Tuesday, May 28, 2013
Matthew McConaughey on set in New Orleans
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Can stapedectomy surgery reverse my hearing loss?
I’ve been gradually losing my hearing. My doctor says he can restore my hearing with a procedure called stapedectomy. Can you tell me about it?
To answer your question, I need to explain how you hear. It is an amazing process. Sound travels in waves through the air into your ear canal. Inside the ear canal, the sound waves are amplified. The waves strike your eardrum. The eardrum is a thin membrane, similar to the wall of a balloon.
Right behind the eardrum is a group of tiny bones called ossicles. When the sound waves cause the eardrum to vibrate, the vibration is transmitted to the tiny bones. These bones then transmit the vibrations through fluid in a part of your inner ear called the cochlea. Inside the cochlea are tiny hairs. Vibrations in the fluid are transmitted to the hairs. When the hairs vibrate, signals are sent up the main nerve for hearing. Those signals then land in a part of the brain where the signal is received and interpreted.
Why is the way we hear so complicated? Don’t ask me, I didn’t design it. But I count myself lucky every day that I can hear.
Not surprisingly with such a complex process, many things can go wrong. For example, hearing loss can occur when something blocks sound waves from passing through the outer or middle ear. The source of the obstruction can be any number of things: earwax, fluid, inflammation, a cyst or other abnormal growth, or something accidentally lodged in the ear. Not unexpectedly, this happens more often in infants than in adults. But I once saw a man in his 50s who was having trouble hearing in his left ear. It turned out he had the cotton from the end of a Q-tip stuck inside his ear canal.
The obstruction can also be caused by otosclerosis, which is most likely the cause of your hearing loss. Otosclerosis is the abnormal growth of the tiny ossicle bones. It usually occurs on the stapes, the smallest ossicle in the middle ear. Hearing loss occurs because the stiffened stapes can no longer vibrate and pass sound waves from the ear canal to the inner ear.
Stapedectomy can correct otosclerosis. Working through the ear canal, the surgeon removes all or part of the stapes. He or she replaces it with an artificial stapes that can vibrate. (I’ve put an illustration of this procedure below.)
An abnormal bone growth, as shown in the top figure (A), sometimes prevents the stapes from vibrating and passing sound waves to the inner ear. To correct this condition, the surgeon removes the stapes bone and replaces it with a prosthesis (B). After surgery, sound waves pass through the eardrum, vibrating it. The vibrations pass to the malleus and then the incus, which is connected to the prosthesis. These vibrations cause the prosthesis to move, and the sound waves pass into the inner ear.
A major risk of stapedectomy is hearing loss, which can be total. Some doctors will not operate until the hearing loss is great enough to justify the risks of surgery.
With newer techniques and materials, the risks of this operation are not as great as they used to be. Still, it’s important to discuss the risks and benefits with your doctor. If you decide to go ahead with it, choose a surgeon who performs this operation frequently.
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FDA Approves New Drug to Fight Advanced Prostate Cancer
By EJ Mundell
HealthDay ReporterWEDNESDAY, May 15 (HealthDay News) -- The U.S. Food and Drug Administration announced Wednesday that it has approved a drug to help men with advanced prostate cancer whose disease has spread to the bones.
The drug, Xofigo, is targeted to patients with late-stage, metastatic disease that has spread to the bones but not to other organs, the FDA said in a news release. It is meant for patients who have already undergone surgery and/or drug therapies such as hormone-based treatments.
The FDA said Xofigo was approved more than three months ahead of the original August 2013 deadline the agency had set for a complete review. Instead, the drug was reviewed under the agency's "priority" review program, designated for medicines that appear safe and effective in a context where no good alternative therapy exists.
"Xofigo binds with minerals in the bone to deliver radiation directly to bone tumors, limiting the damage to the surrounding normal tissues," Dr. Richard Pazdur, director of the Office of Hematology and Oncology Products in the FDA's Center for Drug Evaluation and Research, explained in the news release.
In a clinical trial involving more than 800 men with symptomatic prostate cancer that was resistant to hormonal therapy and had spread to the bones, men on Xofigo survived a median of 14 months compared to a little over 11 months for men taking a placebo. Side effects from Xofigo included nausea, diarrhea, vomiting and swelling of the legs and feet. Low levels of red and white blood cells, as well as platelets, were also reported among some patients taking Xofigo, the FDA said.
