Colorectal Cancer

Screening Saves Lives

Now THAT I understand.
If youre over 50, get tested for colorectal cancer.
Polyps and colorectal cancer dont always cause symptoms.
Thats why screening is so important screening helps
find precancerous polyps, so they can be removed before
they turn into cancer.
See your doctor and get screened.
TM
whatdoctorsknow.com
On Call with Dr. Porter
Steve Porter, MD
Publisher and Chairman
How many times have we said to ourselves: I need to get out more
and exercise. But then, we put it off because we have too much
to do, are too tired or for some other contrived excuse.
This months issue is dedicated to those who would like to have back the ability
just to walk, let alone exercise. People who suddenly wake up and cant move
their legs and need help to do the very basics of life such as walking to the
bathroom, getting up to get the remote or even going for an afternoon stroll.
In this issue is a moving feature about Tyler Campbell, a young man
with a promising football career who, one Sunday after a game, couldnt
get out of bed. The diagnosis? Multiple Sclerosis. To his credit, Tyler
isnt discouraged by his disease. Much the opposite. He has decided to
hit MS head on and lead the fight to find a cure. When you read Tylers
story I hope youll be inspired by his grit and drive. But most of all, I
hope, like all of us at the magazine, you have earned a new respect
for what we have and realize how quickly things can change.
Also in this issue is some great in-depth information about
colon cancer, hemophilia, brain injuries and more.
I hope you enjoy the issue and as always, we
enjoy hearing from our readers.
Till next issue.
whatdoctorsknow.com
WHAT DOCTORS KNOW
And you should, too!
P44
Health Hints
38 Helping Heal Little Hearts
42 Myth 2: Cancer is a Disease
of the Wealthy, Elderly and
Developed Countries
44 Do You Have Dental Jitters?
46 Birth Control: Whats Best?
P12
Taking Control
12 A Promising Athletic Career
Cut Short by MS
16 The Nitty Gritty About Hemophilia
20 Relief Through Acupuncture
33 Gut Feelings About Gastritis
34 For the Love of Sports
whatdoctorsknow.com
Vol. 2 Issue 3
01 On Call With Dr. Porter
04 Meet Our Doctors
06 Medicine in the News
29 CDC Vital Signs: Making
Health Care Safer
40 HealthWatchMD:Colon Cleanses
56 Know Your Specialist:
Nephrologist
In Every Issue
Contents
22 MS-What We Know &
What We Dont Know
48 Prep Your Colon
60 Hemophilia-The
Royal Disease
On The Cover
Inquiring Minds
52 Traumatic Brain Injury, Dementia and Genetic Testing
53 New Smartphone App
54 Esophageal Cancer
58 New Head Lice Treatment
59 Can Ethnic Background Increase Risk?
62 Whats the Rush?
64 Scientific Innovations in Colorectal Cancer Screening
66 Helping Epilepsy in Children
P52
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Meet Our Doctors
Copyright 2013 by What Doctors Know, LLC. All rights reserved. Reproduction of this magazine,
in whole, or in part is prohibited unless authorized by the publisher or its advertisers. The
Advertising space provided in What Doctors Know is purchased and paid for by the advertisers.
Products and services are not necessarily endorsed by What Doctors Know,LLC.
Calling All Doctors. Our readers want to hear from you. What healthcare
issues do you want to address? What do you want to tell patients all
over the country? Whats new in your practice, in your specialty?
Drop us a line and let us know about any healthcare topic you want
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Send story ideas to: submit@whatdoctorsknow.com
Steven Porter, MD
Founder and
publisher of What
Doctors Know, Dr.
Porter is recognized
as one of the top
gastroenterologists in the country.
He is the medical director of the
endoscopy lab at a leading hospital in
Ogden, Utah and has been practicing
for more than 25 years. Contact
Dr. Porter at (801)387-2550.
Timothy J. Sullivan, MD
Contributing editorial
advisory board member of
What Doctors Know, Dr.
Sullivan spent 25 years
in full-time academic
medicine at Washington University,
University of Texas Southwestern
Medical School, and Emory University.
He currently has a full-time allergy
and immunology practice in Atlanta,
Georgia and is a clinical professor at
the Medical College of Georgia.
Vicki Lyons, MD
Founding member
and chairman of the
editorial advisory
board of What Doctors
Know, Dr. Lyons is
a board certified and fellowship
trained allergist and immunologist
practicing in Ogden, Utah. She
has been practicing for 20 years.
Contact Dr. Lyons at (801)387-4850
or www.vicki-lyonsmd.com.
Patrick T. Ellinor, MD, PhD
Associate dean for
academic programs and
personnel and a professor
of clinic dentistry at
the UCLA School of
Dentistry. Dr. Mito has been a practicing
dentist and UCLA faculty member since
1977. Dr. Mito credits Dr. Kenneth
Mazey, clinical psychologist, for his
significant contributions to protocols
for the management of dental fear.
David A. Ahlquist, MD
Gastroenterologist and
professor of medicine
at the Mayo Clinic in
Rochester, Minnesota.
Dr. Ahlquist's
research includes early detection of
colorectal and other gastrointestinal
neoplasms, and the development
of new noninvasive tools to screen
patients for neoplasms. Dr. Ahlquist
is also involved in the identification
of molecular markers in the stool
and blood for better screening and
detection of cancer and precancers.
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WHAT DOCTORS KNOW
And you should, too!
Published by
What Doctors Know, LLC
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Tips To Proper Hand Washing
Knoxville, Tenn. Hand washing is one of the most important
ways to avoid getting sick and to prevent spreading germs.
It is very important both at home and in the hospital.
Millions of microbes are on hands and can cause colds,
the flu or diarrhea. These disease-causing microbes can be
picked up by touching doorknobs, stair railings, telephones
and any other surfaces that multiple people touch.
Because proper hand hygiene is one of the primary
responsibilities of your healthcare team, feel free to ask any
member of your healthcare team if they have washed their
hands before they have any direct contact with you.
You may see your healthcare workers using a quick drying,
alcohol based, waterless hand gel or foam. These gels are fast
acting and are a highly effective in killing hospital germs.
Waterless gels are an acceptable alternative to washing your
hands with soap and water when your hands are not visibly dirty.
Also, remind your visitors to clean their hands
with soap and water or an alcohol-based hand
rub before they enter and leave your room.
How to Properly Wash Your Hands
Wetyourhandswithcleanandpreferablywarmrunningwater
Applysoapandrubyourhandstogethercreatinglather
Scruballsurfacesonyourhandsfor1015secondsincluding
underyourfingernailsandthebackofyourhands
Rinsehandswell
Dryyourhandsandifpossibleuseapapertoweland
thenuseyourpapertoweltoturnoffthefaucet
When to Wash Your Hands with Soap and Water
Handsarevisiblysoiled(dirty)
Handsarevisiblycontaminated
withbloodorbodyfluids
Beforeeating
Afterusingtherestroom
Afterchangingdiapersorcleaningupa
childwhohasgonetothebathroom
Beforeandaftertouchingsomeonewhoissick
Beforeandaftercaringforawound
Aftercoughing,sneezingorblowingyournose
Afterhandlingananimaloranimalwaste
Afterhandlinggarbage
How to Use an Alcohol-based Hand Sanitizer
Applyproducttothepalmofonehand
Rubhandstogether
Rubtheproductoverallsurfacesofhands
andfingersuntilhandsaredry.
whatdoctorsknow.com
Maywood, Ill. The hot dog that rolls off the plate, the
babys cookie that falls on the floor, or the candy bar that
slides across the table. Conventional wisdom has that you
have five seconds to pick it up before it is contaminated.
Fact or folklore?
A dropped item is immediately contaminated and cant
really be sanitized, said Jorge Parada, MD, MPH, FACP,
FIDSA, medical director of the infection prevention and
control program at Loyola University Health System.
When it comes to folklore, the five-second rule should
be replaced with When in doubt, throw it out. "
Items that come into contact with a surface pick up
bacteria (and dirt!). How much bacteria and what
kind of microbes depends on what was dropped
and the surface it is dropped upon, he said.
If you rinse off a dropped hot dog you will probably
greatly reduce the amount of contamination, but
there will still be some amount of unwanted and
potentially non-beneficial bacteria on that hot dog,
said Parada, who admits to employing the five-second
rule on occasion. Maybe the dropped item only picks
up 1,000 bacteria, but typically the innoculum, or
amount of bacteria that is needed for most people to
actually get infected, is 10,000 bacteria well, then
the odds are that no harm will occur. But, what if you
have a more sensitive system, or you pick up bacteria
with a lower infectious dose? Then, you are rolling
the dice with your health or that of your loved one."
And using your own mouth to
clean off a dropped baby pacifier?
That is double-dipping; you are
exposing yourself to bacteria and
you are adding your own bacteria
to that which contaminated the
dropped item. No one is spared
anything with this move, Parada said.
Parada likens the scenario of dealing with
exposure to bacteria to that of being
burned, with temperature and time
being analogous to type and amount
of bacteria. The hotter the surface, the
easier and worse you will be burned
like the more virulent, or harmful, the
bacteria the easier and sicker you may
get. One only has to touch a white-hot
surface momentarily to get burned and
sometimes it doesnt take a lot of bad bugs
for you to get sick. On the other hand, if hold
your hand to a less hot surface, but do so for a
longer period, the more you will be injured, too."
Parada said there are degrees of risk with contamination.
So, a potato chip dropped for a second on a rather clean
table will both have little time to be contaminated and
is likely to only pick up a miniscule amount of microbes
definitely a low risk, he said. On the other hand,
food that lands on a potentially more contaminated
spot, such as the floor, and stays there for a minute is
going to pick up more bacteria and pose a greater risk.
In the same time period, rock candy is less likely to pick
up contamination than a slice of cheese. As an extreme
example, whether its rock candy or a slice of cheese,
I dont think anyone would invoke the five-second
rule if it fell in the toilet, said Parada, a professor at
Loyolas Stritch School of Medicine. At the end of the
day, this is a polite social fiction we employee to allow
us to eat lightly contaminated foods, Parada said.
And what about that old saw of building up a
healthy immune system through exposure?
There actually is certain research that supports the
importance of being exposed to bacteria at critical
times in a childs development, Parada said. But
I believe this development applies to exposure of
everyday living. I do not advocate deliberately exposing
ourselves to known contaminants. That would
probably be a misplaced approach to building up our
defenses. If you want to be proactive in building up
your defenses, eat right, exercise and get adequate
sleep and remember to get your vaccines.
Five Second
Rule Is Full
Of Bugs
whatdoctorsknow.com
Study Finds Doctors And Pharmacy
Shopping Are Linked To Prescription
Drug Overdose Deaths
Morgantown, W.Va. A published study conducted
by researchers at West Virginia University has
found that doctor and pharmacy shoppers are
at a greater risk for drug-related death.
Marie Abate, Pharm.D., professor in the WVU School
of Pharmacy and faculty affiliate with the WVU
Injury Control Research Center, was part of a team of
researchers who explored prescription and drug-related
death data to determine how many subjects visited
multiple doctors and pharmacies to obtain medications.
The study examined information from the West
Virginia Controlled Substance Monitoring Program
(WV CSMP) and drug-related death data compiled by
the Forensic Drug Database from July 2005 through
December 2007. Of the more than one million
subjects 18 years and older, 698 were categorized
as deceased. Doctor shoppers accounted for about
25 percent of deceased subjects, while nearly 17.5
percent of the deceased were pharmacy shoppers.
In addition, approximately 20 percent of doctor
shoppers were also pharmacy shoppers, and 55.6 percent
of pharmacy shoppers were doctor shoppers. Younger
age and greater number of prescriptions dispensed also
contributed to having greater odds of drug-related death.
The article reporting this research, Doctor
and Pharmacy Shopping for Controlled
Substances, appeared in the June 2012 issue of
Medical Care. It concludes that prescription-
monitoring programs may be useful in identifying
potential shoppers at the point of care.
The WV CSMP compiles data for each controlled
substance prescription filled in the state, Dr. Abate
said. These programs currently exist in most states, and
efforts are underway to create one large program that
would compile the controlled substance prescription
data from all participating states. Physicians can consult
the CSMP to determine if a patient had recently
filled other prescriptions, from different physicians,
for the same drug or similar types of drugs.
Similarly, pharmacists should routinely consult the
CSMP when patients come into the pharmacy with a
new opioid or other controlled substance prescription,
she added. This allows pharmacists to determine if
patients had recently filled similar prescriptions
at different pharmacies or from different
physicians. While patients might appropriately
see different physicians to treat a medical
problem or condition, there should not
be overlapping prescriptions for similar
medications within the same time frame.
The paper also emphasized collaboration and
communication between doctors and pharmacists.
Abate suggested that physicians contact other
involved physicians and pharmacies if a patient
had recently filled or is trying to fill similar
prescriptions, and pharmacists should do likewise.
Ways of tackling the problem at a broader level
might be to hold periodic joint meetings of both
local physician and local pharmacy organizations
to specifically discuss possible strategies for
reducing and detecting doctor and pharmacy
shopping in their area, Abate said. Doctors
and pharmacists could also collaborate to present
community seminars to help educate the public
about the dangers of misusing or abusing opioids
and other potentially addicting medications.
whatdoctorsknow.com
Eating Disorders Are Serious Medical Issues
Tdap Recommended For
Pregnant Women
Atlanta, Ga. The Advisory Committee for Immunization Practices voted 14 to 0, with one
abstention, to recommend that providers of prenatal care implement a Tdap immunization
program for all pregnant women. Health-care personnel should administer a dose of Tdap
during each pregnancy irrespective of the patients prior history of receiving Tdap. If not
administered during pregnancy, Tdap should be administered immediately postpartum.
This builds upon a previous recommendation made by ACIP in June 2011 to administer
Tdap during pregnancy only to women who have not previously received Tdap. By
getting Tdap during pregnancy, maternal pertussis antibodies transfer to the newborn,
likely providing protection against pertussis in early life, before the baby starts getting
DTaP vaccines. Tdap will also protect the mother at time of delivery, making her less
likely to transmit pertussis to her infant. If not vaccinated during pregnancy, Tdap should
be given immediately postpartum, before leaving the hospital or birthing center.
The U.S. remains on track to have the most reported pertussis cases since 1959, with more
than 32,000 cases already reported along with 16 deaths, the majority of which are in infants.
Los Angeles, Calif. Eating disorders such as anorexia
nervosa, bulimia nervosa and binge eating are serious
medical illnesses that can significantly disrupt lives,
harm physical health and, in some cases, prove fatal.
But in addition to the several million Americans
who have a diagnosable eating disorder, many more
show symptoms that, while not meeting the criteria
for a diagnosis, should be cause for concern. Experts
at the UCLA Eating Disorders Program say these
individuals, too, should see a trained professional
for consultation and, when warranted, treatment.
Rough estimates suggest that about 1 percent of U.S.
females have symptoms of anorexia nervosa, such as
preoccupation with dieting and a misperception of
their actual size, "but they do not experience the
extreme weight loss characteristic of the disease,"
says Michael Strober, Ph.D., the Resnick
Professor of Eating Disorders and director
of the UCLA Eating Disorders Program.
Similarly, Dr. Strober adds, the
number of people who don't
reach the frequency threshold for
a diagnosis of bulimia nervosa
but still engage in binge eating
and purging behavior is believed to
be roughly equivalent to the number
meeting the diagnostic criteria.
The majority of people with symptoms that
fall short of an eating-disorder diagnosis do
not ultimately progress to a more severe illness, Dr.
Strober notes. But that doesn't mean these individuals
aren't at increased risk. "With any psychiatric disorder,
minor symptoms increase the risk of major symptoms
over time," Dr. Strober says. "So for eating disorders,
it's as hazardous to ignore minor symptoms as it is to
presume that they foreshadow a more ominous future."
Moreover, says Cynthia Pikus, Ph.D., associate director
of the UCLA Eating Disorders Program, eating-disorder
symptoms below the threshold for a diagnosis can still
have a negative impact on relationships and everyday
function. For that reason as well as the increased risk
that such symptoms might worsen, Dr. Pikus says,
the presence of even minor symptoms should not
be ignored. "It's important to identify the signs
early on and get treatment before the symptoms
become entrenched or intensify," she says.
Eating disorders are not limited to adults.
Promoting a healthy self-esteem and strong
sense of self can reduce the likelihood of
a child eventually showing symptoms
of an eating disorder. "Parents
and other significant adults in
children's lives should demonstrate
that there are many qualities that
contribute to the child's value beyond
appearance and weight," Dr. Pikus
explains. "That can be conveyed both
verbally and by modeling what's important."
whatdoctorsknow.com 0
Even Moderate
Smoking A Death
Risk In Women
years old at the studys start. On average, those who
smoked reported that they started in their late teens.
During the study, 351 participants
died of sudden cardiac death.
Other findings include:
Light-to-moderatesmokers,definedinthisstudy
asthosewhosmokedoneto14cigarettesdaily,
hadnearlytwotimestheriskofsuddencardiac
deathastheirnonsmokingcounterparts.
Womenwithnohistoryofheartdisease,cancer,
orstrokewhosmokedhadalmosttwoandahalf
timestheriskofsuddencardiacdeathcompared
withhealthywomenwhoneversmoked.
Foreveryfiveyearsofcontinuedsmoking,
theriskclimbedby8percent.
Amongwomenwithheartdisease,therisk
ofsuddencardiacdeathdroppedtothatofa
nonsmokerwithin15to20yearsaftersmoking
cessation.Intheabsenceofheartdisease,there
wasanimmediatereductioninsuddencardiac
deathrisk,occurringinfewerthanfiveyears.
Sudden cardiac death results from the abrupt loss
of heart function, usually within minutes after the
heart stops. Its a primary cause of heart-related
deaths, accounting for between 300,000-400,000
deaths in the United States each year.
Sudden cardiac death is often the first sign of heart
disease among women, so lifestyle changes that reduce
that risk are particularly important, said Sandhu, who
is also a visiting scientist at Brigham and Womens
Hospital in Boston, Mass. Our study shows that
cigarette smoking is an important modifiable risk factor
for sudden cardiac death among all women. Quitting
smoking before heart disease develops is critical.
Dallas, Texas Women who are even light-to-
moderate cigarette smokers may be significantly
more likely than nonsmokers to suffer sudden
cardiac death, according to new research in
Circulation: Arrhythmia & Electrophysiology,
an American Heart Association journal.
The findings indicate long-term smokers may
be at even greater risk. But quitting smoking
can reduce and eliminate the risk over time.
Evenlight-to-moderatecigarettesmokingis
associatedwithasignificantincreaseinthe
riskofsuddencardiacdeathinwomen.
Theriskofsuddencardiacdeathrose8
percentforeachfiveyearsofsmoking.
However,within15-20yearsofsmoking
cessationtheriskofsuddencardiacdeath
dropstothatofanonsmoker.
Cigarette smoking is a known risk factor for
sudden cardiac death, but until now, we didnt
know how the quantity and duration of smoking
effected the risk among apparently healthy women,
nor did we have long-term follow-up, said
Roopinder K. Sandhu, M.D., M.P.H., the studys
lead author and a cardiac electrophysiologist at
the University of Albertas Mazankowski Heart
Institute in Edmonton, Alberta, Canada.
Researchers examined the incidence of sudden cardiac
death among more than 101,000 healthy women
in the Nurses Health Study, which has collected
biannual health questionnaires from female nurses
nationwide since 1976. They included records dating
back to 1980 with 30 years of follow-up. Most of the
participants were white, and all were between 30 to 55
whatdoctorsknow.com
A Promising Athletic Career
Cut Short By MS
T
yler Campbell had dreams of following
in his Heisman Trophy winning fathers
footsteps. As a running back at San
Diego State University, he was well on his
way until one morning, his legs stopped
working. Not only could he no longer
run. But his legs couldnt support his 61 235 pound
body. He literally had to be carried to the doctor.
What he at first thought was just the after affects
the aches and pains of having played the day before
turned out to be an athletes worst nightmare. Tyler
Campbell was diagnosed with multiple sclerosis (MS).
The initial diagnosis of MS only put a temporary hold
on his athletic career. Medications and treatment
allowed him to play his senior year. With the success
of treatments through his senior year, his vision
of an NFL career seemed real once again. But the
disease progressed to the point where he had to face
a terrible reality. His playing days were over.
That was 2007. Six years later, Tyler has adjusted and with
an athletes frame of mind, he has embraced the challenge of
living with MS. It certainly didnt stop him from pursuing
other goals. He finished his degree in business management
and only three years ago, he went public with the diagnosis
by volunteering at a charity bike ride for the National MS
Society. He is now an ambassador for the organization.
He married his best friend and college sweetheart,
plans on having a family and is dedicated to bringing
awareness to MS, along with raising funds for research
and a cure. His goal is to see a cure for the disease
within 10 years. At his side is his famous father Earl
using tools he learned on the football field: adversity
comes every day, and we can either fall victim to that
adversity, or we can prevail. We always have a choice.
whatdoctorsknow.com
As an ambassador for MS, Tyler and
his family work tirelessly educating
others about the disease and more
importantly, doing everything
possible to help find a cure. We
visited with Tyler to ask him about the
daily challenges of living with MS.
What are the challenges of living with MS?
Fatigue is a very big factor because no matter how you
try to manage it, it is still a lingering issue. I am young
and vibrant and I still find myself tired at the end of the
day. I do my best to pay attention to warning signals
for when I need to slow down and get some rest.
How has life changed for you in living with MS?
I am actually more motivated and more ambitious
because I have MS. I have more to prove and I
want to overcome the stigmas of MS and prove
I can still aspire to be whatever I want to be in
spite of the disease. I want to be an example
for others living with MS and inspire them.
What in your life has prepared you to
face this unexpected challenge?
Football and sports are all about overcoming adversity
and I have been an athlete my entire life. My family also
raised me in the church and my faith prepares me for
dealing with MS and everything else I face in my life.
Do you think your marriage is stronger than others
because of the battle you both are waging?
I think so because we had the luxury of coming
into the marriage knowing about my disease.
Shana has seen me at my worst and she is so
supportive and we face everything together.
What are her struggles in dealing in dealing with MS?
She just hates to know that I am affected by a disease
period. Her love is so strong and to know MS is not
something she can control or fix is frustrating.
What cant you do without her?
I cant function without her. She gives my life
meaning and purpose. She is my best friend.
What thoughts went through your mind
when you were diagnosed with MS?
Can I still play football?
whatdoctorsknow.com
What have you learned most about the
disease since being diagnosed?
I learned that people pay attention to how I carry
myself and as long as I handle my disease with grace, I
can encourage others. I choose to fight hard and stay
strong to inspire others to keep pursuing their dreams.
I learned that just because I have MS doesnt mean I
cant accomplish great things and it is important for
people especially newly diagnosed patients to know this.
What are some of the myths?
One myth I heard in the beginning was that
you cant drink milkshakes because you have
MS. There was a long period of time I went
without ice cream but I love it now.
What are some of the things you wish people
understood and knew about MS?
It is not a terminal illness. People think because MS
deals with the brain, they think I am dying. It is
important to educate people about MS. They know
about cancer and other diseases and we dont have
the answers about MS. Nobody can tell me how I
contracted MS. We try to raise awareness about MS
through our signature charity fundraiser, Flavors of
Austin and our website, www.proplayerfoundation.org.
If you could tell a person who has never had
MS or never known anyone with MS, one thing
about the disease, what would you tell them?
It is actually a good time because medication is the
best it has ever been. There are new medications
that help with coping with and managing MS better
than ever and we are on the cutting edge of research.
Hopefully, a cure for MS is on the horizon.
What are some of the most common
misconceptions about MS?
That we cant live a functional life. Since I have
been diagnosed with MS, I have finished my degree,
gotten married, am expecting a child, work at Earl
Campbell Meat Products, exercise, ride rollercoasters,
drive, started a charity event called Flavors of Austin
and much, much more. The future is bright!
whatdoctorsknow.com
How do you want to be treated as a person with MS?
Is it ok for people to ask you questions? Is it ok for
people to ask and not offend? I want people to know my
life is an open book. Questions do not bother me at all.
The more I speak to people the more I can educate and
break down any myths about MS. I am happy to do it.
How well can you function with MS?
I have to watch my fatigue levels
and be careful in the heat.
Do you give seminars, speeches, etc.?
Yes, I was the keynote speaker at the National
MS Societys annual meeting held in Dallas and
I was also the keynote speaker at the Lone Star
Chapters On the Move luncheon and hopefully
there are more opportunities to come.
How is Earl (Sr.) involved in the fight?
He is our secret weapon. He works at educating himself
more than I do. He is hosting Flavors of Austin with
Pro Player Foundation and does numerous interviews
to raise awareness. We use his platform in the NFL to
speak about MS whenever the opportunity is available.
How close are we to finding a cure?
From my understanding, closer than we have ever
been. I hope it is within 10 years but we are making
exciting progress in finding ways to stop MS,
restore function lost to MS and end MS forever.
What do you do to manage the disease?
I stay active aerobically. The support of my wife
and my family and friends is invaluable. I stay in
tune with my faith and stay prayerful. Finally,
I volunteer with Pro Player Foundation and the
National MS Society. We host events called the
Flavors of the Gaslamp and Flavors of Austin with
the Pro Player Foundation. Being involved in these
projects allows me to give back and make a tangible
difference in the lives of people battling MS.
Does the quality of life have to change
dramatically when you are diagnosed with MS?
No, it does not have to change dramatically. You just
have to be smart about how you manage your life and
monitor yourself. It is important for me not to overdo it.
What would your advice to others with MS
be as far as living that quality of life without
feeling it has to be compromised?
Instead of feeling like my life is being taken away,
I have a tremendous amount of motivation. I feel
that the Lord chose us because we are a select few
who have the ability to cope with MS. It makes us
special and unique and we have a purpose to assist
and inspire others. -This information provided
courtesy of the National Multiple Sclerosis Society
Photos courtesy of San Diego State University Athletic Departm
ent
whatdoctorsknow.com
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imply put, hemophilia is a bleeding
disorder that prevents blood from clotting
properly. There are 13 proteins in blood
called clotting (coagulation) factors, which
work together in a series of steps to form
blood clots. People with hemophilia are
missing one of these clotting factors, so they may
need special treatment to make their blood clot.
What are inhibitors?
Inhibitors are a complication of hemophilia. Replacing
the missing Factor VIII or Factor IX through
infusion usually treats people with severe hemophilia
A or B. For some people, however, this treatment
does not work. Their bodies react as though the
treatment is an invader, or foreign object, and their
immune system develops antibodiesinhibitors
that attack and neutralize the Factor VIII or IX. The
neutralized factor is not able to stop the bleeding.
What is acquired hemophilia?
Acquired hemophilia is a rare but dangerous
bleeding disorder. Each year, it occurs in
1 to 1.5 out of 1 million people.
Acquired hemophilia is associated with the following:
thebodysnaturalclottingprocessisdisrupted
thebodyproducesantibodiesthatfight
itsownblood-clottingproteins
theconditioncanleadtospontaneous,uncontrolled
bleeding,mostoftenintheskinandsofttissues
itcanoccurinmenandwomenwithno
personalorfamilyhistoryofbleeding
Acquired hemophilia is hard to detect.
The most common symptoms are:
Bleedingintotheskin
Bleedingintosofttissues
Internalbleeding
Unlike classic hemophilia, patients with acquired
hemophilia do not usually have joint bleeds. However,
bleeding into skin and soft tissues, along with
the complications, can be very serious. Acquired
hemophilia is diagnosed with laboratory tests that
measure clotting time and Factor VIII levels.
What is congenital Factor VII deficiency?
Congenital Factor VII (FVII) deficiency is a
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bleeding disorder in which there are low levels of
FVII in the blood. FVII plays an important role
in the blood-clotting process. When there is not
enough FVII in the blood, clotting can take much
longer than normal or may not occur at all.
FVIIdeficiencyisrare,affectingan
estimated1in500,000people
Mild-to-moderateFVIIdeficiencyismarkedby
increasedbleedingaftersurgeryandtrauma
SevereFVIIdeficiencyismarkedbyspontaneous,
severe,andevenlife-threateningbleeding
What causes congenital FVII deficiency?
An abnormal gene that is inherited by a child from
both parents causes congenital FVII deficiency.
Who gets congenital FVII deficiency?
The affected FVII gene is not linked to
gender. Men and women have an equal chance
of being born with FVII deficiency.
Signs of congenital FVII deficiency
The most common signs of congenital FVII
deficiency, other than excessive bleeding after
injury or invasive procedures, include:
frequentnosebleeds
Bleedingfromthegums
Veryheavy,prolongedmenstrualbleeding
Headbleedsinnewborns
Heavier-than-normalbleedingatcircumcision
Intestinalbleeding
FVII deficiency can be detected at birth. However,
some people with FVII deficiency grow into adulthood
without knowing they have it. The blood test that
confirms FVII deficiency is called a clotting assay. It
measures the amount of time it takes to create a clot.
Surgery is a growing option for people with inhibitors
People with inhibitors have been successfully treated
by surgery for a wide variety of conditions, from
simple dental procedures to major heart surgery.
Surgery can be an effective choice to improve a wide
range of physical conditions and ailments. It can
be planned (elective) or emergency surgery.
Orthopedic surgery
People have orthopedic surgery to improve
their joints and relieve pain. The damaged
joint can either be repaired or replaced.
Common joints are the knees, ankles,
shoulders, hips, and elbows.
Nonorthopedic surgery
Nonorthopedic surgery is commonly
performed to improve access to
veins. A central venous access device
(CVAD) is implanted in the upper arm or chest.
The CVAD is connected to a catheter (or port) that
is threaded into a large vein. Injections are given
into the CVAD so fluid may flow into the vein.
Emergency surgery
Emergency surgery is done in response to an urgent
medical need, such as treating injuries suffered in an auto
accident. This type of surgery must be done right away.
Consequences of active bleeding
Early treatment of a bleed is important. WFH
guidelines recommend that bleeds be treated within
2 hours if possible. The faster treatment can be
administered and help form stable clots, the better it
is at stopping bl1eeds. A joint bleed happens when
blood collects in a joint. If a joint bleed is not treated
properly, it can lead to serious consequences.
Joint bleeds:
canoccurinelbows,ankles,orknees,
withkneesbeingmostcommon
canhappenasaresultofaninjuryoroccurwithout
anytypeofinjuryjointbleedingandjointdisease
arethemostcommoncomplicationsinhemophilia.
When a bleed happens, the body removes the
blood in a slow process by breaking down blood
and reabsorbing all of the breakdown agents. After
time, it becomes more and more difficult for the
body to reabsorb all the byproducts of blood.
This may cause blood buildup in the joint.
Treat early when there is minimal blood in the joint
Treating bleeds early makes it easier for your body
to remove the blood in the joint, because there
is less of it. Knowing the short-term and long-
term effects of a joint bleed may help you to
understand the importance of treating early.
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Short-term effects of a
joint bleed include:
Bloodentersthejoint
Caused by an injury or
can happen on its own
Jointswellsand
becomesinflamed
Swellingcangrowto
cantaloupeknee
Long-term effects of a joint bleed:
Synovitis(swellingoftissues)
Permanent swelling and
tissue growth caused by
breakdown products from
blood (thicker synovium)
Easier bleeding because
of uneven tissue growth
Pain/limited motion
Arthropathy(changestobone)
Cartilage destruction because of breakdown
products (enzymes) from blood
Cysts/wearing away of bone
Permanent damage/destroyed joint
How do I recognize the symptoms of a joint bleed?
Keeping in mind the signs and symptoms of a joint
bleed may better help you know the right time to
treat a bleed. Symptoms of a joint bleed include:
Tinglingsensation,ortightnesscalledanaura
Warmthskinwarmtothetouch
Swellingslightpuffinesstolarge,swollenjoint
Painincreasingwhenjointisnottreated
Limitedmotionofjoint
Painmaybeabsentafternumerousbleeds
How do I recognize my childs
symptoms of a joint bleed?
If you have a small child and are not sure
when he or she is getting a joint bleed, here
are some of the signs to watch for:
Reluctancetouseanarmorleg
Favoringonelimboveranother
Aspotthathurtstothetouch
Walkingslowlyinsteadofrunning
Limping
Abnormalswellingorstiffnessina
knee,elbow,orotherjoint
Treatment for Surgical Bleeding
NovoSeven

