Sunday, December 18, 2011

Botox for Hair Loss?

Botulinum toxin A (Botox) is used to treat wrinkles, excessive sweating and headaches. A new study from Canada shows that it might be useful to male-pattern baldness. The pharmaceutical company that manufactures the product paid for the study and the exact methods have not been revealed, citing intellectual property rights.
Fifty men had botulinum toxin A injections to their scalp muscles, followed by a second session twenty-four weeks later. Assessment included change in hair counts in a 2-cm scalp area, changes in hair loss counts collected by lint roller from the subject's pillow, and patient responses to a questionnaire.
In the 40 patients who completed the study, after 48 weeks mean hair counts increased 18% from baseline, a statistically significant change. Hair loss was also significantly reduced, by a mean of 39%. The reduction in hair loss and increase in hair counts were not correlated. The treatment response rate was 75%. The subjects noted statistically significant increased hair growth. No adverse events were noted.
In this study, each patient received 150 units of botulinum toxin A. When bought in large quantities, a very good wholesale price is $365/100 units. Most medical practices double or triple the wholesale cost, not unlike a retail store mark-up. There is no indication as to how long the beneficial effects lasted. When used for wrinkle reduction, the effect of botulinum toxin A lasts four to six months. 

Tuesday, December 13, 2011

NIH panel advocates delaying treatment for low-grade prostate cancer

Men with localized, low-risk prostate cancer should be closely monitored until disease progression warrants treatment, concluded an independent panel of the National Institutes of Health.

The panel identified emerging consensus in the medical community on a definition for low-risk prostate cancer including a prostate-specific antigen (PSA) level less than 10 ng/mL and a Gleason score of 6 or less. Using this definition, the panel estimated that more than 100,000 men diagnosed with prostate cancer each year would be candidates for active monitoring rather than immediate treatment. About 10% of men who are eligible for active surveillance choose it, most often because of physician recommendation. About a quarter of patients who choose observation will subsequently undergo therapy within two to three years, and about half by five years.

"Predicting whether a particular individual's cancer will progress is difficult," the report states. "The only clear current indicator of disease progression is an increase in Gleason score. The value of PSA doubling time is uncertain. New indicators of disease progression are needed, potentially including imaging techniques to identify clinical important tumors, molecular classification of cancers, and genetic classification of a patient's risk for progression."

Finally, because of the very favorable prognosis of PSA-detected, low-risk prostate cancer, the panel recommended that strong consideration be given to avoiding the term "cancer" when talking to patients, because of the anxiety it creates.

Saturday, December 10, 2011

app-solutely fabulous

Here is a terrific app designed to teach patients about the complexities of managing diabetes. Created by QuantiaMD in partnership with the University of California, San Francisco, DiabetesIQ is available for iPhone, iPod touch, iPad, or Android phone or tablet.

This app uses a quiz-show type format wherein players answer multiple-choice answers about diabetes and compare their answers in real time to other app users. As players complete quizzes they advance through multiple game levels. They also gain access to specific resources that are available at USCSF such as a carbohydrate exchange guide, a food exchange guide, a food exchange list and exercise recommendations.

It’s hard to make time for health education – but people spend plenty of time with their smart phones. This is an easy and fun way to get short bursts of information.

To download via the app store: DiabetesIQ

Wednesday, December 7, 2011

Flu Activity, 2011 Week 48

As of the week ending December 3, 2011, fifteen case of flu in were reported in Connecticut; there have been three cases in Fairfield County (one each in Fairfield, Norwalk and Stratford). The surrounding states also report minimal activity. During week 47 (ending November 26, 2011), 1.9% of surveillance cultures collected nation-wide were positive for flu. 

Sunday, December 4, 2011

Every Little Bit Helps

The benefits of leisure time physical activity are well known. Studies have show that 150 minute per week of vigorous exercise prolongs life expectancy. A recent study in Taiwan shows even less activity has a good effect.

Compared to inactive individuals, those who exercise as little as fifteen minutes per day had a 14% reduction in all-cause mortality and had a three year longer life expectancy. Each additional fifteen minutes of daily exercise beyond the first fifteen further reduced all-cause mortality by 4% and all-cancer mortality by 1%. These results were applicable to all age groups and both sexes.

Regular exercise has a big impact in reducing heart disease. Being active increases HDL cholesterol (“good” cholesterol) and decreases unhealthy triglycerides. Moderate activity, such as walking at a brisk pace, is safe for most people. However, if you have chest pain, shortness of breath, muscle pain or dizziness with your usual activities you should check with your physician before starting an exercise program.

There are some special considerations with cold weather exercise: dress in layers so that you can stay comfortable as you generate heat. Be sure to protect your hands, feet and ears from frostbite. There are few hours of daylight and the sun is low in the sky – consider wearing a reflective vest, even for a short stroll. And always carry a cellphone!

Anyone can devote just fifteen minutes daily to walking. Here is a walking journal to help get started. 

Sunday, November 27, 2011

Hip Impingement

Hip impingement is increasingly recognized as a common cause of hip pain in athletes, adolescents, and young (less than age 50) adults. The hip is a ball and socket joint with a wide range of motion, stabilized by a capsule, surrounding muscles and cartilage (the labrum). Hip impingement happens when the ball hits the edge of the socket due to structural mismatch. This causes injury to the cartilage and can lead to hip arthritis if untreated. While activity increases symptoms, this is not due to overuse.

Activities that are troublesome include prolonged sitting, leaning forward, getting in or out of a car or pivoting in sports. People are predisposed to impingement by congenital or development abnormalities. The onset of pain is usually gradual and progressive. Since the normal activities of daily living cause pain, it’s not helpful to recommend rest. Anti-inflammatory medications can sometimes be helpful and it’s wise to try physical therapy to improve hip muscle flexibility and strength, as well as posture. Success with these measures may be due to the young age of the patients. If these measures do not give adequate relief, consultation with an orthopedist is needed as well as imaging studies.

Arthroscopy can give good results. The goals are to alleviate impingement, to repair or remove injured tissue and to prevent or delay osteoarthritis.

Wednesday, November 16, 2011

The Binge Season

Who doesn’t love comfort food? Unfortunately, the American population is far too comfortable. Americans love to eat and drink and at this time of the year there are fewer opportunities to be physically active. 

The binge season (Thanksgiving through New Year’s) is a good time to really pay attention to what we eat and much we consume. No one gained weight from eating too much turkey – it’s the second helpings of everything else that are deadly. Not only do we all eat too much but we drink too much as well. Non-alcoholic beverages can pack a huge caloric punch (be sure to be seated when reading the nutrition label on the eggnog).  

We need to set better examples for our children. Today, two-thirds of adults and nearly one in three children are overweight or obese. It is certainly not easy but we need to save ourselves and our children.

Enjoy the holidays and enjoy your food – just enjoy a little less food.

To get started:

Healthy Eating: Make It Happen

Losing Weight

Tuesday, November 8, 2011

2011-2012 Influenza Season Week 43

Flu activity is minimal across the United States and there has not yet been confirmed influenza in Connecticut as of the week ending October 29. This is certain to change in the coming weeks. Flu shots are plentiful and easy to obtain. There are very few people who should not be immunized – almost everyone should have a flu shot.