Health Tip: Your Family Has a Medical History

Your doctor probably has asked you questions about your family history, since it may have a significant impact on your well-being. Read more

Health Tip: Be Proactive at Your Next Doctor Visit

(HealthDay News) -- If you don't go to the doctor very often, it's important to make the most of every visit.

It's your opportunity to talk to your doctor about any health problems, or questions that you have.

Here are conversation pointers for your next medical visit, as recommended by the American Academy of Family Physicians:

• Bring up any symptoms or health concerns that you have.
• Create a log of your health history and bring it to your appointment.
• Tell your doctor about any stress in your life that could be affecting your health.
• Discuss any medications or supplements that you take, and any side effects that you suspect may be caused by them.
• Bring any recent medical records, test results or X-rays.
• Clarify anything your doctor says that you don't understand.
• sk for extra time to spend with your doctor, if you need it. If your doctor can't be available personally, a nurse or physician assistant may be able to spend time with you.
  
  

Could Anger at the System Bring You and Your Doc Together Online?

By Scott Mowbray
Patients and health-care providers are all over the Internet: Patients talk to each other and organize into disease-specific networks, while HMOs build websites that allow members to check billing, look up doctors, and sometimes upload medical test results and other data.

According to Web observer Clay Shirky, however, there’s a huge divide between patients and the medical system online, in part because Big Medicine is afraid of the new power of patients in a traditionally closed, top-down world.
That will change, Shirky predicts, and anger among doctors may accelerate the process. Read More

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Health Tip: Be a Smart Patient

(HealthDay News) -- Although your doctor and other health-care professionals do their best to help you stay safe, there are things you can do to prevent problems.


The Cleveland Clinic offers these suggestions on how to be a smart patient:

• If you have a question or concern about your health or treatment, talk to your doctor about it. Bring a friend or family member if you need help understanding what you must do.


• Give your doctor and pharmacist a complete list of every medication you take, including those sold over-the-counter. Ask about any side effects or sets of drugs that shouldn't be taken together.


• Always get your test results. Ask your doctor at the time of the test when results will be available, and when you can discuss them together.


• If you are able to choose a hospital, discuss the choices with your doctor.


• If you need surgery, ask your physician what will happen, what to expect, and what you need to do.

A Doctor on Vacation: Diagnosing Disease Wherever She Goes

By Dena Rifkin, MD

As I prepared for a vacation recently, I realized that it’s getting harder and harder to really “check out” of any kind of job these days. The ubiquitousness of BlackBerries, Wi-Fi, cell phones, and other devices designed to keep us forever in touch with each other make it impossible to really escape. As a doctor, I face an added difficulty in taking a break from my work—the inescapable urge to diagnose disease in random passersby. Read More

How Doctors Learn From Patients

By Dena Rifkin, MD
I need to learn a new technique for inserting a large intravenous line. As a resident, I learned how to place these lines (used for medications and dialysis) in the groin or neck by locating the arterial pulse with my fingers, looking at the anatomical landmarks nearby, and then calculating in my mind where the vein ought to be. After a while I could reliably get a needle into the vein by ‘feel.’

Since then, a bedside ultrasound device has become part of the procedure, allowing you to actually ‘see’ the vein you are aiming for—a pretty amazing difference from the way I learned. I’m told it’s awkward the first few times you try it, since you have to juggle the ultrasound and the needle while keeping everything sterile. So, I asked my colleagues to teach me.
Read More

Go Ahead, Email Your Doctor...As Long As It's Not Serious

A near-death experience taught me the perils of online communication with my patients
by Dena Rifkin, MD

I read a news item today reporting that only one in three U.S. doctors communicate with patients via email. We doctors were accused of lagging behind other professionals in online communication.

Well, I am one of the physicians already communicating with patients via email. Like everything else about the digital world, it has its benefits and its drawbacks. I fully agree that simple things, like prescription refills, routine lab reports, and so forth can be handled best by email—often, these do not even require the intervention of a physician.

It's when we get into questions about health problems that email can be problematic.

I returned from a holiday weekend at home to find an email from a patient waiting for me. It had been sent late on Friday night. "Dear Doctor," my patient wrote. "I am very worried." He went on to describe bleeding, fatigue, and weakness. He asked me to call him when convenient. Then he ended the message: "I hope you have a good holiday."