Pazdur noted that "Xofigo is the second prostate cancer drug approved by the FDA in the past year that demonstrates an ability to extend the survival of men with metastatic prostate cancer." The other drug, Xtandi, was approved by the FDA last August for men with hormone treatment-resistant prostate cancers that have spread or recurred, and who had previously been treated with the drug docetaxel.
According to the American Cancer Society, prostate cancer remains the leading cancer type among men outside of skin cancer, and about one man in every six will develop the illness during his lifetime. Caught early, it is often curable. About 239,000 new cases of prostate cancer are diagnosed among American men each year, and nearly 30,000 men die from the disease annually.
Xofigo is co-marketed in the US by Wayne, N.J.-based Bayer Pharmaceuticals and Algeta US of Cambridge, Mass.
Please help!!
hey everyone I need some input REALLY bad. ok so I was off work for a while, sat around and was really lazy only walking and basic needs. I ate 2200 calories and I never gained weight. I now have been working midnights at a grocery store. I carry lots of heavy boxes and our night crew is waay understaffed so we all work super fast and even run around alot. I weighed my self last week and I was 110 pounds. I have not been on the scale since I started work so dont really know if I lost weight. I weighed myself today and was 108 pounds. does that mean I burned 7000 extra calories last week? and does that mean I need to eat 1000 more calories a day just to maintain. oh and my stats are male, 110 pounds, 5'5, and 20 years old. I REALLY need to know if i should be eating more and how much more? please help!
Sienna Miller on the street in NY
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So I tried to not log my food...
Well, I guess I'm not ready. I gained two real pounds over 2 weeks, ( not water or food matter or poop)
I had been writing down what I ate in a journal without the calorie counts.
I over ate almost everyday without knowing it.
So, I need to pay more attention to portion sizes. This way I can stop logging all the time. :)
Chronic Heartburn May Raise Odds for Throat Cancer: Study
By Steven Reinberg
HealthDay Reporter
THURSDAY, May 23 (HealthDay News) -- People who suffer from frequent heartburn may be at increased risk for cancers of the throat and vocal cords even if they don't smoke or drink alcohol, a new study says.
Interestingly, common over-the-counter antacids seemed to protect against these cancers while prescription medications such as Prilosec, Nexium and Prevacid didn't, the researchers said.
"There has been a controversy about whether heartburn contributes to cancers of the larynx or pharynx," said lead researcher Scott Langevin, a postdoctoral research fellow at Brown University in Providence, R.I.
"And we found out that it does elevate the risk of these cancers. There is about a 78 percent increase in the risk for cancer in people who experience heavy heartburn," he said. "This is important in figuring out who to monitor more closely."
The other finding, which Langevin called "surprising," was the protective effect of common antacids in reducing the risk of cancer.
"We didn't see that protective effect with prescription medications. But it should be noted that people who take them are those who get the worst heartburn, so we shouldn't read too much into that," he said.
Langevin added that it's hard to explain that medication finding, and other studies will be needed to see if it's really the case. "It's possible that these drugs didn't have that protective effect because these were the worst cases of heartburn," he said.
The report was published May 23 in the journal Cancer Epidemiology, Biomarkers & Prevention. And while it uncovered an association between heartburn and cancer of the throat and vocal cords, it didn't prove a cause-and-effect relationship.
Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society, said "the study shows that reflux is associated with an increased incidence of cancers of the larynx and pharynx."
Lichtenfeld said the role of antacids in reducing the risk of cancer needs more study. "Researchers need to determine why antacids work and, more importantly, whether antacids make a difference in also reducing cancer of the esophagus," he said.
Why other medications didn't lower the risk isn't clear, Lichtenfeld said. And it points to one limitation of this type of study: It can't take into account all the variables.
To come to their conclusions, Langevin's group compared more than 600 patients with throat or vocal cord cancer with more than 1,300 people without a history of cancer. All the patients answered questions about their history of heartburn, smoking and drinking habits, and family history of cancer.
In addition, since some head and neck cancers are caused by the human papillomavirus (HPV), the researchers tested all the participants for antigens to the virus.
