Fate of frail patients hinges on Supreme Court

If the Supreme Court strikes down President Barack Obama's health care law, it wouldn't just be politicians dealing with the fallout.

Nearly 62,000 patients with serious medical conditions would be out of luck.

They're the "uninsurables," people turned away by insurance companies because of medical problems but covered through a little-known program in the law called the Pre-Existing Condition Insurance Plan. The plan would have to shut down if the entire law is invalidated.

Cancer patient Kathy Watson is worried she'll be uninsured again without the program. The Florida small businesswoman credits the coverage for saving her life this year when she had to be hospitalized with a serious respiratory infection.

She says simply: "Without it, I would have been dead March 2."

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Fate of some patients hinges on Supreme Court

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For Dementia Patients, Feeding Tubes May Increase Bed Sores

HealthDay – 1 hr 38 mins ago MONDAY, May 14 (HealthDay News) -- Feeding tubes increase the risk of bed sores in bedridden dementia patients, according to a new study.

The finding challenges the long-held belief that providing nutrition through feeding tubes helps prevent bed sores or helps promote their healing in this group of patients, the authors of the Brown University-led study said.

The researchers did not look at how feeding tubes could cause bed sores (also called pressure ulcers), but they noted that feeding tubes can cause agitation in patients, who then have to be restrained and sedated. Feeding tubes also may increase the risk of diarrhea.

Together, these factors may cause and worsen bed sores, the researchers said.

The researchers examined data from nursing homes and Medicare claims in order to compare thousands of dementia patients. Among patients who did not initially have a bed sore, 35.6 percent with a feeding tube ended up with at least a stage 2 bed sore, compared with 19.8 percent of patients without a feeding tube.

A stage 2 bed sore is an open sore in the upper layer of the skin. A stage 4 bed sore is the most serious type.

After making statistical adjustments, the researchers concluded that patients with a feeding tube were 2.27 times more likely to develop a bed sore than those without a feeding tube. The risk of developing a stage 4 bed sore was 3.21 times higher for those with a feeding tube.

Among patients who already had a bed sore, short-term improvement in the sore occurred in 27.1 percent of patients with a feeding tube and in 34.6 percent of those without. Patients without a feeding tube were 0.7 times more likely to have an improvement in a sore than those with one, the researchers determined.

The study was published May 14 in the journal Archives of Internal Medicine.

"This study provides new information about the risks of feeding tube insertion in people with advanced

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FDA warns MS patients about risky treatment

Reuters – 1 hr 36 mins ago WASHINGTON (Reuters) - U.S. drug regulators are warning people with multiple sclerosis that an experimental treatment that props open internal veins in the neck and chest can cause death or serious injury.

The Food and Drug Administration on Thursday said at least two people had died from the procedure, which uses stents or balloon angioplasties to widen veins that connect the brain and spinal cord to the heart. One person was permanently paralyzed, and others had bleeding in the brain, suffered strokes, blood clots or other side effects.

It is unknown how many people received the treatment and how many had problems, as stents and angioplasties are not approved for this use by the FDA, the agency said. Stents are steel mesh coils that can keep arteries open, while balloon angioplasties use a balloon at the tip of a catheter to open blocked blood vessels.

The FDA could not immediately identify the stent models being used in such treatments.

The FDA announcement relates to a controversy that has developed in the multiple sclerosis (MS) community about the causes of the chronic, progressive disorder of the brain and spinal cord.

The disease, which affects about 2.5 million people worldwide and has no cure, attacks the central nervous system and can lead to numbness, paralysis and loss of vision. Drugs that treat the condition, from companies like Biogen Idec Inc and Sanofi SA, can often only prevent relapses or slow its progression.

The underlying cause of MS is unknown. Some researchers believe that although it is typically thought of as a disorder of the immune system, it may actually be caused by blood vessel changes. Their theory is that veins bringing blood from the brain and spine back to the heart sometimes become too narrow, making blood leak back into the brain tissue. They say that could trigger inflammation, eventually causing the balance and muscle problems seen in MS.

Other scientists have not been able to show a link between MS and compromised blood flow, which is called chronic cerebrospinal venous insufficiency, or CCSVI, or prove the condition exists at all.

Meanwhile, MS patients seek new treatments, prompting patient advocacy and research groups to invest in more research studying the link between multiple sclerosis and CCSVI.

"Our position is that the evidence is simply insufficient to determine whether there's a link," said Dr. William Maisel, deputy director and chief scientist of the FDA's devices division. "We want patients to be aware this treatment (with stents or balloon angioplasty) is unproven, that there are significant risks associated with the treatment, (and) the benefits are uncertain."

The FDA said people who want to try the experimental treatment should first discuss the risks with their doctor, or should try the treatment while participating in clinical trials.

