February 23, 2011

You Don't Have to Live With Daily Aches and Pains!

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February 24, 2011
Bottom Line's Daily Health News
In This Issue...
  • You Don't Have to Live With Daily Aches and Pains!
  • Dramatic Improvements in Eye Care -- Retina Procedures Become Easier, Safer, Less Painful and More Effective
  • Get a Household Magic Tip-of-the Day... Free
  • Catching a Cold from Alcohol
  • Secret to Reversing Arthritis Pain

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Dramatic Improvements in Eye Care

I like to think of myself as a strong woman, but I wasn’t so tough when I scratched my cornea a few weeks back -- it was easily the most painful injury I’ve ever suffered. Fortunately, I healed fairly quickly. But the experience was awful enough that my interest was piqued by some reports I’ve seen about new procedures, including surgical ones, being performed on aging eyes. None of us is getting any younger, and I was a little horrified to think I might be vulnerable to problems that would require a doctor to do something painful to my eyes -- the good news, I learned, is that while there are many more procedures being done on adult eyes today (in part because of our aging demographic), they hurt less and help more. That’s the type of story I enjoy covering for Daily Health News.

Why So Many Eye Procedures?

Age makes us vulnerable to numerous eye problems beyond the farsightedness that is more or less inevitable by the fifth decade of life. Older people are more likely to suffer retinal tears and macular degeneration, and then there is diabetic retinopathy, which is more common with age (and, of course, even more so since we’re in the midst of a type 2 diabetes epidemic). Those facts alone account for some of the huge rise in retinal procedures, which -- according to a recent report -- have more than doubled in the past decade.

I contacted Pradeep Y. Ramulu, MD, PhD, assistant professor in the glaucoma division of The Wilmer Eye Institute at Johns Hopkins Hospital in Baltimore and author of the study that identified this surge in surgeries. We discussed the prevalence of retina problems and what people should expect if they end up having one.

Dr. Ramulu told me that there has been a notable change in how retina problems are treated. Whereas ophthalmologists used to be able to perform only a single, and not terribly effective, treatment for problems affecting the retina, patients now are more likely to undergo a series of therapies, often on an ongoing basis, that may not only slow down their vision loss but may even restore some vision!

Do What To My Eye?

After sharing my own squeamishness with the idea of getting things done to my eyes, I asked Dr. Ramulu to tell me about the new treatment techniques for retina problems...

Intravitreal injections: A poke in the eye

What it is: Medication (such as Lucentis or Avastin, which both restrict abnormal blood vessel growth) is injected, via a needle, directly into the eye in order to reach the problem areas. Anesthetic eyedrops (and sometimes injections of anesthesia) are given beforehand so that the outcome is, by all reports, apparently worth the minor discomfort. Many people (as many as 36%) actually have some of their vision restored by this procedure!

Who needs it? These injections help patients with macular degeneration (one of the most common causes of adult-onset blindness in this country), but unfortunately only the wet form, not the more common dry form. Wet macular degeneration occurs when abnormal blood vessel growth develops under the retina, in the back of the eye, leaking fluid that leads to damage and vision loss. Injections enable direct delivery of medications that fight blood vessel growth.

How it’s better: Previous treatments used lasers to obliterate new blood vessels under the retina, which could slow the destruction but not stop or reverse it. New medications, on the other hand, actually can fix some of the damage and lead to improvement in vision.

Risks: Infection, retina detachment, bleeding, cataract if the needle accidentally hits the lens of the eye -- all of which are very rare, Dr. Ramulu said.

Vitrectomy: Cutting out the gooey center of the eye

What it is: Surgical removal of the vitreous, which is the jellylike substance that makes up much of the volume of the inside of the eye.

Why do this? Vitrectomy is a preliminary procedure that ophthalmologists must perform before proceeding with the treatment of a variety of eye problems, Dr. Ramulu explained. "To do anything physically to the retina (aside from using a laser), you need to first remove the vitreous jelly in order to have space to perform surgery, among other reasons," he explained. (Note: The jelly gets replaced with saline solution, silicon oil or intraocular gas to maintain pressure both during the surgery and afterward.)

What it’s used for: Problems that necessitate vitrectomy include:
  • Detached retinas
  • Large retinal tears
  • Bleeding into the eye resulting from proliferative retinopathy (scar tissue formation on blood vessels in the retina)
  • Macular holes (literally a hole in the center of the retina responsible for the central part of your vision or in the membranes that form over the retina).
How it’s better: While vitrectomy isn’t a new procedure, it’s becoming easier for surgeons to perform (more training and better, microsized surgical instruments). The procedure can be done without suturing, which reduces the likelihood of infection and also speeds healing for the patient.

