Nov
01
2006

Think Feet With Diabetes

About 2 million Canadians are currently living with diabetes. It can be a “silent” disease, as patients may have few symptoms. Once diagnosed with diabetes it is of great importance to be vigilant of lifestyle and nutrition to keep the condition under control. A common problem for about 15% of diabetics is the development of a diabetic foot ulcer. Of those afflicted 14-24% will require an amputation of a lower extremity as a result. In addition to this the mortality rate of patients with below knee amputation due to the complications of a diabetic foot ulcer is 19-55% after three years.
Even though these statistics sound ominous, a lot can be done in the way of prevention. According to the Canadian Diabetes Association guidelines, a diabetic patient should have a foot exam performed at least annually. Diabetic peripheral neuropathy is the leading cause of diabetic foot ulcers. The physician can examine the feet for loss of sensation. He will check for foot calluses and will debride those, which are pre-ulcer state. The physician also checks for poor circulation in the foot at that time.
If there is no loss of protective sensation, an annual exam will suffice, but if there is loss of sensation, several exams per year may be needed. A vascular surgeon may have to assess the patient to see if the foot circulation is sufficient. Infection is a warning sign and has to be treated promptly. Finally, any source of pressure to the foot needs to be removed or offloaded.
A proactive approach to keep the feet healthy starts at home.

Think Feet With Diabetes

Think Feet With Diabetes

The following points are important especially to the patient with diabetes:
-Inspect your feet on a daily basis. Check for sores, blisters or cracks that don’t heal.
-Check your footwear. If there is debris (sand, pebbles) remove promptly.
-Wash your feet daily with warm, not hot water and dry them well, especially between your toes.
-Trim your toenails. If you have difficulties doing that, seek out the help of a podiatrist. Also don’t use the homemade approach cutting corns and calluses.
-Keep the circulation to your feet going: put up your feet when you sit. Wiggle your toes, move your ankles, don’t cross your legs for long stretches of time.
-Shop for suitable footwear! Ask the sales clerk to measure both of your feet in order to determine the proper size. Shop in the afternoon, as your feet can swell during the day.
-Don’t break in a tight fitting new shoe! This may injure your feet. A new shoe should be comfortable right away.
-Don’t delay looking after problems. If a cut, sore, bruise or blister does not start to heal after a day, see a physician.

More information about diabetic feet: http://nethealthbook.com/arthritis/foot-pain/effects-diabetes-feet/

Reference: Parkhurst Exchange, October 2006 Edition, page 26

Last edited November 1, 2014

Oct
01
2006

Successful Gene Therapy For Melanoma

Scientists at the National Cancer Institute in Bethesda, Md. have developed a modality of gene therapy to treat patients with melanoma.
The therapy alters the patients’ own lymphocytes to recognize and attack cancer cells. Dr. Steven Rosenberg and his team developed the new technique by drawing a blood sample containing normal lymphocytes from an advanced melanoma patient. Next the cells are infected with a retrovirus, which delivers genes that target specific receptors on T cells. Once the cells are infused back into the patient, these receptors attach themselves to the molecules on tumor cells and activate the lymphocytes to destroy the cancer cells. This method is called “adoptive cell transfer”. In early experiments there seemed to be little or no benefit, but researchers refined the methods and found valuable and promising aspects regarding the treatment of melanoma patients. It is crucial to administer the cells in their most active growth phase. This was shown in a group of 14 patients, where 2 terminal melanoma patients experienced cancer regression. Dr. Jeffrey Medin, head of the clinical research program in gene therapy at the Ontario Cancer Institute in Toronto agrees that this new therapy is a breakthrough as it has virtually brought terminal patients “back from the brink”. It is also exciting to see that the researchers could refine the techniques in order to create a more successful therapy. As a result the method will be more applicable to other cancers and broader populations.

Successful Gene Therapy For Melanoma

Successful Gene Therapy For Melanoma

Although adoptive cell transfer has only been used in melanoma patients so far, the researchers have shown ways to engineer cells of the immune system in a similar way to attack breast, liver cancer or lung cancers.

More information about treatment of melanoma: http://nethealthbook.com/cancer-overview/skin-cancer/melanoma/treatment-melanoma/

Reference: The Medical Post, September 19, 2006, page 1 and 61

Last edited November 1, 2014

Jan
01
2006

Prevent Foot Problems In Diabetics

Diabetes has reached epidemic proportions in North America. Two million Canadians (about 20 million in the US) have diabetes, and the number is expected to rise dramatically. At one time or another about 15-20% of patients with diabetes will need hospitalization with a diabetic foot complication. The conditions, which are of concern, are diabetic foot ulcers, severe infection and circulation problems in fingers and feet (peripheral circulation). Health budgets are stretched, as the cost of treating a single foot ulcer has been estimated at $2,183, so the total cost over the lifetime of current diabetics will exceed $650 million (about 6.5 billion $ in the US). Foot ulcers appear like a small item considering the fact that the need for amputation of a lower extremity is the next severe problem that can arise. The average patient who undergoes a below knee amputation will spend 84 days in hospital and another 38 days in rehabilitation.
To prevent the development of foot ulcers, it is important to screen diabetic patients for predisposing factors like the loss of protective sensation in the feet (diabetic neuropathy) as well as structural changes resulting in areas of increased pressure. A study conducted in southwestern Ontario found that only 15% of patients with type 2 diabetes were screened to identify those at risk for foot ulcers. Screening is the first step, after which a podiatrist will have to take over. Footwear prescribed by a podiatrist can be an avenue of prevention, but ongoing podiatric care as well. The small number of diabetic foot screenings shows that podiatric medicine has not been used as a tool to recognize and treat diabetic foot problems.

