Wednesday, 1 August 2007

So Avandia stays, but will doctors prescribe it?

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It was plastered all over the news earlier this week. The committee of advisors to the U.S. Food and Drug Administration voted 22-1 to keep GlaxoSmithKline's Avandia on the market. They also voted 20-3 the evidence reveals Avandia increases risk of heart attack. Comforting, isn't it? Avandia, used to treat type 2 diabetes, has been under attack for cardiovascular risks since a late May study showed a 43 percent higher risk of heart attack.

Okay, so Avandia will likely get a black box warning from the FDA, its sternest alert to doctors. Pascale Boyer Barresi, an analyst at Bordier & Cie in Geneva stated the black box is likely and Avandia sales will probably not recover to previous levels. They might gain 10 to 15 percent, but doctors who switched their patients will not switch back. No doubt a big factor in Avandia sales will be new prescriptions. In the U.S. they fell 45 percent after the May report, and I'm sure Glaxo investors are wondering if Avandia has potential to grow market share. This drug drew $3.3 billion in 2006 sales. Stuart Weiss, an endocrinologist with New York University Medical Center, stated until new data comes in, it will be difficult to start new patients on the drug. This is feedback from an endo, don't forget endocrinologists and cardiologists tended to reside in opposing camps when the Avandia news broke in May. Endos were more skeptical of the May study -- cardiologists gave it more weight.

Once the FDA finally weighs in, I suspect Glaxo's public relations and sales teams will launch one giant persuasion campaign. New type 2s are being diagnosed daily, and Glaxo wants Avandia up and front for consideration. Will doctors and patients follow their advice? The FDA's committee of advisors have left the room, now let's see what the FDA decides on labeling. Read more in Bloomberg.

Adult survivors of childhood leukemia exercise less, increasing complications

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Survivors of childhood acute lymphoblastic leukemia (ALL) face an increased risk of complications as a result of their cancer treatment. For a variety of reasons, many survivors avoid simple exercise and lifestyle changes that could reverse this damage, according research out of Memorial Sloan-Kettering.

Such ALL survivors are less physically active than the general population, according to the researchers. Also, survivors of ALL who received cranial radiotherapy, or "whole brain radiation", report the lowest activity among all adults, suggesting that this therapy, when administered in childhood, may affect an individual's activity in the future.

The reseachers note that the survivors are not lazy, but that the "whole brain radiation" treatment alters something in the central nervous system, leading to a decrease in the level of physical activity.

Because of the risk associated with cranial radiotherapy and improved chemotherapy drugs, cranial radiotherapy is now only used to treat children with very aggressive forms of ALL.

Reaching out to someone with cancer: just do it

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It is hard to know what to say to someone who has cancer. It's even harder if someone is in the process of dying from cancer. Reaching out can become big and complex and overwhelming. We fear not knowing what to say or what to do, or saying something that causes more pain.

In Anna Quindlen's novel, One True Thing, a novel about a mother's death from cancer, the main character narrates about how people stopped coming by to see them, calling, reaching out. The main character runs into one such friend of her mother's in the grocery store one day:

I could almost see the sentence forming in their mind before they could say it: "I've been meaning to stop by, but ..."...

When Mrs. Duane began to say that she'd been meaning to stop by, I looked into her clear blue eyes, the color of sky, wise and so aware of the duplicity of what she was saying that they darted away from my own, and without thinking I interrupted, "Then do it. Don't regret that you didn't. What she has is not catching."...

"No one has come to see my mother since the week before Christmas. She's lonely and she's sad and she thinks that everyone's forgotten her and all because it's too uncomfortable for anyone to deal with anything deeper than winter ski plans and shopping for dinner."

The next day Mrs. Duane called and asked if she could come over for lunch.

When in doubt, it's always better to reach out, even with just the smallest of gestures and even in the worst of circumstances.
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Get angry? Get heart disease too

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It seems road rage may be more dangerous than just the risk of a traffic accident or blown temper -- a new study shows that hostility, anger, and depression can significantly increase a person's chances of developing heart disease or suffering a heart attack. It seems that psychological factors, like anger, can push up inflammation levels over time, which have been proven to contribute to heart health issues. Now scientists will begin evaluating whether interventions like meditation and anger management can decrease the risk. So be ready angry heart patients, you may have therapy sessions and anger management in their futures!

Save the date: In Living Pink with YSC

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Celebrate Young Survival Coalition's Seventh Annual York In Living Pink

Date: Monday, October 15, 2007 from 7:00 - 10:00 p.m.

Place: Marquee, 289 10th Avenue (between 26th and 27th Streets), New York City

The theme of this year's event is "Sweet Soiree," so named to recognize the considerable, multi-year funding provided by Hershey's. The event will be held at the exclusive Marquee Nightclub in Chelsea. Guests will enjoy cocktails (wine and mixed vodka drinks) and hors d'oeuvres from Danny Meyer's Hudson Yards Catering while being entertained by a DJ and a special, to-be-announced musical guest.

A silent auction with coveted items ranging from trips to fine jewelry and a moving video, which interviews six YSC constituents, created by renowned film producer, Beth Murphy, will be shown. Movie actress Gabrielle Union has graciously offered to participate again as our celebrity host.

Tickets are $125, $250, $500 or $1,250. $500 tickets come with a ILP custom-made tote designed by co-chair Stacy Morgenstern's clothing line, Boy Meets Girl(R), and access to the VIP lounge. For $1,250, you will receive 2 tickets, 2 ILP totes, access to the VIP lounge and ½ table with bottle service.