(Reporting by Anna Yukhananov; Editing by Michele Gershberg, Maureen Bavdek and John Wallace)

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Exercise May Boost Survival in Breast, Colon Cancer Patients

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Older Lung Cancer Patients Less Likely to Be Treated

HealthDay – Fri, May 4, 2012 FRIDAY, May 4 (HealthDay News) -- A study of seniors with non-small cell lung cancer found that older patients are less likely to receive treatment than younger patients, regardless of their overall health and prognosis.

Non-small cell lung cancer is the most common type of lung cancer.

For this study, U.S. researchers looked at data from more than 20,000 lung cancer patients aged 65 and older in the VA Central Cancer Registry between 2003 and 2008 and found that, for all stages of lung cancer, younger, sicker patients were more likely to receive treatment than otherwise healthy older patients.

That may not be best for patients, the researchers said. Previous research has shown that older lung cancer patients who are otherwise healthy can benefit from treatment, while those with other illnesses are more vulnerable to the toxicity of cancer treatments.

"It's clear that, as human beings and physicians, we fixate on age in deciding whether to pursue cancer treatments, including lung cancer treatments. Instead, we should be looking at our patients' overall state of health," lead author Dr. Sunny Wang, a physician at the San Francisco VA Medical Center and an assistant clinical professor of medicine at the University of California-San Francisco, said in a university news release.

The study was published May 1 in the Journal of Clinical Oncology.

Patients aged 65 to 74 who were severely ill from other illnesses -- and thus less likely to benefit from and more likely to be harmed by cancer treatment -- received treatment at about the same rate as patients in the same age range with no other illnesses.

These patients were more likely to receive treatment than patients aged 75 to 84 who had no other illnesses and better prognoses.

"The message here is, don't base cancer treatment strictly on age," Wang said. "Don't write off an otherwise healthy 75-year-old, and don't automatically decide to treat a really ill 65-year-old without carefully assessing the risks and benefits for that patient."

More information

The American Cancer Society has more about non-small cell lung cancer.

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Patients leaving hospital against advice fare worse

Reuters – 14 hrs ago NEW YORK (Reuters Health) - Hospital patients who leave against medical advice may have an increased risk of being readmitted or dying within a month, a study at one New York medical center finds.

In the U.S., about 500,000 hospital patients a year sign themselves out against medical advice.

Studies have suggested that decision can be unwise: patients hospitalized for asthma, HIV or a heart attack, for example, have been found to have an increased risk of readmission when they leave contrary to doctors' recommendations.

But the new study, reported in the American Journal of Medicine, suggests patients are also at increased risk of dying within 30 days of leaving against medical advice.

Researchers found that of 84,000 patients treated at their medical center, those who left against doctors' advice were more likely be readmitted within the next month: one-quarter of them ended up back in the hospital, versus 11 percent of patients who went home after a planned discharge.

They were also twice as likely to die: 1.3 percent died during the month after leaving the hospital, compared with 0.7 percent of patients with a planned discharge.

"That's the really sobering finding," said lead researcher Dr. William N. Southern, of Montefiore Medical Center and Albert Einstein College of Medicine in New York.

"These patients are not only at greater risk of readmission," he said, "they are also more likely to die in the next 30 days."

The exact reasons are not certain, Southern told Reuters Health.

Patients who signed out against medical advice tended to have a shorter hospital stay than patients with a planned discharge.

"So it may be that they aren't staying long enough to complete a course of treatment," Southern said in an interview. "But it may also be that they are not getting the follow-up care they may need."

The bottom line, according to Southern, is that people should be aware of the risks of leaving the hospital early.

That does not mean they have to follow "doctor's orders."

"Refusal of care is a patient's fundamental right," Southern said.

But, he added, patients do not always sign out because they don't want treatment. Often, it's for a personal obligation like work or caring for a family member.

The findings are based on 84,000 patients treated at Montefiore Medical Center between 2002 and 2008. That included 3,544 patients who signed out against medical advice.

Patients who checked out early were different from their counterparts in other ways too. For example, they were more likely to have a history of substance abuse or psychiatric conditions or to be on Medicaid, the government health insurance program for the poor.

But even when the researchers accounted for those differences, as well as factors like age and race, patients who left the hospital against advice still had twice the risk of dying.

Of course, the specific risks to any one person would depend on the illness being treated, overall health and other factors. "Our findings suggest that whatever your baseline (death) risk is -- whether it's high or low -- it would be twice as high if you leave the hospital against medical advice," Southern said.

A limitation of the study, though, is that it reflects a single medical center -- one located in a high-poverty area of New York. Southern said it's not known whether the results would be the similar at all hospitals.

But he said the findings do give hospital staff something to communicate to patients. Until now, it had not been clear whether discharge against medical advice was associated with death risk specifically.

"Now we know that it is," Southern said.

SOURCE: http://bit.ly/JcvCbG American Journal of Medicine, online April 17, 2012.

