallstones.

To lower your risk of gallstones, the first thing you should focus on is a dietary strategy. If you are overweight, take a slow and steady course to weight loss, like a Weight Watchers program, and then maintain a healthy weight. Increase your consumption of both soluble (e.g. guar gum and pectin, oat bran, wheat bran, and soy fiber) and insoluble fiber. An easy way to do this is to increase your consumption of fruits and veggies.

While you don't have to become a vegetarian, they are known to have a significantly lower incidence of gallstones. If you like coffee, you are in luck: Coffee drinking has also been associated with a reduced risk of gallstone symptoms. Regular aerobic exercise, such as jogging, running, racquet sports, and brisk walking for 30 minutes five times a week, will not only help you with your weight management goals, but it may also significantly reduce your risk of gallbladder disease. As for preventive medicines, there is some controversy about whether nonsteroidal anti-inflammatory drugs, like aspirin or ibuprofen, may help reduce risk. There is also a prescription drug called Actigall which is FDA approved to prevent gallstones.

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