Marion County Medical Center

Health Shorts

June 2006

Think Twice Before Choosing the Knife
Some surgical procedures are necessary; others are elective, and patients should think twice and balance benefits against risks before making a final decision.

Spinal fusion is the most controversial type of back surgery. Of the 125,000 Americans who elect to have spinal fusion each year, at least 40 percent still feel back pain a year later.

Arthroscopic knee surgery has a role for treating sports injuries, but a VA study found that it offered no benefit for treating arthritic pain. Nevertheless, about 660,000 procedures are performed each year.

Most cases of shoulder tendinitis resolve on their own, but 140,000 Americans choose to have shoulder acromioplasty, despite the costs and risks of surgery.

About 650,000 women have uterine hysterectomies; many of these are believed to be unnecessary.
Gastric bypass surgery can be an effective treatment for obesity...but it’s costly and has potentially serious complications.
[SOURCE: American Academy of Orthopaedic Surgeons; American Society for Bariatric Surgery; Agency for Healthcare Research and Quality; “Under the Knife,” Forbes, October 27, 2003]

High Carb, Low-Fat = Weight Loss
More than 22,000 postmenopausal women following a high-carbohydrate, low-fat diet lost an average of five pounds over a year and maintained a lower weight than women in the control group over a seven-year follow-up period.

Researchers who conducted the Women’s Health Initiative Dietary Modification Trial believe the weight loss resulted from replacing dietary fat with complex carbohydrates from fruits, vegetables and whole grains. While a diet high in refined carbohydrates can lead to weight gain, one focusing on complex carbs can have the opposite effect.
[SOURCE: “Carbs Aid Weight Loss in Older women,” Environmental Nutrition, March, 2006]

Whole Grains Reduce Inflammation
A recent observational study suggests that consumption of whole grains may protect against the systemic inflammation that is frequently a factor in type 2 diabetes and cardiovascular disease.

In an observational trial involving women with type 2 diabetes in the Nurses’ Health Study, those consuming higher levels of whole grains, bran and cereal fiber had significantly lower levels of the inflammatory markers, c-reactive protein (CRP) and tumor necrosis factor-receptor 2 (TNF-R2). Further studies are needed to establish a cause-effect relationship.
[SOURCE: Lu Qi, et al, “Whole-Grain, Bran, and Cereal Fiber Intakes and Markers of Systemic Inflammation in Diabetic Women,” Diabetes Care, February, 2006]

Whole Grains–Count the Benefits
A three-year study of 229 post-menopausal women already diagnosed with a heart condition found that those eating six servings or more of whole grain foods a week had slower buildup of plaque in their arteries.

Other benefits documented in studies include:

a 30 to 36 percent reduction in stroke risk,
a 21 to 30 percent lower risk of type 2 diabetes,
a 25 to 28 percent reduced risk of heart disease
a lower risk of death from heart disease and
a lower likelihood of weight gain and obesity.

[SOURCE: Alice Lichtenstein, American Heart Journal, July, 2005; Nadine Sahyoun, American Journal of Clinical Nutrition, January, 2006; Majken Jensen, American Journal of Clinical Nutrition, December, 2004; Whole Grain Council, Whole Grain Health Studies, 2003-2006]

‘King Seed’ High in Protein, Lysine
So powerful was amaranth in Aztec culture that the Spanish conqueror Cortez decreed that anyone growing the grain would be sentenced to death. Fortunately, amaranth survived and became known as “king seed” and “seed sent by god” in some parts of Asia.

Today, popped amaranth is sold on the streets as a snack in South America and is eaten in many parts of the world in cereals, breads, muffins, crackers and pancakes. It has a high level of complete protein plus lysine, an amino acid rarely found in grains.

[SOURCE: Whole Grains Council, “Whole Grains, from A to Z,” 2003-2006]

Americans Eating More Whole Grains
In the eight weeks immediately after release of the 2005 Dietary Guidelines, Americans started following the recommendation to eat more whole grains. Sales of whole grain breads increased 12 percent, whole grain rice went up 19 percent and whole-grain breakfast cereals 16 percent. Compared to the same period a year earlier, shoppers bought 13 percent more pounds of whole grain products.

Guidelines recommend three to six servings of whole grains a day with whole grain foods comprising one half of all grains.
[SOURCE: Lisa Mancino, “Going with the Grain,” Food Market Dynamics and USDA’s New Dietary Guidelines, September, 2005]

Distress No Reason for Back Surgery
Chronic back pain can lead to a great deal of distress, but distressed persons may be among the least likely to benefit from back surgery, according to research presented at the 2005 meeting of the American Academy of Orthopaedic Surgeons.