The researchers found that among those who weren't heavy smokers or drinkers, frequent heartburn increased the risk for cancers of the throat and vocal cords by 78 percent.
The researchers also found that taking antacids -- but not prescription medications or home remedies -- reduced the risk for these cancers by 41 percent. The protective effect of antacids was independent of smoking, drinking or infection with HPV, they said.
New Analysis Says Evidence Lacking for HRT-Breast Cancer Link
By Kathleen Doheny
HealthDay ReporterTHURSDAY, March 14 ( HealthDay News) -- Although several large studies in recent years have linked the use of hormone therapy after menopause with an increased risk of breast cancer, the authors of a new analysis claim the evidence is too limited to confirm the connection.
Dr. Samuel Shapiro, of the University of Cape Town Medical School in South Africa, and his colleagues took another look at three large studies that investigated hormone therapy and its possible health risks -- the Collaborative Reanalysis, the Women's Health Initiative (WHI) and the Million Women Study.
Together, the results of these studies found overall an increased risk of breast cancer among women who used the combination form of hormone therapy with both estrogen and progesterone. Women who have had a hysterectomy and use estrogen-only therapy also have an increased risk, two of the studies found. The WHI, however, found that estrogen-only therapy may not increase breast cancer risk and may actually decrease it, although that has not been confirmed in other research.
After the WHI study was published in July 2002, women dropped hormone therapy in droves. Many experts pointed to that decline in hormone therapy use as the reason breast cancer rates were declining.
Not so, Shapiro said: "The decline in breast cancer incidence started three years before the fall in HRT use commenced, lasted for only one year after the HRT drop commenced, and then stopped."
For instance, he said, between 2002 and 2003, when large numbers of women were still using hormone therapy, the number of new breast cancer cases fell by nearly 7 percent.
In taking a look at the three studies again, Shapiro and his team reviewed whether the evidence satisfied criteria important to researchers, such as the strength of an association, taking into account other factors that could influence risk. Their conclusion: The evidence is not strong enough to say definitively that hormone therapy causes breast cancer.
The study is published in the current issue of the Journal of Family Planning and Reproductive Health Care.
The new conclusion drew mixed reactions from experts.
In an editorial accompanying the study, Nick Panay, a consultant gynecologist at the Queen Charlotte's & Chelsea Hospital in London, supported the conclusions of the new analysis. "If there is a risk, the risk is small, and the benefits of HRT can be life-altering," he wrote. "It is vital that we keep this in perspective when counseling our patients."
The hormone therapy in use today, Panay said, is lower in dose than those used in the previous research. "In principle, we tend to start with lower doses than we used to and increase as required until full symptom relief has been achieved," he said.
Ryan Gosling in The Place Beyond The Pines
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Costlier Heart Device May Not Be Worth It, Study Suggests
By Brenda Goodman
HealthDay ReporterTUESDAY, May 14 (HealthDay News) -- Patients prone to dangerously fast heart rhythms may get just as much help and have fewer complications with less-expensive implanted defibrillators that run one wire to the heart instead of two, a new study shows.
Implantable cardioverter defibrillators, or ICDs, are like having an emergency "crash cart" in the chest. The devices can sense runaway heart rhythms and deliver powerful shocks to jolt the heart back to a normal, steady pace.
Studies have shown that the devices cut deaths in patients at risk for sudden cardiac arrest because their heart muscles are too weak to effectively pump blood throughout the body, a condition called cardiomyopathy.
But little evidence exists to help doctors decide when it's better to choose a single-chambered ICD for patients or the more complex dual-chambered model.
The study, published in the May 15 issue of the Journal of the American Medical Association, compared the fates of more than 32,000 Medicare patients who received ICDs, from 2006 through 2009. None of the patients also needed a pacemaker, a device that speeds up a slow heartbeat.
"There is evidence for greater risk of complications. Not clear evidence of benefit. That risk-benefit ratio really doesn't support the routine use of dual-chamber devices for primary prevention," said study co-author Dr. Pamela Peterson, an associate professor of medicine at the University of Colorado at Denver.