Prevent Foot Problems In Diabetics

Prevent Foot Problems In Diabetics

The proactive approach of seeking the input of a podiatrist early will translate into significant benefits for the patient with type 2 diabetes.

More information on complications of diabetes:  http://nethealthbook.com/hormones/diabetes/complications-diabetes/

Reference: Parkhurst Exchange, December 2005, page 162

Last edited October 30, 2014

Jul
01
2005

Diet Can Influence Acne

The old dermatological dogma that diet can play a role in the development of acne has been tossed back and forth. Some parties agree, others disagree. An old study by Fulton et al., which goes back to 1969, claims that patients who ate chocolate bars were compared to those who ate”pseudo-chocolate”, and no difference was found between the two groups. Both had the same amount of acne lesions. Critics of this poorly designed study however point out, that the” fake chocolate” contained just as much sugar and just as much trans fat as real chocolate. Trans fats are also known to contribute to inflammation, a condition that is present in acne.
In the meantime a 2002 study that was published in the Archives of Dermatology has taken a closer look at acne. Researchers took a look at islanders from Papua, New Guinea, and the Ache people of Paraguay. Both groups eat a non-Western low-glycemic diet. 1315 subjects were checked, and not a single case of acne was found. Even though this is merely an observational study, the results are impressive. Similar results have been reported in Okinawans, the South African Bantus, the Zulu and the Inuit. Even though these groups are continents apart, the common denominator is the same. Each group eats a non-Western diet. Another publication in 2005 in the Journal of the American Academy of Dermatology evaluated data from the Nurses Health Study II for a link between teenage acne and milk intake, and there was indeed a positive association. It may be that a milk allergy could be the explanation. Further evaluation is needed to pinpoint, which active compounds in milk are the culprits.

Diet Can Influence Acne

Diet Can Influence Acne

For now research points out that hyperinsulinemia, a metabolic condition stemming from an overload of highly refined and high glycemic carbohydrate foods, and its related hormonal cascade is the crucial link between the Western diet and acne. Other factors may emerge from investigating how milk consumption worsens acne.

More info on acne: http://nethealthbook.com/dermatology-skin-disease/acne-vulgaris/

Reference: The Medical Post, May 31, 2005, page 29

Last edited October 28, 2014

Jun
01
2004

Eczema – More Than Skin Deep

Dermatologists have seen more than a threefold increase of eczema in the last thirty years. The condition is common especially in childhood. Skin irritants can play a role. Dr. Harvey Lui, Professor for Dermatology at the University of British Columbia in Vancouver, Canada, also observed, that eczema is much more common in the Asian population. Patients who came from the warmer climate of Southeast Asia and are exposed to a harsher, colder climate will get into trouble more easily, as dryness of the skin will aggravate the skin condition.

Dr. Lui also stresses, that patient education about sensible skin care is of great importance. Fighting fire with fire – like taking a hot shower to combat itchy and dry skin- will make things worse in the long run. Inflamed skin needs to be kept cool. Dr. Lui also stresses that skin has to be kept from drying out. These simple measures for which no prescription is needed are often neglected.

In severe cases the traditional steroid cream has been replaced by preparations, which have an effect on the immune response. Dr. Lui explains that eczema is partially an exaggerated response of the immune system to whatever is noxious or irritating in the environment. The medication tacrolimus (Prograf) is a naturally derived compound that makes the immune cells (T-cells) less active, as they are responsible for the overactive response. It is called an “immunomodulator”.

Eczema - More Than Skin Deep

Eczema – More Than Skin Deep

Due to this knowledge more treatment options are available than in the past. Atopic eczema is very often combined with asthma and allergies and tends to run in families. As the immune system gets strengthened during childhood, eczema tends to be worse in the young person, and time can be the greatest ally in the healing process.

More info on skin rashes: http://nethealthbook.com/dermatology-skin-disease/skin-rash/

Reference: 1. The Medical Post, March 2, 2004 (p.2 and 65) 2. “Guidelines of care for atopic dermatitis”
Hanifin J – J Am Acad Dermatol – 2004 Mar; 50(3), p.391

Last edited Oct. 26, 2014

Jun
01
2004

Cellulite – Quacks And Facts

California dermatologist Dr. Mitchell Goldman presented an overview at the American Academy of Dermotology, and stated that there are many types of treatment options available to combat cellulite including creams, massage, diet, and exercise. He cautioned however, that nobody at this time has done a study which evaluates the 20 creams that are currently on the market. It is true that a large variety of ingredients in the creams directly help stimulating the fat metabolism, increasing circulation and lymphatic flow.