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Aspirin works as well as blood thinner in heart patients

"Aspirin works as well as the blood thinner warfarin, or Coumadin, in most patients with heart failure when it comes to preventing death, stroke or brain hemorrhage, said a major international study on Wednesday. (AFP Photo/Tim Boyle)" title

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Stopping Blood Thinners Raises Stroke Risk for Patients With Irregular Heartbeat

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Trauma patients taken by chopper may fare better

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Carnosine is Lacking in Type 2 Diabetic Patients

Carnosine is one of the most potent nutrients known for protecting against the adverse consequences of high blood sugar.  Thus, it is a wake-up call for every type 2 diabetic to find that a new study shows that patients are lacking carnosine in their muscles. 

One of the key factors to correct type 2 diabetes is an active exercise program.  This helps muscles use extra calories while reducing insulin resistance.  However, the muscles of diabetic patients are under stress, due to high blood sugar that can be acting as “cement;” it is like honey or maple syrup drying on the counter for a few days.  This process is called glycation, which means sugarcoating and cementing of flexible structures.  While one’s eyes, kidneys, and heart are very sensitive to this issue over time, in general, muscles also suffer problems.  This can prevent a person from getting a good response to exercise. 

Carnosine is highly concentrated in muscles, including your heart.  It acts as both an antioxidant and anti-glycation compound, helping prevent high blood sugar from inducing damage.  Thus, it is one of the very best nutrients to help a type 2 diabetic, yet it is lacking in type 2 diabetics.  Possibly carnosine has been used up trying to defend against the problem or a non-red meat diet has predisposed a person to a lack of this nutrient. Regardless of the reason, there simply is not enough carnosine.

Carnosine does a great deal more than simply protect muscles.  It has previously been shown to prevent kidney damage from type 2 diabetes.  A new study shows that it can enhance wound healing and another shows it can help protect the vascular system in the eyes so that high blood sugar does not induce glycation damage. 

Several days ago I mentioned the importance of getting iron to work properly in your body, especially if you are overweight, as are many type 2 diabetic patients are.  Carnosine is an important iron buffer compound, helping to keep iron working in a friendly way in your body.  Many studies show that carnosine also protects your brain, contributing to an anti-aging benefit.

Doses of carnosine in the range of 50 – 300 mgs are good for basic stress management and nerve health.  Doses of 1,500 mg per day are more likely to be of help for any person whose fasting blood sugar is over 90 and would like some help to protect against the glycation problems caused by high blood sugar that wreak so much health damage over time.  Of course, people must still take steps to fix their metabolism.

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Short Walks May Ease Fatigue in Pancreatic Cancer Patients

HealthDay – 4 mins 34 secs ago TUESDAY, April 10 (HealthDay News) -- Regular walking can help reduce fatigue in some pancreatic cancer patients, a new study suggests.

The study included 102 white men and women aged 66 or 67 who underwent pancreatic cancer surgery and were divided into two groups just before they were discharged from the hospital.

One group was sent home with normal instructions that did not include a walking or exercise routine. The other group was told to walk for increasingly long intervals each week for three months. The goal was to walk 90 to 150 minutes per week by the end of the program.

At the start of the study, 85 percent of all patients reported moderate to severe fatigue. By the end of the study, improvements in fatigue levels were reported by 27 percent of those in the walking group and 19 percent of those in the control group. The patients in the walking group also reported less pain than those in the control group.

The study was published in the April issue of the Journal of the American College of Surgeons.

"The beauty of this program is that we're not asking for high-intensity aerobics or a target heart rate," lead author Theresa Yeo, an associate professor of nursing at Thomas Jefferson University School of Nursing in Philadelphia, said in a journal news release. "It's low to moderate intensity, and they can sit if they need to. They don't have to push through it if they are not feeling well that day."

Chronic fatigue affects up to 96 percent of people who are treated for cancer, according to the U.S. National Cancer Institute.

"The message in pancreatic cancer care has typically been that these patients are just too sick to do this, but that's not true anymore," Yeo said. "There is no reason that patients can't become active, even if they did not exercise before."

More information

The U.S. National Cancer Institute has more about fatigue in cancer patients.

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Many Patients Skip Recommended Colonoscopy: Study

HealthDay – 1 hr 22 mins ago TUESDAY, April 10 (HealthDay News) -- Although a colonoscopy is considered the "gold standard" for colon cancer screening, a new study finds that many patients are reluctant to have the test.

Patients are more likely to opt for a simple fecal occult blood test -- a brief part of a medical exam -- that checks for bleeding, which can be a sign of colon cancer, the researchers said.

"The best test is the one that the patient actually performs," said lead researcher Dr. John Inadomi, a distinguished professor and head of the division of gastroenterology at the University of Washington, in Seattle.