Tickets will be available online soon or you can contact Alison Dichter, YSC's Development Associate, at 646-257-3019.

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Is this prediabetes in action?

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Ever wonder what would happen to a non-diabetic's blood sugar if they loaded up on a pile of concentrated sugar, preservatives and weird science fats? Doctors and the ADA call it prediabetes. This clip takes it to the extreme by sandwiching the center of 16 double stuff Oreos! Sometimes you have to be insanely blunt to make your point.

This is a brilliant example of the diabetes epidemic in action. In today's world -- many people are eating for convenience without realizing the consequences. More convenient equates to less nutritious - more preservatives, more sugar and even more fattening (the wrong fats, too!) The combination increases the amount of time our digestive enzymes need to work on these lab-derived ingredients. This sustains an elevated blood sugar following the time of consumption. Add the ADA definition of pre-diabetes (a blood sugar between 140 to 199 mg/dl 2 hours after a meal) and there you have it -- a potential player on Team Diabetes!

Think what would happen if this guy was in his doctor's office 2 hours after this stunt. I'd like to thank his employer for keeping him busy (whatever he's paid to do) well after the lunch hour - and protecting him from becoming another statistic. Big ups to HR for hiring this guy!! If he's not in marketing already -- you might consider a transfer and give this guy a raise. He's my Oreo hero.

Insulin grown in tobacco plants

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Yes, the title conjures up images of a futuristic world in which diabetics puff their way back to health. "New! Insulin Cigarettes!" In fact, it's rather more innocuous than that: scientists have engineered a type of insulin-containing tobacco plant that could - in theory, at least - be used as a diabetes treatment.

A study has just been completed of its use. Once freeze-dried and broken down into powder, the insulin-containing tobacco leaves were administered to mice. The scientists who came up with the plant (and who are based at the University of Central Florida), found the powder successfully prevented diabetes symptoms in the mice after eight weeks. It seems pretty safe to assume, they speculate, that humans with type 1 diabetes could get similar results from ingesting plant-based insulin.

The only snag so far is the image problem associated with tobacco. As a result, lead researcher Henry Daniell, is proposing a switch to lettuce, which is cheap, easy to grow and - oh, yeah! - is not associated with cancer. Good move.

The results of this study appear in the Plant Biotechnology Journal (July 2007).

Obese man denied adoptive rights

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Gary Stocklaufer, a state-certified foster parent from Missouri, received some shocking news from a judge in mid-July. About three months ago, Stocklaufer and his wife Cynthia welcomed baby Max to their foster home after a cousin was unable to raise him. They decided to proceed with formal adoption. The Stocklaufers headed to family court thinking the adoption would be a simple process, but received news he was too fat to be an adoptive father. Gary weighs 500 pounds.

The Stocklaufers are devastated. Mr. Stocklaufer called the action out-and-out discrimination as his weight is immaterial to his ability to serve as an adoptive father. He does not understand why he cannot adopt his own cousin when he is already a licensed foster parent and has cared for many children. A further CNN news report quoted a court appointed legal guardian stated Mr. Stocklaufer may develop diabetes or sleep apnea. Utterly outrageous!

Get this -- the Stocklaufers adopted their son Bobby seven years ago from the same judge who ruled he is now unfit due to obesity. Mr. Stocklaufer weighed the same seven years ago. I see a lawsuit on the horizon, or at least a successful appeal. Two attorney experts interviewed by CNN think the judge totally blew it. What is your opinion? As of this morning, about 70 percent believe the judge was wrong. Place your vote and read the full story here.

Man's pump needle torn out in scuffle with police

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The police came knocking at the home of Parlier, California, resident Terry Hillblom (59) in April 2006. They were there to deal with a dispute between Hollblom's daughter and her son, but Hillblom got involved and ended up scuffling with a sheriff's deputy, and getting arrested. Hillblom, who has diabetes and wears an insulin pump, says his pump's needle was torn out during the incident. Worse still, he claims the deputy involved would not let him reinsert it before taking him into custody. He says when he told the deputy he needed to fix the pump, the officer said "I don't care." Hillblom was later allowed to reattach the pump but says by then his blood sugar was more than twice its normal level.

Hillblom's not taking this lying down though - last week he filed a lawsuit over the incident. The deputy, Hillblom says, not only damaged his pump connection, but also entered the home without permission or a warrant, and Hillblom wants damages. The Fresno Bee reports that Hillblom is a prominent local resident, former attorney, and vice president of a medical-related non-profit.

As for the deputy involved, he maintains Hillblom caused his own injuries by resisting arrest. Says Hillblom's lawyer, however, "What I know from prior cases is that officers sometimes lose their temper and feel civilians fail the attitude test and they sometimes misuse their power."

What is most disturbing about this case? It's not the fact that the needle was torn out, but the fact that Hillblom was not allowed to fix it immediately. Like the incident involving Doug "Mr. Universe" Burns, this seems like yet another example of police ignorance causing harm to diabetics. Police must be better informed about diabetes, particularly the seriousness of disconnecting person from pump!

"Hope is in a Cure" video will move you

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Seriously, you'd have to have a heart of pure stone not to be moved by this YouTube video called "Hope is in a Cure." To a fairly sappy soundtrack (okay, okay I'm not a Whitney Houston fan), we see a photo slideshow unfold, telling the story of one little girl's daily experiences with type 1 diabetes. The power of this piece is in its simplicity: a series of one family's snapshots illustrates perfectly what these brave kids go through and the sacrifices the whole family must make when type 1 enters a child's life. Not to mention the agony the moms and dads go through. That is something I can only imagine - and hope I never have to experience myself.

