| 12/05/05 | NEWSLETTER | carlstonmd.com |
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| Dear Patients | HOME | |
I hope this newsletter finds
you and your family well. The number of items in this newsletter suggests
that it has been too long since the last. While that may be true, certainly
the main reason is that I have been quite busy in the office seeing many
of you with the first wave of cooling weather indoor illnesses. That
fact, plus traveling to a sports medicine meeting and the Thanksgiving
holiday has given me lots to do. Best, Michael Carlston, M.D. |
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| In This Issue: | INDEX | |
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| ELIMINATING LICE | TOP | |
Last fall (10/29/04) I wrote a piece about a new treatment
for the problem of increasingly tenacious head lice
<http://www.carlstonmd.com/newsltrs/nl102904.htm>.
The sole published study on this new product
<http://pediatrics.aappublications.org/cgi/content/full/114/3/e275>
was extremely promising. It turns out that there was a good reason for the secrecy and the awkwardness surrounding distribution of the product. |
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| PACIFIERS AND SUDDEN INFANT DEATH SYNDROME | TOP | |
Pacifiers can have their down sides, especially when introduced too early or continued too long. Recent research indicates that infants using nighttime pacifiers from 2 months to one year of age are at significantly lower risk for SIDS. Maybe it keeps an airway open? Maybe the pacifier keeps the baby a bit more awake? Summarizing what we know works - “back to sleep”, nonsmoking household, avoiding fluffy bedding, night time pacifier, baby in parents room and baby probably not in parents bed. The last one some folks have a hard time with. Data does show this to be an increased risk, but I wonder if the rare horrific report of an intoxicated parent falling asleep on an infant confuses the statistics. |
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| DON'T BE FAT PHOBIC | TOP | |
| The Dietary Approaches to Stop Hypertension (DASH) diet has
gotten a great deal of deservedly favorable attention since it came out
in 2001. The diet is close to the traditional Mediterranean diet, emphasizing
lots of fruit, veggies, poultry and carbohydrates, along with limited amounts
of nuts and low-fat dairy products. Patients following the diet generally
see significant improvements in blood pressure and LDL (the “bad
cholesterol). However, the diet also lowers the good cholesterol (HDL)
and does not improve triglycerides, which are another cholesterol related
risk factor for heart disease. Researchers decided to try tweaking the diet to see if they could do better. They were successful when they added more vegetarian protein (nuts and beans), low fat dairy and monounsaturated oils (olive oil and again, nuts), exchanging these for some of the carbohydrates. Those patients (all with borderline high blood pressure at the beginning of the study) dropped their blood pressures, improved their blood profile and cut their predicted risk of hypertension and heart disease by 20%. |
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| TOP | ||
| Over my years exploring and teaching about alternative medicine including homeopathy, I have been fortunate to meet a number of exceptional people, fellow travelers on the same road. One of them, Claudia Witt, has been very active recently. She was the lead author of a newly published relatively long-term study of over 100 homeopathic medical practices in Germany and Switzerland. Roughly 3,000 patients were adults and over 1,100 were children. The most common diagnoses were allergic rhinitis (essentially hay fever) in men, headaches in women and atopic dermatitis (most commonly eczema) in children. They sought homeopathic care almost entirely for chronic health problems of long-standing and got much better by both patient and physician ratings. The greatest success was seen in the youngest and sickest patients. | ||
| TOP | ||
| It was only a few years ago when glucosamine sulfate was considered “far
out”. My first experience of its growing acceptance was at a reception
at UC San Diego in the late 1990’s. I had been the keynote speaker
at a meeting presenting research on alternative medicine conducted at UCSD.
