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More Americans Getting Knees Replaced, And at Younger Ages...

Aging baby boomers are getting bum knees replaced at a greater rate, and at a younger age, than ever before, a new U.S. study confirms. The data, from the National Hospital Discharge Survey, shows that between 2000 and 2010, more than 5.2 million total knee replacements were performed in the United States. By 2010, the […]

Telling My Coworker with the Bad Back About My Bakersfield Chiropractor... I work with a guy who is hunched over by mid shift almost every time we work together. His back hurts him. He takes over-the-counter pain medications every day. I know that cannot be good for your liver. After a couple of hours of repetitive movements and lifting, his lower back starts to hurt. He started wearing a back brace after going to the doctor, but I think those things just end up making your back muscles weaker. I...
More Evidence Weight-Loss Surgery Helps Fight Type 2 Diabetes... Prior research has suggested that weight-loss surgery might help people rid themselves of type 2 diabetes, and a new study finds that the effect might be long-lasting. “This is a very important study because it’s the first randomized trial comparing bariatric surgery to medical treatment of diabetes with five years of follow-up,” said Dr. Philip Schauer, who directs the Bariatric and Metabolic Institute at the Cleveland Clinic. Schauer was not involved in the new British study, which was led...
More Men With Breast Cancer Having Second Breast Removed... There has been sharp rise in the number of American men with cancer in one breast who have surgery to remove their cancer-free breast, a new study said. The study authors said this is the first research to identify this trend in men, which has been occurring in American women for the past two decades. “The increase in the rate of this costly, serious procedure with no evidence of survival benefit comes, paradoxically, at a time of greater emphasis...
Impotence Drug Aids Treatment of Rare Lung Disease: Study... A combination treatment that includes the active ingredient in the erectile dysfunction drug Cialis may reduce death and hospitalization from an incurable lung disease that mainly affects women, a new clinical trial shows. When combined with a blood pressure medication called ambrisentan (Letairis), a high dosage of tadalafil (Adcirca) significantly reduced the progression of pulmonary arterial hypertension, according to results published in the Aug. 27 issue of the New England Journal of Medicine. The condition involves high blood pressure...

More Evidence Weight-Loss Surgery Helps Fight Type 2 Diabetes...

weight-loss-9.15Prior research has suggested that weight-loss surgery might help people rid themselves of type 2 diabetes, and a new study finds that the effect might be long-lasting.

“This is a very important study because it’s the first randomized trial comparing bariatric surgery to medical treatment of diabetes with five years of follow-up,” said Dr. Philip Schauer, who directs the Bariatric and Metabolic Institute at the Cleveland Clinic.

Schauer was not involved in the new British study, which was led by Dr. Francesco Rubino of King’s College London. Rubino’s team tracked five-year outcomes for 53 obese patients with type 2 diabetes. The patients were randomly selected to undergo either one of two types of weight-loss surgery, or just to continue with conventional drug therapy to help control their diabetes.

The study found that half of the 38 weight-loss surgery patients maintained diabetes remission, compared with none of the 15 patients in the drug treatment group.

And regardless of whether or not their diabetes went into full remission, patients who underwent surgery still tended to have lower blood sugar levels than those treated with drugs, the researchers reported Sept. 3 in The Lancet.

The patients in the surgery group also used far fewer diabetes and heart medications, the research team added.

“The ability of surgery to greatly reduce the need for insulin and other [diabetes] drugs suggests that surgical therapy is a cost-effective approach to treating type 2 diabetes,” Rubino said in a news release from the college, where he is chair of bariatric and metabolic surgery.

The new study backs up findings from previous research. For example, a study published in July in JAMA Surgery, of 61 obese people with type 2 diabetes, found that weight-loss surgery was better at keeping the disease at bay compared to diet and exercise alone.

And in 2014, another study from King’s College London, published in The Lancet Diabetes & Endocrinology, found that obese people who underwent the surgery had a lower risk of developing type 2 diabetes.

The new study is among the first to suggest that these benefits last over time, Rubino’s team said.

This study also found that, over five years, the heart risk of people who’d undergone weight-loss surgery was about half that of those in the drug treatment group. Also, patients who had weight-loss surgery were less likely to have diabetes-related complications such as heart attack, stroke and kidney disease.

None of the patients in the surgery group died or had long-term complications.

The researchers noted that while people in the bariatric surgery groups lost more weight than people treated with drug therapy, weight loss alone didn’t predict whether or not diabetes would recede. That suggests that the benefits of surgery in curbing type 2 diabetes may rely on more than just shedding excess pounds, the British team said.

The two methods of weight-loss surgery included in the study were gastric bypass or biliopancreatic diversion. According to the study authors, the former involves a shrinking of the size of the stomach and a rerouting of part of the small intestine, while the latter involves a more extensive intestinal bypass.

There were pros and cons to each method, the team found: More people saw their diabetes go into remission with biliopancreatic diversion, but patients who got gastric bypass had fewer nutritional side effects and had better quality of life overall.

In assessing the effectiveness of surgical and drug therapy, the British team looked at outcomes such as blood sugar control, the need for diabetes and heart medications, cholesterol levels, complications from diabetes or the bariatric surgery, and overall quality of life.