How it feels: When vitrectomy is done under local anesthesia, it is typically an outpatient procedure. Very occasionally it requires general anesthesia, and those patients may need to stay in the hospital for monitoring. The surgery typically takes one to three hours, leaving the affected eye red and sore, often for several days or longer. During recovery, patients are advised to limit head movements and avoid lifting heavy objects.

Risks: Bleeding, infection and the possibility of recurrent retinal detachment -- again, all quite rare.

If You Need Retinal Surgery

If you have retinal problems that require injection or vitrectomy, Dr. Ramulu advises seeking care from a retinal specialist, an ophthalmologist who has received special training in retina-related conditions and the techniques required to treat them. Most such specialists work in hospitals and eye-care clinics, and your ophthalmologist should be able to give you a referral.

Even if your eyes are fine so far, it’s important to know the signs of macular degeneration and retinal tears/detachment so that you can, if needed, seek treatment right away. Symptoms that indicate you should see an eye doctor soon include seeing a new floater (a dark, floating shape in your field of vision) or if you suddenly see flashes of light. Dr. Ramulu said that most people who have these two symptoms don’t have serious problems, but cautioned that it is always wise to make sure that there is no tear or detachment of the retina. Clear signs that you should see an ophthalmologist immediately, on the other hand, include sudden partial or complete loss of your field of vision, such as a "curtain" that suddenly appears over a part of your visual field.

Source(s):

Pradeep Ramulu, MD, MHS, PhD, assistant professor of ophthalmology, The Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore.

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Catching a Cold from Alcohol

Given how often we hear reports on the health benefits of drinking moderate amounts of alcohol -- including wine and beer -- I think people may be surprised to hear about a spate of studies showing that even what many would consider moderate alcohol intake (two to three glasses of wine a day, for instance) may raise your susceptibility to infectious diseases while also slowing your body’s ability to repair a bone fracture or heal a wound.

Alcohol Impairment

These findings and others were reported at a recent conference of the Alcohol and Immunology Research Interest Group at Loyola University Medical Center near Chicago. I got an early report on the event from Elizabeth J. Kovacs, PhD, director of the University’s Alcohol Research Program. According to Dr. Kovacs, the findings center on one key fact of biology -- alcohol impairs the ability of most immune cells to do their jobs.

Dr. Kovacs explained that all immune cells are produced in the bone marrow -- some then get sent to other parts of the body. So it’s not entirely surprising to learn that one group of findings centers on bone health. One of the ongoing studies (by Dr. Kovac’s colleague John J. Callaci, PhD) reveals that excessive alcohol consumption during adolescence may lead to brittle bones later in life, while another study suggests that this also may be true in adults, as alcohol slows fracture repair.

Another form of immune damage: Since specific immune cells "remember" specific viruses, they’re involved in giving us long-term immunity against flu and other diseases. Dr. Kovacs said that research has now demonstrated that moderate drinking increases susceptibility to infection and disease due to weakened immune cells. Other studies link alcohol intake to slow healing, not only from accidental injuries but also surgical procedures.

How Much Is Too Much?

You probably want to know how much alcohol it takes to cause these problems, but there’s no clear and reliable answer to that question as yet. According to Dr. Kovacs, the National Institutes of Health recommends that women should drink no more than seven drinks a week and men no more than 14 (barring any binge drinking, of course). However, she said, even that amount may not be safe for a person who is taking medication... elderly... ill with hepatitis or diabetes or any of a long list of other sicknesses... or for a woman who is pregnant or for a person who almost never drinks alcohol.

I asked Dr. Kovacs whether there’s anything one can do to reverse the effects alcohol may already have wrought to his/her health. She explained that when you stop drinking, white blood cells that help the body heal itself may recover in a few weeks. But, she said, regarding the damage drinking does to the ability of immune cells to quickly respond to pathogens, the time line is quite different -- it can take many months.

I had one more question for Dr. Kovacs -- is there any way to fortify the immune system against the effects of alcohol? Not really, she said -- noting that while a good diet, exercise and adequate sleep are helpful in supporting your immune system, "even these aren’t a bulwark against alcohol." Bottom line -- let’s take it easy on alcohol.

Source(s):

Elizabeth J. Kovacs, PhD, professor and vice chair of research at the department of surgery at the Stritch School of Medicine of Loyola University Medical Center in Maywood, Illinois. She is also a professor at the school’s department of microbiology and immunology, director of the Alcohol Research Program and director of research at the Burn and Shock Trauma Institute.

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Be well,


Carole Jackson
Bottom Line's Daily Health News


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