About one-third of patients received a single-chamber ICD, in which an electrical lead is attached to the heart's lower right pumping chamber. The other two-thirds got dual-chamber devices, in which wires are attached to the upper and lower chambers of the heart's right side.
After a year, patients who got single-chamber ICDs were no more likely to die or be hospitalized than patients who got the more expensive dual-chamber models. They were, however, slightly less likely to face serious complications, including fluid build-up around the heart or lungs and mechanical problems with the device that required a second surgery to fix.
That was true even after researchers adjusted their results to control for any differences between patients who got single- and dual-chamber devices.
Overall, close to 4 percent of patients with single-chamber ICDs had complications with their devices compared to about 5 percent of patients with dual-chamber models, the investigators found.
The study was observational, which means researchers couldn't prove that the type of ICD was the only reason patients fared the way they did. Though they tried to carefully control their data for important differences between the two groups, other factors they couldn't measure, such as medications people were taking, may have influenced the results.
The study was funded by a grant from the U.S. Agency for Healthcare Research and Quality.
How should I "up" my calories?
Skies Not-So-Friendly for Passengers With Nut Allergies
By Robert Preidt
HealthDay ReporterFRIDAY, March 15 (HealthDay News) -- For most passengers, airline travel is safer than ever these days. But for people with peanut or tree-nut allergies, a routine flight can end in disaster.
Many airlines still serve peanuts and tree nuts, or snacks and meals that contain these products, which can cause severe reactions in allergic travelers.
An international online survey completed by 3,200 passengers revealed that 349 had suffered an allergic reaction during an airline flight, according to a new study.
Although the risk of an in-flight reaction is small, "it's hard to imagine a more helpless situation than having a reaction while you're at 35,000 feet in an airplane," lead study author Dr. Matthew Greenhawt, of the Food Allergy Center at the University of Michigan, said in a university news release.
"This study identifies some things passengers can do to reduce their anxiety," Greenhawt said. "We want them to fly. It can help improve their quality of life."
Passengers who took certain precautions were much less likely to have suffered an allergic reaction while flying, the study authors found. These measures included:
Requesting any type of allergy-related accommodationRequesting a peanut/tree nut-free mealCleaning their tray table with a sanitizing wipeAvoiding use of airline pillows and blanketsRequesting a peanut/tree nut-free buffer zoneRequesting that other passengers not eat products with peanuts or tree nutsNot eating airline-provided foodThe study was published in the March issue of the Journal of Allergy and Clinical Immunology-In Practice.
"Flying with a peanut/tree nut allergy is equal parts frustrating and frightening for allergic passengers," said Greenhawt. These passenger-initiated behaviors may help concerned patients planning to fly commercially, he added.
Another finding of the study was that a common and effective treatment for severe allergic reactions -- epinephrine -- is underused on airline flights. Only 13 percent of the passengers who suffered an allergic reaction received epinephrine.
"Despite that 98 percent of passengers had a personal source of epinephrine available, epinephrine was underused to treat a reaction," Greenhawt said. "Flight crews were not always readily alerted to reactions when they occurred [50 percent of cases], but interestingly, when they were notified, it was associated with a higher odds that epinephrine was used to treat the reaction."
He said he hopes the findings inspire airlines to consider how they could work with passengers to reduce risk. Perhaps one solution is to train crew to be more proactive, Greenhawt concluded.
Antibiotics May Relieve Back Pain Symptoms
WebMD Health News
May 10, 2013 -- Taking antibiotics could relieve symptoms of chronic lower back pain for up to 40% of people, according to a new study.
Danish researchers say they've found a link between many cases of back pain and infection from bacteria.
Some experts have questioned how many people are likely to benefit from this treatment. Others have cautioned that boosting antibiotic use in the face of growing resistance could be counterproductive and lead to more superbugs.
Back pain is a common condition, affecting about 4 out of 5 people at some point in their lives.
Recommended treatments include painkillers, hot or cold compresses, lifestyle changes, physical therapy, and keeping active. In extreme cases, when other treatments have failed, surgery may be carried out to remove part of a damaged disc.
The latest studies from the University of Southern Denmark build on previous research, which shows that between 7% and 53% of patients with herniated discs have a type of bacteria. In these patients the bacteria entered the disc at the time it was herniated, or "slipped."