Three days had passed. My heart was racing as I called his home phone number. Fortunately, he was still alive, but he had not sought any other medical help. I sent him directly to the emergency room and he spent several days in the hospital recovering from a serious intestinal bleeding episode.

All of our patients are asked to sign a consent form before we communicate via email, and part of that consent involves agreeing not to use email for acute health problems requiring urgent attention, like this one. But it is so easy to send an email—much easier than calling the on-call physician or going to an emergency room. I've had other, less extreme encounters where patients emailed about issues that really needed to be addressed in person.

If you choose to email your own doctor, realize that these e-encounters are probably best reserved for administrative problems or minor updates to ongoing discussions (like telling the physician that a recent medication worked well or didn't work), rather than new medical problems. At the very least, you'll save your doctor a Monday morning heart attack like the one I nearly had.

Chemotherapy Has Turned Me Into a Bloodhound

Cancer drugs scramble the signals that the nose and tongue send to the brain, with bizarre results by Jason Carpenter

When one of the doctors offhandedly mentioned that my sense of taste or smell could be affected by the high-dose chemotherapy treatments I was getting in my battle against multiple myeloma, I didn't pay much attention. Not until I found I could detect the slightest whiff of anything from 20 feet. Not until anything I put in my mouth had a taste so intense that I vomited every meal for two weeks.

It was a horrible cycle that I could not break: When a meal came back up, it smelled awful and made me puke more. My mom, who spent some time at the hospital with me and at my house after I was discharged, developed a two-puke-pan routine: She would remove one pan on my command, then slip another one under me so I didn't have to endure the output.

While in the hospital, I developed a vomit association with just about everything the institution stocked for supplies: bathroom soap, hand soap, paper towels, hand sanitizer, toilet paper, and even facial tissue (I could smell tissues rippling in the air across the room). Clearly, some of this was in my head, but a good portion of it was not, according to breastcancer.com.

Thirty-two days after my transplant, I cannot smell hospital supplies without gagging. Because I need to constantly disinfect my hands and face (trying to banish germs that could attack my weakened immune system), I've had to switch to neutral-smelling antibacterial baby wipes. Things are somewhat better: I gag but don’t usually vomit, though I do risk hurling on my laptop just writing this down. I'm told this will slowly ebb over the next weeks or months.

Even my sense of touch has been affected. For the first few post-op visits to the hospital, I nearly jumped out of my skin with pain when the nurse drew blood. I have had my blood drawn hundreds of times, and it's never hurt like this. The nurse noticed and said, "Your nerves are sensitive because of the chemo. It's completely normal."

Normal, my ass. I'm a bloodhound; my food tastes as if someone turned the volume to 11; and I screech like a little girl when I have my blood drawn. But I’ll say it again: I'll take all these wacky side effects over cancer.

As to my progress, I went to the doctor today and my white blood count is back up to 4.1 (close to the low end of normal), my platelets are good, and my red blood cells are charging back. The doctor is so pleased with my recovery that I don't need to see her for three weeks. She even said that I can start to ease the restrictions of being around people. Which means I’m planning to play poker again, tonight, latex gloves and all.

See Jason Carpenter's ongoing video postings about his life with cancer. Warning: Some expletives.

Stem Cell Transplant Update: Advice On Hair Falling Out

When You Really Need Your Doctor...and She's in Fiji

How to get great medical care from the doctor on call (from a doctor on call)
by Dena Rifkin, MD

A couple of my colleagues were out of town this week, so I’ve been taking care of some of their patients for them. This is known as covering, and we do it all the time: nights, weekends, holidays, vacations.

The days when doctors were on call 24 hours a day, seven days a week, are, by and large, gone with the horse-drawn ambulance and the once-ubiquitous black bag.

How does coverage work? Well, a lot depends on the system. Some practices cancel everything but urgent care while they are away. For others, the practice must continue—for instance, dialysis patients must come three times a week, every week. Some practices have electronic medical records that make it easy to look up old records if a patient calls in with a new problem.