RT from Novo Nordisk is the only

recombinant Factor VII product available for the
treatment of bleeding episodes and prevention
of surgical bleeding in patients with hemophilia
A or B with inhibitors to FVIII or FIX, patients
with acquired hemophilia, and patients with FVII
deficiency. If a product is recombinant, it is genetically
engineered without human
blood or plasma.
How does NovoSeven RT
work?
There are 13 factors in the
clotting process. Clotting
happens when each factor
works together in the right
order. The clotting process can
be slowed or stopped if one
factor is blocked or missing.
In order for a stable clot to
form, the deficient factor in
the blood clotting process
must be replaced or bypassed.
NovoSeven

RT is called a
bypassing agent because it
skips the need for Factor VIII
or IX in people with inhibitors;
instead it activates Factor X directly. For people with
FVII deficiency, NovoSeven RT is used to replace the
missing factor, so the clotting process can continue.
Why viral safety is important
Viral safety means protection from viruses that could
be passed through human blood. This safety feature
of treatment is very important for anyone with a
bleeding disorder. NovoSeven

RT is a recombinant
product. This means it is made without any human
blood or plasma. Therefore, NovoSeven

RT effectively
stops bleeds without the risk of viruses that
are passed through human blood.
Wont raise inhibitor titers
NovoSeven

RT, eliminates the worry of raising your

titer. A titer measures the strength of an inhibitor.
The higher the titer in the blood, the stronger the
inhibitor. People with inhibitors want to keep their
titers low. Factor VIII and Factor IX can raise titers.
No risk of increased titers.
NovoSevenRTistheonlybypassingagent
thatdoesnotcontainanyFactorVIIIor
Factor IX so there is no risk of
increased titers with treatment
Well-tolerated treatment
Tolerability refers to the way your body tolerates a
medicine or treatment. Well-tolerated means your
body is likely to react well to a medicine, with few
side effects. NovoSeven

RT is well tolerated by most

patients and is considered safe because it works only
where it is neededat the site of injury. So there is
a low incidence of thrombosis, also known as blood
clots, forming in other parts of your body. The risk
of thrombotic adverse events is less than 1%. -This
information provided courtesy of Novo Nordisk
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RelievingTraumaticBrainInjurySymptoms
T
he movie The Hurt Locker, which
received best picture of the year in 2008,
helped portray what our veterans are being
exposed to during wartime. It is easy to see
through the lens of a camera, why we see
traumatic brain injury (TBI) occurring at
such high rates. TBI is defined as a non-degenerative,
non-congenital insult to the brain from an external
mechanical force, leading to possible concussion, skull
fractures, internal hemorrhage,
or other internal injuries.
This may result in permanent
or temporary impairment
of cognitive, physical, and
psychosocial functions, with
an associated diminished or
altered state of consciousness.
Veterans are at high-risk
for TBI and blast-related
concussions because of
the frequent exposure to
improvised explosive devices,
suicide bombers, land mines,
mortar rounds, and rocket-
propelled grenades. These
types of injuries account for
upwards of sixty-five percent
of combat injuries, and of
these, sixty percent of theses
vets have symptoms of TBI.
Symptoms can be mild to
severe. Mild symptoms include
headaches, dizziness, and
fatigue, lack of concentration,
irritability, sleep problems,
balance issues, and ringing
in the ears. More severe
symptoms include being
easily confused, forgetful, and troubled with constant
and intense headaches. Difficulty with speech and
difficulty with decision making are also common
symptoms that require ongoing rehabilitation. Many
of these symptoms are debilitating. Too often, these
returning Veterans are unemployable, and unable
to attend school for re-training. This presents a
tough challenge for a young Veteran who has his
or her whole life ahead of them upon returning.
Relief Through
Acupuncture
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Medical treatment often consists of rehabilitation,
mental health counseling, vocational rehabilitation,
and group therapy. Patients can be on a long list of
medications to treat the various symptoms. Common
medications are antidepressant, sleep aides, migraine
medications, anti-seizure medications, and narcotics.
At the George E. Whalen Veterans Health
Administration (VHA) in Salt Lake City,
acupuncture is being used to provide some
relief to these patients. Acupuncture has
become one component of the Integrative
Medicine program being offered, under the
umbrella of Holistic Medicine. Patients are
seen on an outpatient basis, where they are
being treated for a variety of health issues
including, chronic pain, post-traumatic
stress disorder and traumatic brain injury.
With the use of even a few basic points,
patients are reporting a decrease in the
intensity of their headaches, better sleep,
and an ability to cope on a daily basis. One
patient, Jim came to the Acupuncture
clinic for treatment of his severe headaches,
and his sleeplessness. Jim, a 27 -year old
male, and Iraq war vet, got caught in a cross
fire in 2003. A bullet entered his helmet, but
did not penetrate his skull. The blast resulted
in a blood clot located in the parietal area of his
brain. For the first year, his words were slurred and
his concentration and short-term memory adversely
affected. He reports developing severe, debilitating
headaches, which he describes helmet-like. He is
haunted by nightmares. This combination causes
him to lose a lot of time at work, which results in
some depression and worry over financial issues.
After working with Jim over several weeks, he began
to respond, reporting a decrease in his headaches,
better sleep, relaxation, and an ability to cope
better with his chronic pain. Jim was also taught
to do several of these points for himself while
at home, and finds this helpful in diminishing
his headaches before they get too severe.
Acupuncture will not be able to provide
a cure for Veterans with TBI, but it will
give them some relief when used in
conjunction with other medical treatments.
-This information provided courtesy
of George E. Wahlen Department of
Veterans Affairs, Salt Lake City, UT
whatdoctorsknow.com
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M
ultiple sclerosis (MS) affects more than 2.5 million
people worldwide, according to the National
Multiple Sclerosis Society. Because it is the most
common neurologic disease among young adults,
there is increasing urgency to find a cure.
While anyone can develop MS, there are environmental
patterns that identify vulnerable populations. The National MS
Society reports that women are diagnosed with MS at least two to
three times more often than men, and most are diagnosed between
the ages of 20 and 50. Geographically, people who live in more
temperate regions, further from the equator, are more likely to develop
MS. Research studies suggest genetic factors and ethnicity may also
play a role. The disease is more common in Caucasians especially
those of European descent but also occurs in African-American,
Hispanic/Latino ethnic groups and, more rarely, in Asians.
What is MS?
MS is an autoimmune demyelinating disease that affects the central nervous
system. According to the USC Multiple Sclerosis Comprehensive Care
Center and Research Group, autoimmune diseases are those in which
the bodys own immune system, which normally targets and destroys
substances foreign to the body, mistakenly attacks normal tissues. In MS,
the immune system attacks myelin, the fatty, insulating tissue that wraps
around the fingerlike projections from nerve cells called nerve processes,
much like the insulation on electrical cords. Nerve processes facilitate
communication between the central nervous system and different parts
of the body. Damage to myelin makes it difficult for the brain to send to
and receive messages from the body. This can lead to the many symptoms
of MS. Myelin damage is accompanied by inflammation in the central
nervous system, much like the redness and swelling experienced when we
cut a finger or scape a knee. Constant inflammation and damage lead to a
buildup of scar tissue, or plaques, which can be detected through magnetic
resonance imaging (MRI). Early in the disease, damage to myelin may be
repaired, but as MS progresses, repaired processes are likely to break down.
WhatWeKnowAnd
WhatWeDontKnow
MS
whatdoctorsknow.com
Making a Diagnosis
According to the Multiple Sclerosis Association of
America (MSAA), neurologists most reliably diagnose
MS through laboratory tests and neurological
history examinations. Laboratory tests are especially
important because they can rule out other diseases
that may have symptoms similar to MS.
Medical History and Neurologic Exam. A physician
obtains a medical history from a patient or
suitable person who is familiar with the patient.
Medical history includes information such as
name, birthplace, family history, travel, allergies
and other important details about a patients life.
Medical history reports help physicians formulate a
diagnosis and provide appropriate medical care.
Physicians can also perform a variety of neurologic
exams to evaluate functions such as vision, motor
activity (e.g., ability to walk or maintain balance,
coordination), sensory modalities (e.g., ability to feel and
locate touch and pain), memory, ability to concentrate
and mental and emotional health. In several cases,
medical history, neurologic exams and an MRI may
provide sufficient evidence for MS diagnosis. Neurologic
exams provide evidence of damage that has occurred or
is occurring in the central nervous system, and an MRI
may prove this, says Lilyana Amezcua, M.D., assistant
professor of clinical neurology, co-chief and medical
director of the Multiple Sclerosis Comprehensive
Care Center and Research Group at the Keck School
of Medicine of the University of Southern California
(USC). If a diagnosis cannot be confirmed through
these criteria, there are additional tests available.
Magnetic Resonance Imaging (MRI). MRIs are a
diagnostic tool used for scanning internal structures of
the body using magnetic fields. The National MS Society
suggests that MRIs are more useful for evaluating the
extent of damage to the myelin, also known as plaques,
and areas of inflammation. Areas where the myelin is
damaged may appear as bright white spots or darkened
areas on MRI scans. However, it is important to note that
these spots or indications of damage can also appear on
scans of people who do not have MS mainly the elderly.
MRI is currently our best clinical marker of disease, but
clearly it lacks sensitivity in its ability to differentiate other
conditions, which is still a problem, says Dr. Amezcua.
Evoked Potential (EP). EP tests record the central
nervous systems electrical responses to stimulation
of different senses such as hearing and vision. EPs are
effective because they can detect evidence of scarring
along nerve pathways that might not be evident during
a neurologic exam. These tests are useful tools when
a neurologist needs more evidence of damage to the
myelin, or white matter, Dr. Amezcua says. They are
helpful in showing that lesions occur in several places in
the CNS. The concept is called dissemination in space.
Cerebrospinal Fluid (CSF) Analysis. In CSF analysis, a
thin needle is inserted into a space between the bones
of the spine, and a small amount of cerebrospinal fluid
is collected. This procedure is sometimes referred
to as a spinal tap or lumbar puncture. CSF analysis
can detect specific immune system proteins and
oligoclonal bands, which are composed of antibodies.
The National MS Society reports that oligoclonal
bands are found in spinal fluid of nearly 90 percent
of people diagnosed with MS. Because oligoclonal
bands are common of other neurologic diseases as
well, CSF analyses are not definite proof of MS. CSF
can be very informative, but if results prove negative,
it does not erase the possibility of MS, Dr. Amezcua
says. You have to look at the whole picture.
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Symptoms of MS
The symptoms of MS can be classified in three
categories: primary (directly due to the disease
itself), secondary (due to inadequate management
of primary symptoms), and tertiary (those that
result from complications of the disease).
Symptoms are often variable and unpredictable. No
MS patient is alike, says Dr. Amezcua. However, we
do recognize the most common types of symptoms.
For instance, the National MS society reports that initial
complaints of symptoms usually concern blurred vision,
uncontrolled eye movements, or double vision. Visual
symptoms can occur as a result of optic nerve involvement
or other areas in the brain which control visual function,
Dr. Amezcua adds. Progression of symptoms can then
lead to numbness and tingling in the body or extremities.
Numbness in the body can be mild or so severe that
it can impair movement like walking or writing.
Additional MS symptoms may include:
Numbnessorweaknessinoneormorelimbs
Partialorcompletelossofcentralvision,
usuallyinoneeye,oftenwithpainduring
eyemovement(opticneuritis)
Doublevisionorblurringofvision
Tinglingorpaininpartsofthebody
Electric-shocksensationsthatoccurwithcertain
headmovements,knownasLhermittessign
Tremor,lackofcoordinationorunsteadygait
Slurredspeech
Fatigue
Dizziness
What are the different types of MS?
There are four forms of MS, including relapsing-
remitting, primary-progressive, secondary-progressive
and progressive-relapsing. Because symptoms of
MS are so variable and often go unnoticed, these
groups help physicians categorize patterns of
progression and identify the best treatment options.
Relapsing-Remitting
Relapsing-remitting MS is the most common form of
MS, affecting about 85 percent of cases at presentation,
Dr. Amezcua says. Patients with relapsing-remitting
MS may experience relapses or exacerbations, also
known as flare-ups or attacks. These are episodes of
worsening symptoms or inflammation in the brain
and spinal cord that can be mild or severe enough to
interfere with body functions. A relapse can last from
24 hours to several weeks, according to the National
MS Society. Relapses are typically followed by periods
of remission where partial or full recovery or healing
occurs. This completes the relapsing-remitting cycle.
Primary-Progressive
Primary-progressive MS is one of the three progressive
forms of MS. This type of MS is characterized
by steady progression of symptoms and a lack of
relapses from the onset of disease. Progression
may vary from patient to patient, with temporary
improvements or stability. Primary-progressive is less
common, only about 10 percent of the population
is diagnosed with this form, says Dr. Amezcua.
Secondary-Progressive
Secondary-progressive is the second type of progressive
MS and the most common form after relapsing-
remitting. In this form of MS, patients initially show
similar symptoms as relapsing-remitting patients, but
will experience fewer relapses over time accompanied
by steady worsening of symptoms and some measures
of disability. The natural history of MS suggests that
most patients with relapsing-remitting will convert
overtime to secondary-progressive if left untreated,
Dr. Amezcua says. About 80 percent of patients will
experience this form after 20 years of the disease.
Progressive-Relapsing
This form is typically characterized as progressive from the
onset, with occasional periods of relapses. In other words,
patients may experience worsening of neurologic function
from the beginning. In contrast to relapsing-remitting,
periods between relapses are distinguished by disease
progression instead of a cycle of relapse and remission.
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Causes and Risk Factors for MS
Although the cause of MS is not clear, research
studies indicate that people with MS have a
genetic predisposition to develop the disease. This
predisposition, combined with a bevy of environmental
factors, may lead to the disease. There is some
speculation that a viral or bacterial infection caused
by Epstein-Barr virus (EBV) or measles virus may
provide a trigger for development of MS, but at this
time, definitive evidence has not emerged. Evidence
suggests that damage to the nerves is the result of cells
of the immune system inappropriately targeting proteins
shared between these viruses and myelin, said Wendy
Gilmore, Ph.D., associate professor of neurology and
chief of the division of MS and neruoimmunology
at the Keck School of Medicine of USC.
Treatment Options
There is no cure for MS, but there are several beneficial
strategies for managing the disease. Treating MS
requires managing symptoms with a healthy approach.
Symptoms vary from patient to patient, so its important
to work with your doctor to develop a treatment plan
that is specific to your needs, suggests Dr. Amezcua.
Disease Modification Drugs
The Food & Drug Administration (FDA) has
approved several medications for MS management.
Some require special monitoring procedures to
ensure safety. Your doctors can go over these
medications with you and determine which is best
for your needs and type of MS. Below is a list of
FDA approved disease-modifying drugs for MS:
Aubagio(teriflunomide):oralmedication
Avonex(interferonbeta-1a):injectablemedication
Betaseron(interferonbeta-1b):injectablemedication
Copaxone(glatirameracetate):injectablemedication
Extavia(interferonbeta-1b):injectablemedication
Gilneya(fingolimod):oralmedication
Novantrone(mitoxantrone):injectablemedication
Rebif(interferonbeta-1a):injectablemedication
Tysabri(natalizumab):intravenous(IV)
medicationbyamedicalprofessional
Why is MS so difficult
to diagnose?
By Lilyana Amezcua, M.D.
Assistant Professor of Clinical Neurology, Co-
Chief and Medical Director of the Multiple Sclerosis
Comprehensive Care Center and Research Group at the
University of Southern California (USC), Department
of Neurology at the Keck School of Medicine of USC
There is no single test, at this time, for diagnosing MS.
Diagnosis relies on clinical signs and symptoms and
may be supported by specific laboratory tests. Because
symptoms, such as blurred vision or numbness, can
be mild and temporary, with recovery occurring over
several days or weeks, people may write them off as
insignificant. This can make the MS diagnosis more
difficult. While no single laboratory test is yet available
to diagnose MS, magnetic resonance imaging (MRI),
evoked potentials (EP), and spinal fluid analysis are
useful to support a clear, definitive diagnosis.
In order to diagnose definite MS, a physician
must consider the following criteria:
Evidenceofdamagelocatedinatleasttwoseparate
areasofthecentralnervoussystem(CNS),including
thebrain,spinalcordandopticnervesAND
Proofthatthedamageoccurredmorethan
onetime,atleastonemonthapartAND
Ruleoutallotherpossiblediagnoses
Living With MS
Managing MS involves more than medical
treatment; health activities and emotional support
are equally important. There are several strategies
for maximizing wellness and dealing with emotional
challenges. Support centers like the National MS
Society or the USC MS Comprehensive Care Center
provide assistance for concerns after diagnosis.
Exercise
The USC MS Comprehensive Care Center suggests
that exercise is an essential component of managing
MS symptoms. Studies show that moderate aerobic
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exercise improves cardiac health, stamina and mood,
and helps manage symptoms like fatigue, weakness
and difficulties involving the bladder and bowel.
Stretching exercises can also relieve stiffness and
improve flexibility and mobility. At the USC MS
Comprehensive Care Center, we find that patients who
exercise on a routine basis do much better overall,
says Dr. Amezcua. Before starting an exercise regimen,
consult a physician about personal needs and limitations.
Healthy Diet
Diet cannot cure or prevent MS, but eating a low-
fat, high-fiber and balanced diet can promote healthy
digestion and overall well-being. The National MS
Society suggests that vitamin D may be beneficial for
the immune system and may aid in cell regulation,
growth and differentiation. Vitamin D also promotes
calcium absorption for stronger bones. Certain
symptoms can be minimized with proper nutrition. For
instance, drinking more water and snacking frequently
can help with fatigue. There is not one single diet
that will work for every person with MS. Patients
should examine which diet keeps a healthy balance and
promotes energy for him or herself, Dr. Amezcua says.
Stress Management
The correlation between stress and MS are unclear,
but stress can cause mental and physiological strain in
anyoneregardless of an MS diagnosis. Physiological
discomfort like an upset stomach or tightness in the
neck can be a result of stress. The National MS Society
provides a comprehensive list of stress signs including
continual boredom, chronic irritability, feeling down,
excessive anxiety, worry or distractibility. We cannot
avoid stress, but we can certainly learn to deal with
it by using mechanisms that promote serenity such
as yoga and laughter, suggests Dr. Amezcua.
Rehabilitation & Physical Therapy
Rehabilitation services help to manage MS by
improving and stabilizing the bodys movement. There
are several venues available for rehabilitation therapy
including the home, outpatient or inpatient facilities,
fitness centers or gyms and MS centers. Rehabilitation
centers and specialists can address topics such as
mobility, coordination, personal care and fitness.
Services for speech and memory difficulties are also
available. Patients at the Keck School of Medicine
of USC are fortunate to have access to programs
like Optimal Living (supported by the National
MS Society) and Lifestyle Redesign (supported by
USC Occupational Therapy), says Dr. Amezcua.
Treating Emotional Change
People diagnosed with MS may experience a lot
of emotions during the process, which is natural,
says Dr. Amezcua. There are spectrums of strategies
to help patients manage emotions related to MS
such as education seminars; individual, group, and
family counseling and support networks. Connecting
with others who have been diagnosed with MS
is possible through the National MS Society and
MSAA. At USC, we specifically try to reach out
and identify early on whether patients are having a
difficult time coping with MS, says Dr. Amezcua.
-Molly Rugg, courtesy of USC Health Sciences
Outlook
By Wendy Gilmore, Ph.D.
Associate Professor of Neurology and Chief of the division of MS and Neuroimmunology,
Department of Neurology at the Keck School of Medicine of USC
Although a cure for MS has not yet
emerged from research efforts, great hope
can be found in rapidly expanding progress
in the following specific areas of study:
1) Early detection. MS is increasingly
recognized to occur in children, suggesting
that the disease process may start early in
life. Development of tools to recognize and
diagnose MS early may lead to strategies
to stop disease activity, delay disease
progression and disability, and maintain
MS as a manageable disease for life.
2) Contro l of inflammation in the central
nervous system. It is well known that
inflammation is a consistent feature of
the damage that occurs in MS. Current
disease-modifying drugs for MS are
primarily anti-inflammatory agents, and
though they are helpful, new drugs in
the pipeline show promise for more fine-
tuned and effective anti-inflammatory
and immune modulatory action.
3) Protection against additional
damage in the central nervous system.
In addition to controlling inflammation,
new strategies for protecting nerve
cells in the central nervous system
are currently under active and intense
investigation. Protection of the nervous
system, also known as neuroprotection,
is essential to limiting damage in MS.
4) Promotion of central nervous system
repair. As damage accumulates in the
central nervous system, repair processes
become blocked, or less effective in MS
patients. New studies have identified
several molecules that are responsible for
blocking repair, leading to investigation of
new drugs designed to release the blocks.
MS is a complicated disease that requires a
multidisciplinary and multifaceted approach
to diagnosis, treatment and management.
In addition, research in MS involves
multiple scientific disciplines that reflect
our current understanding of MS as an
autoimmune, inflammatory demyelinating
disease of the central nervous system
that is triggered by an environmental
factor, or multiple environmental factors,
in genetically susceptible individuals.
Learning new insights into how the disease
develops and developing new treatment
strategies for MS is highly dependent upon
innovative research in diverse areas such
as epidemiology, genetics, immunology,
autoimmunity, imaging, neural stem cell
biology, central nervous system repair
mechanisms, pharmacology and more.

