February 29, 2012

Bell Curve Thinking Saves Me Big $$ on Azilect and Other Meds

As I recently mentioned, I've been on a new kick. (Friends and family no doubt are saying "there he goes again!"). This time, it's thinking about my health issues from the perspective of the Bell Curve, used in statistics to show normal distribution of a variable.

One of the first issues that came to mind is my gut feeling (actually emanating from my gut) that I'm over-medicated or that I'm having adverse reactions from the mix of meds I'm taking. Looking at the Bell Curve got me thinking that health researchers (and my doctors) are probably looking at the experience of the average patient (think the 68.2% in the dark blue in the above picture) when they come up with the recommendations for the amount and timing of the prescribed meds.

But of course I'm convinced I'm not your average patient. So I decided to see what would happen if I deviated a bit from my doctors' recommendations. Not surprisingly, the first med I looked at was my Azilect (rasagiline), commonly prescribed, with levodopa/carbidopa, for those of us with Parkinson's. My neurologist gave me the standard prescription of 1mg, once a day. Azilect was first on my test list because I had just renewed my 90-day prescription . . . at a cost of $1,100! Although my insurance paid the lion's share, the tariff on this drug is the main reason I ended up in Medicare's Donut Hole last year, which meant I had to purchase meds from my own pocket for the balance of the year.

February 28, 2012

Back To The Future: I'm Returning to Nepal for a Wedding and Coming Back with Three New Members of My Nepali Family Here

As a confirmed neophiliac (see http://bit.ly/yR6aPT), I'm very excited about the next chapter in my life that begins Wednesday night, February 29, when I leave for Nepal. On March 9, I’ll attend the Kathmandu wedding of my Nepali housemate Nimesh and his bride Bhawana, who will become a most welcome addition to our household when Nimesh brings her back with him to the USA.

As if all of that weren’t excitement enough, my delight is doubled because Laxmi and Rahel, the wife and son of my good friend Ramesh, will fly with me to America. I think of Ramesh, Laxmi, and Rahel as my "adopted family." After being separated for the past three years while Ramesh worked here, they will again be reunited.

Some background information might be helpful….

February 27, 2012

Using the Bell Curve In Thinking About Health Issues May Improve the Quality of My Life and Perhaps Even Prolong It

That's the Bell Curve which shows the most common type of distribution for a variable. It's called a "bell curve" -- d'oh! -- because the graph looks like a bell.

I started thinking about the bell curve and health after talking recently with a friend who has a particularly virulent cancer. He was told he could expect to live another 12 to 18 months. For those with this cancer, that prognosis may  reflect what will happen to the 68.2% shown in the dark blue area. The 0.1% at the far left represents the few who die within a week or two of the diagnosis. Let's hope my pal will join the 0.1% at the far right, who end up living for years after the diagnosis.

I also thought of my dear friend Lily who has been my role model for "aging with zest" and is now age 93. She's surely out there somewhere beyond the 2.1% marker on the right in a bunch of variables: age, energy, quality of life. It's unlikely I'll be so lucky.

Then I started thinking about the bell curve's applicability to my health issues. For example, my doctors' prescriptions for the dosage and timing of the meds I take probably come from studies on what's best for those in the dark blue. But is that where I am?

On an issue I've been writing about a lot lately -- dietary supplements -- the hype for a particular vitamin (D is the current darling) or supplement (antioxidants are up at the top of the current hit list) often comes from anecdotal reports of the phenomenal results achieved by a few individuals who may well be way out on the O.1% right-hand tail of any chart of individual responses to popping the vitamin or supplement pill.

But, on the other hand, warnings regarding potential serious side effects from taking a particular medication or supplement may reflect the experience of a few who would be out on the left-hand tail of the curve. Meanwhile, the 50% to the right of the median line are getting some benefit from it.

This is the first in a series of posts I plan to make over the next weeks, as I explore what happens if I use the bell curve to consider my own health issues. But the series will be interrupted, frequently I hope, because I'll also be sending reports (and photos) of my return to Nepal for the wedding of my housemate Nimesh and his arranged-marriage bride Bahwana. I've met the bride-to-be on Skype and can easily understand how Nimesh fell immediately in love with her. On a bell curve of successful, happy marriages, I predict their marriage will be off the scale on the right hand side.

February 24, 2012

Warning on Supplements from Best-Selling "The End of Illness" Author

Earlier this month, a series of pieces about dietary supplements on this blog ended with a post reviewing the lack of evidence supporting their use. We hear this concern more and more these days. For example, I just finished reading the chapter on vitamins and supplements in the current, well-reviewed best seller The End of Illness by Dr. David Agus, a professor of preventive medicine at the University of Southern California Keck School of Medicine. According to the book blurb, Dr. Agus is a leader in cancer care, and in new approaches to personalized health care.