There's a heartbreaker of a shot in here of the little girl asleep, hands tucked daintily and securely under her pillow, asleep and in one sense relaxed, yet on guard against the next skin prick she knows will eventually come.

"Hope is in a Cure" was posted by Lisa of Londonderry, New Hampshire. I don't know who made it. Check it out today. Better yet, send the link to a few people you know. Too few people understand what "type 1 families" live with day-to-day. Let people know that diabetes never takes a vacation and never sleeps. And let them know the Juvenile Diabetes Research Foundation needs our support - you can start by supporting the upcoming Walk to Cure Diabetes.

Vote was overwhelming to keep Avandia on the market

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The votes of yesterday's advisory panel on Glaxo's Avandia demonstrate how dysfunctional this government can be. I was just reading up on the details. There were two key votes. On the question: does Avandia increase risk for heart attack, the vote was 20 to 3 in agreement. Yet, incredibly, the same panel also voted overwhelming - 22 to 1 - to keep Avandia on the market.

Coverage on the subject in today's New York Times described the meeting as "extraordinary" in that US Food and Drug Administration officials were openly in disagreement with each other as to what steps to take. As I mentioned yesterday, one of those officials, Dr. David Graham, said the drug should be withdrawn. However, Dr. Robert Meyer, another FDA high-up-official, disagreed.

Let's recap: Glaxo knew Avandia might cause heart trouble and informed the FDA of this. The FDA did nothing. An article in the New England Journal of Medicine (May 2007) stated the drug increased the risk of heart attack. The FDA twiddled its thumbs. Now this? The drug may stay on the market at the behest of the same FDA officials who voted in agreement that it poses a heart risk. Has the world gone mad? The sooner we get some reform at the FDA, the better off we will all be.

Also worth noting: the Times reports that Dr. Steven Nissen, whose NEJM article sparked the controversy, says he would have voted to remove Avandia from the shelves. Also quoted was Dr. Sidney Wolfe of Public Citizen, a drug safety advocacy group. Observed Dr. Wolfe: "If Avandia were up for approval today based on what we know now, it would be rejected."

Boy sells lemonade to buy hypo-sniffing dog

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Mark Rinkel is one super kid. He has been selling fresh-squeezed lemonade to raise money for his younger brother Jason, aged 9 years, who has type 1 diabetes. Jason often has hypoglycemia (low blood sugar) overnight, and the Rinkel family is seeking a specially trained dog to detect and alert the family during times of Jason's hypoglycemia or hyperglycemia.They pledged to raise $6,000 of the $16,000-$25,000 total cost for a service dog.

Mark is one heckuva entrepreneur. By this past Sunday evening, he had raised nearly $4,000. It is not just lemonade sales, people are writing sizable checks as they sip on refreshing Jason-Ade. Mark's mom, Marisa Rinkel, shared that besides the work behind the lemonade stand, Mark has also created a website to solicit donations for the cause. Makes your heart sing. Check out the story from ABC 7 News/Denver.

Diabetes control is now a virtual reality

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SugarStats makes it simple to virtually track, monitor and share key statistics to help manage your diabetes online. Here's your chance to get rid of the annoying paper trail and replace it with high tech efficiency. You would anticipate such a brilliant idea to cost boatloads. No sir -- this perk is free!

SugarStats gives you a simple and easy-to-use way to input and access your data anywhere with a web browser. Get rid of that pen and paper log -- it's all online! Track and manage meds, foods and activity. Drill down into specific timeframes to get a clear picture. Visualize your progress with easy to read graphs and trends. Share your statistics with your family, friends or doctor. This is such an awesome tool! Your desire to take control of your diabetes is so easy, thanks to Marston's brilliant interface. Sign up free or take a tour.

It seems every day I learn about an extraordinary diabetic doing something to improve the daily struggles of this unforgiving disease. Kudos Marsten! You're another shining player on Team Diabetes!

Campaign for research funding kicks off

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Beginning today, advocates across the country will be meeting with their Congressional representatives in an effort to push legislators to approve funding for type 1 diabetes research.

The Juvenile Diabetes Research Foundation's Promise to Remember Me Campaign kicks off at 11 a.m. on the Cannon House Office Building Terrace in Washington, DC. Congressman Eric Cantor, R-Virginia, will join recording artist and American Idol finalist Elliott Yamin at the event. Yamin, who has type 1 diabetes, is set to perform at 5 p.m.

As part of the campaign, the JDRF invites participants to share their story of living with diabetes with legislators and encourage them to vote for type 1 diabetes research. The effort aims to join hundreds of families with legislators in the next 10 months to discuss funding for type 1 diabetes research; Yamin is the campaign's celebrity spokesperson.

Cantor is a sponsor of HR 2762, a bill that would reauthorize the Special Diabetes Program, which coordinates the efforts of research scientists to find a cure for juvenile diabetes.

U.S. doctor compensation only serves doctors

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The cost of health care is like a kick in the gut. A good friend of mine and her husband pay over $600 a month for their portion of the policy (her small business employer pays the rest), and her family deductible is $2,000. Over $9,000 a year for family health insurance, not including the 20 percent co-pays on each post-deductible bill. If you have a particularly unhealthy year or a chronic disease like diabetes, this can run thousands more until you reach a cap. I thought we had it bad, their costs are double what my family pays. I'm not going to even get into the costs of private health insurance or the plight of the uninsured.