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Estevan misses
bedtime at home.
St. Jude patient Estevan:
Worlds Best Snuggler
But at this moment, hes fighting cancer.
Thats why St. Jude Childrens Research Hospital spends every moment changing
the way the world treats children with pioneering research and exceptional care.
And no family ever pays St. Jude for anything. Dont wait. Join St. Jude in finding cures
and saving children like Estevan. Because at this moment, he should be in his own
bed, begging to read three more books.
Help them live. Visit stjude.org.
1
Making Health Care Safer
Hospital stays from
infections tripled in the last
decade, posing a patient safety
threat especially harmful to
older Americans.
Hospitals following infection
control recommendations
lowered infection
rates by 20% in less than
2 years.
Almost all
infections are connected to
getting medical care.
20%
94%
3X
People getting medical care can catch serious
infections called health care-associated
infections (HAIs). While most types of HAIs
are declining, one caused by the germ
C. difficile* remains at historically high
levels. C. difficile causes diarrhea linked to
14,000 American deaths each year. Those most
at risk are people, especially older adults, who
take antibiotics and also get medical care.
When a person takes antibiotics, good germs
that protect against infection are destroyed
for several months. During this time, patients
can get sick from C. difficile picked up from
contaminated surfaces or spread from a
health care providers hands. About 25% of
C. difficile infections first show symptoms in
hospital patients; 75% first show in nursing
home patients or in people recently cared
for in doctors offices and clinics. C. difficile
infections cost at least $1 billion in extra health
care costs annually.
* (klah-STRID-ee-um DIFF-i-seel)
To learn more about how to stop the spread
of C. difficile

