Archive for the 'Recent Medical News' Category

Antibiotics for Chronic Low Back Pain??? Really???

Okay, this is, in my humble opinion, pretty damn interesting.

For years, I’ve felt (and discussed with my patients) my belief that there is just something fundamental that we (the collective “we” of the medical community) are missing when it comes to understanding back pain.

One of the fundamental truths of medical practice is that whenever you see a lot of different treatments being used for a problem, most likely all of them have pretty darned similar less-than-stellar results. It makes sense, when you think about it. If there was one treatment that had great results and stood out from the rest, well then that is the treatment that would be used almost all of the time. Since however, treatment A is little if any better than treatment B, which is little if any better than C, and D, etc., oftentimes the choice of treatment ultimately boils down to individual preference based upon factors such as where one trained, statistically insignificant anecdotal experiences, etc.

Well, back pain is a lot like that. Lots of different types of medical (and pseudo-medical) practitioners out there seeing patients for back pain, doing lots of different types of “treatments”, and for the most part results are pretty similar, and often pretty disappointing.

Fortunately, for acute back pain, most of the time, it gets better regardless of what is done or isn’t done. This occurs in about 90% of cases if I recall correctly (and I’m too lazy to google this right now). There are some general guidelines out there for conservative care, that if followed seem to work out pretty well for most folks, regardless of whether they go see the family medicine doctor, the neurosurgeon, the chiropractor, the school nurse, the local voodoo specialist, the massage therapist, their priest, etc., or if they go see nobody at all. It just gets better in most cases. In most cases it just doesn’t make a damn bit of difference.

Now that isn’t to say that if you have acute back pain you should avoid going to the doctor (If you’re wondering if you should go see your doctor for this, or any other cause, go see your doctor!). “Most” is not synonymous with “All”. Every once in a while, acute back pain is from some particular specific cause that may indeed respond quite differently depending upon what is or is not done for it. I know I’m biased as a family physician, but I think this is one of the great values of have a good relationship with a primary care doctor. He/she can help separate the zebras from the horses.

Anyway, it’s all well and fine to say “Thankfully most acute back pain will get better.” But what about those cases that don’t get better? What about those folks who go on to develop chronic back pain? Well that is a different kettle of fish altogether.

Chronic back pain is serious business. As with acute back pain, there is a veritable slew of various people offering all sort of treatments, etc. A lot of people suffer for great lengths of time. A whole lot of loss of quality of life, productivity, money,…you name it. People desperate for relief often find themselves repeatedly on the operating table being cut open, developing dependence upon habit forming narcotic pain medicines, etc. It really can ruin people’s lives. Some folks fortunately get relief with surgery, but for too many, their problems get no better and/or only get worse. It can lead to long term disability, loss of income, destroyed relationships, etc. It truly can be tragic.

As I mentioned at the start of this post, I’ve always been bothered with the nagging feeling that when it comes to back pain “We just aren’t getting something.” Heck, most likely it’s more like we just aren’t “getting” a bunch of somethings. I truly believe that when it comes to back pain (and a whole lot of other stuff), someday in the future, people will look back upon those of us practicing medicine today and snicker a bit, marveling at how stupid and silly we are about a lot of things. We do this ourselves, smugly looking back upon medical practice a century or two ago and laughing at some of the silly notions they had, so I suppose it is only fitting that folks in the future do the same to us.

So, what’s the point of this post? Why, after a pretty long period of inactivity has Dr. Sam decided to bother to log onto his blog and blather on like this?

It has to do with this article and this article.

You can go read them for yourselves (and I recommend you do, as it is quite fascinating), but in a nutshell, some (awesome) folks in the frozen north (Denmark), spent years looking into the possibility of bacterial infection being behind a substantial number of cases of chronic low back pain, and it looks like their hunch was correct. This is a BIG DEAL folks!!!! In that second article linked, it shows how they were able to successfully treat a pretty substantial number of chronic low back pain sufferers with a simple antibiotic.

This reminds me a lot of the story of the Aussie doctors who proved that most stomach ulcers are related to a bacterial infection (Helicobactor pylori). Completely changed the practice of medicine.

If this chronic low back pain stuff pans out, it too will be practice-changing and will make a HUGE difference in the lives of a HUGE number of people. Kudos to our Danish friends!!! I agree with the brit doc quoted in the first linked article who was talking about this stuff being potentially Nobel Prize worthy.

Anyway, go read the linked articles. This is good stuff!!! Yay Science!!!

Cheers,

Sam

More Stem Cell Stuff

University of Georgia and Department of Defense have developed a gel the call “Fracture Putty” which contains stem cells. So far in lab rats, it has shown dramatic improvement in healing of fractures.

Read about it here

As a physician, I’m pretty excited about all of the recent stuff I’ve been seeing about stem cells.

I’m really hoping some of this stuff makes it into mainstream medicine soon.