Alex Berenson's July 29 column in The New York Times made me ponder about the rising costs of health care. Berenson points out liberals say our government needs to force cuts in prescription drugs and insurance company profits -- conversatives often claim people need to pony up more of their own medical costs. I nearly coughed up my coffee on that one ... how in the heck can you ask a middle-class family to pay thousands more than they are already paying?

Here is what caught my eye in the column -- Dr. Peter B. Balch, a pulmonary physician and former senior adviser to Medicare/Medicaid stated it is the way doctors are paid that is driving up costs. In the U.S., doctors are compensated for each test or procedure performed, rather than a flat salary. Doctors have financial incentive to drive up health care costs. Primary care physicians and pediatricians make less money ($125,000-$200,000 a year) because they do not order as many complex procedures as specialists raking in $200,000-$300,000 a year or more.

What's even worse is there is hardly a policing system to reign in the stroke of a doctor's pen. H.M.O.s are better at refusing to pay, but Medicare stinks at the job. Dr. Stephen Zuckerman, a health economist at the Urban Institute, explained doctors have steadily increased procedures on Medicare patients, increasing their income from Medicare. Zuckerman further believes these extras have not helped patients much -- there's no strong evidence of improved health status. Medicare and some insurers are timidly moving toward small bonuses for doctor care which meets certain standards, but Dr. Alan Garber, an internist and director of the Center for Health Policy at Stanford University, argues the U.S. needs to pay docs fixed salaries and bonuses based on the health of their patients. Dr. Dana Goldman, director of health economics at the RAND Corporation, stated doctors are misleading themselves if they think the current system serves patients' needs.

You mean a doctor who would spend considerable time with a patient with type 1 or type 2 diabetes to try and influence positive diet and exercise lifestyle changes? Not in this screwed up compensation system, there's no money in it. Don't forget about doctors' ridiculously high malpractice premiums. One big merry-go-round. When will this nation get dizzy enough to stop the ride?

Heart Failure programs are working

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A few years ago, a large national initiative was launched to fight heart failure. Heart failure, which happens when the heart can't pump enough blood to vital organs, is a serious condition that affects thousands of people each year. Called Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF), the program was implemented into 259 hospitals in the US and aimed to improve the treatment of heart patients in the hospital and beyond. Their main focus included:
  • Communication between staff and patients
  • More fervent anti-smoking campaigns
  • Improved heart monitoring.
Recent reports have found that the programs have been highly successful, leading to less deaths both in the hospital and after discharge. And it's predicted that if the program continues to have this much success, it could mean 40,000 less deaths and 1.4 million less days of hospital stays per year.

Obesity is socially contagious

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A new study shows that obesity is socially contagious, and having obese parents, siblings or friends dramatically increases your chance of becoming obese yourself. The same is true in reverse as well -- thin people are more likely to have thin friends and family, and obese people who lose weight increase their friends' odds of losing weight as well.

So why is this? With parents and siblings, where you have the same genetic make-up and were raised with the same eating and exercise habits, I can see the connections. But what about friends? Perhaps people subconsciously seek out people who are the same size as them, who either make them feel ok about being overweight or who practice the same healthy habits that are conducive to being thin.

My friends are of all shapes and sizes and I would say they don't influence my size, but maybe that's why I'm neither skin thin nor overweight. What about you?

Vitamin D and blood pressure

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The big buzz this summer is about vitamin D -- mainly, our lack of it. You can get vitamin D through food or by spending just a few minutes (sans sunscreen) in the sun each day. It's been linked to cancer prevention and most recently to multiple sclerosis, and over at That's Fit, I recently read that not it's also being linked to blood pressure.

According to a recent report out the NHANES III, a study that followed over 12,000 adults over six years found that those with the lowest amounts of vitamin D in their body had blood pressure readings that were slightly higher than those who had more vitamin D upon testing. Larger studies need to be done to confirm that the link exists.

If you do choose to go out in the sun to get your vitamin D, keep in mind that 2-10 minutes is usually enough for most people and that vitamin D can also be obtained through foods like salmon, tuna, milk, and liver.

Vioxx side effects started as early as 18 days after usage

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When Vioxx first hit pharmacies across the nation, it was a happy day for those of us who suffer from arthritis pain. The new pill was a million times better than regular old ibuprofen and far less of an interference than painkillers. We could take Vioxx and get on with our days in a way that we had not been able to in a long time. Too bad the pill turned out to be a killer.

Although Vioxx held so much promise, it turned out to be deadly. Patients suffered from fatal and nonfatal heart attacks, strokes and sudden death from cardiac causes, blood clots and chest pain. In a new study published this week, research shows the miracle pills started to cause problem in as little as two weeks, not the 18 months the manufacturer previously claimed. However, since Merck & Co. was forced to remove the drug from circulation due to its deadly tendencies, the studies were discontinued.

Heart patch helps heart grow new cells

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A new patch containing a naturally occurring compound called periostin was recently tested in rats and was successful in creating new heart muscle cells, called cardiomyocytes. This is a spectacular feat, according to researchers, because heart muscle, once damaged, does not regenerate. But in rats with damaged hearts, the patch improved heart function and increased the number of these types of cells.

Periostin is found in the human body and the compound helps encourage cardiomyocytes to divide. Researchers hope that this finding may one day lead to a treatment that can help patients on heart transplant lists improve heart function enough that they can be taken off the list. Read more about the study and findings here.