The hospital where I work has an electronic-record system, and I can access it from home, which makes taking care of urgent calls much easier. But still, there are times when it’s pretty hard to figure out what’s going on when an unknown patient with a complicated history calls. Patients often call for reassurance about a new symptom—they don’t want to have to go to the ER (who would?). Sometimes we can provide that reassurance, and sometimes we can’t.
Continue reading »

The Soaring Cost of Dental Care Is Nothing to Smile About

Let’s drill down into why it’s so expensive to have a healthy mouth
by Amy O'Connor

This is me holding my $1,200 crown (it recently popped out, hence this blog), my husband’s $450 mouth guard, and the retainer I have worn since I was a teenager.

Notice that I am not smiling. We spend far more on dental care and devices than we do on doctors, and it’s getting more expensive as we get older. Continue reading »

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Meet the War Doctors Saving Our Soldiers' Lives

A new documentary film puts a face—and a price—on battlefield medicine
by Sally Chew

The original inspiration for the new documentary Fighting for Life was a pre-Iraq War threat in Congress to shut down the Uniformed Services University in Bethesda, Md., which has trained one of every four current active-duty military physicians. It’s hard to imagine lawmakers will try that again anytime soon, considering the tens of thousands of Iraq vets who will likely need physical and/or psychological care for decades to come, but director Terry Sanders won’t rest easy. He wants those of us caught up in our own health issues or waiting for the next installment of House to appreciate the brutality and the accomplishments of modern military medicine while getting to know a few of these docs, along with their shrapnel-pocked charges.

Among the latest high-tech advances in battlefield care is the ability to move patients neatly and quickly in mobile hospitals (aka airplanes): Continue reading »

The Hidden Costs of Your Doctor Visit

Are parking fees, co-pays, plus the half-day’s wages you lose sitting in my waiting room keeping you from getting the health care you need?
by Dena Rifkin, MD

I was commiserating with a patient about the cost of parking at our medical center. Depending on the length of a visit, the ticket in the garage here can cost $5 to $10. Not a fortune, but if you need to see your doctor monthly, it adds up. “Ah, doctor,” she said, “this is the problem: It is too expensive to stay healthy!”

Her comment made me think again about co-payments, that $10, $15, or $25 you fork over to see someone like me even before your insurance company decides if it will cover your entire visit and all the tests you need.

The actual charge for the visit and associated tests is much more than that, of course, though people with health insurance rarely see the actual charge for the visit. So why does the co-pay exist, if it’s such a small fraction of the total cost? Continue reading »

Heart Failure Raises Risks After Non-Cardiac Surgeries

(HealthDay News) -- Older people with heart failure face heightened odds of complications and death after non-cardiac surgeries, according to the largest study ever conducted on the issue.

"We're trying to draw attention to this major problem," said lead researcher Dr. Adrian F. Hernandez, an assistant professor of medicine at Duke University in Durham, N.C.

Heart failure, the progressive loss of the heart's ability to pump blood, is widespread among older Americans, but it sometimes is overlooked as a risk factor when surgery is needed, he said.

"Most physicians focus on whether [older patients] have coronary artery disease or have a risk of heart attack," Hernandez said. "Heart failure is by far a more important risk factor, but it doesn't usually have greater weight when they want to identify patients at risk of complications or consider how they want to treat them after surgery."

Symptoms of heart failure include shortness of breath, fatigue and swelling of the legs.

Hernandez' group published the study in the April issue of Anesthesiology. They used Medicare data on more than 159,000 people undergoing major surgery not involving the heart, such as hip replacement operations. Past estimates have put the incidence of heart failure in the older population between 5 percent and 12 percent, but the new study found the condition in almost 20 percent of those having surgery.

The study divided the participants into three groups: those with heart failure, with or without coronary artery disease; those with only coronary artery disease; and those with neither condition.

Nearly 98 percent of all those who had surgery were discharged soon afterward from the hospital. But 17.1 percent of those with heart failure had to be re-hospitalized within 30 days, compared to 10.8 percent of those with coronary artery disease and just 8.1 percent of those with neither ailment.

In the month after a surgery, 1.6 percent of those with heart failure died, compared to 0.5 percent for those with coronary artery disease and 0.3 percent of those with neither condition, the study found.

Steps can be taken to reduce the toll, Hernandez said.