 

Attacking Leukemia with T-Cells

A report published today in the New England Journal of Medicine details a potential new treatment not only for Leukemia but for other cancers as well.

Go read the full report for further details, but in a nutshell, researchers at Univ. of Pennsylvania harvested T-cells from patients with Chronic Lymphoid Leukemia.  They then genetically modified them to target the cancer cells, as well as modifying them so that, unlike in previous similar trials, the modified cells would proliferate and persisit in-vivo.  They then transfused the cells back into the patients.

While this is a VERY small trial, the results were beyond delightful. 

Lets hope the better funding they are almost certain to receive leads to something remarkable.

Kudos to science!!

 

Hot Coffee and Hot Tea May Protect Against MRSA

This is an interesting study that was recently in the Annals of Family Medicine.

Basically, the researchers wanted to find out if there was any association between drinking Hot Tea and/or Hot Coffee and levels of nasal colonization with MRSA.

Their findings do suggest that drinking Hot Coffee and/or Hot Tea may decrease the likelihood of nasal MRSA colonization.

I think it would be premature based on this study to draw anything conclusive, particularly with regards to the “Why” of any such protective effect, but it’s an interesting study nonetheless, and I think one that warrants further investigation.

Remote Control Endoscopy Camera

Researchers in japan have developed a remotely controlled miniature camera that can be used for endoscopy.

It looks a bit like a tadpole.  It appears very similar to the “capsule endoscopy” cameras that came on the scene several years ago.  With those, you basically swallowed a camera that was encased in a clear pill shaped container.  This thing passively moved along your gastrointestinal tract snapping pictures until you pooped it out.

With this new gizmo from Japan, it’s not a passive journey.  It has a little mechanical tail sticking out of it with which a doctor using a joystick can control it and basically pilot it through your GI tract.

It can apparently be inserted from either end….i.e. via your mouth or your “other end”.

According to this article, it was originally tested on dogs and is now ready for us.

Some potential advantages I see are the ability to get pictures within places not really reachable with current endoscopes…i.e. the small intestine, and also, I would imagine this procedure would likely need less anesthesia/sedation perhaps.

The potential negatives I see are 1. This thing getting stuck somewhere and requiring surgery to remove and 2. This thing causing a perforation, illeus or intususception.

Still, overall it looks like a pretty cool device to me.

FDA Chantix Warning

And right on the heels of my last post about the FDA warnings on Actos and Avandia and the inevitable lawsuits to come….here’s a new FDA warning about Chantix and increased cardiovascular risk.

Chantix lawsuit anyone?

Here’s my page on Chantix from a couple years ago.  Enjoy.

Cheers!

FDA Warning On Actos

The FDA has come out with some new warnings about Actos and it’s association with bladder cancer.

You can read about it here.

It wasn’t too long ago that they came out with warnings about another drug in the same family, Avandia. That one has serious cardiovascular concerns.

I’m sure it won’t be too long before we start seeing a bunch of advertisements from lawyers wanting you to join lawsuits related to Avandia and Actos.

I know lots of doctors will fear being named in these lawsuits related to Avandia and Actos and will stop prescribing them.  It’ll make life a little more difficult for the drug reps who are tasked with convincing doctors to use these drugs.

Cheers!

Is Multiple Sclerosis Caused By Low Vitamin D?

It has long been known that genetics and environment play a part in risk of developing MS.

It has also long been known that risk of MS goes up as people live further and further from the equator.

Now a study has come out showing that proteins activated by Vitamin D interact with genes on Chromosome 6 that have been shown to have the strongest effect on development of MS.

Specifically, people carrying a copy of the gene variant DRB1*1501 are more likely to develop MS.  Those carrying two copies of this variant are even more likely to develop this devastating disease.

This study suggests that the aforementioned proteins that are activated by Vitamin D bind to the DNA sequences adjacent to the DRB1*1501 gene and alter it’s function.

On the surface at least, this seems to make sense.

Adequate skin exposure to particular wavelengths of ultraviolet radiation in sunlight is a major source of Vitamin D in humans.  Folks living further from the equator tend to get less of this exposure, and tend to have lower levels of Vitamin D.

So, it certainly would not surprise me if Vitamin D is playing a role in the increased MS risk seen in these folks.

You can read more about this study here.

There is a lot of debate regarding Vitamin D, effects of low levels, appropriate testing guidelines, appropriate guidelines for “normal blood levels, appropriate treatment of high levels, etc.

Perhaps, if there is any interest, I’ll devote a future post to some of these issues.

How ’bout it readers?  Would you like to see a more detailed post about Vitamin D?

Cheers,

Sam

In a Vial, Crocodile

SchnappiI saw a sort of neat story on the BBC News website about researchers in Louisiana who are taking proteins from alligator blood and trying to use them to develop new antibiotics.

Other than handbags and good eating, alligators are mostly just a bit of a nuisance in these parts.

I think it would be great if these researchers are successful in their quest.