Stopping C. difcile infections
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
www http://www.cdc.gov/vitalsigns
Problem
C. difcile infections are
at an all-time high.
causes many Americans to
become sick or die.
infections are linked to 14,000
deaths in the US each year.
Deaths related to increased 400%
between 2000 and 2007, due in part to a
stronger germ strain.
Most infections are connected with
receiving medical care.
Almost half of infections occur in people
younger than 65, but more than 90% of deaths
occur in people 65 and older.
Infection risk generally increases with age;
children are at lower risk.
About 25% of
in nursing home patients or in people recently
germs move with patients from
one health care facility to another, infecting
other patients.
Half of all hospital patients with
infections have the infection when admitted and
may spread it within the facility.
The most dangerous source of spread to others
is patients with diarrhea.
Unnecessary antibiotic use in patients at one
facility may increase the spread of in
another facility when patients transfer.
When a patient transfers, health care providers
are not always told that the patient has or
recently had a infection, so they may
not take the right actions to prevent spread.
infections can be prevented.
Early results from hospital prevention projects
show 20% fewer infections in less
than 2 years with infection prevention and
control measures.
England decreased infection rates in
hospitals by more than half in 3 years by using
infection control recommendations and more
careful antibiotic use.
SOURCE: CDC, 2012
For Clinicians:
6 Steps to Prevention
P
r
e
v
e
n
t
i
o
n
1. Prescribe and use antibiotics
carefully. About 50% of all antibiotics
given are not needed, unnecessarily
raising the risk of C. dicile infections.
2. Test for C. dicile when patients
have diarrhea while on antibiotics or
within several months of taking them.
3. Isolate patients with C. dicile
immediately.
4. Wear gloves and gowns when
treating patients with C. dicile , even
during short visits. Hand sanitizer does
not kill C. dicile , and hand washing
may not be sucient.
5. Clean room surfaces with bleach
or another EPA-approved, spore-killing
disinfectant after a patient with
C. dicile has been treated there.
6. When a patient transfers, notify the
new facility if the patient has a
C. dicile infection.
3
How C. difcile
Spreads.
SOURCE: CDC, 2012
Doctors Oce
Hospital
George, a 68-year-old man, goes to the
doctors oce and is diagnosed with
pneumonia. He is prescribed antibiotics,
drugs that put him at risk for C. dicile
infection for several months.
Hospital
Wears gloves
Three Days Later
George goes back to the hospital for treatment of diarrhea and
tests positive for C. dicile. He is started on specic antibiotics
to treat it. Health care workers wear gloves and do not spread
C. dicile. George recovers.
Rehab Facility
Does not
wear gloves
Two Days Later
George transfers to a rehabilitation facility for his leg and
gets diarrhea. He is not tested for C. dicile. The health care
worker doesnt wear gloves and infects other patients.
George breaks his leg and goes to a hospital.
A health care worker spreads C. dicile to him
after forgetting to wear gloves when treating
a C. dicile infected patient in the next room.
One Month Later
Deaths caused by C. difcile infections*
*Age-adjusted rate of C. difcile as the primary (underlying) cause of death.
SOURCE: CDC National Center for Health Statistics, 2012
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5
10
15
20
25
Deaths per
1,000,000
For more information, please contact
Telephone: 1-800-CDC-INFO (232-4636)
TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov
Web: www.cdc.gov
Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Publication date: 3/6/2012
What Can Be Done
CS229311-B
Federal government is
Tracking and reporting national progress
toward preventing infections in
many types of health care facilities. These
programs help track the size of the problem,
antibiotics used, and people at risk.
Promoting prevention programs
and providing gold-standard patient safety
recommendations (see http://www.cdc.gov/
HAI/organisms/cdiff/Cdiff_infect.html).
Providing prevention expertise, as well as
outbreak and laboratory support to health
departments and facilities.
States and communities can
Encourage health care facilities to track and
share data using CDCs National Healthcare
Safety Network.
Develop regional prevention
projects with many types of facilities.
Help health care facilities in their
prevention efforts.
Provide a standardized form for facilities to use
during patient transfers, especially between
hospitals and nursing homes.
Patients can
Take antibiotics only as prescribed by your
doctor. Antibiotics can be lifesaving medicines.
Tell your doctor if you have been on antibiotics
and get diarrhea within a few months.
Wash your hands after using the bathroom.
Try to use a separate bathroomif you have
diarrhea, or be sure the bathroomis cleaned
well if someone with diarrhea has used it.
Health care facility administrators can
Support better testing, tracking, and reporting
of infections and prevention efforts.
Make sure cleaning staff follows CDC
recommendations, using an EPA-approved,
spore-killing disinfectant in rooms where
patients are treated.
Notify other health care facilities about
infectious diseases when patients transfer,
especially between hospitals and nursing
homes.
Participate in a regional
prevention effort.
Doctors and nurses can
Prescribe antibiotics carefully (see http://www.
html). Once culture results are available, check
whether the prescribed antibiotics are correct
and necessary.
Order a test (preferably a nucleic acid
test) if the patient has had 3 or more unformed
stools within 24 hours.
Be aware of infection rates in your facility
or practice, and follow infection control
recommendations with every patient. This
includes isolating patients who test positive for
infection and wearing gloves and
gowns to treat them.
www http://www.cdc.gov/vitalsigns
whatdoctorsknow.com
Gut Feelings About Gastritis
When Your Stomach's Sick
Y
our stomach lining has an
important job. It makes
acid and enzymes that help
break down food so you
can extract the nutrients
you need. The lining also
protects itself from acid damage by
secreting mucus. But sometimes the
lining gets inflamed and starts making
less acid, enzymes and mucus. This
type of inflammation is called gastritis,
and it can cause long-term problems.
Some people think they have gastritis
when they have pain or an uncomfortable
feeling in their upper stomach. But
many other conditions can cause these
symptoms. Gastritis can sometimes
lead to pain, nausea and vomiting.
But it often has no symptoms at all. If
left untreated, though, some types of
gastritis can lead to ulcers (sores in the
stomach lining) or even stomach cancer.
People used to think gastritis and
ulcers were caused by stress and spicy
foods. But research studies show that
bacteria called Helicobacter pylori are
often to blame. Usually, these bacteria
cause no symptoms. In the United
States, 20% to 50% of the population
may be infected with H. pylori.
H. pylori breaks down the inner protective
coating in some peoples stomachs and
immune cells mistakenly attack
healthy cells in the stomach lining.
Gastritis can be diagnosed with an
endoscope, a thin tube with a tiny
camera on the end, which is inserted
through the patients mouth or nose
and into the stomach. The doctor
will look at the stomach lining and
may also remove some tissue samples
for testing. Treatment will depend
on the type of gastritis you have.
Although stress and spicy foods
dont cause gastritis and ulcers, they
can make symptoms worse. Milk
might provide brief relief, but it also
increases stomach acid, which can
worsen symptoms. Your doctor may
recommend taking antacids or other
drugs to reduce acid in the stomach.
Talk with a health care provider if
youre concerned about ongoing pain
or discomfort in your stomach. These
symptoms can have many causes.
Your doctor can help determine
the best course of action for you.
-Source: NIH News in Health,
November 2012, published by the
National Institutes of Health and the
Department of Health and Human
Services. For more information go
to www.newsinhealth.nih.gov
Watch for Ulcers
Gastritis can lead to ulcers over time.
Symptoms of ulcers include pain between
the belly button and breastbone that:
startsbetweenmealsorduringthenight
brieflystopsifyoueatortakeantacids
lastsforminutestohours
comesandgoesforseveraldaysorweeks
Contact your doctor right away if you have:
suddensharpstomachpainthatdoesntgoaway
blackorbloodystools
vomitthatisbloodyorlookslikecoffeegrounds
causes inflammation. I
tell people H. pylori is
like having termites in
your stomach, says
Dr. David Graham,
an expert in digestive
diseases at Baylor
College of Medicine in
Texas. You usually dont
know you have termites until
someone tells you, and you
ignore it at your own risk. H.
pylori can spread by passing
from person to person or
through contaminated food or
water. Infections can be treated with
bacteria-killing drugs called antibiotics.
One type of gastritis, called erosive
gastritis, wears away the stomach
lining. The most common cause of
erosive gastritis is long-term use of
medications called non-steroidal anti-
inflammatory drugs. These include
aspirin and ibuprofen. When you
stop taking the drugs, the condition
usually goes away, says Graham.
Doctors might also recommend
reducing the dose or switching to
another class of pain medication.
Less common causes of gastritis include
certain digestive disorders (such as
Crohns disease) and autoimmune
disorders, in which the bodys protective
When his wife urged him to join her at the tae
kwon do class, Jeff Kallberg of Minneapolis feared it
was too dangerous for a man in his 30s with severe
hemophilia, but he reluctantly agreed 37, he proudly
boasts a black belt.to give it a try. Now four years
later, at age 37, he proudly boasts a black belt.
Playing and competing benefit
the body in more ways than one
K
allberg is not alone. People with bleeding disorders of all ages are
participating and competing in a wide variety of sports, including
ones once thought off-limits. Many say that as a result of their active
lifestyle and regular conditioning, they feel better and can do more
than ever. Understandably, they are eager to spread the word that
with modern treatments for bleeding disorders, sports can be safe
and fun when practiced responsibly. The benefi ts are signifi cantfor both
body and soul. That is the theme sounded in such popular guides to sports
and fi tness as the new National Hemophilia Foundation (NHF) pamphlet,
Playing It Safe: Bleeding Disorders, Sports and Exercise and the Hemophilia
of Indiana chapters video,Living Healthy with Hemophilia (see sidebars).
ITS GOOD FOR THE BODY
Exercise is, of course, benefi cial for everyone. It increases your energy, helps
maintain a healthy weight and reduces the risk of other weight-related illnesses such
as diabetes and heart disease. Exercise also has an added bonus for people with
bleeding disordersit builds strong muscles and lowers the risk of joint bleeds.
NHFs Do the 5 campaign, which gives five key steps to a longer and healthier
life, includes, exercise and maintain a healthy weight to protect your joints.
For the love of
SPORTS
whatdoctorsknow.com
whatdoctorsknow.com
The weight control benefi ts of exercise are especially
critical for young people with hemophilia and von
Willebrand disease (VWD) between the ages of 13
and 19 who, according to the Centers for Disease
Control and Prevention (CDC), are almost twice
as likely to be overweight than children their age
in the general population. Exercise can help shed
excess pounds that put added strain on joints and
limit range of motion. And while physical fi tness
is key, it should go hand in hand with a healthy,
balanced dietwhich is an equally important part of
maintaining a normal weight and overall good health.
But before starting any new sport or exercise regimen,
as NHF stresses in Playing It Safe, it is crucial
to properly prepare to lower the risk of injury:
Talkwithyourdoctororhemophilia
treatmentcenterstaffabouttheactivity
Knowtheearlysignsofableedand
howtotreatitpromptly
Makesureyouwearadequateprotectiveequipment,
suchasahelmetandelbowandkneepads
Buildupyouractivityslowlydoitforshorttime
periodsatfirsttoseehowyourbodyresponds
Doconditioningexercisessuchasstretchingand
weighttrainingtoimproveflexibilityandendurance
Finally, its always a good idea to keep gym teachers,
coaches and trainers informed about your bleeding
disorder or your childs bleeding disorder and work
with them to tailor movements to your abilities.
If I have an injury, my tae kwon do instructors know to
take it seriously, says Kallberg. If theres something I really
dont want to do theyre not going to give me a hard time,
and they help me modify the activities to what I can do.
The most recommended sports for people with
bleeding disorders are those that put less impact
on joints but still do a lot for muscle strength and
flexibility. Swimming, walking, golf and bike
riding are good suggestions. However, with proper
safeguards, its possible for people with bleeding
disorders to enjoy a wide variety of outdoor activities.
For example, organizations such as Disabled Adventure
Outfi tters (www.specialadventures.org), based in
California, take people with bleeding disorders on
carefully supervised weeklong white-water rafting
and rock climbing excursions. A nurse accompanies
the group, and participants are required to infuse
beforehand, regardless of whether they are on
prophylaxis, says Richard Pezzillo. Pezzillo, 22, has
hemophilia and often helps guide the adventure trips.
Pezzillo says the excursions are all about showing
people what they can do in life, not what they cant
do. He adds: The growth I saw from these kids [on
the trips] was phenomenal and for myself, too, being
able to challenge myself in a responsible setting.
Pezzillos sentiment is practiced every
summer in camps for children with bleeding
disorders nationwide, where campers are
encouraged to try activities and sports
they might never do otherwise. The most
popular include horseback riding, hiking,
water skiing, rock climbing and archery.
The key is that at camp, kids learn how
to do these sports safely and correctly.
Because team sports are an important part
of growing up and also help to contribute to
a childs social and emotional development,
NHF encourages parents to give their
children a chance to participate. And while
some sports like soccer and basketball may
Jeffkallbergexcels
attaekwondo
andsaysthesport
hasimproved
hiscoordination
andbalance.
Mollyselfridge(right)andher
teammembershareapassionfor
swimming.mollyhasattaineda
nationalrankingandcompetesoften.
whatdoctorsknow.com
become more competitive and dangerous for
older children and teens, there are many other
sports that may prove the perfect alternative.
ATHLETES BY LEAPS AND BOUNDS
Finding the perfect alternative was the case
with Mollie Selfridge, 13, and her brother
Zachary, 11, of San Jose, California, who
both have hemophilia and VWD. After
trying soccer, basketball and baseball, which
all caused frequent ankle bleeds,the siblings
discovered a passion for swimming and now
regularly compete in national swim meets.
Swimming is a really fun time just to
work hard and hang out with friends, and
it helps me a lot with my hemophilia,
says Mollie. It also lets me move my
joints without hurting them, and I dont
get as many muscle bleeds as I did with soccer.
Zachary agrees, adding swimming helps the joint pain
because I get to stretch out my arms and legs. Both
Mollie and Zachary have attained national rankings in
swimming. Zachary is currently eighth in the nation
in his age group and is setting his sights even higher.
My goal is to get national times and go to senior nationals
and maybe to the Olympics in 2012 or 2016, he says.
Playing it (Safe)
The National Hemophilia Foundations
new Playing It Safe: Bleeding Disorders,
Sports and Exercise is a helpful guide
for deciding what sports are right
for anyone living with a bleeding
disorder.Topics covered in the
44-page booklet include conditioning,
stretching and flexibility, weight
training and cardiovascular exercise.
An added bonus is a color-coded chart ranking some 60
sports activities according to the level of risk involved on a
scale of 1 to 3. Some popular activities are ranked as follows:
Safe (ranked 1)archery,bicycling,golf,
hiking,swimming,TaiChiandwalking
Moderate Risk (ranked 2)aerobics,bowling,
jogging,rollerskating,tennisandyoga
Dangerous (ranked 3)boxing,football,
hockey,trampolineandwrestling
For a free copy of Playing It Safe or other
information on exercise and bleeding disorders,
call the NHF Information Resource Center at (800)
42-HANDI or e-mail handi@hemophilia.org.
Zacharyselfridge
hopestocompete
inthe2012or
2016olympics.
Like Molly and Zachary, Luis Aguayo, 17, of
Arnold, Missouri, also tried team sports fi rst, but
when his grandfather showed him how to play
golf, he not only found his niche, he excelled.
Aguayo recently won the 2005 NHFZLB Behring
Junior National Golf Championship and two years
ago won a Junior Professional Golfers Association
(PGA) championship. His goals: Make it to the
state high school championship, win a college
scholarship and eventually become a pro golfer.
Im not going to let hemophilia hold me back,
says Aguayo.No matter what kind of disorder
or handicap you have, if you want to accomplish
something bad enough, you can almost always
overcome it with hard work and determination.
Kyle Widdison, 14, of Jacksonville, Missouri, is a
pitcher and third baseman on his high school baseball
team, and also the NHFZLB Behring Junior National
Baseball Champion. Widdison is equally proud of
his achievement in junior high when he pitched a
no-hitter and hit three home runs in one game.
When I was 9 or 10, I got hit in the eye with a ball,
says Widdison. I thought it would heal, but it kept
bleeding. So,they performed surgery, and thats when my
von Willebrand was diagnosed. I havent had any serious
incidents since. If I get hit by a pitch or a batted ball, I
just take medicine, and it usually heals up after that.
Youngsters with high aspirations have role models