"The first thing is to check on what the conditions are that might influence the patients outcomes," he said. "We have to identify therapies that lower the risk of a poor outcome and assure that all patients, when they have surgery, are carefully monitored."

Close attention should be paid to be sure that symptoms of heart failure are kept to a minimum, Hernandez said. Medications such as beta blockers and diuretics can be used to keep heart failure under control, he added.

But he noted that it's not certain how effective such measures might be in reducing risks -- only a rigorous, controlled study could answer that question definitively.

"We are planning to do such studies, but our planning is still in the early stages," he said. "We still need to identify sponsors of such a study."

One expert applauded the new research.

The increase in surgery risk due to heart failure has been noted before, but "this is a big study that involves a lot of people. It solidifies that the risk is real, and the risk is substantial," said Dr. Robert Hobbs, a staff cardiologist at the Cleveland Clinic whose work covers heart failure and transplant medicine.

Measures that can be taken to reduce the risk include simply not performing surgery, if possible, on someone whose life might be endangered, Hobbs said. "If surgery is necessary for someone with heart failure, there should be targeted use of heart failure medications before the operation and an effort to avoid overloading the body with intravenous fluid during the procedure," he said.

"And we would certainly watch them more carefully in the postoperative period," Hobbs added.

More information
Learn about heart failure, its symptoms and treatment, from the U.S. Library of Medicine.

Know Suicide's Warning Signs

(HealthDay News) -- While many people view spring as a time of renewal and hope, the greatest number of suicides in the United States occur each year in April and May, notes the American College of Emergency Physicians.

It's not clear why suicide rates spike in the spring, said ACEP President Dr. Linda L. Lawrence. But "we do know that suicide is the 11th leading cause of death for all ages in the United States, with one suicide occurring every 16 minutes or about 11 suicides per 100,000 people," she said in a prepared statement.

"Moreover, suicide is the second leading cause of death among 25- to 34-year-olds and the third leading cause of death among 15- to 24-year-olds. Men take their own lives nearly four times more often than women, with men ages 75 and older having the highest rate of suicide, although over a lifetime, women attempt suicide two to three times as often as men," Lawrence said.

For every successful suicide attempt, there are 25 failed attempts that often leave people seriously injured and in need of medical care. More than 90 percent of all suicides are linked with a mood disorder or other psychiatric illnesses, which can be treated through behavioral therapy and medication, Lawrence said.

"So we want to build greater public awareness and understanding of suicide in order to prevent these needless deaths and injuries from occurring," she said.

As part of that effort, the ACEP wants to educate people about the warning signs of suicidal behavior, which include:

• Feeling depressed, down or excessively sad.


• Feelings of hopelessness, worthlessness or having no purpose in life, along with a loss of interest or pleasure in doing things.


• Preoccupation with death, dying or violence, or talking about wanting to die.


• Seeking access to medications, weapons or other means of committing suicide.


• Wide mood swings -- feeling extremely up one day and terribly down the next.


• Feelings of great agitation, rage or uncontrolled anger, or wanting to get revenge.


• Changes in eating and sleeping habits, appearance, behavior, or personality.


• Risky or self-destructive behavior, such as driving recklessly or taking illegal drugs.


• Sudden calmness (a sign that a person has made the decision to attempt suicide).


• Life crises, trauma or setbacks, including school, work or relationship problems, job loss, divorce, death of a loved one, financial difficulties, diagnosis of a terminal illness.


• Putting one's affairs in order, including giving away belongings, visiting family members and friends, drawing up a will or writing a suicide note.

If a person is threatening to commit suicide, take it seriously, remain calm and take the following steps, ACEP advises:

• Don't leave the person alone. Prevent access to firearms, knives, medications or any other item the person may use to commit suicide.


• Don't try to handle the situation alone. Call 911 or the local emergency response number. Phone the person's doctor, the police, a local crisis intervention team, or others who are trained to help.


• While waiting for help, listen closely to the person. Let the person know you're listening by maintaining eye contact, moving closer, or holding his or her hand, if appropriate.
  Ask questions to determine what method of suicide the person is considering and whether he or she has an organized plan.


• Remind the person that help is available.


• If the person does attempt suicide, immediately call for emergency medical assistance and administer first aid, if necessary.

More information

For more on preventing suicide, visit the U.S. Centers for Disease Control and Prevention.