Of course, natural selection being what it is, I’m sure that MRSA (Methicillin Resistant Staphylococcus Aureus) would likely eventually evolve into GRSA (Gator Resistant Staph Aureus).

By the way, the picture above of the little alligator is one I took back in 2003 at the Dauphin Island Sea Lab Estuarium.

He always sort of reminded me of Schnappi, the darling of German MTV, when my wife and I were living over there in 2004-2005.

(Oh, and before some smarty-pants feels the need to correct me, I do know the difference between alligators and crocodiles, but “See ya later, alligator” didn’t seem nearly as original for the title of this post.)

Hands Only Cardiopulmonary Resucitation (CPR)

L’Inconnue de la SeineThere was an interesting story on MSNBC.COM about hands-only CPR.

As a physician, every two years I get re-certified in Basic Life Support (BLS), which is essentially what most folks know as CPR,  as well as Advanced Cardiac Life Support (ACLS), which is essentially what they try to portray in shows like “E.R.” when everyone is dramatically yelling  stuff like “Give him an amp of epi, stat!”.

Since finishing residency, I no longer practice any obstetrics (for reasons discussed in my medical liability and malpractice reform blog post), so I no longer get re-certified in Advanced Life Support in Obstetrics (ALSO).

I have never gotten certified in Advanced Trauma Life Support (ATLS), which is something that the surgeons and ER docs all get certified in. I don’t do ER medicine, so I haven’t really been able to justify the extra expense and time involved with getting this certification. I keep thinking perhaps I will get it someday though, as moonlighting in the local ER may be something I’d like to pursue in the future.  For now though, I’ll leave the chest tubes and tracheotomies and such to others. Continue reading ‘Hands Only Cardiopulmonary Resucitation (CPR)’

What you eat does matter!

whole wheat pasta and vegetablesHuh, this post title sounds different than what you emphasized in your last two weight-loss posts Dr. Sam?

I thought you said it was all about the calories.”

If that’s what you thought, go read those posts (The Hacker’s Diet and How to Lose Weight) again, a little more closely.

What I was emphasizing with those posts was that when it comes to losing weight (fat), it’s primarily all about the calories you consume.

I don’t want this message however to be misinterpreted as saying something along the lines of “As long as the calories are where they need to be, eat whatever the heck you want.”

That is most definately NOT my message.

Continue reading ‘What you eat does matter!’

New Treatment for Alzheimer’s

Sometimes I like to surf around news sites in other parts of the globe to get a better feel for what’s going on in other countries, as well as how the foreign press is presenting what’s going on here in the U.S.

In my opinion, access to folks in all the far flung places of the world is the greatest thing about the Internet.

Anyway, I was buzzing around the website for England’s The Daily Telegraph the other day, reading all the news that’s “Fit for Brits,” when I came across an interesting story about some breakthrough medical research being done at UCLA on Alzheimer’s Dementia.

Here’s the story titled UCLA drug aids Alzheimer’s patient ‘in minutes’. Please give it a read, and then come back here. It’ll only take a minute or two.

Continue reading ‘New Treatment for Alzheimer’s’

Vacuum treatment for Heart Attacks

This will be a quick post, which I think is only fair considering the Epic War and Peace style dissertation I put the readers through with my last post on How to Lose Weight.

This is just a sort-of follow up to my post about Penumbra.  If you remember, at the end of that post, I posed a couple of questions about potential other uses for this technology.

One of those other uses I wondered about was whether or not this treatment could be used for occlusive arterial conditions other than strokes, such as heart attacks for instance.

Well, it seems I’m not the only one who considered this sort of idea.  A study published in today’s New England Journal of Medicine titled Thrombus Aspiration during Primary Percutaneous Coronary Intervention shows very promising results from a study in the Netherlands looking into just just this sort of thing.

As promised, I will keep this post short by avoiding going into a lot of details about this study.  Hit the link above if you wish to get into the nuts and bolts of it.

In a nutshell however, the Dutch researchers compared doing a conventional stent placement in a heart attack victim vs first using a device (that sounds very much like the Penumbra device) to vacuum the clot out of the blocked coronary artery prior to placement of a stent.

They found that using the vacuum technique resulted in better perfusion and outcomes compared to conventional stent placement alone.

Penumbra

I just read an interesting story about a new treatment for occlusive strokes.

The device is known as Penumbra and is being put out by the company of the same name Penumbra, Inc.

From the story I read, and from my brief visit to the company website, it looks like it might have promise to treat some stroke victims who otherwise would be sort of out of luck.

Basically, from the description, this is a catheter type device that is threaded into the femoral artery (The great big artery in your groin that feeds blood to your leg), and is worked in retrograde fashion up the aorta and then into the appropriate arteries (carotid, etc.) until reaching the site of the blocked artery inside the skull. It then acts basically like a vacuum cleaner and sucks out the blood clot that is blocking the artery and causing the stroke.

Continue reading ‘Penumbra’







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