The researchers stressed that this was a relatively small trial and a much larger trial is warranted before firm conclusions can be drawn.

Nevertheless, the trial “shows that surgery is quite durable in the long term — for at least five years,” Schauer said. “And, that the procedure is relatively safe with a very low complication rate.”

However, like any invasive procedure, weight-loss surgery comes with risks and recovery time, and it can be expensive. The cost of weight-loss surgery varies, but the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates the cost is generally between $20,000 and $25,000. Insurance coverage for the procedure depends on the insurance company.

Schauer hopes the new findings might help widen access to the surgeries.

“Physicians should strongly consider surgery as an important option for long-term control of diabetes,” he said. “In addition, insurance companies and third-party payers should consider reviewing the coverage of bariatric surgery in their standard insurance policy.”

Telling My Coworker with the Bad Back About My Bakersfield Chiropractor...

I work with a guy who is hunched over by mid shift almost every time we work together. His back hurts him. He takes over-the-counter pain medications every day. I know that cannot be good for your liver. After a couple of hours of repetitive movements and lifting, his lower back starts to hurt. He started wearing a back brace after going to the doctor, but I think those things just end up making your back muscles weaker. I told him that he should go see the Bakersfield chiropractor I go to when my back hurts. It took a few promptings but he finally went.

After having an examination and some therapy the first day, he was feeling better. The doctor told him that his journey toward a strong and pain free back was not over in one visit.

More Americans Getting Knees Replaced, And at Younger Ages...

Aging baby boomers are getting bum knees replaced at a greater rate, and at a younger age, than ever before, a new U.S. study confirms.

The data, from the National Hospital Discharge Survey, shows that between 2000 and 2010, more than 5.2 million total knee replacements were performed in the United States. By 2010, the operation had become the leading inpatient surgery performed on adults aged 45 and over.

The rate at which middle-aged and older Americans got their knees replaced almost doubled over the years covered by the study, for men and women, the researchers found.

People aren’t putting off the procedure for as long, either. In 2000, the average knee replacement patient was about 69 years old, but by 2010 that age had dropped to just over 66, the findings showed.

One expert said there’s been a change in doctors’ and patients’ attitudes toward the timing of knee replacement.

“In the past, the trend amongst orthopedic surgeons was to delay performing a joint replacement on a patient until a person was so hindered by their joint pain that they were nearly incapacitated in their activities of daily living,” said Dr. Neil Roth, an orthopedic surgeon at Lenox Hill Hospital in New York City.

However, “that philosophy has evolved,” he said, so that nowadays surgeons “perform joint replacements sooner, to prevent physical deterioration and deconditioning, and to try to maintain activity levels.”

The new study was led by Sonja Williams of the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) and published in the September issue of the NCHS Data Brief.

Looking over the data, her team also noted a gender gap in knee replacement rates, with women significantly more likely to get a new knee compared to men. In 2010, about 65 of every 10,000 women aged 45 or older got a knee replacement, the research showed, compared to about 45 of every 10,000 men of similar age.

Why is the operation becoming more popular for both genders? According to Roth, aging boomers are demanding more mobility as they age.

“People want to remain active longer, well into their 8th and 9th decades of life, and painful joints are not conducive to remaining active,” he said.

Joint replacements are getting better, too, he added.

“Technologically, the longevity of knee and hip implants has also improved, lasting sometimes up to 15 years or longer,” Roth said. “While that still may necessitate revision surgery for those patients in the younger age groups, 45 to 64, it may not require two revision surgeries.”

Also, “the surgeries are more sophisticated now,” Roth said, “especially with the use of [surgical] navigational systems, as well as custom-made knee and hip replacements.”

The bottom line, he said, is that “all of these factors have led to an increased utilization of joint replacements for those needing them at an earlier age and has put aside the mantra of ‘waiting until you can’t take it any longer.'”

Roth stressed that these procedures remain invasive and complex, are not without risk, and shouldn’t be taken lightly. “Joint replacement surgery is still a major surgical procedure with significant risks, such as blood clots, infection and loss of motion,” he said.

Dr. Eric Grossman is co-director of joint replacement surgery at Northern Westchester Hospital in Mount Kisco, N.Y. He agreed that the rise in joint replacement has largely been based on patient demand.

“Patients today are unyielding in their desire to continue to be active and maintain a physically vivacious life,” Grossman said. “For patients with severe, debilitating arthritis, a total knee replacement can reliably achieve significant improvements in a patient’s pain and functional level, including returning to walking, cycling, tennis, golf, and skiing among other activities.”

And there’s been one other improvement boosting uptake of the operation, he added.

“Hospital lengths of stay continue to decline as refinement of the rehabilitation is also improved,” Grossman said. “Patients used to be hospitalized for weeks. In some cases today the surgery is being done on an ambulatory basis, but most commonly patients stay in the hospital for just one to three nights.”

More Men With Breast Cancer Having Second Breast Removed...

There has been sharp rise in the number of American men with cancer in one breast who have surgery to remove their cancer-free breast, a new study said.