Arthroscopic Surgery Eases Tough-to-Treat Tennis Elbow

(HealthDay News) -- Arthroscopic surgery can offer long-term pain reduction and increased mobility for people with tennis elbow, U.S. researchers report.

Of the 30 patients who underwent the surgery and were followed by the researchers for almost 11 years, 93 percent said they would have the procedure again, according to a study slated for presentation Saturday at the annual meeting of the American Orthopaedic Society for Sports Medicine, in Calgary, Alberta, Canada.

An arthroscope is a tiny tube with lenses, a video camera and a small light that allows surgeons to see and work inside a joint without making a big incision. According to the researchers, arthroscopic surgery speeds rehabilitation and has fewer complications than open surgery.

In the study, a team led by Dr. Champ L. Baker III, an orthopaedic resident at the University of Pittsburgh, followed 30 patients who underwent surgery for tennis elbow for 130 months. The patients were enrolled through Hughston Clinic in Columbus, Ga.

"This is the first longitudinal study of arthroscopic treatment of tennis elbow," said Baker in a prepared statement. "The initial success from our original short-term study was maintained long-term. I am happy to say that arthroscopic release is a good treatment option for lingering tennis elbow."

Baker recommends the surgery for people who have suffered with the condition for more than a year but have found no relief through other approaches, including rest.

Tennis elbow results from repetitive motions with the arm extended and the wrist moving up and down. In addition to playing tennis, lifting heavy boxes, long-term keyboard use and shaking hands on the campaign trail can all cause the condition.

More information
To learn more about elbow injuries and disorders, visit the U.S. National Library of Medicine.

Frying Tumors Can Boost Lung Cancer Survival

(HealthDay News) -- Needle-delivered frying or freezing technologies can be useful weapons against both lung and kidney cancers, new research shows.

In one study conducted in France, patients with advanced lung cancer who were not candidates for surgery underwent a procedure known as radiofrequency ablation (RFA), which basically heats the tumors and kills them.

Seventy percent of the patients with lung metastases or primary non-small cell lung cancer were still alive after two years -- similar to results seen after surgery.

Furthermore, 85 percent of patients with non-small cell primary lung cancer treated with RFA had no viable tumors visible on imaging one year later, while 77 percent had no viable tumors after two years.

"It means that you can actually do a very good job of local control of lung tumors in patients who aren't fit for surgery," said Dr. Damian Dupuy, a professor of diagnostic imaging at Warren Alpert Medical School at Brown University and director of tumor ablation at Rhode Island Hospital in Providence.

"The medical establishment, being very conservative, has always said if you aren't fit for surgery you just basically get chemo and radiation and most of the time [they] don't work well and you die of your tumor. But even the most unfit for surgery can have this procedure safely," Dupuy said.

The Brown researcher was not involved in the French study, but his group completed a lung cancer trial last year with similarly good results.

The new study, led by Dr. Thierry de Baere of Institute Gustave Roussy, in Villejuif, France, was to be presented Monday at the annual meeting of the Society for Interventional Radiology in Washington, D.C.

Lung cancer is the number one cancer killer in the United States and a full 25 percent of patients who have operable disease can't undergo surgery because of co-existing conditions, Dupuy noted.

"This is a huge advance for them," he said. "This procedure is done at almost every hospital that has an interventional radiologist, which is most. It's like a lung biopsy."

"If you have to stick a needle in to diagnose lung cancer anyway, why not do it in a single sitting?" Dupuy asked.

Most patients go home the same day, he noted. According to Dupuy, the procedure may also hold promise for pain relief in patients who are dying.

Two other studies presented at the meeting used the other end of the temperature spectrum -- cryoablation -- to successfully freeze and kill kidney cancer tumors.

"This is a minimally invasive, non-surgical cancer treatment without an incision, explained Dr. Christos S. Georgiades, lead author of one of the studies and an assistant professor of radiology and surgery at Johns Hopkins Hospital in Baltimore. "You put a probe, which is basically a needle, into the tumor, freeze the central volume of the tissue with temperatures close to negative 150 degrees centigrade. The patients don't feel the cold."