in brothers Corey and Perry Parker of Southern
California, who became professional athletes despite
their hemophilia. Corey played baseball for six years,
including three with the Detroit Tigers. Perry, a
professional golfer for 18 years, has competed on the
PGA tour and has won fi ve Canadian tour events.
whatdoctorsknow.com
Luisaguayo
foundhis
nicheingolf.
Actively involved in the bleeding disorders community
and in mentoring young athletes, the brothers helped
coordinate the golf and baseball competitions at the
NHF Junior National Championships. Corey is past
president of the Hemophilia Foundation of Southern
California and presents a program called Gettin in
the Game that teaches kids the importance of physical
fi tness and exercise for
maintaining healthy joints.
Perry directs a golf tournament
that raised $90,000 last year
for the Hemophilia Foundation
of Southern California.
The Parkers are eager to share
their experiences and make
sure youngsters appreciate
how things have changed for
people with hemophilia.
I never finished a [baseball]
season without being hurt or
out for at least a month, Corey
says. When I was growing
up, nobody self-infused,
so I never learned. I relied
on other people. My bleeds
were a lot worse than they
Watch More
Hemophilia of Indiana, a chapter of the National Hemophilia Foundation
(NHF), has produced a welcomed addition to the available resources on fi
tness and bleeding disorders with its new Living Healthy with Hemophilia,
a DVD made possible by a National Prevention Program grant from NHF.
The 28-minute videomade in conjunction with Healthy Living with Teresa Tanoos
(a nationally syndicated Indianapolis TV program) and the Indiana Hemophilia
and Thrombosis Centerhighlights the importance of individual fi tness,exercise
and eating right through several interviews with experts in the fi eld as well as
with stories from several children and adults about their sports of choice.
We took a proactive approach to preventing complications from hemophilia
through exercise and fi tness, says John Spickelmier, director marketing and
communications for Hemophilia of Indiana. It also emphasizes there is much that
people with hemophilia can do. The message is get out there, grab it and go for it.
Copies of the DVD are available by calling the NHF Information Resource
Center at (800) 42-HANDI or by e-mail at handi@hemophilia.org.
might have been because Id wait to see if it got really
bad, and Id try to hide it from the other players. So,
it wasnt my hemophilia that held me back. It was
how I dealt with my treatment that held me back.
Perry says that although his parents were supportive, he
was discouraged by doctors and coaches from playing
sports. Nevertheless, he stuck with basketball throughout
high school and has been golfi ng since age 10.
For some reason I had the inner strength to say I
was going to do it, but I never in my wildest dreams
ever thought Id be playing pro golf, Perry says.
Kids today have a huge advantage because they can
infuse before they participate or if they get hurt.
That will keep them in the game, whereas when I
was a kid if I got hurt Id be out a month or two.
Most athletes today take their bleeding disorder in
stridebut they do take it seriously. They are careful
to infuse before or after a practice or event if their
bodies dictate or their doctors advise. These athletes
work out regularly to keep muscles and joints in
peak condition and they agree that the benefi ts
they reap from their sport far outweigh the risks.
Both of my ankles and my right elbow are arthritic,
and when Im real active I get achy, says Kallberg.
But, I also get achy if I just walk around the mall or
grocery store. I get so much more out of tae kwon
do because of what it does for the rest of my body.
He adds that the martial art has improved his coordination
and balance so much that he has resumed water skiing.
Youve got to take care of your body and be proactive
and fi t,and the extra benefi ts are some of the fun things
that come with it, Kallberg says. -Phyllis McIntosh,
courtesy of the National Hemophilia Foundation
whatdoctorsknow.com
Helping Heal
Little Hearts
W
aiting on the arrival of your bundle
of joy is an exciting time and,
as days tick by, the prospect of a
healthy bouncing baby becomes
a reality. Yet most families dont
know the risks of congenital heart
defects (CHD), what they are and how they are treated
until they are diagnosed just before, or after, the baby
is born. Thats why the American Heart Association
is working to educate parents and their loved ones
during pregnancy on things they should know.
Before Blake was born, I wish I had known how common
CHDs are in children and that, as a mother there was
nothing that I did to cause his condition, commented
Tiffany Galligan, mom and caregiver to Blake, 4. It
would have been great to know that they are treatable
and, if detected early, children can live full, happy lives.
In fact, about 32,000 infants are diagnosed with a
congenital heart defect each year and 1.3 million
Americans are living today with a CHD.
Blake was diagnosed with Hypoplastic
Left Heart Syndrome, or HLHS. He
had his first open-heart surgery at seven
days old, the second at five months old
and his third when he was three years- old. No
one in our family had a similar condition this was
new to us, Tiffany continued. We were in shock
and disbelief when he was diagnosed at a day old and
felt like our world was crashing down around us.
Parents need credible information and peer support
during this time. In an effort to help provide families
the tools and information parents need to help
prepare them, or offer support and information
during diagnosis and treatment, the American Heart
Association has a web portal that breaks down the
meaning of a CHD, most common types of CHDs,
treatment, and what caregivers can do when their
little one is diagnosed with a CHD and personal
stories that help offer support and motivation.
The diagnosis of a congenital heart defect can be
devastating and frightening for parents. Medical care
teams are able to educate families about congenital
heart disease, whether the diagnosis is made prenatally
American Heart Association offers
tools and resources for families of
children with congenital heart defects
and big
ones, too!
whatdoctorsknow.com
or after birth. With the knowledge and support given
by health care providers, parents as well as extended
families are better equipped to tackle the medical and
surgical treatment, which may be difficult, as they help
their child along the road to recovery. Commented
Catherine L. Webb, M.D., M.S, Pediatric Cardiologist,
Professor of Pediatrics and Communicable Diseases
at the University of Michigan Medical School and
spokesperson for the American Heart Association. I
often find myself reassuring parents that there is nothing
they could have done to prevent their child's congenital
heart defect. Its not anyone's fault. Although
congenital heart disease is the leading cause of death
in children with birth defects, the prognosis is quite
hopeful, as there are more than 1.3 million Americans
living today with some form of a congenital heart
defect. Parents should also know that the American
Heart Associations tools and resources are focused on
preventing as well as improving diagnosis and outcomes
in congenital heart disease. The prognosis for patients
with CHD is far superior today compared to even 10
years ago. Research supported by organizations, such
as the AHA, will continue to improve outcomes and
quality of life for patients with congenital heart disease.
As for Blake whats his prognosis? He is living
life as a normal kid. He plays soccer, swims, goes to
gymnastics and attends preschool. We dont know
what the future has in store for our little guy. He may
need more surgeries later down the road, or even a
transplant, but we are enjoying every day, every smile
and every accomplishment, Tiffany concluded. I
just hope the parents of kids with CHDs take care of
themselves so they can take care of their little ones.
For more information on congenital heart
defects and support for caregivers visit www.
heart.org/congenitalheartdefects and www.
heart.org/caregivers. -This information provided
courtesy of the American Heart Association
whatdoctorsknow.com 0
HealthWatchMD
with Dr. Randy Martin
Provided courtesy of Piedmont Healthcare
Dr. Randy Martin: The concept of colon cleansing is very trendy
right now and we hear about many celebrities endorsing this
procedure for health and weight loss. But is it really safe and good
for your health? I met with Piedmont Hospital gastroenterologist
Dr. Michael Galambos to learn more about these procedures.
Colon Cleanses:
Celebrity Weight-loss
Secret or Potentially
Life-Threatening?
whatdoctorsknow.com
Dr. Randy Martin: While its common
to read about celebrities undergoing
these procedures, there is currently no
FDA oversight of colonic cleansing. Lack
of technician training and equipment
sanitation protocol can have serious
consequences for your health. If you
are concerned about your weight
or your health, see your doctor.
What is a colon cleanse?
Michael Galambos, M.D., a
gastroenterologist at Piedmont Hospital,
explains that our colon eliminates waste
indigestible food products from our bodies.
The concept of colonic cleansing
encompasses a variety of alternative medicine
practices to flush the colon and digestive
tract, he says. The idea is that there
are a lot of non-specific complaints that
people have, such as headaches, fatigue,
and irritability. Some people seek a simple
form of weight loss and the theory is
that if they clean their colon, it will be
beneficial to their health and goals.
Colonic hydrotherapy
Colonic hydrotherapy involves placing a
tube in the rectum and injecting water, often
containing herbs and other additives, to flush
feces from the colon, says Dr. Galambos.
While many people consider colon cleanses
to be medical solutions, Dr. Galambos
stresses that this is not the case.
The additives in these solutions are
considered nutritional supplements, he
says. Hence, they are not monitored
or licensed by the Food and Drug
Administration (FDA). There is no
scientific supervision of these procedures.
In fact, training, equipment and sanitation
protocol is not standardized, he adds.
Potentially deadly consequences
There can be severe complications from
undergoing these procedures, says Dr.
Galambos. Colonic perforations can
occur if the devices are inappropriately
placed in the rectum or if the patient has
certain colonic diseases. The pressure
from flushing this much fluid from the
system can lead to a perforation.
These are immediate, life-threatening
complications, he stresses.
If you are considering undergoing a colon
cleanse, keep Dr. Galambos advice in mind:
Our bodies already have the natural abilities to
flush out waste and toxins from our systems.
The bacterial floor in the intestines,
specifically the colon, is an important part
of our system. It helps our immunology
and ability to break down waste products.
MYTH 2:
CANCER
IS A DISEASE
OF THE WEALTHY,
ELDERLY AND
DEVELOPED
COUNTRIES
CANCER IN DEVELOPING COUNTRIES
Cancer is a global issue and becoming an increasing public health
problem in poorer countries.
EVIDENCE
Cahcer how accouhIs !or more deaIhs worldwide Ihah HIV/AIDS,
Iuberculosis ahd malaria combihed. O! Ihe 7.6 millioh global deaIhs !rom
cahcer ih 2008, more Ihah 55% occurred ih less developed regiohs o! Ihe
world. 8y 2030, 60-70% o! Ihe esIimaIed 21.4 millioh hew cahcer cases per
year are predicIed Io occur ih developihg couhIries.
Cervical cahcer is |usI ohe example o! Ihe disproporIiohaIe burdeh borhe ih
Ihe developihg world. Over 85% o! Ihe 275,000 womeh who die every year
!rom cervical cahcer are !rom developihg couhIries. I! le!I uhchecked, by
2030 cervical cahcer will kill as mahy as 430,000 womeh per year, virIually all
ih Ihese couhIries.
1here are massive ihequiIies ih access Io paih relie! wiIh more Ihah 99%
o! uhIreaIed ahd paih!ul deaIhs occurrihg ih developihg couhIries. Ih 2009,
more Ihah 90% o! Ihe global cohsumpIioh o! opioid ahalgesics was ih
AusIralia, Cahada, New Zealahd, Ihe US ahd some Luropeah couhIries,
wiIh less Ihah 10% o! global quahIiIies used by Ihe oIher 80% o! Ihe
world's populaIioh.
GLObAL ADVOCACy
mESSAGE
Effcacious and cost-
effective interventions
musI be made available
ih ah equiIable mahher
Ihrough cahcer prevehIioh,
early deIecIioh ahd
IreaImehI delivered as
parI o! haIiohal cahcer
cohIrol plahs (NCCPs) IhaI
respohd Io Ihe haIiohal
cahcer burdeh. Access
to effective, quality
and affordable cancer
services is a right o! all
ihdividuals ahd should hoI
be deIermihed by where
you live.
TRUTH:
CANCER IS
A GLObAL
EPIDEmIC
It affects all
ages and socio-
economic groups,
with developing
countries bearing
a disproportionate
burden.
C
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1
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CANCER VS INFECTIOUS DISEASES
Many developing countries are now facing a growing double burden
of infectious diseases and non-communicable diseases (NCDs),
including cancer.
EVIDENCE
WhilsI some quesIioh Ihe appropriaIehess ahd hecessiIy o! cahcer
ihIervehIiohs ih couhIries !acihg high burdehs o! ih!ecIious diseases
ihcludihg HIV/AIDS, Ihe disIihcIioh beIweeh ih!ecIious diseases ahd NCDs
is ih !acI harrowihg wiIh HIV/AIDS movihg ih mahy cases !rom ah acuIe,
!aIal disease Io a chrohic illhess, ahd mahy cahcers o! high ihcidehce ih
developihg couhIries havihg beeh caused by chrohic ih!ecIiohs.
NCDs ihcludihg cahcer, ahd ih!ecIious diseases, should hoI be seeh
as compeIihg prioriIies buI ihsIead as global healIh issues IhaI
disproporIiohaIely a!!ecI developihg couhIries. 1hey require ah ihIegraIed
approach IhaI builds capaciIy ih haIiohal healIh sysIems Io proIecI
ihdividuals across Ihe specIrum o! diseases.
CANCER AND AGEING POPULATIONS
Cancer not only affects the elderly, but young men and women, often
in their prime working years, particularly in the developing world.
EVIDENCE
ApproximaIely 50% o! cahcer ih developihg couhIries occurs ih ihdividuals
less Ihah 65 years o! age. 1his is a Iragedy !or !amilies ahd !or populaIiohs,
ahd has Ihe poIehIial Io have a lohg-Ierm impacI oh ecohomic developmehI.
MosI o! Ihe 750,000 cervical ahd breasI cahcer deaIhs per year occur durihg
a womah's reproducIive years.
Cahcer is also a disease o! youhg people. For childreh aged 5-14, cahcer is a
leadihg cause o! deaIh ih mahy couhIries. However, morIaliIy is ohly parI o!
Ihe picIure, wiIh cahcer-relaIed illhess ahd disabiliIy limiIihg opporIuhiIies
!or educaIioh, ahd ulIimaIely impedihg !ull parIicipaIioh ih Ihe work!orce.
ParehIs ahd caregivers o! childreh may also be severely impacIed by Ihe
sighi!cahI cosIs o! IreaImehI, pushihg !amilies !urIher ihIo poverIy.
CANCER AND WEALTH
The impact of cancer on all populations is devastating but especially so
for poor, vulnerable and socially disadvantaged people who get sicker
and die sooner as a result of cancer.
EVIDENCE
Demographic di!!erehces correlaIe highly wiIh commoh cahcer risk !acIors
e.g. poor huIriIioh, Iobacco use, physical ihacIiviIy ahd alcohol.
IhequiIies ih access Io cahcer services are also associaIed wiIh socioecohomic
sIaIus, wiIh poor ahd vulherable populaIiohs uhable Io a!!ord expehsive
cahcer medicihes ahd IreaImehIs which musI o!Ieh be paid by paIiehIs ouI-
o!-pockeI, as well as experiehcihg oIher obsIacles Io access such as disIahce
Io qualiIy IreaImehI !aciliIies.
GLObAL ADVOCACy mESSAGE
Individuals, families and communities
are affected by cancer at all ages.
1he core elemehIs o! a cancer control
and care continuum must be decided
wiIhih each couhIry accordihg Io
khowledge o! Ihe cahcer burdeh based
on information !rom populaIioh-based
cahcer regisIries, as well as country-
specifc cancer risks for all ages, exisIihg
healIh resources ahd ih!rasIrucIure,
poliIical ahd social cohdiIiohs, ahd
culIural belie!s ahd pracIices.
GLObAL ADVOCACy mESSAGE
Social protection measures, including
universal health coverage, are essehIial Io
ehsure IhaI all ihdividuals ahd !amilies have
!ull access Io healIhcare ahd opporIuhiIies
Io prevehI ahd cohIrol cahcer.
All people should have access to proven
effective cancer treatment and services
oh equal Ierms, ahd without suffering
economic hardship as a cohsequehce.
GLObAL ADVOCACy mESSAGE
Resource appropriaIe ahd evidence-
based improvements in cancer control
should be part of overall health systems
strengthening in developing countries.
IhvesImehI ih a diagohal approach IhaI
!ocuses oh Ihe ihIegraIioh o! healIh
services, ihcludihg Ihe ihcorporaIioh
o! cahcer prevehIioh ahd mahagemehI
ihIo primary healIhcare will Iackle
cahcer-speci!c prioriIies while
addressihg Ihe gaps wiIhih Ihe healIh
sysIem, optimising the use of resources
and increasing capacity Io respohd Io
mahy diseases ahd populaIioh groups.
worldcancerday.org
UNION FOR INTERNATIONAL CANCER CONTROL
UNION INTERNATIONALE CONTRE LE CANCER
62 route de Frontenex t 1207 Geneva t Switzerland
Tel. +41 (0)22 809 1811 t Fax +41 (0)22 809 1810 t info@uicc.org tuicc.org
whatdoctorsknow.com
Do You Have
Dental Jitters?
Exploring the causes and ways to get over it
D
ental phobia or dental fear affects an estimated 30 to 40 million Americans, thats
roughly 9 to 13 percent of the population. Thats a lot of people who avoid regular dental
check-ups and needed treatment for several years or even decades because of a deep-
seeded fear of the dentist. Only when an individual is faced with a dental emergency
or unbearable pain will they break down and with great trepidation visit a dentist.
For more than 30 years, I have observed and worked with people who fear
the dentist. I have found that most people fear the dentist because of misperceptions about
treatment, fear of pain, and fear of the unknown. Naturally, people will do everything
in their power to avoid a fearful situation, even if it compromises their health.
However, there are several coping mechanisms and methods to control anxiety and
fear associated with going to the dentist. With patience, trust, and behavioral therapy,
dental phobic individuals will reach a point where they will be able to control their
fear and get on track with restoring and maintaining good oral health.
whatdoctorsknow.com
The following methods are
what I recommend to people
who have dental phobia
and want to get over it:
1