Smoking while pregnant will raise your baby's blood pressure

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New research shows that raised blood pressure can be added to the list of negative side-effects babies get from their mother when she smokes during pregnancy. 456 healthy full-term babies were tested at 2 months of age and those with mothers who smoked during pregnancy had higher blood pressures on average than those whose mothers did not smoke. The higher blood pressure readings did not seem linked necessarily to low birth weight, the mother's age, or whether or not the babies were breast-fed, and follow-up studies will need to be done to see if the negative blood pressure effect stays with the children as they grow up.

Picture it: 120 calories and other servings sizes in photos

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One of the major reasons many of us are carrying a few extra pounds is that we're simply eating too much food, whether our diet is healthy or not. I can definitely relate to this -- I'm pretty vigilant about serving sizes these days but a few years ago, I thought a serving of cereal or pasta was the amount that could fit in my bowl or on my plate. Now I realize that this could have been three to four servings of food in one meal. Another problem with servings sizes is that food manufacturers often list a serving size as 250g or 4oz or 550ml. What does this mean exactly? Most of us aren't going to take the time to measure or weight our food, so we have to take some sort of guess.

If you have this problem with food, here's a handy resource we found at Diet Blog. Have you ever wondered what 120 calories looks like? Here's your answer. Keep these images in mind the next time you put together a snack.

Exercise of the Week: Incline Pull-Up

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For this week, I would like to introduce you guys and gals to a variation of the traditional pull-up. Called the Incline Pull-Up, this exercise is also very effective at targeting the muscles in your back and arms and core, but it does not require the ability to be able to lift your entire body weight.

To perform the Incline Pull-Up, start by placing a bar across a sturdy platform -- preferably a squat rack. The bar itself should be positioned at a height about equal to your stomach when you stand next to it. Next, slide your body underneath the bar and grasp it with both hands a bit wider than shoulder-width apart. Keeping your feet together and planted on the floor, you want to lift your upper body by pulling chest toward the bar. Throughout the entire movement, your feet should remain situated in the same place.

I found a good video demonstration of the Incline Pull-Up on a website. To view it, click HERE.

Lead singer of KISS cancels concerts because of heart problems

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The frontman of rock band KISS had to cancel a southern California concert last Friday (July 27th) because of heart troubles. According to music magazine NME, Paul Stanley's heart started racing during sound check and paramedics were called in to help regulate his heart beat.

While his heart problems don't appear to be life threatening at the moment, Cardiologists at Cedars Sinai recommended that Stanley cancel the concert to avoid damaging his heart further. Fans weren't left out in the cold though -- the remaining three members of the band took to the stage in his absence, marking the first time the band has played as a trio.

Cheney had heart surgery this weekend

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According to The White House this past weekend Vice President Dick Cheney had minor heart surgery to replace an implanted cardiac device intended to "monitor and correct his heart rhythm" (it's a an implantable cardioverter-defibrillator). The procedure was performed at George Washington University and was without complication, and apparently Cheney was back to his normal schedule later that same day. Cheney has suffered 4 heart attacks (whoa), the first way back when he was only 37, and at the young age of 66 has already had 2 angioplasties and a quadruple heart bypass surgery.

Are you taking your medication as prescribed?

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As someone who takes medication daily for asthma, I know how tiresome taking daily meds can be and how easy it is to forget a dose, especially when you're feeling good. Improper use of medication is a huge problem in the United States, however, and experts predict that nearly half of all patients with chronic illnesses don't take their medication as prescribed. Those with diseases that are symptom free initially -- such as heart disease -- are especially at risk. For instance, high blood pressure is known as the "silent killer" because it damages the body but causes few external symptoms, but nearly half of all hypertension suffers stick to medication guidelines.

Part of the problem is patient education and consistency, and part of the problem comes from poor wording on prescriptions. A recent study found that even a surprising 21% of physicians aren't consistent with their own medications. Government leaders are working on an aggressive campaign to help people understand the importance of taking their medications as prescribed. If you have questions about your medication, be sure to talk to your doctor before changing or dropping the dose.

Battling cancer AND your insurance company, NY Times cancer feature

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More from the New York Times series on cancer this past weekend:

In another article in the feature, Gordon Hendrickson talks about his battle with pancreatic cancer ... and his health insurance company.

Upon his diagnosis, Hendrickson received relatively good news, that his pancreatic cancer was operable and that such an operation would increase his survival greatly. However, he also received bad news. His insurance company said they would only pay for the surgery, the highly-complex Whipple procedure, if he went to one of five surgeons in his hometown.

Hendrickson wanted to have the surgery performed at M.D. Anderson in Houston, as the surgeons there had much more experience with Whipples than those in his hometown.

After bringing his evidence to a state review board, namely that the five surgeons that his plan had recommended had collectively only performed a total of five Whipples in their whole careers, Hendrickson won the case and his healthcare plan covered his surgery in Houston.

Hendrickson's story is yet another example of how patients must be their own best advocates in our challenging healthcare system.

What's in store? Hopes and dreams and so much more

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Gloria Elisa has this to say about the gift of cancer:

When my twin was diagnosed with cancer, it was certainly a wake up call. I don't think I would ever refer to it as a gift -- even now. It was two years of so many ups and downs and unimaginable hard lessons, but in turn we finally received the good news of over 14 months of remission. However, I can tell you what I learned from my twin sister is positive -- her incredible strength, faith, grace and sense of humor even during the toughest time of her life. Yes, it made us all stronger and it showed us who our true friends are, but there were those moments of uncertainty and fear which I cannot call a gift that I wish to relive ever again. Having said that, I can say that there is a light at the end of the tunnel -- after cancer, but it certainly was not a gift to our family.

