April 4, 2011

Germs on Your Shoes

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April 5, 2011
Bottom Line's Daily Health News
In This Issue...
  • The Natural Way to Promote Healthy Blood Pressure!
  • How Stents May Help MS  
  • Drug-Free Treatment Reverses Even Bone-on-Bone Arthritis...
  • Keep Germs From Walking Through Your Home
  • Really Big Laugh

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How Stents May Help MS

Multiple sclerosis (MS) has been incurable and intractable for so long that there was a collective gasp from the medical community in 2009 when an Italian vascular surgeon, Paolo Zamboni, MD, published a study in the Journal of Vascular Surgery describing a new surgery that, he said, relieved two major MS symptoms -- fatigue and brain fog -- and also might help ameliorate other symptoms as well, including improving energy level.

If you have or know someone who has MS, you might have picked up on this apparent breakthrough back then -- but curiously there has been little said about it in the mainstream health media since the announcement. Even many people who follow health news closely wouldn’t be able to say whether Dr. Zamboni’s procedure has really turned out to be a godsend for MS patients. This disease of the central nervous system is so widespread and so insidious, it’s definitely time we found out -- so let’s see where things stand right now.

A Controversial Matter

Some doctors believe that stenosis (narrowing) of the principle veins that carry blood from the brain, a condition that is also known as chronic cerebrospinal venous insufficiency (CCSVI), slows drainage of the blood from the brain and spinal cord, and even causes the blood to reflux back into both. And some think that, left uncorrected, the reflux may lead to oxygen deprivation and iron deposits in the brain tissue and theorize it may contribute to -- or even cause -- MS. The controversial new surgery Dr. Zamboni brought to light is called transluminal angioplasty and helps to correct the stenosis by opening those principle veins and widening them with stents.

However, many doctors are not convinced that reflux blood is a problem -- if it exists at all. Nor for that matter are they sure how many MS patients actually have CCSVI or even how specific the condition is to the disease. Furthermore, doctors worry that the surgery for CCSVI carries considerable risk. Not surprisingly, this has caused a huge controversy in the MS world.

Dr. Zamboni’s study investigated 109 MS patients and 177 people without MS and found that all participants with MS had CCSVI while not one of the others did. Other studies have not replicated these findings, however. For example, in a large follow-up study at the University of Buffalo, just over half of MS patients were found to have CCSVI and, even more surprising, nearly 25% of the healthy "controls" also had CCSVI but with no symptoms.

Dr. Zamboni also reported that the surgery, which he performed on 65 MS patients, was quite successful, in particular for patients with relapsing-remitting (RR) MS, the most common form of the disease in which occasional relapses or flare-ups are interspersed with longer periods of disease remission. At a reassessment 18 months after surgery, RR MS patients had "significant improvement" in physical and mental quality-of-life measures compared with their condition before surgery.

However, there is little information to date about results of similar surgeries performed for CCSVI, and several alarming problems have emerged. One concerns use of angioplasty stents for the surgery. Neurologist Robert Fox, MD, medical director of the Mellen Center for Multiple Sclerosis at Cleveland Clinic, explained to me that angioplasty stents are designed for placement in arteries, which get progressively smaller the further they are from the heart, whereas veins grow larger as they get closer to the heart. This increases the likelihood that a stent placed in a vein will travel, a circumstance that can be quite dangerous -- and indeed, one MS patient in the US ended up having emergency surgery to remove a stent from her heart.

In spite of these problems and the questions surrounding CCSVI, in general, a number of doctors in the US and abroad continue to perform the surgery on MS patients. Clearly, though, we need much more information to guide people in the MS community. Fortunately, a major step in gathering information about issues surrounding CCSVI, including what would be optimal ways to diagnose it, is now underway in the form of two-year studies at seven MS centers funded by the National MS Society in the US and the Multiple Sclerosis Society of Canada.

Dr. Fox’s Advice

Acknowledging the difficulty of doing so, Dr. Fox urges people with MS to hang on while researchers work to close the information gap between what patients want to be true and what we know is true. We discussed some of the specific questions people have regarding this controversial therapy...
  • What causes the vein blockages in MS patients? We don’t know -- the ongoing studies are taking a step back to establish the true role blockages do or do not play in MS, along with what may or may not be different about them in MS patients and people without the disease. We want to find out if CCSVI is a possible cause of MS or is a result of it. MS, as well as other neurological conditions, cause the brain to atrophy, becoming what we call a "sick brain," and that alone may create vascular changes. If a sick brain is behind CCSVI, the condition, when it exists, may not be a factor in causing MS, but rather a result.
  • Still, if MS patients’ doctors find blockages, why not just have them fixed? Not only are we not certain whether CCSVI has anything to do with MS, we also believe that the body is typically able to manage damaged veins by putting other veins to work. This means there may be no reason to open a vein and no benefit to be gained from it.
  • Shouldn’t MS patients at least be tested for CCSVI? We are not recommending this yet -- we do not yet know what imaging techniques are most effective for making a careful diagnosis. And if a test does show CCSVI, we don’t yet have the information we need to know what to do about it.
  • The Internet is filled with offers for "medical-tourism" vacations overseas, some of which say this surgery is guaranteed as successful with no risk. While such claims are clearly exaggerated, could any of this be helpful? CCSVI surgery has generated a great deal of buzz in social media and on medical-tourism Web sites, and there is a lot of misleading information out there. One thing we do know to be absolutely true is that CCSVI surgery is a risky procedure.
  • When are we going to have the information we need to know whether CCSVI surgery is a real possibility to help MS patients have better lives? Information is coming in rapidly. By the end of this year, I believe, we will have many interesting results to share.
Bottom line: Until there is a follow-up to Dr. Zamboni’s study via large clinical studies, says Dr. Fox, there is no way to know for sure whether CCSVI surgery really is hope... or just hype. It’s understandably difficult for MS patients to be patient... but for now, that’s the strategy that seems to make sense.