In the first study of 61 patients who had spinal surgery for lower back pain, the researchers found bacteria in 46% of the slipped discs.
In a second study, the research team recruited 162 patients who had been living with low back pain for more than 6 months following a slipped disc. Half of the patients were given a 100-day course of antibiotic treatment, while the others received a placebo.
After a 1-year follow-up period, those who'd taken antibiotics were less likely to still have lower back pain and physical disability. They were also less likely to have leg pain and to have taken days off work because of their back.
The researchers estimate that about 35% to 40% of people with long-term back pain have excess fluid in the spinal vertebrae and might benefit from this type of treatment.
The findings are published in the European Spine Journal.
Media reports that antibiotics could be a cure for back pain have alarmed John O'Dowd, a consultant spinal surgeon and president of the British Society for Back Pain Research.
"Unless you've had a disc herniation ... I don't think you should be getting too excited, and I don't think this is going to be a treatment for you," O’Dowd says. "I think this is another useful building block of evidence, but I don't think it's either a cure or the answer to back pain."
CT Scans Reduce Lung Cancer Deaths, Study Confirms
By Randy Dotinga
HealthDay ReporterWEDNESDAY, May 22 (HealthDay News) -- Physicians weighing the benefits and risks of CT scans for detecting lung cancer now have more information to help with the decision. A new analysis of a 2010 U.S. study finds that low-dose CT scans pick up significantly more lung tumors than chest X-rays do.
People with a long history of smoking are at high risk for lung cancer, the deadliest form of cancer in the United States. But doctors have to consider the potential harm of radiation exposure when ordering screening. The initial 2010 trial suggested that the low-dose CT scans can save lives, but they're not yet routine and insurers typically don't pay for them.
"There's a whole bunch of stuff that has to be worked out," said Dr. Norman Edelman, chief medical officer of the American Lung Association. This includes the prospect of expanding screening to a wider group and relying on radiologists less experienced than those who reviewed the lung scans in the initial study.
Already, some medical centers are offering CT lung scans below cost, at $200 or $300, apparently in the hope that they'll recoup their loss by detecting suspicious nodules in the lungs of patients, he said.
About 158,000 people die from lung cancer in the United States each year, often because it's detected too late for effective treatment. The new analysis of the 2010 study indicated that by identifying malignancies sooner, low-dose CT scans will reduce the death tally.
Who should get screened is a question that must be addressed, said Dr. Otis Brawley, chief medical officer and executive vice president of the American Cancer Society. "Everyone wants to jump toward screening as an answer," Brawley said.
The initial study involved 53,000 current and former heavy smokers, aged 55 to 74, who underwent a CT scan or chest X-ray every year for three years, starting in 2002.
By 2010, the death rate among those who got the CT scans was 20 percent lower than for those who got X-rays.
CT scans revealed potential signs of cancer in 27 percent of those scanned, compared to 9 percent of people who got X-rays, the researchers found. In both groups, about 91 percent had at least one more test.
Most of those suspicious spots and nodules weren't actually cancerous.
After follow-up, lung cancer was diagnosed in 1.1 percent of the patients in the CT group and 0.7 percent of the X-ray group, the researchers reported in the May 23 issue of the New England Journal of Medicine.
The CT scans were much more likely to pick up lung cancer in its early, more treatable stages: stage 1 cancer was found in 158 CT scan patients versus 70 X-ray patients, according to the study.
Ryan Gosling in a film still from The Place Beyond The Pines
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Can You Reverse Type 2 Diabetes?
WebMD Feature
The idea of "reversing" type 2 diabetes through lifestyle changes is appealing.
It's true that exercise and healthy eating habits should be a part of every diabetes treatment plan and can make a big difference. But there's more to it than that.
Sometimes those habits will turn your diabetes around, but this depends on the severity of the disease, how long you've had it, and your genes.
It's a myth that type 2 diabetes is only about lifestyle or obesity.
True, most people with type 2 diabetes are overweight or obese, but thin people can get type 2 diabetes, too.
Also, "not everybody with obesity gets diabetes. The ones that get it have a genetic predisposition," said Yehuda Handelsman, MD, a past president of the American Association of Clinical Endocrinologists.