Its very important
that you talk to your
dentist or potential
dentist to make sure they
are aware of your phobia
and they have the time and
desire to work with you
on overcoming your fear.
If necessary, you may even
ask your dentist if he or she
would be willing to meet
in a non-clinical/neutral
setting to discuss your
fears, such as the reception
room or business office.
2

Avoiding stimulants
such as caffeine
is an effective
way to minimize jitters
and agitation. I advise
people to avoid caffeine
at least six hours prior
to dental treatment.
3

When you go in for
your treatment, you
may want to create
a signal to indicate to
your dentist to temporarily
stop treatment. This will
help you feel more in
control of the situation.
4

Folding your
hands over your
stomach can help you feel reassurance if
you are anxious while in the dental chair.
5

Try eating protein prior to going to a
dental appointment. This will help reduce any
feelings of hunger while in the dental chair.
6

A really good technique to calm
yourself down before and during a dental
appointment is to focus on calm steady
breathing. Fear can sometimes lead people to
either hold their breath or breathe too rapidly.
7

Another effective method of reducing dental
phobia is oral and intravenous sedation while
undergoing treatment. However, this is only
a temporary method and avoids the issue of long-
term fear. It can be a method to allow the dentist
to get your urgent dental needs under control while
you work on developing your coping skills.
8

For children, the key is have their first dental
appointment by six months of age so they begin
to become accustomed to the dental office. Their
first visit should not be for an emergency as this could
traumatize them and set the stage for future fears.
If none of these techniques work to help relieve dental
phobia, I encourage people to seek out fear reduction
therapy with a clinical psychologist or other mental
health professional. I have found that many patients
who have mastered coping skills, either on their own
or with the guidance of a psychologist have built the
confidence they needed to start seeing their dentist
regularly without the aid of sedative agents. -Ronald S.
Mito, DDS, FDS, RCSEd, UCLA School of Dentistry
whatdoctorsknow.com
Birth Control: What's Best?
A

study to evaluate birth-control methods
has found dramatic differences in their
effectiveness. Women who used short-
term methods like birth-control pills,
the patch or vaginal ring were 20 times
more likely to have an unintended
pregnancy than those who used longer-acting forms
such as an intrauterine device (IUD) or implant.
Results of the study, by researchers at Washington
University School of Medicine in St. Louis, are reported
May 24, 2012 in the New England Journal of Medicine.
Birth-control pills are the most commonly used
reversible contraceptive in the United States, but their
effectiveness hinges on women remembering to take
a pill every day and having easy access to refills.
In the study, birth-control pills and other short-term
contraceptive methods, such as the contraceptive patch
or ring, were especially unreliable among younger
women. For those under 21 who used birth-control
pills, the patch or ring, the risk of unplanned pregnancy
was almost twice as high as the risk among older
women. This finding suggests that increased adolescent
use of longer acting contraceptive methods could
prevent substantially more unplanned pregnancies.
This study is the best evidence we have that long-
acting reversible methods are far superior to the
birth-control pill, patch and ring, says senior author
Jeffrey Peipert, MD, the Robert J. Terry Professor
of Obstetrics and Gynecology. IUDs and implants
are more effective because women can forget about
them after clinicians put the devices in place.
Unintended pregnancy is a major problem in the
United States. About 3 million pregnancies per year
50 percent of all pregnancies are unplanned.
The rate of unintended pregnancy in the United
States is much higher than in other developed nations,
and past studies have shown that about half of these
pregnancies result from contraceptive failure.
whatdoctorsknow.com
IUDs are inserted into the uterus by a health-care
provider. The hormonal IUD is approved for five
years, and the copper IUD can be used for as long as
10 years. Hormonal implants are inserted under the
skin of the upper arm and are effective for three years.
Many women, however, cannot afford the upfront costs
of these methods, which can be more than $500.
We know that IUDs and implants have very low failure
rates less than 1 percent, says Brooke Winner,
MD, a fourth-year resident at Barnes-Jewish Hospital
and the studys lead author. But although IUDs are
very effective and have been proven safe in women
and adolescents, they only are chosen by 5.5 percent of
women in the United States who use contraception.
Earlier contraceptive studies asked women to recall
the birth-control method they used and number of
pregnancies. For this study, the investigators wanted
to determine whether educating women about the
effectiveness of various birth-control options and
having them choose a method without considering
cost would reduce the rate of unintended pregnancy.
Birth control was provided to women at no cost.
The study involved more than 7,500 women enrolled in
the Contraceptive CHOICE project. Participants were
ages 14-45 and at high risk of unintended pregnancy.
The women were sexually active or planned to become
sexually active in the next six months. They either
were not currently using contraception or wanted to
switch birth-control methods.
The women also said they did
not want to become pregnant
for the next 12 months.
Participants in this report could
choose among the following
birth-control methods: IUD,
implant, birth-control pills,
patch, ring and contraceptive
injection. The women were
counseled about the contraceptive
methods, including their
effectiveness, side effects, risks
and benefits. Participants were
permitted to discontinue or
switch methods as many times
as desired during the study.
Investigators interviewed
participants by telephone at
three and six months and every
six months thereafter for the
remainder of the study. During
each interview, participants
were asked about missed periods
and possible pregnancy. Any
participant who thought she
might be pregnant was asked to come in for a urine
pregnancy test. Those who were pregnant were asked
if it was intended and what contraceptive method,
if any, they were using at time of conception.
Over the three-year study, 334 women became
pregnant. Of these, 156 pregnancies were due to
contraceptive failure. Overall, 133 (4.55 percent)
of women using pills, the patch or ring had
contraceptive failure, compared with 21 (0.27
percent) of women using IUDs and implants.
This study also is important because it showed
that when IUDs and implants are provided at
no cost, about 75 percent of women chose these
methods for birth control, Winner says.
Women who chose an IUD or implant were more
likely to be older, to have public health insurance and
to have more children than women who chose other
contraceptive methods. Women who chose pills, the
patch or ring were more likely to have private health
insurance and to not have had children previously.
If there were a drug for cancer, heart disease
or diabetes that was 20 times more effective, we
would recommend it first, he says. Unintended
pregnancies can have negative effects on womens
health and education and the health of newborns.
-This information provided courtesy of Washington
University in St. Louis School of Medicine
whatdoctorsknow.com
Prep Your Colon
G
astroenterologists at Washington
University School of Medicine in
St. Louis have found that when
patients dont adequately prep for
the test by cleansing their colons,
doctors often cant see potentially
dangerous pre-cancerous lesions.
Reporting in the journal Gastrointestinal Endoscopy, the
researchers say that doctors often missed at least one pre-
cancerous growth in about one-third of patients who did
not properly prepare for their colonoscopy. Those polyps
and other markers of cancer risk were only discovered
months later when patients had their next colonoscopy.
Although several studies have found that up to
a quarter of colonoscopy patients dont prepare
adequately for the test, the new study is the first
to point out the potential consequences of poor
bowel preparation in outpatients at average risk.
Because so many of the patients had a follow-
up screening less than a year after the initial test,
we strongly suspect that most of the pre-cancerous
growths found during the second colonoscopy
already were present at the time of the initial
test, says first author Reena Chokshi, MD, a
gastroenterology fellow at Washington University.
The researchers say their findings suggest that if
a physician is having difficulty seeing the colon
due to inadequate bowel prep, the colonoscopy
should be stopped and rescheduled.
We often can detect preparation problems during
the first few minutes of the procedure, Chokshi says.
And based on this study, we would say that rather
than subjecting a patient to the potential risks of a full
colonoscopy when we may not be able to detect polyps,
or other pre-cancerous growths called adenomas, it may
be better to bring that patient back as soon as possible
for a repeat procedure with better bowel preparation.
On the day before a colonoscopy exam, people are
asked to stop eating solid food and to consume
only clear liquids. Later in the day and the next
morning, patients drink bowel-cleansing mixtures
to empty the colon prior to the examination.
The test itself usually takes less than an hour, and
patients are sedated during that time. Using a tiny
camera, doctors are able to look at the walls of the
What happens on the day before a colonoscopy may
be just as important as the colon-screening test itself.
whatdoctorsknow.com
colon in an attempt to detect polyps and other pre-
cancerous growths. Once detected, those growths
can be removed during the course of the colonoscopy.
Patients often must miss two days of work: the day
of preparation and the day of the test. Recently, the
outpatient endoscopy center at Washington University
and Barnes-Jewish Hospital in St. Louis has begun
screening patients on Saturday mornings to reduce the
number of vacation days some patients have to use.
Many patients say that the bowel preparation before
the colonoscopy is the worst part of having the test,
but its also very important because in order to see
polyps or cancers, we really have to be able to clearly
see the entire wall of the colon, says senior author Jean
S. Wang, MD, PhD, assistant professor of medicine
in the Division of Gastroenterology. Inadequate
preparation makes that very difficult for a physician.
The researchers retrospectively studied patients who
had an average risk of colon cancer and got screening
colonoscopies in the outpatient endoscopy center.
Individuals with a history of inflammatory bowel
disease, a family history of colorectal cancer or a medical
history of colon polyps were not included in the study.
In the five-year span between 2004-09, 373 patients at
the center were identified as having inadequate bowel
preparation. Of the 133 patients who later had a second
colonoscopy during the study period, 33.8 percent had
at least one pre-cancerous adenoma detected in that
repeat screening. And almost one in five of that group
were considered to be at high risk for colon cancer
because they either had more than three adenomas
detected, or the test discovered at least one large lesion.
In fact, the researchers found that 18 percent of the
patients who had a second colonoscopy would have
been given different recommendations if their polyps
and adenomas had been detected during the initial
screening, such as more frequent colonoscopies to
monitor the development of growths in the colon.
It generally takes several years for an adenoma to become
cancerous, Chokshi says. But its hard to know where in
that sequence a particular adenoma is when we detect it.
So it certainly is possible that any lesion we miss during
a colonoscopy could develop into a malignancy before a
persons next colonoscopy, especially if it doesnt happen
until 10 years later. -This information provided courtesy
of Washington University in St. Louis School of Medicine
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When your child comes home with lice, you want to take action. Prescription Sklice Lotion
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Traumatic Brain Injury,
Dementia and Genetic Testing