Robert Fox, MD, neurologist, medical director of the Mellen Center for Multiple Sclerosis at Cleveland Clinic, Cleveland.

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Keep Germs From Walking Through Your Home

Is your home a shoe-free zone? More to the point, should it be?

I’ve been contemplating this issue, in part because we’re up to our ankles in the muddy season here on the East Coast (made all the worse by my daughters in their soccer cleats). I can’t help but wonder what besides mud comes in on their cleats, or for that matter, our everyday shoes. After all, whatever the time of year, the streets are a virtual dumping ground for animal feces, dropped and decaying foods and possibly pathogens in... ahem... various bodily fluids.

Indoor Shoes

I started asking people about shoes in their homes and quickly discovered that many people have rules. For instance, I spoke with an acupuncturist who endorsed keeping shoes on because, he says walking on cold floors is bad for the muscles. Not so, said another acupuncturist who is also a podiatrist -- he assured me that cold floors won’t hurt you but does advise wearing shoes or slippers to keep feet comfortable and protected, since he sees an awful lot of needless foot injuries. And speaking of that, another vote in favor of footwear came from a restaurant-owning friend -- she told me that the very first rule for chefs-in-training is to keep shoes on when preparing food. It makes sense -- if you happen to drop the knife when slicing and dicing in bare feet, the damage to your toes could be permanent.

Sock It to Us...

I’ll give you the dirt on wearing outdoor shoes inside in just a minute -- but let me first note that whatever you wear or don’t wear on your feet inside the house, put safety first. Socks may protect your feet from dirt -- at least partially -- but they can be slippery, too... so slippers may be the best solution. Look for a pair with soles that will grip the floor.

To get the inside story on the filth on shoes, I called microbiologist Philip M. Tierno, Jr., PhD, author of The Secret Life of Germs and director of clinical microbiology and immunology at New York University Langone Medical Center. Dr. Tierno says absolutely the ideal is to take your shoes off at the door. "The street is a repository for all sorts of really disgusting things," he says, "and when you step in them while walking, your shoes accumulate those things... and bring them into your home."

Though he said this issue hasn’t been studied, Dr. Tierno points out (rather poetically) that the absence of evidence is not evidence of absence. For example, say you step on sputum from someone who has the flu -- do you have any doubt that your shoes could then transfer the pathogens to your rug where you or your child later sits? That shoe debris probably won’t kill you, says Dr. Tierno, but it can definitely make you sick.

Sanitizing Measures

Dr. Tierno acknowledges that in this country, guests generally expect to keep their shoes on. He has advice on how to be sure your house stays sanitary in spite of visiting soles...
  • Hard floors with area rugs are preferable. These are easier to clean than wall-to-wall carpeting -- another problem is that the padding under wall-to-wall becomes a repository for numerous germs, bacteria and more that seeps through over time.
  • If your home is carpeted and outside shoes are worn inside, sanitize the carpeting weekly with an alcohol-based spray (Lysol works well) and vacuum with a strong machine equipped with a HEPA filter to keep what’s sucked up from flying into the air. (This applies to area rugs as well.)
  • Clean floors regularly with a disinfectant. Dr. Tierno believes that conventional cleaning products are most effective, but if you use only "green" products, be sure that the one you buy contains thymol, a component of thyme oil, the only green ingredient strong enough to do the job, he said. Products that contain thymol include the brands Seventh Generation and Benefect.
  • Clean up food and drink spills immediately to prevent decay and having resulting germs or bacteria tracked into other areas of the home.
Dr. Tierno reminds us to always wash hands after sitting on the floor or rug, especially before eating, drinking or touching your face. And, while not advocating that we all turn into "clean freaks," he added one more bit of advice that I will be sharing with my family: That famous "five-second" rule is a no-no -- if food falls on the floor even for just a second or two, it belongs in the trash, not in your mouth. You don’t know what shoe carrying what germs has walked on that spot!

Philip M. Tierno, Jr., PhD, author of The Secret Life of Germs (Atria) and director, clinical microbiology and immunology at New York University Langone Medical Center, New York City.

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Be well,

Carole Jackson
Bottom Line's Daily Health News

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1 comment:

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