Jeffery C. Wang, M.D., a UCLA spine surgeon, reported that psychologically distressed patients often have poor surgical results even though they may otherwise appear to be good candidates.
[SOURCE: Jeffery C. Wang, M.D., American Academy of Orthopaedic Surgeons; Salynn Boyles, WebMD Medical News, June 15, 2005]

Intensive Rehab Is Good Option
A study of 349 patients with low back pain found that those getting 75 hours of intensive rehabilitation had similar benefits over a two-year period as those undergoing spinal surgery. The subjects getting surgery showed slightly less disability, but the difference was dubbed “marginal” by the researchers.

The rehab consisted of exercises for flexibility, strength and endurance plus cognitive behavioral approaches to manage pain.
[SOURCE: B.J. Fairbank, “British Medical Journal Online first, May 23, 2005]

Back Pain Is Hazardous to Brain
If you have back pain so bad you think your brain is crying out for relief, you’re right. A Northwestern University study using MRI images found that the gray matter of a person’s brain may shrink 5 to 11 percent a year as a consequence of persistent back pain–equivalent to the effect of 10 to 20 years of aging. One explanation, researchers said, is that nerve cells are working overtime to cope with the pain.
[SOURCE: A. Apkarian, The Journal of Neuroscience, November 23, 2004]

Ultrasound Useful for Treatment
In addition to its role in providing diagnostic scans, ultrasound is frequently used for the treatment of soft tissue injuries such as tennis elbow or plantar fasciitis.

Ultrasound can deliver deep heat that speeds healing by increasing blood flow to a joint, muscle or tendon injury. And in a recently developed procedure, an ultrasound-guided needle is used as a tiny surgical instrument to break up scar tissue and restore function much more rapidly than is possible with arthroscopic surgery.
[SOURCE: “Deep Heat Treatment,” Clinical Reference Systems, 2004; Peggy Peck, “New Ultrasound Therapy for Tennis Elbow,” WebMD Medical News, December 6, 2002; Paula Moyer, “Painful Muscular Condition Responds to Noninvasive Ultrasound,” WebMD feature, February 28, 2002]

Using Sound To Measure Bone Density
New, compact ultrasound devices have given doctors another way to measure bone mineral density and identify persons at risk of fractures related to osteoporosis.

The ultrasound device takes measurements from the heel without exposing the patient to radiation. A 2001 study published in the Journal of Bone and Mineral Research found it as accurate as x-ray scans in identifying at-risk patients.

Although an ultrasound scan is less expensive, dual energy x-rays (DEXA) and CT scans are generally considered more sensitive since they take measurements from the spine or wrist where bone density changes are likely to show up sooner.
[SOURCE: Jim Kelly, “Ultrasound Takes Osteoporosis by the Heel,” WebMD Medical News, February 20, 2001]

Half Empty or Half Full?
In 1995, persons diagnosed with metastatic colon cancer could expect to live an average of 11 months. In 2006, with new drugs and other treatments available, life expectancy has more than doubled. But it’s still only about two years.
[SOURCE: R. Morgan Griffin, “New Drugs Show Promise, But More Research Needs To Be Done,” WebMD Feature, January 30, 2006]

Cancer Drugs Raise Treatment Cost
More targeted cancer drugs introduced over the past decade have eliminated many of the devastating side effects associated with traditional chemotherapy, but they are also several hundred times more expensive than the older drugs–often costing $50,000 to $150,000 for a year’s supply.

For cancer patients who cannot keep up with insurance co-pays, the Patient Advocate Foundation of Newport News, VA is one group that provides assistance. The Foundation does not cover all kinds of cancer, however.
[SOURCE: Alex Berenson, “Cancer Drugs Offer Hope, But at a Huge Expense,” New York Times, July 12, 2005]

Flipping the Angiogenesis Switch
Angiogenesis is the body’s process of developing new blood vessels whenever they are needed, such as to heal wounds. A built-in mechanism, however, prevents angiogenesis from occurring when it isn’t needed.

When a malignancy occurs, something happens to keep the angiogenesis switch turned on and allow the tumor to grow. Soon the cancer’s blood vessels grow out of control and in a disorderly, mangled fashion.

Many recent cancer drugs are aimed directly or indirectly at the angiogenesis process. They may keep the switch from being turned on, block signals from the tumor or make the signals ineffective. Some try to make the mangled blood vessels more normal.
[SOURCE: “Angiogenesis Inhibitors: New Cancer Drugs Stop Tumor Growth,” MayoClinic.com, May 22, 2006]

Health Shorts

June 2006

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