In the wake of NFL suicides, a call to consider
genetic testing for young athletes
S
hould high school athletes
and prospective military
personnel be genetically
tested to determine if
they are at increased risk
for dementia caused by
repeated head injuries? The dean of
the University of Virginia School of
Medicine and the director of Mount
Sinais NFL Neurological Program
are asking that question and offering
recommendations to clarify the
ethical issues that accompany it.
The long-term effects of traumatic brain
injury [TBI] have been spotlighted
by the high-profile suicides of former
NFL players Junior Seau and Dave
Duerson. Increasing evidence suggests
that repeated head injuries, whether
from sports or the battlefield, can
lead to dementia in later life. But
genetics play an important role as well,
potentially increasing the risk for late-
life dementia more than 10 fold.
That has prompted Steven T. DeKosky,
MD, vice president and dean of UVAs
School of Medicine, and Sam Gandy,
MD, the chair in Alzheimers research at
the Mount Sinai School of Medicine, to
examine whether genetic testing could
help avert dementia and reduce the costs
of dementia care a figure estimated
to top $1 trillion annually by 2050.
Key information missing
In a new editorial in the journal
Science Translational Medicine,
DeKosky and Gandy note there is a
lack of vital information on which to
base a decision on the value of such
genetic testing. They conducted an
informal poll of experts in Alzheimers
disease, TBI and related areas, and
they found a significant majority of
the 45 respondents agreed that it
was premature to introduce genetic
testing into schools or the military.
What is needed, DeKosky and Gandy
conclude, is additional information to
evaluate the usefulness of such testing.
Finding solutions
One approach to collecting the
necessary data, they suggest, would be
to set up a network of research centers.
This would allow for the collection
of data from an array of subjects,
including high-risk adolescents exposed
to brain injuries through sports. The
information could then be used to
create predictive mathematical models.
DeKosky and Gandy also suggest
that valuable data could be drawn
from studies now being assembled,
such as the National Institute of
Child Health and Development
Vanguard Study, which plans to
track major life events of 100,000
children until their 21st birthdays.
Ethical and psychological issues
DeKosky and Gandy note that there
are both ethical and psychological
complexities to the question of
genetic testing. There is a very real
concern about the effect of genotype
information on family members
and on personal employability and
insurability, they write. In addition,
recruiting high school-age subjects
for genotyping and follow-up
could be controversial as parental
informed consent would be required,
necessitating pre-test genetic counseling
for adolescents and their parents.
Conclusion: An idea
worth considering
Despite such concerns, DeKosky and
Gandy conclude that considering
genetic testing for high school
athletes and the military is, without
a doubt, a worthwhile challenge.
If lifestyle modifications for [those
at genetic risk] such as avoiding
high-impact sports or opting for
military careers that do not put the
brain at risk can reduce dementia
prevalence in 2050 by even 1%, they
write, we would gain an annual
savings of $10 billion in costs of
care and immeasurable savings in
terms of human suffering. -This
information provided courtesy of the
University of Virginia Health System
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Esophageal

Cancer
NewUnderstanding
ofFastest-Rising
SolidTumorinU.S.
whatdoctorsknow.com
whatdoctorsknow.com
R
esearchers at Columbia University Medical
Center (CUMC) have identified the critical
early cellular and molecular events that
give rise to a type of esophageal cancer
called esophageal adenocarcinoma, the
fastest-rising solid tumor in the United
States. The findings, published online in Cancer Cell
(21(1) 3651 (2012), challenge conventional wisdom
regarding the origin and development of this deadly
cancer and its precursor lesion, Barretts esophagus, and
highlight possible targets for new clinical therapies.
Lacking a good animal model of esophageal
adenocarcinoma (EAC), researchers have been hard
pressed to explain exactly where and how this cancer
arises. What is known is that EAC is usually triggered
by gastroesophageal reflux disease (GERD), in which
bile acid and other stomach contents leak backwards
from the stomach to the esophagus, the muscular tube
that moves food from the mouth to the stomach. Over
time, acid reflux can irritate and inflame the esophagus,
leading to Barretts esophagus, an asymptomatic
precancerous condition in which the tissue lining the
esophagus is replaced by tissue similar to the lining of
the intestine. A small number of people with Barretts
esophagus eventually go on to develop EAC.
Using a new genetically engineered mouse model
of esophagitis, the CUMC researchers have clarified
critical cellular and molecular changes that occur
during the development of Barretts esophagus and
EAC. In human patients, acid reflux often leads to
overexpression of a molecule called interleukin-1
beta, an important mediator of the inflammatory
response, reported study leader Timothy C. Wang,
MD, the Dorothy L. and Daniel H. Silberberg
Professor of Medicine at CUMC. Thus, Wang and
his colleagues created a transgenic mouse in which
interleukin-1 beta was overexpressed in the esophagus.
Overexpression of interleukin-1 beta in the mouse
esophagus resulted in chronic esophageal inflammation
(esophagitis) and expansion of progenitor cells that
were sustained by the notch signaling pathway. Notch
is a fundamental signaling system used by neighboring
cells to communicate with each other in order to
assume their proper developmental role. When we
inhibited notch signaling, that blocked proliferation
and survival of the pre-malignant cells, so thats a new
possible clinical strategy to use in Barretts patients at
high risk for cancer development, noted Dr. Wang.
For decades, investigators thought that the physiological
changes associated with Barretts esophagus originate
in the lower esophagus. However, our study shows
that Barretts esophagus actually arises in the gastric
cardia, a small region between the lower part of the
esophagus and the upper, acid-secreting portion
of the stomach, said Dr. Wang. What happens
is that the bile acid and inflammatory cytokines
activate stem cells at this transition zone, and they
begin migrating up toward the esophagus, where
they take on this intestinal-like appearance.
The researchers also demonstrated that these changes
occur primarily in columnar-like epithelial cells, rather
than in goblet cells, as was previously thought.
All told, the findings present a new model for
the pathogenesis of Barretts esophagus and
esophageal adenocarcinoma, said Dr. Wang.
Barretts esophagus affects about 1 percent of adults
in the United States. Men are affected by Barretts
esophagus twice as frequently as women, and Caucasian
men are affected more frequently than men of other
races. The average age at diagnosis is 50. At present,
there is no way to determine which patients with
the condition will develop EAC. EAC is increasing
in incidence about 7 to 8 percent a year, making it
the most rapidly rising solid tumor in the U.S.
Treatment with acid-reducing drugs can lessen
symptoms of GERD and lower the chances of
developing Barretts esophagus and EAC. Low-grade
EAC is highly treatable with endoscopic radiofrequency
ablation, photodynamic therapy, or surgical resection.
Patients with severe disease may require open surgery,
in which most of the esophagus is removed. The
overall five-year survival rate with advanced disease
is about 25 percent. -This information provided
courtesy of Columbia University Medical Center
whatdoctorsknow.com
W
hat Is a Nephrologist?
A nephrologist specializes in kidney care
and treating diseases of the kidneys.
Nephrologists are educated in internal
medicine and then undergo more
training to specialize in treating patients
with kidney diseases. They commonly treat chronic kidney
disease (CKD), polycystic kidney disease (PKD), acute
renal failure, kidney stones and high blood pressure and are
educated on all aspects of kidney transplantation and dialysis.
Nephrology is categorized as a specialty of internal
medicine. Nephrologists must graduate from an
approved medical school, complete a three-year
residency in internal medicine and pass the American
Board of Internal Medicine (ABIM) certification
exam before they can begin to study nephrology.
Once they have passed the ABIM exam and been
accepted into a nephrology program, they must complete
a two- to three-year fellowship in nephrology. This
fellowship must be accredited by the Accreditation
Council for Graduate Medical Education (ACGME).
During this fellowship, aspiring
nephrologists learn about:
Glomerular/vascular disorders. Glomerular/vascular
disorders are disorders of the glomeruli or clusters of blood
vessels in the kidneys. Kidney doctors learn treatment
methods to help slow the progression of these disorders
to preserve kidney function for as long as they can.
Tubular/interstitial disorders Tubular/interstitial
disorders affect the tubules of the kidneys and the surrounding
tissues. The tubules collect the filtered fluid from the kidneys
that ultimately becomes urine. Kidney doctors learn the
symptoms of these disorders and how to treat them.
Hypertension Hypertension is another word for
high blood pressure, and, second to diabetes, it is the
leading cause of end stage renal disease (ESRD) in the
U.S. When kidneys excrete too much of a substance
called renin, blood pressure may increase. Kidney
KNOW YOUR SPECIALIST
Nephrologist
doctors learn about the different kinds of medicines
that can lower blood pressure, as well as other methods
for lowering blood pressure such as diet and exercise.
Dialysis. Dialysis is the process of cleaning the blood when
the kidneys no longer function. Kidney doctors learn about
hemodialysis and peritoneal dialysis the two types of
dialysis so they can match their patients with the dialysis
treatment that works best for their health and lifestyle.
Kidney transplantation. A kidney transplant takes
place when someone receives a kidney from someone
else to replace the function of his or her own damaged
kidneys. Nephrologists learn about all aspects of
kidney transplantation so they can help their patients
understand and prepare for this procedure.
Mineral metabolism. Mineral metabolism disorders
occur when there are abnormal amounts of minerals in
the blood. Kidney doctors learn how to correct or manage
mineral metabolism disorders to make sure their patients
get the amount of minerals they need for healthy growth
and to keep their bodies functioning as they should.
Management of acute kidney failure. Acute kidney
failure occurs when the kidneys suddenly stop
working. Sometimes the kidneys can recover from
acute kidney failure. Kidney doctors learn to treat all
reversible situations that cause acute kidney failure,
such as kidney stones, infections or major blood loss.
Management of chronic kidney disease. Chronic kidney
disease (CKD) occurs when the kidneys slowly lose
function over a period of time. There are five stages to
CKD, with the last stage being end stage renal disease
(ESRD) or kidney failure. Kidney doctors learn about
the five stages of chronic kidney disease and how to
manage them so they can slow the progression of kidney
disease and keep their patients as healthy as possible.
Nutrition. Nutrition plays a big part in slowing the progression
of kidney disease and living well with kidney failure. Kidney
doctors learn what nutrients kidney patients can and cannot
have so they can help their patients get the nutrition they need.
Interpretation of x-rays, sonograms and other tests Some
kidney diseases are discovered through x-rays, sonograms
and other tests. Kidney doctors learn how to interpret the
results of these tests so they can make accurate diagnoses.
In addition, most nephrology fellowships require
one to two years of clinical or laboratory research,
during which time each physician becomes a true
expert in more specialized areas of study.
During fellowship, nephrologists-in-training learn to
diagnose and manage kidney diseases. They must be familiar
with all surgical procedures associated with dialysis such as
vascular access and catheter placement. They become experts
on all forms of dialysis treatment, including hemodialysis
and peritoneal dialysis, and learn to perform kidney biopsies,
tests during which small pieces of tissue are collected from
the kidney for examination under a microscope. Once this is
done, they are eligible to take the ABIM nephrology exam.
To specialize in pediatric nephrology (caring for children),
students must take additional courses and pass another exam.
What does a nephrologist do?
A nephrologist generally sees patients who are referred
by their primary care physicians or general physicians for
problems related to the kidneys, high blood pressure or
certain types of metabolic disorders. If someone feels they
are having problems with their kidneys, they can seek out
the care of a nephrologist. When a kidney doctor first
meets with a patient, he or she will usually go over the
patients medical history and do a complete physical.
A nephrologist will then do blood and urine tests to
determine how well the patients kidneys are functioning.
He or she may also order a kidney ultrasound. When
necessary, a nephrologist may perform a kidney biopsy in
order to better determine what is wrong with the kidneys.
However, a nephrologist is not a surgeon and typically
does not perform operations. Treatment of kidney cancer,
prostate operations and removal of kidney stones are
usually handled by a different type of physician known as
a urologist. -For more information visit www.davita.com
whatdoctorsknow.com
whatdoctorsknow.com
New Head Lice Treatment
Now Available
About Head Lice
Head lice are wingless parasites that feed on
human blood and live close to the human scalp.
They move by crawling and are mainly spread
by head-to-head contact, most commonly
among preschool children attending childcare,
elementary schoolchildren and the household
members of infested children. Infrequently,
transmission may occur by contact with items
recently used by an infested person, such
as clothing, brushes, towels or pillows.
Formoreinformation,pleaseseeFullPrescribingInformationfor
SkliceLotionlocatedatwww.Sklice.comorcall855-4-SKLICE.
I
n the United States, infestation with head lice is most common among preschool
children attending childcare, elementary school children, and the household members
of infested children. Although reliable data on how many people in the United
States get head lice each year are not available, an estimated 6 million to 12 million
infestations occur each year in the United States among children 3 to 11 years of age.
Sanofi Pasteur, the vaccines division of Sanofi has made its Sklice