The study authors said this is the first research to identify this trend in men, which has been occurring in American women for the past two decades.

“The increase in the rate of this costly, serious procedure with no evidence of survival benefit comes, paradoxically, at a time of greater emphasis on quality and value in cancer care,” said study leader Dr. Ahmedin Jemal, vice president of surveillance and health services research at the American Cancer Society.

The study included more than 6,300 men who had surgery for cancer in one breast. Their surgeries occurred between 2004 and 2011. The percentage of men who also had their cancer-free breast removed rose from 3 percent in 2004 to 5.6 percent in 2011, the study found.

Those mostly likely to have their cancer-free breast removed were younger, white and privately insured, the study said.

Findings were published online Sept. 2 in the journal JAMA Surgery.

“Health care providers should be aware that the increase we’ve seen in removal of the unaffected breast is not limited to women, and doctors should carefully discuss with their male patients the benefits, harms and costs of this surgery to help patients make informed decisions about their treatments,” Jemal said in a journal news release.

Men account for only about 1 percent of breast cancer patients in the United States.

The percentage of women with invasive breast cancer in one breast who have their cancer-free breast removed rose from 2 percent in 1998 to 11 percent in 2011. This, despite the risk of complications and a lack of evidence that it improves the chances of survival, according to background information from the study.

Impotence Drug Aids Treatment of Rare Lung Disease: Study...

A combination treatment that includes the active ingredient in the erectile dysfunction drug Cialis may reduce death and hospitalization from an incurable lung disease that mainly affects women, a new clinical trial shows.

When combined with a blood pressure medication called ambrisentan (Letairis), a high dosage of tadalafil (Adcirca) significantly reduced the progression of pulmonary arterial hypertension, according to results published in the Aug. 27 issue of the New England Journal of Medicine. The condition involves high blood pressure in the arteries leading into the lungs.

Patients who took the combination therapy were half as likely to die, require hospitalization or have severe progression of their illness, when compared with people who only received one of the two drugs, researchers found. People using tadalafil for pulmonary arterial hypertension take 40 milligrams (mg) a day, while the dosage for erectile dysfunction runs between 2.5 mg and 20 mg a day.

The results were so encouraging that the marketer of ambrisentan in the United States has submitted a request to the U.S. Food and Drug Administration so this combination use can be added to the drug’s label, said senior study author Dr. Lewis Rubin, an emeritus professor of medicine at the University of California, San Diego School of Medicine.

Dr. Carl Pepine, past president of the American College of Cardiology, said the results “offer an easy-to-use additional treatment for patients who have this unfortunate condition, who are largely women.”

The two drugs work in different ways to ease the effects of pulmonary arterial hypertension, so researchers decided to see if their impact would be greater used in tandem, Rubin explained.

“This is a complex disease. There’s no magic bullet,” Rubin said. “We postulated that the more pathways you target, the better the effect would be.”

Pulmonary arterial hypertension causes people to be chronically short of breath, as their blood has difficulty getting through the lungs to pick up oxygen. It eventually leads to heart failure because the heart has to pump harder to keep blood circulating through the body.

Pulmonary arterial hypertension is relatively rare, Rubin said, affecting about 50,000 people in the United States. Average survival is roughly two years following diagnosis.

Tadalafil works by blocking PDE5, an enzyme that breaks down a substance called nitric oxide that promotes dilation of blood vessels. With more nitric oxide available, the arteries feeding the lungs are better able to dilate, increasing blood flow.

Ambrisentan works by inhibiting endothelin, a substance that causes blood vessels to constrict, Rubin said. Thus, one drug promotes dilation of blood vessels while the other works to prevent constriction.

Researchers recruited 500 people with pulmonary arterial hypertension to take part in the clinical trial. The study involved 120 medical centers in 14 countries, and ran between October 2010 and July 2014.

About half of the study participants received both drugs, while one-quarter received the high dose of tadalafil alone and another quarter received ambrisentan alone.

Only about 18 percent of people on combination therapy died or experienced severe progression of pulmonary arterial hypertension, compared with 31 percent of people taking either ambrisentan or tadalafil alone, the study found.

And it appeared that using the two drugs together produced no additional side effects, Rubin and Pepine said.

“I was impressed with the relatively good tolerability,” said Pepine, director emeritus of the cardiovascular medicine division at the University of Florida College of Medicine in Gainesville. “I think that will encourage us to use this combination treatment earlier in the course of the disease. It’s possible we might be able to prevent these women from emerging into a very symptomatic stage, where their daily activities are greatly impaired.”

The men taking the combination therapy also might derive other benefits from the tadalafil, given that the dosing is higher for pulmonary arterial hypertension than it is for erectile dysfunction, Rubin said.

“These are sick patients. It’s not uncommon for the men to have erectile dysfunction because they’re sick. Clearly, some of them are deriving some off-target benefits, if you will,” Rubin said. “But their main focus is they can’t breathe and their heart is giving out.”

The clinical trial was funded by Gilead Sciences and GlaxoSmithKline, which sell ambrisentan in the United States and Europe, respectively.