What a Teaching Hospital Is All About

By Dena Rifkin, MD

My last post about how doctors learn from patients inspired a lively (sometimes heated) discussion, and I read the response to it with great interest. I think some good points were made. Notably, one reader took issue with my statement that a patient who helped me learn by letting me practice drawing blood from him “understood what a teaching hospital is all about.”
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What is Fucoxanthin?

From Cathy Wong,


Fucoxanthin is a type of carotenoid found naturally in edible brown seaweed such as wakame (Undaria pinnatifida) and hijiki (Hijikia fusiformis), which are used widely in Asian cuisine. Wakame is the seaweed used in miso soup.

Fucoxanthin is also found in much smaller amounts in red seaweed (the kind typically used in Japanese sushi rolls) and green seaweed.

Both wakame and hijiki are available at Japanese specialty food stores, some health food stores and online. Although brown seaweed is the richest source of fucoxanthin, you would have to eat an unrealistic amount of it daily to get fucoxanthin levels close to those used in research studies.

Fucoxanthin is also available as a nutritional supplement in capsule form and can be found in some health food stores and online.

Why Do People Use Fucoxanthin?
Weight Loss
Fucoxanthin is being explored for weight loss.

So far, only animal studies have been done. Japanese researchers have found that fucoxanthin (isolated from wakame) promotes the loss of abdominal fat in obese mice and rats. Animals lost five to 10% of their body weight.

Although it's not fully understood how fucoxanthin works, it appears to target a protein called UCP1 that increases the rate at which abdominal fat is burned. Abdominal fat, also called white adipose tissue, is the kind of fat that surrounds our organs and is linked to heart disease and diabetes. Fucoxanthin also appears to stimulate the production of DHA, one of the omega-3 fatty acids found in fatty fish such as salmon.

Although it's promising and already a popular nutritional supplement, more research is needed to determine if fucoxanthin will work in the same way in humans. If it does prove to be effective, fucoxanthin could be developed into a diet pill for obesity.

Diabetes

Fucoxanthin has also been found in animal studies to decrease insulin and blood glucose levels. Researchers hypothesize that fucoxanthin anti-diabetes effect may be because fucoxanthin appears to promote the formation of DHA (the omega-3 fatty acid found in fish oil). DHA is thought to increase insulin sensitivity, improve triglycerides and reduce LDL ("bad") cholesterol.

Cancer

Preliminary research in test tubes suggests that fucoxanthin may have anti-tumor effects. No studies have looked at whether this holds true in humans or if taken orally. It's far too early for fucoxanthin to be used as a complementary treatment for cancer.

Side Effects
Because there hasn't been research on fucoxanthin in humans, the possible side effects aren't known.

People shouldn't consume large amounts of wakame or other types of seaweed as a source of fucoxanthin. Seaweed is rich in iodine and excessive consumption may result in iodine poisoning. High levels of iodine can interfere with the function of the thyroid gland. Also, consuming excess amounts of iodine-rich foods isn't recommended if there is a known allergy or hypersensitivity to iodine.

Watch your blood pressure if you buy Sony products i.e. in Thailand

SONY Customer Service Sucks

Why?

Dear Sirs, I bought a laptop in your Sony outlet here in Chiang Mai; since I bought them I have only problems. 2 times was the charger broken, 1 time the changed the main board; after the changed the main board I received the laptop back in an unfinished status.. I gave it back and they send it again to Bangkok with the promise to fix this in one week. Now impossible, because they have to order some spare parts from Singapore. What I bought was a new laptop for THB 70.000; and what I got is a crisis of reparation. I can't accept and will inform the customer protection organization of Thailand about my experience with my buy of a sony laptop. Sincerely, Dr. Bettermann

The blood pressure is going up, but still under control.

Dear Dr. Bettermann,
We are sorry to learn of you disappointment regarding the VAIO. We investigated with concerned Department and would like to inform that:
On October 28, 2006, The VAIO model VGN-SZ31SP/B, Serial no. 7000119 was purchased from Chi Chang Computer, Chiangmai.

On May 5, 2007, you sent the battery model VGP-BPS2C to be checked at Chiangmai service center without notebook VAIO. The symptom was "Could not charge the battery" Technician had checked and replaced the new battery.

On December 7, 2007, you sent VAIO and battery to be repaired at Chi Chang Computer with the same symptom. After checked, technician replaced the Main board and Battery. The set was finished on December 7, 2007 On January 1, 2008, the set was sent to Chi Chang Computer once as the cover keyboard did not closeness after repaired. We would like to apologize for this repairing. Currently, your set was checked and very strict quality control by Technician Supervisor and your set has been repaired, and is being delivered to Chi Chang Computer.

Pertaining to cover keyboard did not closeness, kindly be ensure that necessary action will be taken to prevent similar case from happening again. Please wait Chi Chang Computer contact you for receipt.