, head
lice treatment lotion available by prescription in U.S. pharmacies. The product
is for the topical treatment of head lice infestations in patients 6 months of age
and older, and to be used as part of an overall lice management program.
Sklice Lotion was developed as an effective head lice treatment option well
tolerated in children 6 months of age and older. In clinical trials, Sklice Lotion was
proven to resolve most head lice infestations with one well-tolerated, 10-minute
application. Two weeks after the initial treatment, 71-76 percent of patients treated
with Sklice Lotion were lice-free. The most common side effects included eye
redness or soreness, eye irritation, dandruff, dry skin and burning sensation of
the skin, none of which occurred in more than one percent of treated patients.
Sklice Lotion should be used as part of an overall lice management program,
which includes washing (in hot water) or dry-cleaning all recently worn clothing,
hats, used bedding and towels, as well as washing personal care items such as
combs, brushes and hair clips in hot water. No nit combing is required; however,
if desired, a fine-tooth comb may be used to remove dead lice and nits.
Sklice Lotion contains a broad-spectrum antiparasitic agent, ivermectin,
which was developed from a soil bacterium that produces a family of
compounds (avermectins) shown to bind selectively and with high
affinity to certain ion channels present in invertebrate nerve and muscle
cells but not in mammals. The resulting increased permeability of
the cell membrane causes paralysis and death in certain parasites.
Developed by Topaz Pharmaceuticals, which was acquired by
Sanofi Pasteur in October 2011, Sklice Lotion was approved by
the U.S. Food and Drug Administration (FDA) in February
2012. Sklice Lotion is only available by prescription. Parents must
contact their health care provider before going to the pharmacy.
Sklice Lotion is a prescription medication for topical use
on the hair and scalp only, used to treat head lice in people
6 months of age and older. The product should be used as
part of an overall lice management program including:
Washing(inhotwater)ordry-cleaningallrecently
wornclothing,hats,usedbeddingandtowels.
Washingpersonalcareitemssuchascombs,
brushesandhairclipsinhotwater.
Usingafine-toothcomborspecialnitcomb
toremovedeadliceandnits.
Sklice Lotion should only be used under the direct supervision
of an adult. Avoid getting Sklice Lotion in the eyes.
whatdoctorsknow.com
Can Ethnic Background
Increase Risk?
Study reveals Blacks and Hispanics are at a higher
risk for precancerous colorectal polyps.
B
lacks and Hispanics have a
significantly higher risk of
developing precancerous
colorectal polyps compared
with whites, according
to a study by researchers
at NewYork Presbyterian Hospital/
Columbia University Medical
Center. The findings appeared in
the online edition of Alimentary
Pharmacology and Therapeutics.
Our data suggest that we need
to redouble our efforts to increase
colon cancer screening in areas with
large numbers of racial and ethnic
minorities, said lead author Benjamin
Lebwohl, MD, MS, assistant professor
of clinical medicine and epidemiology
at NewYork Presbyterian Hospital/
Columbia University Medical
Center and Columbia Universitys
Mailman School of Public Health.
The study also found that blacks
and Hispanics have a higher risk
of developing polyps in the upper
portion of the colon, compared with
whites. These lesions would have
been missed had these
patients undergone
sigmoidoscopy,
which examines only
the lower half of
the colon, said Dr.
Lebwohl. Therefore,
colonoscopy, which
examines the entire
colon, may be preferable
to sigmoidoscopy as
a screening test for
blacks and Hispanics.
Colorectal cancer
caused an estimated
51,370 deaths in 2010 the last year
for which data are available. This
type of cancer is largely preventable
if caught early, in the form of
precancerous polyps, or adenomas.
Such polyps are effectively treated
with removal during colonoscopy.
The researchers looked at rates of
advanced adenomas polyps 10 mm or
larger that exhibited aggressive features
under microscopic examination. These
are the kinds of polyps that we are
most concerned may eventually develop
into cancer, said Fay Kastrinos, MD,
MPH, assistant professor of clinical
medicine at NewYork Presbyterian
Hospital/Columbia University Medical
Center and senior author of the study.
We found that blacks and Hispanics
were roughly twice as likely to have
advanced adenomas, compared with
whites, after adjusting for factors
such as age and family history.
Previous studies had shown that
colorectal cancer incidence and
mortality are higher in blacks than in
whites, and that blacks are typically
younger at the time of diagnosis than
are whites. Little was known about the
risk of adenomas among Hispanics.
In the current study, the first to
compare adenomas in white, blacks,
and Hispanics, the investigators
analyzed data from 5,075 men and
women age 50 or older who underwent
first-time colonoscopy at NewYork
Presbyterian Hospital/Columbia
University Medical Center from 2006
to 2010. The study population was 70
percent white, 18 percent Hispanic, and
12 percent black, with a mean age of
62. None of the subjects had signs or
symptoms of colon cancer at the time
of screening. At least one adenoma was
detected in 19 percent of whites, 22
percent of Hispanics, and 26 percent
of blacks, the researchers reported.
The findings run counter to existing
statistics showing that Hispanics have
a lower rate of colon cancer compared
with whites. Surprisingly, we found
that Hispanics have a slightly higher
rate of precancerous polyps, said Dr.
Lebwohl. This adds to other recent
evidence that the rate
of colorectal cancer
among Hispanics
may be increasing
with acculturation.
Doctors generally
advise patients to get
an initial screening
test at age 50, when
overall rates of colon
cancer begin to increase.
-This information
provided courtesy of
Columbia University
Medical Center
whatdoctorsknow.com 0
Hemophilia
-TheRoyalDisease
whatdoctorsknow.com
References to excessive and unexplained bleeding have
been made since antiquity. In the Talmud, a collection
of Jewish Rabbinical writings from the 2nd century
AD, it was written that male babies did not have to
be circumcised if two brothers had already died from
the procedure. In the 12th century AD, an Arabian
physician from Cordoba named Albucasis wrote of males
in a particular village, who had died of uncontrollable
bleeding. Occasional references to bleeding can be
found in the scientific literature of following centuries.
In the U.S., transmission of hemophilia from mothers
to sons was first described in the early 19th century.
In 1803, Philadelphia physician Dr. John Conrad
Otto wrote an account of "a hemorrhagic disposition
existing in certain families." He recognized a particular
bleeding condition was hereditary and predominately
affected males. He traced the disease back through three
generations to a woman who had settled near Plymouth,
New Hampshire in 1720. The word "hemophilia"
first appeared in a description of a bleeding disorder
condition at the University of Zurich in 1828.
Having hemophilia means you may bleed for a
longer time than others after an injury. You also
may bleed internally, especially in your knees,
ankles, and elbows. This bleeding can damage your
organs and tissues and may be life threatening.
Hemophilia usually is inherited and passed from
parents to children through genes. Those born with
hemophilia have little or no clotting factor. Clotting
factor is a protein needed for normal blood clotting.
There are several types of clotting factors. These proteins
work with platelets (PLATE-lets) to help the blood clot.
Platelets are small blood cell fragments that form in the
bone marrowa sponge-like tissue in the bones. Platelets
play a major role in blood clotting. When blood vessels
are injured, clotting factors help platelets stick together
to plug cuts and breaks on the vessels and stop bleeding.
The two main types of hemophilia are A and B. If you
have hemophilia A, you're missing or have low levels of
clotting factor VIII (8). About 9 out of 10 people who
have hemophilia have type A. If you have hemophilia B,
you're missing or have low levels of clotting factor IX (9).
Rarely, hemophilia can be acquired. "Acquired
means you aren't born with the disorder, but you
develop it during your lifetime. This can happen if
your body forms antibodies (proteins) that attack the
clotting factors in your bloodstream. The antibodies
can prevent the clotting factors from working.
Hemophilia can be mild, moderate, or severe,
depending on how much clotting factor is in
your blood. About 7 out of 10 people who have
hemophilia A have the severe form of the disorder.
People who don't have hemophilia have a factor VIII
activity of 100 percent. People who have severe hemophilia
A have a factor VIII activity of less than 1 percent.
Hemophilia usually occurs in males and only about 1 in 5,000
males are born with hemophilia each year. -This information
provided courtesy of the National Hemophilia Foundation
Hemophilia (heem-o-FILL-ee-ah)
is a rare
bleeding disorder in which the blood doesn't clot normally. Often called
the "Royal Disease because Queen Victoria of England (1837-1901)
was a carrier of the hemophilia gene and passed the disease on to several
royal families. Victorias eighth child Leopold had hemophilia and
suffered from frequent hemorrhages, which were reported in the British
Medical Journal in 1868. Leopold died at the age of 31 of a brain
hemorrhage. Leopolds daughter Alice was a carrier, and her son,
Viscount Trematon was born with hemophilia. Viscount died in 1928,
of a brain hemorrhage similar to the one that killed his grandfather.
whatdoctorsknow.com
What's The Rush?
Anewapproachtofastallergyrelief.
R
ush Immunotherapy is a method for
providing rapid relief from allergies. What
is this new procedure and where does this
fit into the treatments we already have?
Seasonal or persistent nasal itching,
sneezing, runny nose, nasal congestion,
sinus headaches, postnasal drainage, sleep disturbance
because of nasal obstruction, as well as itching and
burning of the eyes (allergic conjunctivitis) affects
10-25% of people in Western countries. Pollen and
airborne substances arising from molds, animals, mites
and other insects are common causes of these problems.
Allergic reactions in the lungs result in asthma in
approximately 5% of the worlds population. Tightness
in the chest, shortness of breath, wheezing, and
coughing are common asthma symptoms. Asthma
can limit activities, disrupt sleep, and have a very
negative effect on quality of life. Acute respiratory
tract infections or exposure to allergic triggers can
cause severe or even fatal worsening of asthma.
The goals of therapy for upper airway allergic
reactions (allergic rhinitis, hay fever) include
relief from annoying symptoms, relief from
disturbed sleep, and avoidance of complications
such as middle ear infections or sinus infections.
Antihistamines, decongestants, nasal steroid sprays,
and other nasal allergy sprays often provide relief.
The goals for asthma are control of the symptoms,
prevention of limitations on activities, and
protection from severe worsening during
respiratory tract infections or exposures to allergic
triggers. Bronchodilators, inhaled steroids, oral
asthma medications, and other medications can
provide symptomatic relief for some patients.
Allergic rhinitis, allergic conjuctivitis, and allergic
asthma, often need immunotherapy (allergy shots).
These injections provide control of symptoms and then
resolution of the allergies. Currently this is the only
therapy that can actually reduce or eliminate the body's
unwanted allergic reactions to environmental substances.
whatdoctorsknow.com
Rush Immunotherapy is a new injection procedure
that is revolutionizing how we treat allergies.
Traditional immunotherapy typically involves
injections twice a week with increasing amounts of
antigens (the substances that cause the allergies).
This process usually takes 16 weeks to reach
full treatment doses (maintenance doses).
The Rush Immunotherapy revolution has centered on
the recently acquired knowledge that relief from allergy
symptoms requires lower doses of antigens than are
required to make the allergies go away entirely over
time. Research in United States and Europe has led
to Rush Immunotherapy procedures that allow us to
reach levels of antigens that begin to relieve symptoms
in one day rather than over a period of 2-3 months.
Patients are given high doses of allergy suppressing
medication to minimize reactions at the sites of
injections, or in the rest of the body. Typically 8
injections are given over a period of 5 hours and
the patients are then observed for 2 more hours
as the materials are absorbed into the body.
Rush immunotherapy can be a great convenience for
patients with demanding work
or school schedules. While the
procedure requires a full day in
the office, we avoid nearly 3/4 of
the visits needed to build up to
maintenance doses. A day in the
office also affords time for the
patient to ask questions about
allergic disease and treatment.
There is time to discuss and
demonstrate how to deal with
unexpected late allergic reactions.
As allergy symptoms improve
after Rush Immunotherapy,
patients are much more likely to
return for the final doses to build
up to maintenance. These higher
doses are required not to relieve
symptoms, but rather to gradually
eliminate or markedly decrease
the severity of the allergy itself.
Not everyone is a good candidate
for Rush Immunotherapy. If
asthma control is not stable,
if lung functions are not near
normal, Rush Immunotherapy
may not be safe.
Preschool children may be good
candidates from the point of
view of clinical improvement,
but being kept in a relatively small space can be
very difficult for them. For many patients, Rush
Immunotherapy is an alternative with several advantages
over medications alone, or traditional immunotherapy.
Any form of immunotherapy carries a risk that
the patient may have a troublesome reaction at the
injection site, or that a more severe reaction involving
the whole body may occur. This could include hives
(urticaria), swelling of the eyes, lips, or other structures
(angioedema), even anaphylaxis (reactions that cause
trouble breathing or decreases in blood pressure).
The possibility of an allergic reaction is why allergists rely
upon patient education, observation in the office after
injections, and having an emergency plan for dealing
with rare severe reactions. Rush Immunotherapy patients
are taught about the characteristics of the late allergic
reactions, are given medications to use in case of a reaction,
and are taught the use of self-injectable epinephrine.
Rush Immunotherapy provides a method for
achieving clinical improvement very rapidly and
greatly reduces the number of visits required to
achieve long lasting freedom from allergy. -Vicki
Lyons, MD and Timothy J. Sullivan, MD
Advantages of Rush Immunotherapy
Convenience for patients with limited time.
Doses of immunotherapy that begin giving relief of symptoms
can be reached in one day, rather than over 2-3 months.
The time required to reach full treatment maintenance doses is markedly reduced.
Both the patient and the doctor can quickly determine whether
or not this form of therapy will be successful.
whatdoctorsknow.com
Scientific Innovations in
Colorectal Cancer Screening
C
olorectal cancer also known
as colon cancer is one of the
most deadly cancers among
men and women in the
United States, but its also
the most preventable. Why is
it so important for people to get screened?
Colon cancer indeed remains a common and serious
disease in the U.S. with more than 143,000 new cases
diagnosed and nearly 52,000 resulting deaths each year.
Bringing this to a personal level, roughly one in every
18 Americans will get colon cancer in their lifetime if
current rates continue. The good news is that these
alarming outcomes can be avoided. Experts all agree
that colon cancers can be cured by detecting tumors
at an early stage, and that this cancer can be prevented
altogether if precancerous polyps (the forerunners of
cancer) are discovered and removed. However, because
most early stage cancers and nearly all polyps cause no
symptoms, a screening test is essential for their detection.
How does one best screen for colon cancer?
Effective screening requires a test that accurately
detects both precancerous polyps and early stage
cancer and is affordable, well-tolerated, and accessible.
Two approaches are most commonly used, each with
advantages and disadvantages. One is colonoscopy
which is very accurate but is also invasive, expensive,
whatdoctorsknow.com
requires a cleansing bowel preparation, and often
involves time away from work or daily routines. The
other is fecal occult blood testing, including the fecal
immunochemical test (FIT), which offers a noninvasive
at-home option but is less sensitive in detecting
cancer and typically misses pre-cancerous polyps.
Exact Sciences has developed a patient-friendly
alternative approach to colon cancer screeninga
noninvasive, at-home test called sDNA (or stool-based
DNA testing). It requires no bowel preparation, diet
change, or medication restriction. Importantly, studies
have shown that the sDNA test accurately detects both
early stage cancer and precancerous polyps. The Exact
Sciences test is currently for investigational use only and
is expected to be evaluated by the FDA later this year.
How does the stool-based DNA test work?
Colon cancer and precancerous polyps continuously shed
cells into stool. The sDNA test is designed to detect
specific DNA changes from those shed cells signaling
the presence of cancer or precancerous polyps. The
sDNA test also detects bleeding from cancer or polyps
which adds to the sensitivity of this test approach.
The sDNA test is simple for patients to use. A
stool sample is collected at home and then mailed
to a lab that will process the sample. If the test is
negative, your doctor will recommend when you
should next get screened. If the test is positive, a
colonoscopy should be ordered for follow-up.
Who should be screened for colorectal
cancer using sDNA testing?
According to the American Cancer Society, all
Americans age 50 to 80 should be regularly screened.
Unfortunately, only about half of the population
has ever been screened. Because of its patient-
friendly features, Im hopeful that sDNA testing
will increase the number of people who choose
to be screened and, like cervical PAP smearing,
will effectively prevent cancer and save lives.
When will the sDNA test be available?
Exact Sciences expects to submit results from
a multicenter study which included more than
12,000 patients to the U.S. Food & Drug
Administration (FDA) for approval in 2013.
How can I learn more about sDNA
testing and Exact Sciences?
To learn more, you can visit: www.exactsciences.
com. You can also check them out on Facebook
www.facebook.com/exactsciences and on Twitter @
ExactSciences. -David A. Ahlquist, MD, Mayo Clinic
1
1
Mayo Clinic has licensed technology for the sDNA test to Exact Sciences. As Dr. Ahlquist
is co-inventor of licensed technology, he would share in royalties generated from sales.
whatdoctorsknow.com
Helping Epilepsy
in Children
Minimally invasive technique
is having promising results
E
pilepsy specialists at Miami
Childrens Hospital are the
first in the Southeast--and
the second in the nation--
to offer minimally invasive
laser surgery for children
with seizures that dont respond
to anticonvulsant medications.
Approximately one in five children
with epilepsy (totaling thousands
of children a year) experience
frequent seizures that dont stop with
medication. Miami Childrens Brain
Institute has long been a leader in
helping these children with medically
resistant (or intractable) epilepsy. The
Miami Childrens Hospital (MCH)
program has been ranked among
the top programs in the nation for
pediatric neurology and neurosurgery
by U.S. News and World Report.
Due to the hospitals reputation and
its case experience with more than 850
epilepsy surgeries, the manufacturer of
a new image-guided laser technology
approached Miami Childrens in
2010 to establish protocols for
use of the new technology, called
Visualase. The first patient at MCH
was successfully operated on in May
of 2011. Prior to laser surgery, the
patient was experiencing one or two
seizures per week. Since
the procedure, she has
been seizure free for nine
months and has an excellent
prognosis, according to
Dr. Ian Miller, Director
of Neuroinformatics at
Miami Childrens Hospital,
who is spearheading the
Visualase initiative.
The Visualase system works
by placing a laser probe
at the surgical site using
stereotactic, 3D-computer
guidance in the operating
room. The patient is then
moved to the MRI scanner
where the laser removes the
target brain tissue using
heat under continuous
MRI monitoring. This
allows a very precise region
of tissue to be treated and
minimizes risk of injury to
other parts of the brain.
Doctors hope this method
(as compared to traditional brain
surgery for epilepsy) will allow a very
small incision (so that very little hair
needs to be removed), less postoperative
pain, reduced risk of infection, faster
recovery time and no need for removing
portions of the skull, which reduces
the chance of jaw problems later on.
To date, three patients have
undergone the new treatment at
Miami Childrens, including one child
who came from out of state for the
procedure. Among these children, the
longest hospital stay was three days,
compared with a seven to 10-day stay
required for conventional surgery.
Dr. Miller expressed optimism about
the technology. This is one of the
newest tools in our toolbox to help
children with epilepsy. It is perfectly
suited for small, well-defined lesions in
the brain that cause seizure activity, he
noted. He observed that there are many
causes of epilepsy in children and that
this therapy is a particularly good fit
for conditions such as cortical dysplasia,
hypothalamic hamartoma and tuberous
sclerosis. -This information provided
courtesy of Miami Children's Hospital
Twelveyear-oldJessie
Fernandezundergoes
thefirstVisualase
procedureatMiami
ChildrensHospital
Print PSA-Paul-Laura-8.5x11_Final.indd 1 3/15/12 9:44 AM
whatdoctorsknow.com
Print PSA-Paul-Laura-8.5x11_Final.indd 1 3/15/12 9:44 AM
TRUEor FALSE
?
Colorectal cancer
is the 2nd leading
cancer killer.
TRUE FALSE
Both men
and women get
colorectal cancer.
TRUE FALSE
Colorectal cancer
often starts
with no symptoms.
TRUE FALSE
You can stop
this cancer
before it starts.
TRUE FALSE
Testing for colorectal cancer can save your life.
Screening tests can find precancerous polyps so they can be
removed before they turn into cancer. Screening can also
find colorectal cancer early, when treatment is most effective.
Talk to your doctor and Screen for Life.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
1-800-000-|hF0 (1-800-232-4636) www.cdc.govlscreeoIor||Ie