In Georgiades' study, the procedure was 95 percent effective for tumors 4 centimeters or smaller and almost 90 percent effective in tumors up to 7 centimeters in diameter after one year. This was in patients with disease that had not yet spread beyond the kidney, he noted.

"The technique has been around for a few years, but we're only now proving that it works," Georgiades said. "Patients have recovery close to that of surgery and many do not have to have surgery. Many procedures are done on an outpatient basis."

The third study, from the Barbara Ann Karmanos Cancer Institute in Detroit, looked at tumors treated with cryoablation whose average size was 2.8 centimeters. After 1.3 years, most of the tumors still came up on imaging as dead tissue, the team found.

More information
For more on these and other procedures, visit the Society of Interventional Radiologists.

Rare Gene Mutation Plays Role in Longevity

(HealthDay News) -- A rare gene mutation that restricts a particular growth factor may be one of the keys to living to 100 and beyond, a new study suggests.

This mutation, which seems to decrease the activity of insulin-like growth factor (IGF-1), results in short stature but longer life. Exactly why this might lengthen someone's life isn't known, but the researchers say the finding might prove useful in developing anti-aging drugs.

"We found that people of a hundred years old have mutations in a gene that is related to the growth hormone pathway," said lead researcher Dr. Nir Barzilai, director of the Institute for Aging Research at the Albert Einstein College of Medicine in New York City. "We think this is important, because that's what now happens in nature. The pony lives longer than the horse, the small dog lives longer than a large dog. Apparently, it's true for humans also."

Interestingly, this particular mutation has been found mostly among women, he added.

It might be possible, given these findings, to develop drugs that can prevent aging and age-related disease, Barzilai noted. "There are drugs being developed to decrease growth hormone in patients with tumors, because sometimes cancer is dependent on growth hormones," he said.

"Maybe we can adopt the strategy to slow aging."

The report was published in this week's online issue of the Proceedings of the National Academy of Sciences.

In the study, Barzilai's team looked for this mutation among a population of Ashkenazi Jews who were 100, and their offspring. They also matched these offspring with people who had no history of longevity in their family. The researchers found this particular mutation was more common among those who were centenarians and their offspring. The same research team reported in December 2006 that a particular gene variant that is linked to longevity is also associated with improved mental function in the elderly.

How long growth hormones need to be restricted to produce the slowing of aging isn't known. "Do you have it during early development in the womb, in puberty, or can you have it at any stage that you wish?" Barzilai asked.

Barzilai noted that growth hormone is a very popular anti-aging therapy. Growth hormone changes the tone of the skin and fat distribution, and increases muscle mass.

"However, this study and other studies suggest that, for the purpose of aging and longevity, growth hormone might do exactly the opposite," he said. "In the short run, growth hormones are going to have positive effects, but certainly in elderly people I would suggest, and this study supports the notion, that we will kill them sooner rather than later."

One expert thinks the findings are intriguing but inconclusive.

"This is an interesting study, which has to be replicated by other researchers using a different dataset, because studies on exceptional longevity often cannot be replicated," said Leonid Gavrilov, a research associate at the Center on Aging at the University of Chicago.

The study found a sex-specific increase in IGF-1; it showed up only among the daughters of centenarians, while sons were not affected, Gavrilov noted. "The study does not suggest any explanation, or even a hypothesis, for this sex-specific effect. General conclusions suggested in this paper may be questionable if they are not applicable to men," he said.

"It may be interesting to put this study in a context of other findings, such as being born to a young mother helps to live to 100 years," Gavrilov said.

More information
For more on aging, visit the National Institute on Aging.

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New Stroke Therapies Show Promise

(HealthDay News) -- Several new studies point to the promise of new ways to treat different types of stroke.

The research was presented during a teleconference Friday at the American Stroke Association's International Stroke Conference in New Orleans.

The first trial found some benefit when tPA, the only approved therapy for acute ischemic stroke, was given outside the usual three-hour treatment window. Patients in this Australian trial who were given tPA three to six hours after having a stroke had increased restoration of blood flow and a smaller area of the brain was deprived of blood. The study was expected to be published in the April issue of The Lancet Neurology, but was released Friday to coincide with the meeting presentation.

Ischemic stroke involves an obstruction in one of the vessels supplying blood to the brain. Currently, "clot busters" are only considered effective for the first three hours after a stroke.