His chapter on supplements, titled "The Truth About Synthetic Solutions," has this subtitle: "How to Save Hundreds of Dollars a Year and Rethink the Need for Supplements and Vitamins."

Dr. Agus writes "About half of U.S. adults, maybe more, take vitamins and other dietary supplements, spending over $25 billion a year on dietary supplements." But he thinks there's precious little evidence to demonstrate the products' efficacy. Moreover, Agus claims some of these products can shorten -- not prolong -- life.

Agus asserts that the body is a complex organism, and changing one variable will have many effects... most of which we have no ability to truly understand. For all we know, taking vitamins and supplements may push the complex and delicate chemistry in the wrong direction.

February 23, 2012

"My Name Is John and I'm a Neophiliac." Maybe You Are Also. Take the Test and See.

Never heard of a "neophiliac"? (No, it doesn't mean I'm attracted to dead bodies.) I hadn't heard of it until I read a story last week in the New York Times. Here's the lead to the story:
Do you make decisions quickly based on incomplete information? Do you lose your temper quickly? Are you easily bored? Do you thrive on situations that seem chaotic to others, or do you like everything well-organized?
Much (but not all) of that sounded like me. I became more intrigued the more I read. Researchers have linked this novelty-seeking personality type to the brain's dopamine system. My Parkinson's may be killing off my dopamine cells, but does that mean I should be more inclined to sit at home in a rocking chair? My departure next week for Nepal would seem to argue against it.

February 22, 2012

DEPRESSION: The Placebo Problem

On February 19, the CBS news magazine 60 Minutes aired a segment (“Treating Depression: Is there a placebo effect?”) on which psychologist Irving Kirsch claimed that placebos help most people with depression as much as antidepressant medication.

Needless to say, for the 17 million Americans who take antidepressants – and for the pharmaceutical companies that take in about $11.3 billion every year selling those pills -- the assertion is a bombshell.

Kirsch, associate director of the Placebo Studies Program at Harvard Medical School, explained the common wisdom about placebos: since the expectation of healing is so powerful, people actually DO feel better after taking the “dummy pills.” He also said: “Placebos are great for treating a number of disorders: irritable bowel syndrome, repetitive strain injuries, ulcers, Parkinson's disease.”

Brown University Medical School professor Dr. Walter Brown has conducted several studies which support Kirsch’s findings. He claims that antidepressant use in the last ten years has increased most among people who are mildly depressed… just the group – Brown says – most likely to benefit least from the drugs.

February 21, 2012

On the Couch, Scarfing Polished Rice in South Asia: The Road to Diabetes and Beyond

Not long ago, several local Nepali friends talked about their parents’ recent diabetes diagnoses. Intrigued, I Googled “white rice diabetes Nepal,” and learned that 18% of Kathmandu’s urban population over 40 has type 2 diabetes (with an additional 10% showing pre-diabetic symptoms). By dramatic contrast, only 3-4% of Nepal’s rural population suffers from the disease. I discovered that the shocking urban trend has a lot to do with the city dwellers’ new addiction to processed, machine-hulled white rice… and their greatly increased inactivity. D’oh! Diet and exercise again.

As a result, I was interested – and not surprised -- to see a story in the February 14, 2012 edition of the online journal MedicalXpress. It reconfirmed the trend my Nepali friends had told me about with this headline: “Diabetes risk factors in young Sri Lankans much higher than previously thought.”

Conducted jointly by King’s College-London and Sri Lanka’s National Diabetes Center, the study surveyed 22,507 people aged 10-40 in Sri Lankan cities. Researchers tested for early risk factors for type 2 diabetes, including high body mass index (BMI), raised waist circumference, high levels of physical inactivity, and family history of diabetes.

A whopping 23% of all participants showed at least two risk factors. Even scarier, 24% of all children in the study (aged 10-14) exhibited at least two risk factors. But it got worse: 40% of all females under age 16 showed the risk factors for physical inactivity and obesity.

February 17, 2012

"Dancing Feet Help Defeat Parkinson's" And A Moving MS Video

A friend sent me this video, which has been entered in the 2012 Neuro Film Festival. The American Academy of Neurology Foundation sponsors the event to raise awareness about brain disorders, and to encourage support for research into preventive treatments and cures. The line dance to the tune of "Jingle Bells" at the end is terrific!

For more about the film festival, check their website. The 2012 contest is still open for submissions, so get out your camera.

A Poignant Plea: "Hope and a Clinical Trial To Halt MS"
Intrigued by this contest, I checked out some of the videos that won last year. I found the one (below) especially effective in calling for greater funding.