Again, we do really regret for all the inconveniences you received and apologize regarding repair service. Please kindly accept my sincere apology for the late reply.

However we are indeed very appreciative of your valuable feedback, as it will help us to identify areas of improvement we need to focus on.

For more information, please contact VAIO HelpDesk on 0-2715-6111.

Dear valuable Sony Support Service,

Its seems this Odyssey is not finish.
You have again in your Repair Center my laptop and nobody seems to know what is wrong with it. This is now After 2 weeks.

I called today Sony and asked to get a new laptop that this night mare ended. The answer is no.
After my experience with your service I checked in the internet and there thousand's more out with the same complains and are very unhappy with your company.

So what else you can tell me about your high tech products and your service?
When I get a laptop back what I purchased for THB 7o.000 who works no longer then 3 month?
Your desperate and disappointed Costumer.

What should I do to bring the blood pressure down with my Sony Vaio??

For all disappointned Sony Customer here some advice:

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

Caffeine May Block High Cholesterol Linked to Alzheimer's

(HealthDay News) -- A little caffeine every day could offer some protection from Alzheimer's disease for people with high cholesterol.

Rabbits given the daily caffeine equivalent of one cup of coffee and fed a cholesterol-rich diet for 12 weeks suffered relatively little damage in their blood-brain barrier (BBB), which protects the central nervous system from the rest of the body's circulation, new research found.

The findings were published in the open-access publication Journal of Neuroinflammation.

Previous studies have shown that high levels of cholesterol break down the BBB, exposing the central nervous system to damage from blood-borne contamination. BBB leakage occurs in a variety of neurological disorders such as Alzheimer's disease.

"High levels of cholesterol are a risk factor for Alzheimer's disease, perhaps by compromising the protective nature of the blood-brain barrier. For the first time, we have shown that chronic ingestion of caffeine protects the BBB from cholesterol-induced leakage," Jonathan Geiger, of the University of North Dakota School of Medicine and Health Sciences, said in a prepared statement.

Caffeine appears to offer protection by helping proteins maintain the tight binding of the cells in the BBB, so they stop unwanted molecules from entering the central nervous system.

The findings also confirm previous studies showing that caffeine protects against memory loss in aging and in Alzheimer's disease.

"Caffeine is a safe and readily available drug, and its ability to stabilize the blood-brain barrier means it could have an important part to play in therapies against neurological disorders," Geiger said.

More information
The U.S. National Institute on Aging has more about Alzheimer's medications.

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 »

more discussion: Forum· Addiction Forum · Ask the Doctors Forum · Ayurveda Forum · Ayurvedic & Thai Herbs Forum · Colon Cleansing Forum · Dental Forum · Diabetes Forum · Diet Forum · General Cleansing Forum · Hepatitis A, B. C Forum · Integrated Medicine Forum · Live Blood Analysis Forum · Ozone-Oxygen-Forum · pH - Alkaline - Acidity Forum · Weight Loss Forum

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.

Severe Menopause Symptoms Raise Heart Risks

(HealthDay News) -- Women who have the most severe menopausal symptoms may also be at a higher risk of cardiovascular disease, a new study suggests.

Dutch researchers surveyed 5,648 women, aged 46 to 57, about their menopausal complaints and collected data on other health information such as their cholesterol and blood pressure.

Night sweats were reported by 38 percent of women; flushing by 39 percent.

Those with flushing had higher cholesterol levels than those without the symptom. They also had higher blood pressure, higher body mass index (BMI, a ratio of weight to height) and a slightly higher chance of developing heart disease over the next decade. The women with night sweats had comparable results.

The researchers, from the University Medical Center Utrecht, conclude that the connection between severity of symptoms and heart disease risk may be the result of reduced beneficial effects of estrogen on the functioning of blood vessel walls, as estrogen declines during menopause.

The Dutch researchers were scheduled to present their findings Friday at the American Heart Association's Cardiovascular Disease Epidemiology and Prevention Conference, in Colorado Springs, Colo.

"The implication is the women with the worst symptoms may be at higher risk, clinically, for heart disease," said Dr. Suzanne Steinbaum, director of women & heart disease, at the Heart & Vascular Institute at Lenox Hill Hospital, in New York City.

But the American Heart Association does not advise postmenopausal women to take hormone therapy to reduce heart disease or stroke risk, due to clinical trials that show the hormones, over time, actually increase cardiovascular risks. Hormone therapy is only recommended to relieve very severe symptoms of menopause, and only for the shortest possible period.

The take-home point from this study for the general population, according to Steinbaum, is to pay close attention to improvement in lifestyle habits before menopause and before estrogen levels decline. "One of the things I talk about is lifestyle management to control high blood pressure, high cholesterol," she explained.

If women keep in check the risk factors of heart disease, such as high blood pressure and high cholesterol, by eating healthfully and exercising often before menopause, the transition "doesn't have to be as terrible" as many women fear it will be.