A professor of pharmacy approached me to ask what I thought of glucosamine
and then related his own story of resuming competitive running after starting
it up. As the body uses glucosamine to create a variety of tissues in the body (including joint surfaces) I have long recommended it not only to heal painful joints but also to prevent future problems. For example, many years after serious knee injuries, there is a high likelihood of arthritis developing in the affected joint. Proof of such long-term benefit is hard to come by, but the idea is good and very safe, so I have felt good about this advice. We now have a long-term study showing just such a positive impact. Czech researchers followed patients with osteoarthritis of the knee for eight years. During the first three years of the trial, one half of the subjects took 1,500 mg of glucosamine sulfate daily while the other half took a placebo. For the following five years the patients received standard conventional treatment. After eight years 11 of the 67 in the placebo group had gone on to having knee replacement surgery, while only three of the 69 in the glucosamine group had done so. This study confirms similar, although shorter-term findings, by a group in Belgium. |
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| TOP | ||
| When I was a 127 lb marathon runner during my family practice
residency I had a very poor orthopedics rotation. The orthopod I was training
under was obese, did not exercise and told me that he would see me in 10-15
years for knee replacement surgery because I was destroying my joints with
exercise. 22 years later it is clear that he was wrong. I am still running
four to nine miles and very active. My knee surgeries were mostly the result
of injuries from lifting heavy things like examination tables, and knee
replacement is still nowhere in sight. The misguided orthopod’s comments
were not merely fueled by his need to defend his neglect of his own body;
they were also in keeping with the thoughts of many at that time. Scientists have learned that our assumption that knee cartilage could not repair itself was wrong. A group of men and women, who had meniscal repairs (knee cartilage) in the previous 3-5 years were enrolled in a four month long program of aerobic and weight-bearing activities. Not only did they experience the expected improvements in physical stamina, strength, and joint performance, MRI also showed very good changes with improved elasticity and strength of their remaining joint cartilage. |
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| TOP | ||
| A breath of fresh air (sorry) in hypertension (HTN) research
came in the form of another study supporting the use of a simple technique
to lower blood pressure. Many forms of traditional healing recognize the
importance of breathing patterns in health. Some, such as an aspect of
yoga called pranayama, advocate specific breathing exercises for certain
health conditions. Since reading some positive research a few years ago,
I sometimes recommend a device, which synchronizes breathing to treat hypertension. This new study protocol taught patients to regulate their breathing to either 15 cycles/minute of 6 cycles/minute, and compared the response of those with HTN to controls. They also collected data from the patients while breathing in their usual spontaneous pattern. Both purposeful alterations in the breathing cycle resulted in a significant blood pressure reduction. The 6-cycle/minute regimen caused the greatest reduction. The change appears to result from alteration in the tone of the nervous system (ie, it made the patients relax). Other studies show these effects to be lasting if the exercise is practiced on an ongoing basis. Many questions arise from this line of thought. Are dysfunctional breathing patterns a cause of HTN? Can this be applied successfully to a broad range of patients? Who can benefit the most and to what degree will they benefit? |
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| TOP | ||
| Although Shakespeare claimed that the name of a rose does not
alter its smell, new evidence tells us that if you can’t remember
its name, you might not be able to smell it very well. For a long time,
clinicians have noted that patients suffering from Alzheimer’s Disease
and other forms of dementia begin to lose their sense of smell early in
the process. As Alzheimer’s is particularly difficult to diagnose
with certainty before there is considerable disability, we are always looking
for reliable diagnostic tests. Investigators screened a modestly sized group of patients (210 - 100 with Alzheimer’s Disease, 147 with mild cognitive impairment and 63 normal controls) with a variety of scents. They found that the inability to discern odors identified the 38 patients with mild cognitive impairment who progressed to Alzheimer’s Disease over a 4-year follow-up. They learned that ten of the odors (leather, clove, menthol, strawberry, pineapple, natural gas, lemon, lilac, soap, and smoke) were the most predictive. These data are preliminary and likely to be confused when patients with other neurologic diseases like Parkinson’s are tested. However, this could lead to very simple and practical testing for an especially challenging disease, both diagnostically and clinically. |
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