But first some background. Dave Bexfield went through an experimental NIH-sponsored clinical trial (HALT-MS) for his aggressive multiple sclerosis: a bone marrow stem cell transplant designed to stop disease progression. The consent form he signed warned that the odds of death were 1 in 20. Despite repeated insurance denials, Dave pressed forward. The risky, potentially groundbreaking treatment in March 2010 required over a month of testing, three weeks in the hospital, and intensive rehabilitation. Bexfield also runs http://www.activemsers.org/, a nonprofit website designed to help, motivate, and inspire people with MS to stay as active as possible—physically, intellectually, and socially—regardless of physical limitations.

Here's the video:

I searched for more info about Dave and found a site he updated in August, 2011: About Dave

February 16, 2012

Siri: The New Love of My Life

I just got my first smart phone -- an iPhone. I've always been phone-phobic. I've had a cell phone for years, but always kept it turned off, using it only on rare occasions. Most of my friends know I prefer email to phone calls, which I usually consider intrusive, annoying interruptions.

So, I'm surprised how much I like this iPhone, and I want to learn more about it. The big reason for this change of heart is my growing affection for Siri. If I don't watch out, here's how I could end up:

February 15, 2012

Stem Cells Used to Generate Bone Growth

On February 6, an article in the online journal Nature Medicine produced another moment of excitement for me. Researchers at UC-Davis Health Systems managed to direct stem cells to increase bone strength and growth. The successful test was conducted on rodents, and the next step involves implementing clinical studies with people.

Initial results suggest potential therapies – using one’s own stem cells – to treat osteoporosis and other bone issues, including fractures, infections, and cancer.

Researchers created a hybrid molecule that – once injected into the bloodstream – collected mesenchymal stem cells in bone marrow, and then attached itself to bone surfaces, where the stem cells can do their normal work creating and repairing bone.

Wei Yao, principal investigator and study author, said, "There are many stem cells, even in elderly people, but they do not readily migrate to bone. Finding a molecule that attaches to stem cells and guides them to the targets we need is a real breakthrough."

February 14, 2012

Death and Illness at Downton Abbey

While I have mostly escaped the highly contagious Downton Abbey obsession, several good friends are seriously infected.

This past Sunday's episode on PBS dealt with several medical issues, including death by arsenic, spinal injuries, and the great flu pandemic of 1918, aka “Spanish Flu.” (One of the pleasures of this series has been watching the march of history across the TV screen. Recently we’ve seen electric lights, the telephone, trench warfare during WWI, and – this week – the Victrola. Good grief! How our world has changed in the past century.)

In any case, here’s a brief, intriguing critique from WebMD (one of my favorite online references) of the series’ portrayal of the latest medical matters at Downton. It’s clear that the progress we’ve made understanding how the human body works – and treating it for illness – has been astonishingly dramatic over this past century. There’s reason to believe – isn’t there? – that developments over the next 100 years will be even more amazing.

Here’s the link to the article: Death and Illness at Downton Abbey

February 13, 2012

Interesting Test for Assessing Memory and Thinking

OK, so I sometimes misplace my keys. It doesn’t happen often, but occasionally I’ll find myself in the kitchen and wonder – just for a second! – what the heck I’m doing there. No problem… right?

In my wanderings through cyberspace, I found an interesting “diagnostic instrument” developed by Ohio State University’s Memory Disorders Research Center for assessing memory or thinking disorders. I took the test, which took just a few minutes.

A couple times I had to stop and think during the test, but was happy to see I fell in the “normal” range. My balance, energy, mood, sleep, appetite, and digestion may not always be “normal,” but – for now, anyway – my memory and thinking are apparently OK!

Goofiness aside, it was interesting to see the kind of “instrument” professionals use for assessing possible cognitive impairment. Here’s the link, if you’d like to check it out: Memory and Thinking Test

February 10, 2012

DEPRESSION: Is Ketamine Really the BIG Breakthrough?

On Thursday, February 3, Diane Sawyer aired a report on ABC News about the drug ketamine, and its potential for rapidly treating deep depression. In the piece, a medical expert made an amazing claim -- that ketamine could represent the biggest breakthrough in the treatment of depression in 50 years.

The most common current drug therapies for depression, selective serotonin re-uptake inhibitors (SSRIs) -- like Prozac, Celexa, Luvox, Zoloft, Paxil, and Lexapro – typically take weeks before patients begin benefiting from the drugs’ therapeutic effects. Those pills work by eventually blocking the brain’s absorbtion of the neurotransmitter serotonin, which facilitates the normal firing of synapses, and affects mood.

February 9, 2012

EXERCISE: Let’s Move! Michelle Obama and Jimmy Fallon Go Toe to Toe in the White House

I love this video.