What she doesn't mention in this comment she left after reading On cancer as a gift is that her Hopes & Dreams Cancer Awareness Shop is itself a gift -- to her sister Anne, to those who find themselves visiting her website, and to the recipients of her charitable work.

Accompanying her sister on her twice-traveled cancer journey and becoming both Anne's stem cell donor and caregiver was a sobering experience, says Gloria. Inspired to do something special in honor of her sister and to give back to the cancer community, she created Hopes & Dreams.

"This store gives me the opportunity to create t-shirt designs to bring awareness to Hodgkin's Lymphoma and other cancers and in doing so, I can donate the proceeds of all of the cancer awareness items to charity and pay it forward," she says.

You'll find much more than t-shirts at this location. Take a stroll through the virtual aisles -- and find out for yourself what hopes and dreams are made of.

Skin Cancer in pictures

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Finding an unusual mole can be scary, especially if you don't know the difference between 'normal' and 'abnormal'. I had one a few years ago on my back, and it turned out to be normal but it freaked me out a bit.

Here's a handy visual guide from Fitsugar on how to tell what's normal and what's not when it comes to moles. In a nutshell, look for:
  • Uneven colouring
  • Asymmetric shape
  • Jagged (as opposed to smooth) border
  • Diameter -- it should be no larger than a pencil eraser
If your mole has one of the following characteristics, don't panic. It could be nothing but the point is, you never know. Just see your doctor.

NFL coach Bill Walsh dies of leukemia

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Bill Walsh, builder of an NFL dynasty with his 49ers of the 1980s, died of leukemia Monday at his San Francisco Bay. Walsh, known as The Genius for his innovative, pass-oriented attack, was 75.

Walsh was 102-63-1 with the 49ers and won three Super Bowls and six divisional titles in just 10 years. He was named Coach of the Year in 1981 and 1984 and was inducted into the Pro Football Hall of Fame in 1993. He served twice as the 49ers' general manager and coached at Stanford after leaving the 49ers.

"His coaching accomplishments speak for themselves, but the essence of Bill Walsh was he was an extraordinary teacher," says NFL commissioner Roger Goodell. "If you gave him a blackboard and a piece of chalk, he would become a whirlwind of wisdom. He revolutionized the game with his offense and will always be remembered as one of the most influential people in NFL history."

Walsh was diagnosed with leukemia in 2004. He underwent several months of treatment and blood transfusions and publicly disclosed his illness in November 2006.

Walsh was tough on all fronts -- while fighting cancer and while coaching football.

"One of the greatest challenges of my career was coaching defense against Bill Walsh," said Patriots coach Bill Belichick, the Giants' defensive coordinator when Walsh was with the 49ers. "He turned San Francisco's offense into the best in the league. Beyond being a great offensive coach, Bill mastered running an entire pro football organization. He figured out everything from the big picture down to the smallest detail."

Test your skin protection IQ

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How much do you know about protecting your skin? How often should you apply it? How much should you use to cover your whole body? What kind of rays does sunscreen protect against? UVA? UVB? Both? If these questions have left you scratching your head, check out this quiz from Fitsugar.

Here are some quick sunscreen facts:
  • When you don't use enough sunscreen, the sunscreen you did apply is not nearly as effective.
  • UVA Rays can pass through windows and contribute to aging of the skin. UVB rays cannot pass through windows and can cause skin cancer.
  • SPF 15 blocks out 93% of harmful rays. Impressive, huh?

ABC's Robin Roberts has cancer

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Robin Roberts of Good Morning America has shared some deeply personal news with readers and viewers alike: she has cancer. While preparing for a tribute show for her colleague and friend, Joel Seigel, the hostess discovered she had a lump in her breast.

After visiting her doctor and getting a biopsy, her worst fear was confirmed. She is in the early stages of breast cancer. Her immediate thoughts were, "This can't be. I am a young, healthy woman."

Roberts is tackling the issue head on. By sharing her story with the public, she is setting a stellar example of facing her fears head on. She will soon be undergoing surgery and follow up treatments and her prognosis is very good. To send Roberts your support, click here.

Does aclohol actually increase chances of bowel cancer?

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A British study could raise a ruckus for those who enjoy a glass of wine or a cold beer at the end of the day. After polling nearly 500,000 people in 10 different European countries, a group of researchers with the European Prospective Investigation into Cancer and Nutrition (EPIC) have come to the conclusion that two servings of alcohol per day actually increased the study group's bowel cancer rate by ten per cent. BY increasing that daily intake to 3 or 4 servings, the cancer rate increased to 25 per cent.

Some factors that came in to consideration with the study was the strength of the alcohol consumed. The stronger the drink, the more likely the drinker was to get cancer. Another factor was time. The participants were followed over a six year period, during which nearly 2,000 developed bowel cancer.

The researchers are quick to say that awareness of alcohol consumption is a key factor in the study. Daily alcohol consumption coupled with smoking is unhealthy. Large servings of alcohol are also a danger. for more information, click here.

Some national cancer statistics

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Some national statistics on cancer included in the New York Times feature this week :

According to the American Cancer Society and the National Institutes of Health, there will be over 1.4 million new cases of cancer diagnosed this year.

Approximately 559,000 people will die from cancer this year in the U.S., making cancer responsible for about 1 out of 4 deaths in America.

I found this next statistic interesting, as I have seen so many conflicting numbers on this topic, the number of cancers that can be attributed to lifestyle.