Among her suggestions: Exercise at least 20 to 30 minutes three to five days a week, and eat a diet filled with fiber, vegetables, fruits, multi-grains, legumes and omega-3 fatty acids.

In a second study, also scheduled to be presented Friday at the conference, French researchers found the type of hormone delivery method affects the risk of blood clots in postmenopausal women.

Researchers from Paul Brousse Hospital in Villejuif, France, compared women who did not use hormones with those who used estrogen, taking it either orally or transdermally with a patch. Some women took only estrogen, others took estrogen plus progesterone, pregnane, norpregnane or nortestosterone.

The researchers found that transdermal estrogen alone or in combination with progesterone or pregnane derivatives did not raise the risk for blood clots, while other delivery systems did.

They looked at a population of nearly 86,000 French women -- including 984 with blood clots -- who were followed for more than 10 years.

"This [study] is one more piece of the puzzle," said Dr. Jennifer Wu, an obstetrician-gynecologist at Lenox Hill Hospital in New York City. When women take hormones orally, she said, the metabolism involves much more processing through the liver, for instance.

While the study concluded that the patch delivery is less risky when it comes to blood clots, Wu said "the indications remain the same" for hormone therapy. It should be used only for very severe menopausal symptoms interfering with daily life, for the shortest possible time.

More information
To learn more about menopause and heart disease risks, visit the American Heart Association.

Balancing Your Hormones Without Drugs... You Can Feel Good Again $19.95 [ learn more ] Hormone imbalance can be reversed! Look and feel better than ever, just take the time to learn about yourself and read the information contained in this just released e-book about reversing hormone imbalance. Are you ready to finally look and feel great? If so... read on... - E-Book Version.(BH)

Heart Hormones Beat Back Cancers in Mice

(HealthDay News) -- New research offers early evidence that hormones produced by the heart to control both blood pressure and volume could be harnessed to treat -- and possibly cure -- a wide range of cancers.

Following a month of intravenous treatment with any of four human cardiac peptide hormones, mice engineered to develop human pancreatic and breast cancer experienced dramatic results:

On average, 54 percent of those with breast cancer and 37 percent of those with pancreatic cancer were cured, without tumor recurrence or treatment side effects.

Even tumor shrinkage among non-cured mice was striking, with size reductions of 90-plus percent. And a more detailed analysis, hormone-by-hormone, revealed even stronger anti-cancer properties among certain hormones. In such best-case scenarios, the most effective hormones provoked full tumor elimination -- without surgery, chemotherapy or any other additional treatment -- in two-thirds of the mice with breast cancer and 80 percent of the mice with pancreatic cancer.

"This raises hope for turning cancer -- even when not fully cured -- into a chronic disease," said study author Dr. David L. Vesely, director of the department of molecular pharmacology and physiology at the University of South Florida's Cardiac Hormone Center, in Tampa.

Vesely is scheduled to present his findings April 9 at the Experimental Biology annual conference in San Diego. The findings were originally published in the journal in vivo last year.

"For 350 years, the heart has been thought of simply as a pump," Vesely said. "But we now know it makes hormones that lower your blood pressure and get rid of salt and water. So, first we took four of them that all come from the same gene, and looked at them in laboratory cell cultures, and found that they essentially eliminated 97 percent of exposed cancer cells within 24 hours."

With funding largely from the U.S. Veteran's Administration, the research team then grew human cancer cells in 1-month-old male and female mice, focusing first on pancreatic cancer, which Vesely described as the "worst of all," given the fast pace of its development, its poor treatment track record, and a mean survival rate of just four months.

Nearly 34,000 Americans are diagnosed with pancreatic cancer each year, and 32,000 die of the disease annually.

Some of the pancreatic cancer mice received a saline solution, while others were exposed to a month-long regimen of one of four cardiac hormones: long acting natriuretic peptide (LANP), vessel dilator (VDL), kaliruretic peptide (KP), or atrial natriuretic peptide (ANP).

ANP was found to provide the best anti-cancer effect, eliminating tumors in four of five treated mice. Among those not fully cured, VDL provided the best cancer reduction -- bringing exposed tumors down to just 2 percent of their largest size.

After a year, the researchers found that all the cured mice remained cancer-free. Based on the fact that the normal life span for a mouse is about one year, Vesely and his colleagues concluded that all the treated mice ended up dying of old age, not cancer.

Vesely, who noted that his wife died of breast cancer about five years ago, then turned his focus to that cancer.

He said that in similar mouse experiments, treatments with VDL and KP hormones both produced a 67 percent tumor elimination rate.

"We never expected results this good, of course," he said. "And I don't want to get too carried away here. But if this works in humans, it would be spectacular. Because, of course, one out of every two families [experiences] cancer."

Human trials -- funded by the private San Diego-based firm Kalos Therapeutics -- are to begin within 12 to 18 months. If all goes well, Vesely predicted that a hormone treatment could become available within three years.

However, Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, cautioned that while the notion of a heart hormone cancer treatment has a "seductive" appeal, much more research is required.

"Unfortunately, in general, we see a lot of experiments that seem promising in test tubes and animals but for whatever reason don't translate into anything that has treatment benefit," he said. "And specifically, in this case, we're talking about normal hormones already in circulation in our body, and normal receptors on cancer cells.

"So, in a perhaps simplistic, but nonetheless important, way, the question then arises: Why do people get cancer in the first place if this hormonal mechanism is so effective?" Lichtenfeld said. "And I do not see that the researchers clearly suggest an underlying rational mechanism to explain why this would happen and work in humans.

"So, I understand here that a researcher has lost a wife and a mother to cancer, and I know it's personal," he acknowledged. "And I've certainly learned to never say never. But it would take considerably more replication of this work before I could say this theory will gain traction."

More information
For additional information on current cancer treatment options, visit the American Cancer Society.

Balancing Your Hormones Without Drugs... You Can Feel Good Again $19.95 [ learn more ] Hormone imbalance can be reversed! Look and feel better than ever, just take the time to learn about yourself and read the information contained in this just released e-book about reversing hormone imbalance. Are you ready to finally look and feel great? If so... read on... - E-Book Version.(BH)

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.

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.

Most With High Blood Pressure Don't Follow Recommended Diet

(HealthDay News) -- Few people with high blood pressure follow recommended dietary guidelines that help control the disease, a new study says.

In fact, people with hypertension actually appear to be eating worse than before the government-approved guidelines were introduced, according to the report published in the Feb.
11 issue of the Archives of Internal Medicine. The study said young people, blacks and the obese fared the worst in their dietary habits.

A diet high in fruits, vegetables and low-fat dairy products has been shown to help significantly lower blood pressure, according to background information in the article. This Dietary Approaches to Stop Hypertension (DASH) method, first published in 1997, complements other lifestyle changes, such as reducing sodium and losing weight, and can also help lower cholesterol levels, previous studies have shown.

The DASH diet is recommended by the Joint National Committee on Prevention, Detection and Treatment of High Blood Pressure for all patients with hypertension.

The study analyzed dietary, health and personal data of adults collected in surveys done by the U.S. Centers for Disease Control and Prevention from 1988 to 1994 and from 1999 to 2004.

Using the DASH guidelines, researchers identified goals for eight target nutrients and calculated scores ranging from zero to nine for individuals with and without hypertension from the surveys; those who scored a 4.5 or higher were considered to be following the diet.

Dr. Philip B. Mellen, of the Hattiesburg Clinic in Hattiesburg, Miss., and his colleagues found that among individuals surveyed from 1999 to 2004, 28 percent had been diagnosed with hypertension. These individuals had an average DASH score of 2.92 (compared with 3.12 among those without high blood pressure), and only 19.4 percent followed the diet. Compared with those surveyed in 1988 to 1994, 7.3 percent fewer individuals with hypertension followed the DASH diet, reflecting fewer patients who consumed target levels of total fat, fiber and magnesium.

The findings suggest that the diet of Americans with hypertension has not been greatly influenced by the recommendations emerging from the DASH trial and instead reflect secular trends in the dietary patterns of the overall population, the authors wrote. Moreover, the DASH score was lower in subgroups likely to receive the greatest benefit from the DASH diet -- blacks and obese individuals.

More information
The National Heart, Lung, and Blood Institute has more about high blood pressure and how to control it.

GPS Devices Measure Severity of Peripheral Artery Disease

(HealthDay News) -- The same device that keeps you from getting lost while driving in your car might also give doctors a way to determine the severity of peripheral artery disease (PAD) in patients, French researchers suggest.

People with PAD have clogged leg arteries that cause them severe pain when they walk. In this study, the researchers used Global Positioning System (GPS) devices and a computer spreadsheet to trace and analyze the maximal walking distance (MWD) of 24 PAD patients as they strolled through a public park. MWD is the maximum distance a PAD patient can walk at a normal pace on a flat surface before leg pain forces them to stop.

Currently, a treadmill test is the standard method of determining MWD. However, treadmill assessments are time-consuming, have to be done in vascular laboratories, and may not provide an accurate estimation of MWD or PAD-related disability.

"We found that MWD obtained at a person's usual pace is largely superior to the MWD measured on a treadmill. GPS may allow for a more objective measurement of walking capacity in patients with PAD," study senior author Dr. Pierre Abraham, a physician at the vascular investigation laboratory at University Hospital in Angers, France, said in a prepared statement.

"Patients often report their walking capacity varies from one day to another and also varies from one moment to another within a single stroll," Abraham said.

"GPS allows for the analysis of the distanced walked, of course, but also the speed, duration of resting, and the number of walking bouts over a prolonged recording period," he noted.