"The issue is that we've got a three-hour label, and can we extend that to six hours," said study author Dr. Stephen M. Davis, of Royal Melbourne Hospital. "Based on our results, it gives a lot of encouragement that you can enrich that population. A lot of people arrive too late, and these are ones we would be targeting."

The findings are enough to warrant further trials but not to change current clinical guidelines just yet.

"This should be viewed as very encouraging, as an intermediate step that's leading to the formation hopefully of a larger study that can be more definitive and that could impact our guidelines significantly," said Dr. Philip Gorelick, moderator of the teleconference and head of the department of neurology and rehabilitation at the University of Illinois at Chicago.

A second study looked at patients in China, South Korea and Australia with acute cerebral hemorrhage, the most serious form of stroke.

"High blood pressure is a cause of intercerebral hemorrhage and is also very common at [the] acute state, and we don't know what to do about it," said study author Dr. Craig Anderson, from the University of Sydney in Australia. "We believe that having high blood pressure causes extra bleeding and expansion of blood in the brain. If we can bring blood pressure down, we may be able to arrest bleeding in the brain and bring it under control."

In fact, intensive lowering of blood pressure arrested about half a teaspoon of blood and, Anderson said, "in real life, it might have a bigger treatment effect."

Again, the authors hope the findings will lead to funding for larger trials.

A third trial found that reducing blood pressure in the 60 percent to 70 percent of patients who have elevated levels following acute stroke resulted in reduced dysphasia (communication problems) and some mortality benefits.

"These are very small numbers, and I don't want to hang too much on those results, but I think it's very encouraging, so we can probably go forward and do a much larger phase 3 study," said British study author Dr. John Potter.

For now, Gorelick said, "we continue to recommend that physicians follow American Heart Association/American Stroke Association guidelines. The blood pressure [issue] has not been resolved, and there are important questions of what to do with blood pressure. . . [although] it would be nice to have a definitive plan here and get people on blood pressure-lowering medicine."

Other studies being presented at the conference found that:

• The recently approved Penumbra device, a "vacuum cleaner" which sucks clots out of the brain, was effective for eight hours after the onset of a stroke, adding five hours to a patient's treatment window.
• Aricept (donepezil) improved several measures of executive function and processing speed in patients with a subcortical form of vascular dementia but did not improve overall cognitive scores, according to researchers from the University of Muenchen in Muenchen, Germany.
• Certain chromosomal regions may harbor genes important in assessing individuals at risk for aneurysms. "This is a critical first step if you want to find genes," said study author Dr. Tatiana Foroud, of Medical & Molecular Genetics in Indianapolis. "The ultimate goal is a genetic test to identify individuals at higher risk for aneurysm, and those individuals could have targeted and more costly screening pursued on a regular basis."

More information
Visit the American Stroke Association for more on different types of stroke.

BSD Medical Participates on Invitation at International Conference on Hyperthermic Oncology and Medicine in India

BSD Medical Corporation (AMEX:BSM) today announced that Richard A. White, Vice President of International Sales, along with some of the leading researchers in hyperthermia therapy, spoke and participated in a panel discussion as invited guests at the International Conference on Hyperthermic Oncology and Medicine held at the Mahavir Cancer Center in Patna, India February 16-17.

The two-day meeting was devoted entirely to the use of hyperthermia therapy in treating cancer. The panel upon which Mr. White and international scientists from the field participated was centered upon strategies to bring hyperthermia therapy to developing countries. At the meeting the invited scientists spoke on the clinical support for the use of hyperthermia therapy in treating cancer, as largely performed on BSD Medical's hyperthermia systems.

The conference received strong attention from the Indian Government, as Her Excellency, the President of India, Shrimati Pratibha Devisingh Patil opened the conference. The President said, "Cancer can be controlled if diagnosed well in time, however, in India, about two-thirds of cancer patients are diagnosed at the advanced stage when it becomes more difficult to treat."

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Dr. Nagraj Huigol, the National Secretary of the Association of Hyperthermic Oncology and Medicine (in India), stated that "Hyperthermia could be beneficial even for those suffering from resistant cancers. In fact a combination of the conventional mode of treatment and hyperthermia could create wonders if handled aptly." Dr. Nagraj appealed to the central and state governments to set up prominent medical centers for the benefit of those cancer patients who have lost all hope.