According to this article, about 30 percent of cancer deaths this year will be from cancers caused by tobacco use. Another 33 percent of cancer deaths will be from cancers related to obesity, physican inactivity and poor nutrition combined. I assume that leaves 37 percent of cancer deaths due to genetic or otherwise unknown causes.

As far as age, 77% of all cancers diagnosed this year will be in individuals 55 years or older.

Cancer patients see maze of care from doctors

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If you have been through cancer treatment recently, were you given varying opinions from several medical practitioners? If so, you are not alone, as many cancer patients seem to be lost in haze of confusing medical jargon and differing opinions from several doctors.

With more than 1.4 million new cases of cancer due in 2007, one would expect the knowledge and options to be somewhat standard. As we all know, every case if different and there are so many variables at play that a customized treatment set is needed. Do all doctors pay this much attention to each cancer patient? Very doubtful -- there just are not enough specific cancer specialists to go around in my opinion.

The best defense is a good offense, so eating right and taking care of your body in exemplary fashion is a great idea regardless. But, if you end up developing cancer, it may take a decent dose of leaning and aggressiveness to battle through to the other side.

Alcohol and bowel cancer linked

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As Heather reported on earlier today, another blow to alcohol consumption has been found. European research released this week shows a connection between alcohol consumption and the possibility of developing bowel cancer.

The research concluded that people who drink one or two glasses of beer or win per day increase their chances of developing rectal (bowel) cancer by 10 percent. Is that number such a big deal? Absolutely.

Sound like a low amount? It's not -- and the researchers apparently looked at more than 500,000 people in the study, so the results are quite statistically significant. Out of that population, 18,000 people were found to have bowel cancer and the researchers dug in deep until they found out the correlation(s) with certain lifestyle choices.

It's always a good idea to have alcohol in very moderate amounts (although wine has been found to be healthy and not healthy), and this research points to more evidence to support that point. Will you abandon alcohol completely, though?

Sharp decline in the use of hormones shows drop in breast cancer

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The Journal of the National Cancer Institute published a study that stated -- a sharp decline in the use of premenopausal hormones was followed by a drop in the rate of breast cancer.

In the recent past, large clinical trials were conducted as part of the Women's Health Initiative that raised concerns about the health risks from hormonal therapies to manage menopausal symptoms. This report led many to stop using the drugs.

Since those reports that were published in 2002, the sharp decline in hormonal drugs has also seen a decline in breast cancer cases. They are not sure if this is the only reason that breast cancer rates have dropped.

The researchers however think the results of the trial provide additional evidence that recent declines in breast cancer incidence may be due in part to a decline in the use of postmenopausal hormones.

Book-loving cancer survivor inspires others

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Karen Spengler has been fighting cancer for 10 long years. Cancer's taken a lot out of her--a kidney, part of her leg bone, her hair, which she's lost nine times--but it hasn't taken her spirit, or her love of a good mystery.

Her Story is this: The owner of a Kansas City bookstore specializing in suspense novels, called I love A Mystery, Spengler also runs a support group for breast cancer survivors, called Turning Point. And though probably no other member of the group has, like Spengler, undergone treatment almost continuously for a decade, she's the backbone and the energetic force in the group.

She credits life-saving drugs to her survival against all odds, but there's another important aspect to her battle with cancer -- her positive attitude. Spengler considers herself lucky when most others would see the opposite.

Thought for the Day: What if our water made us sick?

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Here in North America, clean water is something we most certainly take for granted. We flush it down the toilet and the sink, we throw it out if it is not perfectly fresh. We're afraid of out perfectly clean tap water so we invest in expensive filters or buy our water from the store. And yet so many people out there would do anything for that tap water.

Here's a story from Dr. Gupta, CNN's medical correspondent, about a village in China that gets its water supply from the Hengshui River, which happens to be the river that receives heavy metal and mining deposits. On a scale of 1 to 5, 5 being the most toxic--too toxic to safely touch, let alone ingest--the Hengshui rates a staggering 5. Full of known carcinogens like arsenic, lead, zinc and cadmium, the water is slowly killing the people who rely on it, and they have no choice but depend on this water source -- there are no others.

I can't imagine living in a world where the price you pay for water is your life, where you can't rely on anyone to step in and make sure you have a clean water supply. It's truly heartbreaking.

Elizabeth Edwards: asymptomatic and doing fine

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It seems Elizabeth Edwards has a good amount of energy, despite her diagnosis of incurable cancer in March, following a previous battle with breast cancer. Perhaps her energy stems from the fact that she is asymptomatic and feeling quite well.

About her health and her husband's campaign, Edwards says, "I feel good and honestly, the campaign is more helpful. I don't sit at home and worry about what's going to happen to me a year from now, two years from now, 10 years from now. I take a pill in the morning and that's when I think about cancer. No other time of the day do I think about my cancer."

While she does admit she doesn't want to push herself too hard, she doesn't worry about the accompanying her husband, Democratic presidential candidate John Edwards, on his busy campaign trail. And she doesn't worry about what others might think of her decision to press forward.

"Honestly, I didn't hear any criticism from anybody who's been through it. I think people who haven't been through it were critical. I just hope they never have a chance to learn the choices they would make. I'm pretty confident they would choose, as we have, to do things. I can't imagine better medicine for me than to be out doing something."

Cancer by the Numbers: Osteosarcoma

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Overview of osteosarcoma:

There are about 900 new cases of osteosarcoma diagnosed in the US each year. About 400 occur in children and adolescents younger than 20 years of age.