However, GPS can't entirely replace treadmills for measuring MWD, Abraham added. That's because treadmill tests are standardized and simultaneously record multiple measurements, such as blood pressure, oxygen consumption and heart rate. In addition, not all PAD patients can do the outdoor GPS test.

PAD affects about 8 million Americans, and people with the vessel disease face a four to five times greater risk of dying from cardiovascular disease.

The study is published in the current issue of Circulation.

More information
The Society for Vascular Surgery has more about peripheral artery disease.

Chronic Coughs Need a Doctor's Attention

(HealthDay News) -- If you wake up due to coughing or have a cough that lasts for weeks, you may have a potentially serious problem that requires medical attention.

"Cough is the most common respiratory symptom for which patients seek medical attention," Dr. Alan B. Goldsobel, chairman of the American Academy of Allergy, Asthma & Immunology's cough committee, said in a prepared statement.

"Cough protects the body by removing mucus and irritating particles from the respiratory tract. Coughing is a useful function and does not always mean there is a problem ...," Goldsobel explained. "However, coughing at night, after going to sleep indicates the need for medical attention."

Common causes of coughing include: viral upper respiratory tract infections; asthma; nasal and sinus disease; stomach and esophageal problems; an inhaled foreign body; habit; and environmental irritants.

People should see an allergist/immunologist if they have:

• a cough that lasts three to eight weeks or more;
• a cough that coexists with asthma;
• coexisting chronic cough and nasal symptoms;
• a chronic cough and tobacco use or exposure.

More information
To learn more about cough and children, visit the American Academy of Allergy, Asthma & Immunology.

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'Easy Does It' Eases Holiday Stress

(HealthDay News) -- It's supposed to be the happiest time of the year, but don't tell that to the patients who mob the offices of San Diego cardiologist Dr. Mimi Guarneri between Thanksgiving and New Year's.

Some complain of what doctors call "holiday heart" -- skipped beats, high blood pressure and angina due to stress or overindulgence. Others feel physically and emotionally overwhelmed, distracted by thoughts of difficult relatives or missing loved ones.

Guarneri, medical director of the Scripps Center for Integrative Medicine, has different advice for her patients, depending on their situations. But she's always sure to emphasize one theme: relaxation.

"The one thing is do is to take time out, take a deep breath, connect your mind with your body by simple breathing," she said. "And remember to not sweat the small stuff."

Easier said than done, of course. But when it comes to crippling holiday stress, specialists say the simplest pieces of advice are also the best.

Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University in Durham, N.C., advises people to be reasonable with their expectations from the season, and to anticipate trouble -- ranging from long lines at stores and airports, to bouts of sadness when images of absent loved ones come to mind.

By readying yourself for these moments, "they won't come as a shock when you realize, 'I'm getting ready to honk my horn or get steamed over this person who just pulled in front of me.' If you can do that, you can probably head off some of it," Williams explained.

He said it's not clear how many people get the blues around the holidays, but it's probably not uncommon. "It's perfectly normal to get a little bit depressed or a little sad during the holidays at one point or another," Williams said.

However, it may not be as bad as some might assume. In recent years, American researchers have looked at local statistics and debunked the long-held assumption that suicide rates shoot up around the holidays.

Not every episode of Christmastime depression is minor, however. If you find yourself early in the new year having trouble with sleeping or eating -- doing either one too much or too little -- it's possible that you've fallen into a clinical depression.

If that might be the case, "You should seek some professional evaluation and possibly treatment," Williams said.

In other cases, a little self-help can be key. "In the grand scheme of life, we say, 'Don't sweat the small stuff,'" Guarneri said. "We have to realize that a lot of stress is what we put on ourselves, not what other people are putting on us."

If you're alone and feeling isolated, she said, "get out and do service work, which brings joy to people." And, if you have the opposite problem -- too much to do and too many people to worry about pleasing -- learn to do less. "None of this is worth dying for," she said.

More information
Learn more about holiday stress from the American Psychological Association.

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'Hospitalist' Physicians Help Shorten Patient Stays

(HealthDay News) -- A new breed of medical specialists, called hospitalists, can make a small but significant difference in shortening how long a patient needs to stay in the hospital, a new study shows.

The 2002-2005 study of almost 77,000 hospital stays at 45 centers showed that treatment by a hospitalist, rather than a general internist, resulted in about a half-day reduction in overall hospital stays on average, along with an average $268 drop in costs.

At the same time, researchers found no difference in the rate of either patient death or readmission when hospitalists were involved, according to the report in the Dec. 20 issue of the New England Journal of Medicine.

A hopsitalist refers to a physician who cares solely for hospitalized patients.

The term may be new to the general public, but, in the medical profession, "hospitalist has been a recognized and accepted term that has been around for about a decade," said study author Dr. Peter K. Lindenauer, an associate professor of medicine at Baystate Medical Center and Tufts University, in Boston.