More than 800,000 people in India are diagnosed with cancer every year, and more than 400,000 die from the disease annually. Of these, lung cancer (250,000 cases), cervical cancer (126,000 cases) and breast cancer (80,000 cases) are the most prevalent. About 70% of the cases are diagnosed when the cancer is in an advanced T3 or T4 stage, where the use of hyperthermia therapy may be particularly implied for some cancers.

About BSD Medical Corporation
BSD Medical Corp. is the leading developer of systems used to deliver hyperthermia therapy for the treatment of cancer. Hyperthermia therapy is used to kill cancer directly and increase the effectiveness of companion radiation treatments. Research has also shown promising results from the use of hyperthermia therapy in combination with chemotherapy, and for tumor reduction prior to surgery. For further information visit BSD Medical's website at http://www.bsdmedical.com/ or BSD's patient website at http://www.treatwithheat.com/.

Statements contained in this press release that are not historical facts are forward-looking statements, as defined in the Private Securities Litigation Reform Act of 1995. All forward-looking statements are subject to risks and uncertainties detailed in the Company's filings with the Securities and Exchange Commission.

Source: Business Wire

Chemotherapy After Breast Cancer Surgery Effective for Older Women, Too

HealthDay News) -- It's clear that chemotherapy after breast cancer surgery increases survival rates. But many older women aren't being offered this potentially lifesaving treatment.
But, age shouldn't be a deciding factor -- an older woman's general health appears to be a better predictor of positive results after chemotherapy, according to a study published recently in the Journal of the American Medical Association.

"Age alone should not be a contraindication to the use of optimal chemotherapy regimens in older women who are in good general health," the study authors said.

About half of all breast cancers in the United States occur in women older than 65. Past studies have shown that chemotherapy after breast cancer surgery increases the odds of disease-free survival in women between the ages of 50 and 69. But little information has been available for treating women over 70, the study authors said.

One important concern is that older women may experience more toxic side effects from chemotherapy. That's because the kidneys often function less effectively with age, and there's not as great a bone marrow reserve for generating new blood cells in older people.

"There's always been a concern that older women with breast cancer might be under-treated," said Dr. Yelena Novik, an oncologist at New York University Medical Center in New York City. "In clinical trials, the proportion of women over 70, and especially over 75, is very small, so it's hard to know the benefits and the risks. It's understood that older women are more likely to have other medical problems, such as heart disease, hypertension and diabetes, so the question is, should they be offered the same treatment as younger women?"

To answer that question, researchers from cancer centers around the country reviewed data from four previous trials that included almost 6,500 women with lymph-node positive breast cancer. Five hundred and forty-two of the women in the studies were over 65, and 159 were over age 70.

Each of the studies looked at various doses and regimens of chemotherapy, including regimens considered to be potentially more toxic than the others.

A number of factors influenced survival rates, including smaller tumor size, fewer positive lymph nodes, having more chemotherapy, and using the breast cancer drug tamoxifen. Age alone, however, didn't appear to influence survival rates, the study authors found.

Women over 65 were more likely to die of causes other than breast cancer. And they were slightly more likely to die as a result of the treatment than younger women were. Overall treatment-related mortality was 0.5 percent, and 1.5 percent for those women over 65.
"What this study basically showed is that we shouldn't prejudice our treatment decisions based on chronological age," said Dr. Jay Brooks, chairman of hematology and oncology at Ochsner Health System in Baton Rouge, La. "We have a lot of very healthy, older individuals, and to simply preclude someone from taking potentially lifesaving therapy because they've reached some chronological age is just wrong. Would you tell someone who's 68 with coronary vessel disease not to get a bypass?"

Both Novik and Brooks said that recent advances in tailoring breast cancer treatments to the individual patient have likely made the age disparity less of an issue.

"We're hopefully getting smarter in understanding cancer behaviors, which gives us better insight into which drugs to use," Novik said.

Brooks advised older women with breast cancer to "sit down and talk with their doctor about what their individualized risk of recurrence is. We have good tools to offer individualized treatment options, whatever your age."

More information
To learn more about chemotherapy treatment for breast cancer, visit the American Cancer Society.