Yes, I regularly mention how exercise ends up on the “best things we can do” lists for so many illnesses and conditions, like high blood pressure, depression, diabetes, and Parkinson’s.

And I’m always yakking about how much exercise helps me, how much I love my neighborhood walks, and how I need to get on my exercise bike more often.

I can use this fun video as inspiration. Jeez, look at Michelle rockin’ those push-ups! Unfortunately, I'm more like Jimmy... just klutzier.

February 8, 2012

SUPPLEMENTS: So Many Others, like Fish Oil, Antioxidants, Ginkgo, and CoQ10. What about Them?

These past two days, we explored the pros and cons of taking supplementary vitamins and minerals. We're bombarded these days with new claims about the health benefits of many other supplements. Walk into any nutrition store (or down the health-products aisle at Whole Foods) and you're overwhelmed by the number and variety of pill choices.

More than half of all Americans now use supplements. The industry's sales have grown from $8.8 billion in 1994 to $26.7 billion in 2009. But now the trend is slowing, as more and more studies question the value of our supplement additction.

Let's take a look at some recent evidence. Two of the most popular, highly touted nutrient supplements warrant special attention:

February 7, 2012

SUPPLEMENTS: Minerals -- From Diet or Pills?

As we discussed yesterday, vitamins -- particularly megavitamins -- are often hyped like magic potions. Not so with minerals, even though they are equally important to our health.

Major Minerals
Our bodies store some minerals in large amounts. Sodium, chloride, and potassium help maintain a proper balance of water. Calcium, phosphorus, and magnesium support bone health. Sulfur helps stabilize protein structures, including those in hair, skin and nails.

Having too much of one major mineral can result in a deficiency of another. For example, if we ingest too much sodium through table salt or processed foods, we could end up losing needed calcium.  Likewise, too much phosphorus can afftect magnesium absorbtion.

These imbalances are usually caused by overloads from supplements, not food sources.

February 6, 2012

SUPPLEMENTS: Vitamins -- Hype or Hope?

In the last post, we noted that the medical-advice pendulum has swung away from the old recommendation about taking a daily multivitamin. I sometimes wonder if I'm missing certain vitamins or minerals, but medical authorities typically offer reassurance that I'm just fine... as long as I continue to eat right, like the Mediterranean diet.

Megavitamins: Hype or Hope?
Supplement advertisers sound like Mae West: "Too much of a good thing is a good thing." Dr. Irwin Rosenberg, editor of the Tufts Health and Nutrition Newsletter, writes, "The vitamin marketplace has been something of a Wild West show, often placing marketing over science."

In the 1970s, vitamin C emerged as the first megavitamin, thanks to the work of American chemist Linus Pauling. His bestselling book, Vitamin C and the Common Cold, recommended megadoses of the supplement, although research has since debunked his theory.

Next into the spotlight vitamin E, thought to cure maladies ranging from heart disease to impotence. Clinical trials using high doses of the vitamin found no positive effect, and instead discovered potential harm (below).

February 3, 2012

SUPPLEMENTS: Do I Need a Daily Aspirin and Multivitamin?

Note: Here's a slogan I've come to believe: "there are no coincidences." I've been looking forward to doing this series of posts on our increasing use of dietary supplements. I wrote the post below as the second in the series on Thursday morning. That afternoon, my arthritic back was bothering me. I rarely use pain pills, but I decided to take a couple of them. When I got up from my afternoon nap, I quickly realized I'd taken two 5-HTP pills -- a supplement that works splendidly FOR ME, but has adverse side effects if I take more that 25 milligrams. (Since the lowest dosage available is 50mg, I cut the pill in half.). I'll report more on this and the important lessons learned as an appropriate coda to this series of posts on supplements.

Many of us have developed the habit of starting the morning by taking a baby aspirin to prevent a heart attack, and a multivitamin to help fight off everything else -- standard medical advice for years. But now new studies question whether those pills do much good. Some research even suggests they may cause harm.

Daily Aspirin
Aspirin, sometimes referred to as a blood thinner, helps keep blood from forming clots that can block flow to the heart or brain. But aspirin can also lead to excessive internal bleeding. As a compromise, medical authorities have recommended a dosage under 100mg -- the so-called "baby aspirin."

February 1, 2012

Walking for Health

An article / slideshow by Ruth Orenstein in the online journal Everyday Health summarized ten excellent reasons to “walk your way to health."

There were no surprises here for me; I often write about my neighborhood walks… and how they give me more energy, lift my mood, and ease pain. What I liked here was seeing all these great reasons in one place. And with another sunny day in our Nation's Capital today that will approach 70 -- yes, 70! -- degrees, I'm ready for a nice long stroll around my Palisades neighborhood.

Here are those ten reason: