Archive for Miscellaneous
Efficacy, safety, and cost of new anticancer drugs
Really–it’s not me!!! This is stuff coming out in one single issue of one of the more prestigious medical journals!! Does it shock anyone that new cancer drugs are many times more expensive and less effective?? Anyone out there up for an “ounce of prevention” instead??
bmj.com Garattini and Bertele’ 325 (7358): 269
Resistance Exercise and Physical Performance in Adults Aged 60 to 83
There is more than enough information to strongly support resistance training in ALL seniors. I have been pushing all my older patients towards a combination of aerobic and resistance training for some time now and the results are always positive. Of course, motivation is the number one problem with implementing any kind of program like this. Elastic tubing is an inexpensive, safe and easy way for many patients to get a start on this type of training.
Neurological complications of coeliac disease
While this is only a short abstract of a larger review article, it cements the fact that allergy to gluten containing grains (mainly wheat) can have a major impact on the rest of the body; in this case the neurological system. Chalk up effects on the GI system, skin and increased auto-antibodies to thyroid. If patients are unsure, an elimination diet avoiding wheat for at least 2 wks can be used. The beauty of an approach like this is that no one I’ve ever recommended an elimination diet for has ever died… If you don’t like this approach, serum transglutaminase levels can be used as a marker for coeliac disease.
Postgrad Med J — Summaries: Pengiran Tengah et al. 78 (921): 393
Stimulation of Arteriogenesis in Skeletal Muscle by Ultrasound
Just thought I’d drop this one in as a FYI. Keep an eye on this therapy; it has tremendous implications for wound healing, non-healing skin ulcers and possibly coronary artery occlusion.
Circulation — Abstracts: Song et al. 106 (12): 1550
Splinting vs Surgery in the Treatment of Carpal Tunnel Syndrome
Sorry…couldn’t keep my mouth shut on this one. I see CTS frequently in my office and most cases are not difficult to correct. As a brief lesson in anatomy, nine tendons and one soft little nerve (median) run through the carpal tunnel formed by bone on one side and a very tough ligament on the other. When the tendons swell the soft little median nerve takes the brunt of the abuse, leading to symptoms of CTS. Common sense would lead you to figure out why the tendons are swollen. But, as I like to say…”common sense ain’t so common in medicine.” In general, we put on blinders and stare at only the region 3 inches in width around the wrist, using anti-inflammatories, cortisone injections and finally surgery; never once removing the blinders. However, focusing attention slightly more proximal to the muscles of the forearm (both flexors and extensors) usually yields excellent results.
Splinting vs Surgery in the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial.
How are abnormal liver function tests dealt with in primary care?
First of all, it is a shame that we still consider standard liver enzyme levels as a “liver function” test. It absolutely is NOT. With these tests, we are looking for liver damage, not function (with exception of bilirubin, which is somewhat of a functional test). True liver function tests involve what the liver DOES, such as detoxification panels. I love to see a patient come in with altered liver function, because I know there is so much that functional medicine can do for these patients.
bmj.com Abstracts: Sherwood et al. 322 (7281): 276
Kidney stones may be linked with sleep posture
I thought this was an interesting article and gives us yet another tool to aid in the avoidance of renal calculi. Other ways to avoid stones: copious amounts of water, no caffeinated beverages, calcium citrate supplements and more of a plant based diet.
bmj.com Josefson 322 (7293): 1015b
Lactulose may help prevent urinary tract infections
This is an interesting editorial that really opens my eyes to something I’ve seen in practice. While I jump at the chance to recommend probiotics as a vaginal douche to help with UTIs or yeast infections, I have had patients whose irritation has resolved with oral probiotic use. This always surprised me; this article suggests that oral probiotics can lower the load of pathogenic bacteria reaching the stool and thereby lower risk of trans-location to the urinary tract. Interesting concept that may have answered this dilemma for me.
bmj.com Battle et al. 323 (7318): 936
Effect of low doses of 5-methyltetrahydrofolate and folic acid on plasma homocysteine in healthy subjects with or without the 677CT polymorphism of methylenetetrahydrofolate reductase
Sorry about the long title…This study compares the use of folic acid to 5-methyl THF, the active form of folic acid (after being converted by MTHFR). Both showed similar effects at lowering homocysteine. However, the interesting effect here is that, in patients with two sluggish copies of the enzyme MTHFR, 5-methyl THF showed continued lowering of homocysteine 6 month after cessation of supplementation. This suggests that 5-methyl THF supplementation somehow changed the phenotypic expression related to folic acid metabolism.
Promotion of cosmetic botulinum toxin A frowned upon
This is an issue that has me just a little on the nervous side. I have seen numerous ads for salons offering Botox treatments. Salons, mind you. Keep in mind that botulinum toxin is one of the most potent toxins on the planet, and one thimbleful is plenty to wipe out the entire planet. Can’t see myself jumping in line to have the stuff injected just centimeters from my brain by someone who also cuts hair and does nails….(which, ironically, I wouldn’t trust to most PCPs…).
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