He suggests to his patients to try a product for a month, and if there is no improvement, a switch to a different one should be made. The effectiveness of the creams can be enhanced by wearing bioceramic neoprene shorts. They look like normal work-out shorts, and wearing them a couple of hours per day can keep the cellulite from coming back.

Endermology is another treatment which can be useful with cellulite reduction: a mechanical action gently folds and unfolds the affected skin areas under the continous action of rollers. These rollers help improve the microcirculation, stimulate fluid exchange and improve overall cell function.
A variety of scams for treatment lurks on the Internet. Patients seeking treatment should be cautious about the most commonly advertised rip-off treatment called “mesotherapy”.
It involves injecting toxic substances into the body, including carbon dioxide gas. There has never been a scientific study which proves that it works, yet there is a great deal of publicity enticing patients to try it.

Cellulite - Quacks And Facts

Cellulite – Quacks And Facts

It is also important that patients are informed that cellulite is a condition that can be successfully treated, but it cannot be cured. Once you stop using the cream or the controlling treatment, the cellulite will return.

Based on The Medical Post, March 2, 2004, p. 21

Last edited December 8, 2012

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Jun
01
2003

Effect Of Smallpox Vaccination Lasts Much Longer

In the age of threats about bioterrorism many Americans worry about what would happen in the case of an attack with smallpox. Due to concentrated efforts worldwide through the WHO for many years, smallpox could be declared eradicated in the US in 1949 and worldwide in 1972. American children since then were no longer vaccinated. However, 95% of Americans over the age of 35 have been vaccinated and according to a recent study have been shown to still have a very good immune response that likely would make them immune to a bioterrorism attack with smallpox virus. A recent review article in the British Medical Journal (BMJ 2003;326:1164) on May 31, 2003 reports about a study by Oregon researchers from the Departments of Molecular Microbiology and Immunology in Portland. Dr. Mark Slifka and Dr. Erika Hammarlund (Oregon Health Sciences University) collected blood samples from 306 previously smallpox vaccinated volunteers to check for antibody levels as well as T cell responses against smallpox antigens. The volunteers were of different ages and included people who were vaccinated against smallpox as recently as last year and as long as 75 years ago. All of them showed a very good response due to high antibody levels and their serum was able to neutralize the smallpox vaccinia virus in Petri dishes. The T cell mediated cellular immune response showed some slowing down in the older age group. However, another study done by a North Carolina research group and also presented at a meeting from the American Society for Microbiology in Washington, DC. and published recently (New England Journal of Medicine 2002;347:689-90) found that T cell responses lasted a very long time. A group of people vaccinated 35 years earlier, so the North Carolina group reported, had perfect T cell responses to the smallpox vaccinia virus. The conclusion of these studies is that the effect of smallpox vaccination is longlasting.

Effect Of Smallpox Vaccination Lasts Much Longer

Effect Of Smallpox Vaccination Lasts Much Longer

There is no point of vaccinating more often than two times in a lifetime and even one-time vaccinated people often have good immunity. People who are born after 1972 and who have never been vaccinated against smallpox would be well advised to consider vaccination and discuss this with their doctors. There are, however, some known complications of the vaccine such as a myopericarditis (a heart condition) , generalized vaccinia (a skin condition common in people with skin problems like acne or psoriasis), and 1 in 10,000 immunizations will get viral encephalitis, which often leads to brain damage. There is presently a campaign to vaccinate 500 000 frontline healthcare workers in the US against smallpox to be prepared for a smallpox bioterrorism attack. Due to the possible complications so far only 35 000 healthcare workers have volunteered for vaccinations. Link to overview of smallpox from the CDC: https://emergency.cdc.gov/agent/smallpox/overview/disease-facts.asp

Last edited December 9, 2012

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Mar
01
2003

Garlic Component Effective Against Head Lice

The Jan. 21, 2003 edition of the Medical Post published an article about some Argentine research involving the active ingredient of garlic, allicin.

Dr. Juan Barboza and his collegues from the University of Cuyo in Mendoza started their research first with plant lice, as they had been approached by farmers to help them find a natural way to fight lice infestation of their crop .

Of the various chemical compounds in garlic it was the allicin compounds that were most effective in asphyxiating common pests, particularly plant lice. Subsequently they were experimenting with head lice formulations. Shortly after there was a severe outbreak of headlice infestation at the day care center of the university.

This was an opportunity for the researchers to test the efficiency of the new formulation of a mixture of allicin with a mint-scented cream. With only one application of this formulation there was a 96% reduction of the number of head lice within only 1 week!

Garlic Component Effective Against Head Lice

Garlic Component Effective Against Head Lice

Here is a link to other useful hints about head lice.

Last edited December 10, 2012

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