It's not just your genes, or just your lifestyle, that counts. They both matter and affect each other.
"The saying goes that genes load the gun and lifestyle pulls the trigger," says Ann Albright, PhD, RD, director of the CDC's division of diabetes translation.
Because of that connection between genes and lifestyle, diet and exercise alone aren't a guaranteed "cure" for everyone with type 2 diabetes.
What you mean by "reversing" type 2 diabetes also matters. If it means you no longer need medication to control your blood sugar, that's possible with hard work and dedication.
However, if you mean undoing any and all damage that diabetes did to your body, that may be less likely.
Of course, there's no downside to trying, and a lot of potential benefit. Just keep your goals realistic because you need to make those changes last.
Losing extra weight can help you better control your blood sugar. For some people, this will mean taking fewer medications, or, in rarer cases, no longer needing those medications at all.
It needs to be a permanent change.
"The term ‘reversal' is used when people can go off medication, but you still must engage in a lifestyle program in order to stay off the medication. That is a part of treatment," Albright says.
Experts recommend losing 5% to 10% of your body weight and building up to 150 minutes of exercise per week to try to slow or stop the progress of the disease.
If you're not even close to that amount of exercise, start where you are and build up.
"If you sit sedentary most of the day, five or ten minutes is going to be great," Albright says. "Walk to your mailbox. Do something that gets you moving, knowing that you're looking to move towards 30 minutes most days of the week."
In one study, people with type 2 diabetes exercised for 175 minutes a week, limited their calories to 1,200 to 1,800 per day, and got weekly counseling and education on these lifestyle changes. Within a year, just over 10% were able to get off their diabetes medications or improved to the point where their blood sugar level was no longer in the diabetes range, and was instead classified as prediabetes.
Your Pooch Could Raise Your Home's Bacteria Count
By Mary Elizabeth Dallas
HealthDay ReporterWEDNESDAY, May 22 (HealthDay News) -- Man's best friend may bring millions more microscopic pals into the average human home, a new study suggests.
Researchers from North Carolina State University and the University of Colorado found that homes with dogs have more bacteria than other homes, including germs rarely found in households without dogs.
"We can tell whether you own a dog based on the bacteria we find on your television screen or pillowcase," study co-author Rob Dunn, associate professor of biology at NC State, said in a university news release.
The researchers involved 40 homes. Dunn and his colleagues wiped nine of the common surfaces in these residences -- TV screens, kitchen counters, toilet seats, refrigerators, pillowcases and door handles -- with sterile swabs to determine the types and amount of bacteria present.
The researchers found more than 7,700 types of bacteria in the homes, with unique groupings of bacteria depending on the location tested. For instance, bacteria found in refrigerators, on kitchen counters and on cutting boards were usually similar since they all related to food. The bacteria on doorknobs, pillowcases and toilet seats were also similar, but came more often from humans.
"We leave a microbial 'fingerprint' on everything we touch," Dunn explained. "Sometimes those microbes come from our skin, sometimes they're oral bacteria and as often as not they're human fecal bacteria."
But what about differences between houses? "The biggest difference we've found so far is whether you own a dog," Dunn said. "For example, there are bacteria normally found in soil that are 700 times more common in dog-owning households than in those without dogs."
The study showed bacteria in homes can be grouped into three "habitats" or categories: places people touch, places touched by food and places that collect dust. The researchers pointed out the bacteria found on pillowcases in two different homes is likely more similar than bacteria found in the same home but in another "habitat."
"This makes sense," Dunn added. "Humans have been living in houses for thousands of years, which is sufficient time for organisms to adapt to living in particular parts of houses. We know, for example, that there is a species that only lives in hot-water heaters. We deposit these bacterial hitchhikers in different ways in different places, and they thrive or fail depending on their adaptations."
The study was published May 22 in the journal PLOS ONE. The researchers plan to conduct a larger study involving another 40 homes as well as samples from a national survey of 1,300 homes across the country.
"The larger sample size will help us better understand the range of variables that influence these microbial ecosystems," Dunn said. "Does it matter if you have kids or live in an apartment? We expect the microbial populations of homes in deserts to be different from the populations of homes in Manhattan, but no one knows if that's true. We want to find out."