Osteosarcoma forms in the bones. It is most commonly diagnosed in those who are 15 to 25 years of age. It is also the most common type of bone cancer, and the sixth most common type of cancer in children.

Other types of cancer can eventually metastasize to the bone, however this disease originates in the bone and can spread elsewhere to other parts of the body.

Many cases of osteosarcoma, around 80 percent, begin in or around the knee area.

What are the risks of osteosarcoma?

The disease is most seen in boys and can arise from unpredictable errors in the DNA of growing bone cells during times of intense bone growth. Currently, there is no effective way to prevent this type of cancer but with proper treatment most kids diagnosed with osteosarcoma do recover.

What are the symptoms of osteosarcoma?

The most common symptoms experienced is pain or swelling in the leg or arm. Pain may be worse during exercise or at night. A lump may develop at the pain site after a few weeks. Another sign can be a broken arm or a leg because the cancer has weakened the bone and makes it vulnerable to a break or fracture.

How is osteosarcoma staged?

Generally speaking, doctors (especially those treating children) divide osteosarcomas into 2 "stages" - localized and metastatic - when deciding on the best course of treatment.

Localized osteosarcoma: A localized osteosarcoma affects only the bone it started in and the tissues next to the bone, such as muscle, tendon, etc.

Metastatic osteosarcoma: A metastatic osteosarcoma has spread to other parts of the body such as the lungs or to other bones not directly connected to the bone the tumor started in. Most often the spread is to the lungs (85%), but spread to other bones, the brain, or other internal organs may occur.

Patients with metastases found at the time of diagnosis have a worse prognosis, although some can be cured if the metastases can be removed by surgery. The cure rate for these patients is markedly improved if chemotherapy is also given.

What treatments are available for osteosarcoma?

Surgery to remove the tumor, chemotherapy to treat the body systematically in case any cancer cells are roaming around in the body. The surgical treatment could involve amputation of a limb or limb-salvage surgery.

Limb-salvage surgery allows the surgeon to save the arm or leg by only removing the area of bone with the cancer and then putting in a bone graft to fill the gap, saving the child from having to get their limb amputated.

What are the chances for a cure?

Survival rates are 60 percent to 80 percent to those patients who have not shown spread of the cancer to other areas of the body.

Resources Available:

American Cancer Society

Kids Health

Osteosarcoma Online

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Checking for skin cancer signs

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Summer is in full swing and there is no better time to have a reminder about checking yourself for skin cancer signs than now. In addition to ensuring those moles are benign, are there other things you can do to make sure you're safe from skin cancer? Some simple self checks are a great starting point.

Irregularly-shaped skin blemishes that are reddish-brown to brown in color should be checked out, and if those moles have any of the characteristics below, someone qualified like a regular physician, dermatologist or even oncologist may need to take a closer look.
  • Bleeding
  • Itching
  • Rapid growth
  • A sore or area that won't heal
  • A scaly or crusty growth
  • Rough patches that feel like sandpaper

Lower insulin levels cut breast cancer recurrence

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Researchers at the Dana-Farber Cancer Institute in Boston say exercise helps combat breast cancer. Not the first time we've heard this fact. But these same researchers have something new to say -- about the reason physical activity lowers the risk of breast cancer recurrence.

Jennifer Ligibel, MD, of Dana-Farber, reports that exercise lowers levels of the hormone insulin in the bloodstream. This is significant because there appears to be an association between relatively high levels of insulin, seen in obese and sedentary people, and an increased risk of breast cancer recurrence and breast cancer-related death.

"We know that women who are overweight at the time of breast cancer diagnosis have a higher risk of recurrence than lean women, but the reasons for this have not been clear," said Ligibel.

Now we know that study participants who took part in a 16-week program of cardiovascular and strength training were able to lower their insulin measurements by statistically-significant amounts.

"Our findings suggest that the effects of exercise on breast cancer prognosis may be mediated, at least in part, through changes in insulin levels and/or changes in fat mass or deposition," said Ligibel. "Exercise has benefits all through treatment and afterwards. It's an investment in a woman's health and hopefully will prove to lower her risk of dying from breast cancer."

Coaching patients and physicians to make the most of visits

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A review of 33 studies by The Cochrane Collaboration found that giving patients checklists and providing coaching in the doctor's office can help them ask more questions of their physician and receive more useful information in return.

These coaching interventions were most effective if they took place immediately before a consultation. Such coaching increased patient satisfaction and decreased patient anxiety.

The review also examined the value of refresher courses in communication skills for doctors. According to the review, doctors often underestimate their patients' needs for information. Also, physicians are sometimes reluctant to give information they feel could be disturbing or harmful when treating patients with serious or life-threatening illnesses.

In addition, studies have shown that patients talk for only 30 seconds before doctors cut in and take over.

What has your experience been regarding doctors and their communication skills? What advice would you give patients to make the most of their visits?

Coffee connected to lowered colon cancer risk again

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One thing that simply never ceases to leave from the media these days is the subject of coffee drinking. Is it good for you or bad? Studies abound on this issue, and the only real consensus is confusion it seems.

So, let's try another one: a recent piece of research from Japan concluded that consuming three or more cups of coffee a day may cut the risk of colon cancer in women by half. By half?

I wonder if the antioxidant level in coffee has anything to do with that if in fact there is validity to the study. It looked at information from more than 96,000 men and women aged between 40-69 over a period of up to 12 years, so I'm thinking the study has some validity (without looking deeper). The researchers did state that the mechanism in coffee that seemed to have a cancer prevention effect was unknown.