In fact, "There is a Society of Hospital Medicine with 5,000 to 10,000 members, and it is estimated that there may be 20,000 hospitalists across the United States now," Lindenauer said.

"What you can't debate is the number of hospitalists around the country -- there is no going back," added Dr. Laurence McMahon, chief of the division of general medicine at the University of Michigan, in Ann Arbor.

"We need to think about how these new doctors get into the health-care system and how they care for patients who are hospitalized," said Mcmahon, who also authored an accompanying editorial on the issue.

Traditionally, a person's private physician has been responsible for care after hospitalization, he said. That began to change about 30 years ago, with the emerging role of emergency room physicians and critical care physicians, Lindenauer said. "They have been assuming the role of attending physician in those situations," he said. "In some respect, the growth of the hospitalist model of care represents the completion of a series of steps toward specialization that began 30 years ago."

According to Lindenauer, the advent of the hospitalist means another question should be asked when individuals choose a private physician: Will that doctor turn over care to a hospitalist, if and when someone needs hospital care?

"It is a discussion that a patient should have with a primary-care physician when he is thinking about enrolling with that physician," Lindenauer said.

The differences shown in the study -- a shortening of length-of-stay by 0.4 days, on average -- are not great, he acknowledged, but they do add up over time.

"Shortening the length of stay by 0.4 days is small, but when you multiply it out over time by thousands of physicians, the effects can be very large. With 5,000 cases a year, [that's] a savings of 2,000 bed-days," he said.

The study was not able to assess patient satisfaction with treatment by a hospitalist rather than a primary-care physician, Lindenauer said, "But we know that efficiency is important, as important to patients as to physicians." he said.

And while full official recognition of the hospitalist speciality is yet to come, the Society of Hospital Medicine is working closely with the of American Board of Medical Specialties toward such an end, Lindenauer said.

"The differences between hospitalists and other doctors who take care of patients in hospitals are pretty minor," McMahon said. "What really is quite revolutionary is the change in how we take care of patients in the hospital."

More information
There's more on hospitalists at the Society of Hospital Medicine.


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Moderate Exercise Cuts Risk of Metabolic Syndrome

(HealthDay News) -- A brisk 30-minute walk most days of the week is enough to undo metabolic syndrome, a health condition that can lead to heart disease, diabetes and stroke, a new study suggests.

"What we found was a modest amount of moderate intensity exercise was very effective in improving metabolic syndrome risk," said study author Johanna L. Johnson, a clinical researcher at Duke University Medical Center's department of medicine.

At the start of the study, 41 percent of the 171 participants had metabolic syndrome; at the end, just 27 percent did. The study was published in the Dec. 15 issue of the American Journal of Cardiology.

About one-quarter of all U.S. adults have metabolic syndrome, a collection of risk factors that can eventually set you up for more serious health problems. While some experts debate the validity of considering metabolic syndrome a disease unto itself, the risk factors are potentially dangerous. They include a large waist circumference; high blood pressure; high levels of triglycerides; low levels of good (HDL) cholesterol; and high blood sugar. If you have three or more of the five risk factors, you have metabolic syndrome.

Johnson and her colleagues looked at the effects of different amounts and intensities of exercise.
The researchers assigned the 171 men and women to one of four groups. One was a control group, whose members continued to be sedentary. The other three groups included:

• A low amount/moderate intensity group. They did brisk walking three to five days a week, aiming for about 11 miles, and typically putting in about three hours a week.


• A low amount/vigorous intensity group. They did the same 11 or so miles but at a jogging pace, so they ended up getting about two hours of exercise a week.


• A high amount/vigorous intensity group. They jogged at a vigorous pace about 17 miles a week, putting in about three hours.

What was a bit surprising, Johnson said, was the benefits conferred to each group.
"What we found was that modest amounts of moderate intensity exercise [the low/moderate group] were very effective in improving metabolic syndrome," she said. Those who exercised the most, jogging 17 miles a week, gained a bit more benefit in terms of lowered metabolic syndrome scores, she said.

Those in the low amount/vigorous intensity group didn't improve their scores as much as those who did less-intense exercise for a longer period of time, the low amount/moderate intensity group.

Moderate intensity activity every day, or almost every day, may be better for metabolic syndrome risk reduction than more vigorous activity a few days a week, the researchers suggested.

All three groups of exercisers did have a reduction in their waistline circumference. Waist circumferences above 34.6 inches in women and 40.2 in men are a risk factor for metabolic syndrome, the researchers said.

The high amount/vigorous intensity group had the best reduction in body mass index (BMI, a ratio of weight to height). It went from an average of 29.2 to 28.4. A BMI of 30 and higher is termed obese.

So, the bottom line for middle-age, sedentary, overweight people? "If you tell them to go out for a brisk walk 30 minutes on most days of the week, they are highly likely to improve health and metabolic syndrome risk," Johnson said.

The new research confirms advice on exercise from the American College of Sports Medicine and the U.S. Centers for Disease Control and Prevention, she added.

"It confirms that exercise is beneficial," said Kerry Stewart, a professor of medicine at Johns Hopkins University School of Medicine, who also has done research on the topic.

"It confirms the benefit of exercise for reducing metabolic syndrome and all the risk factors that make up metabolic syndrome," he said. The surprise, he agreed, was that moderate activity may be enough.

More information
To learn more about metabolic syndrome, visit the American Heart Association.

Blackberries, Broccoli Sprouts Battle Cancer

(HealthDay News) -- Your local farmer's market might hold the key to cancer prevention, since new research shows that black raspberries, broccoli sprouts and some raw vegetables reduce the risk of esophageal and bladder cancers.

Data from three studies on the subject was presented Thursday at the American Association for Cancer Research's Sixth Annual International Conference on Frontiers in Cancer Prevention, in Philadelphia.

Fruits and vegetables have long been known to help reduce the risk of certain cancers. Based on prior research, the American Cancer Society recommends eating five servings of fruits and vegetables daily.

In the first study, Ohio State University researchers found black raspberries may protect against esophageal cancer by reducing the oxidative stress that results from Barrett's esophagus, a precancerous condition usually caused by gastroesophageal reflux disease. The esophagus is a long tube that connects the throat to the stomach. Reflux disease causes stomach acid to continually splash back up into the esophagus.

"Specifically in the case of Barrett's patients, reflux of the stomach and bile acid contribute to ongoing oxidative damage. Thus, our hypothesis is that feeding a food that is high in potential protective constituents, such as antioxidants, vitamins, minerals and other phytochemicals, may help restore the oxidative balance," lead researcher Laura Kresty said.

People with Barrett's esophagus typically are 30 to 40 times more likely to develop esophageal cancer, which has a poor five-year survival rate of 15 percent.

The team gave 32 grams to 45 grams of black raspberries daily for six months to 20 patients with Barrett's esophagus. They analyzed changes in blood, urine and tissue before, during and after the treatment, and found lower levels of some of the chemical markers of oxidative stress in both urine and tissue samples.

Black raspberries previously have been shown to reduce the risk of oral, esophageal and colon cancer in animal models, according to the researchers, who called for further study in humans.

Dietitian Wendy Demark-Wahnefried, a professor of behavioral science at M.D. Anderson Cancer Center at the University of Texas in Houston, said she would feel comfortable advising people with Barrett's to eat black raspberries. "It couldn't hurt," she said, but added that further studies need to find out if the berries really do prevent cancer.

In other research presented at the meeting, broccoli sprouts and cruciferous vegetables both showed promise in the fight against bladder cancer, according to two separate teams from the Roswell Park Cancer Institute in Buffalo, N.Y.

Using a rat model, a team lead by Dr. Yuesheng Zhang, a professor of oncology, demonstrated that a broccoli sprout extract reduced bladder cancer in rats by 70 percent.

"Our present study shows that broccoli sprout extracts fed to rats in the diet inhibits bladder cancer development induced by a carcinogen. We don't yet know if the extracts inhibit the growth of a existing bladder cancer," said Zhang, who explained that broccoli sprouts are a rich source of a well-known cancer preventive agent known as sulforaphane.

"We next plan to find out if broccoli sprout extracts can fight bladder cancer in humans," Zhang noted.

A second team at the institute found that people who ate three or more servings of raw, cruciferous vegetables per month reduced their risk of bladder cancer by 40 percent.

Cruciferous vegetables include broccoli, cabbage and cauliflower.

The team analyzed the dietary habits of 275 people with early bladder cancer and 825 people who were cancer-free. The researchers specifically asked how many servings of raw or cooked cruciferous vegetables they ate before their diagnosis and whether they smoked.

Analysis of the data showed that the more raw, cruciferous vegetables people ate, the lower their risk of bladder cancer. In comparison to people who smoked and ate fewer than three servings of raw vegetables a day, nonsmokers eating at least three servings of cruciferous vegetables daily were 73 percent less likely to develop bladder cancer.

"In our study, we do find intake of raw cruciferous vegetables showed risk reduction of bladder cancer in smokers, and even the heavier smokers," said lead researcher Li Tang.

The researchers stressed that the benefits are derived from raw cruciferous vegetables, giving cole slaw the edge over cabbage soup when it comes to cancer prevention.

"This confirms that there are a variety of compounds within fruits and vegetables that contribute to reducing the risk of cancer. Research like these studies contribute to our knowledge about what the impact of specific nutrients may be on specific types of cancer," said Colleen Doyle, director of nutrition and physical activity for the American Cancer Society.

"Cooking leaches out some nutrients but makes others more absorbable. Until we know more in this regard, the bottom-line message for consumers is eat at least five servings of fruits and vegetables each day, raw and/or lightly cooked. Focus on those with the most color, since, in general, fruit and vegetables with the most color have the most cancer-fighting antioxidants and phytochemicals."

"Surveys we've done indicate many people don't think they have control over their cancer risk, but studies clearly indicate they do. For the majority of people who don't smoke, watching their weight, being more active and eating a healthy diet are the most important ways to reduce cancer risk," Doyle said.

More information
To learn how diet and physical activity can help prevent cancer, visit the American Cancer Society.

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'Tis the Season For Allergy, Asthma

(HealthDay News) -- It's easy for the holidays to become the season of sneezing, congestion and other woes for people with food or other allergies and asthma, say experts at the American Academy of Allergy, Asthma & Immunology (AAAAI).

But some preventive measures can cut symptoms to a minimum, they say.

"Whether it's feasting on holiday meals, setting up your Christmas tree, or visiting your pet-owning relatives, allergy triggers may be lurking inside of our warm, cozy homes this time of year," Alisa M. Smith, vice-chairwoman of the AAAAI's indoor allergen committee, said in a prepared statement. "Unfortunately, with busy schedules, travel time and the stress of the holidays, it is easy to forget to take the proper care when dealing with allergies and asthma.

However, avoiding potential triggers and taking the proper precautions is necessary to keep symptoms under control."

The AAAAI offers the following tips for people with asthma and different types of allergies:
When you're at parties or family gatherings, inform your hosts about your food allergy and ask about the ingredients used to prepare the meal.

Always carry an injectable dose of epinephrine. Homemade meals/snacks don't have ingredient lists and may be contaminated with trace of amounts of allergenic foods through contact with storage containers or kitchen utensils.

Remind family and friends that strict avoidance is the only way for you to manage food allergies and that even a tiny bit of allergenic foods can trigger a dangerous allergic reaction.
If you're visiting homes where there are pets, take your allergy medication beforehand.

Real Christmas trees often carry microscopic mold spores that can cause allergic symptoms such as sneezing, water eyes, and an itchy nose.

Decorations and artificial trees can gather mold and dust while in storage. Clean them before you start putting them up.

Artificial snow can irritate your lungs if you inhale it. Be sure to follow directions when spraying artificial snow on windows or other surfaces.

The stress of the holiday season can sometimes trigger an asthma attack. Monitor your stress levels. If you do feel stressed, deep breathing and relaxation may help.

If you're sleeping away from home, bring your own pillow with an allergen-proof cover. Ask for down-free pillows.

Avoid wood smoke, which can trigger an asthma attack.

More information
The American Academy of Family Physicians has more about controlling allergy symptoms.

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Gene Tweak Reverses Aging in Mouse Skin Cells

(HealthDay News) -- Scientists say they've been able to temporarily return old skin cells to their youthful state by blocking the activity of a single gene.

"This gene gets more and more active with age," said lead researcher Dr. Howard Chang, an assistant professor of dermatology at Stanford University. "It doesn't exist to make us old. It is active in a number of processes, including the immune system and inflammation."

Chang said tweaking the gene, which produces a protein called NF-kappa-B, will not serve as a "fountain of youth" for the foreseeable future. The protein has a number of functions, some involved with cancer, and as-yet-unknown side effects must be explored before its safety is known. But one possible use is to help heal wounds more quickly in older people, he noted.

What's exciting about the discovery is that a single gene can have an immediate effect on older cells, Chang said. "People have known that you can affect the aging process with drastic interventions, like calorie restriction. Now we are talking about a single gene that, if blocked in an individual who is already old, can return cells to a youthful status, at least temporarily."

The researchers came across NF-kappa-B by searching existing data on genes that become more or less active as people get older. They found that the activity of a number of those genes is regulated by the protein.

They then used a genetically engineered mouse model to test the effect of inhibiting NF-kappa-B activity in a patch of skin cells.

After two weeks, a patch of treated skin from a 2-year-old mouse not only had the same genetic activity as that of a newborn animal but also looked more youthful, with more dividing cells.
It's fascinating "to engineer a mouse so that the rest of the mouse is old, but that one patch is young, to see that even locally, in a targeted way, you can affect the aging process," Chang said.

The finding also adds support to the theory that aging is not simply a process of wear-and-tear but the result of specific genetic changes, he said. And it shows that at least locally and temporarily, those changes can be stopped, Chang added.

The gene treatment has to be used cautiously, because NF-kappa-B is involved in so many different processes in the body, he noted.

A question to be asked now is, "What is the long-term effect of blocking the aging process for a while?," Chang said. "Would the tissue age rapidly again after the treatment stopped, or would they take much longer to age? It's important to sort these things out."

Long-term blockage of the gene would raise serious issues in terms of side effects, Chang said, since the gene is involved in so many body processes. Short-term use -- for wound healing, for example -- might sidestep those problems.

More information
There's more on skin aging at the U.S. National Library of Medicine.

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