"We should not assume that all patients prefer colonoscopy; therefore, patient preferences should be elicited to determine the test to which they are most likely to adhere," he said.

The main difference between the two tests, Inadomi said, is that a fecal occult blood test should be done every year, while for most people a colonoscopy can be done every 10 years starting at age 50.

In addition, any cancerous or precancerous polyps found during a colonoscopy can be removed during the procedure. If a fecal occult blood test proves positive, a colonoscopy is the next step.

The downside of a colonoscopy for many patients is the preparation, which involves fasting and using laxatives the day before the procedure. Many patients also don't like being sedated, and there can be complications, particularly a puncture of the intestine cause by the instrument, Inadomi said.

The report was published in the April 9 issue of the Archives of Internal Medicine.

For the study, 997 men and women were assigned to or given a choice of having a colonoscopy or a fecal occult blood test.

Within a year, 58 percent of the participants had the selected screening test.

Only about 38 percent of those who chose or were assigned to a colonoscopy actually had one, however, compared with more than 67 percent of those who were assigned to or chose a fecal occult blood test, the researchers found.

Significant racial/ethnic differences existed in screening, with whites more likely to have a colonoscopy and nonwhites a fecal occult blood test, the researchers found.

Blacks had the lowest rate of colon cancer screening at 48 percent. Asians and Latinos -- at about 61 percent and 63 percent, respectively -- had the highest rates, the study found.

"We have seen benefit from colon cancer screening with fewer people dying from it," said Dr. Theodore Levin, a gastroenterologist at the Kaiser Permanente Medical Center in Walnut Creek, Calif., and the author of an accompanying journal editorial. "If we want to raise our screening rates then we need to offer people choices other than colonoscopy."

Levin said there are many alternatives to colonoscopy, such as a virtual colonoscopy or sigmoidoscopy, and often when people are given too many choices they end up not doing anything.

"People may become confused and more likely to do nothing, but if you offered them colonoscopy, a test they don't want to do, or another test like a fecal occult blood test, then they are more likely to be screened," he said.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about colonoscopy.

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Gastro Woes Often Strike Rheumatoid Arthritis Patients

HealthDay – 1 hr 34 mins ago MONDAY, April 9 (HealthDay News) -- People with rheumatoid arthritis are at increased risk for gastrointestinal problems, such as ulcers and bleeding, and also for death related to gastrointestinal issues, a new study says.

The findings highlight the need to develop new ways to prevent and treat gastrointestinal complications in rheumatoid arthritis patients, according to the Mayo Clinic researchers.

They examined data collected from 813 rheumatoid arthritis patients and an equal number of patients without the disease between 1980 and 2008.

During that time, the incidence of upper gastrointestinal problems in rheumatoid arthritis patients declined but was still higher than in people without rheumatoid arthritis: 2.9 vs. 1.7 per 100-person years. Rheumatoid arthritis patients also had a higher rate of lower gastrointestinal problems than people without RA: 2.1 vs. 1.4 per 100-person years.

The researchers also found that 229 of the rheumatoid arthritis patients died and that gastrointestinal problems such as bleeds, perforations and obstructions were significantly associated with their deaths.

"Our findings emphasize that physicians and patients must be vigilant for these complications, which can occur without causing abdominal pain," study co-author Dr. Eric Matteson, chair of the rheumatology department at the Mayo Clinic in Rochester, Minn., said in a Mayo news release.

Quitting smoking and reducing use of corticosteroids may be important ways to cut the risk of gastrointestinal complications in rheumatoid arthritis patients, he added.

The study was published online last week in The Journal of Rheumatology.

More information

The American Academy of Family Physicians has more about rheumatoid arthritis.

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Diagnostic Scans Tied to Radiation Risk for Gastro Patients

HealthDay – 1 hr 1 min ago FRIDAY, April 6 (HealthDay News) -- Patients with digestive disorders such as inflammatory bowel disease may be exposed to significant levels of radiation from diagnostic imaging tests, a new study suggests.

Irish researchers analyzed data from 2,590 patients with gastrointestinal disorders between 1999 and 2009, and found that 57 percent of them had undergone diagnostic imaging tests such as computed tomography (CT) imaging.

Higher yearly and total levels of diagnostic radiation exposure were seen in patients with such conditions as inflammatory bowel disease, celiac disease, fatty liver disease and benign liver cysts, as well as in younger patients with irritable bowel syndrome and unexplained abdominal pain syndrome.

The study appears in the April 1 online edition of the journal Clinical Gastroenterology and Hepatology.

"Our results show that significant increases in radiation exposure in the last decade have paralleled the increased use of computed tomography imaging," lead author Alan Desmond, of the Cork University Hospital, said in a news release from the American Gastroenterological Association. "While cumulative exposure is highest in patients with Crohn's disease, high exposure may also occur in patients with other gastrointestinal disorders."

Crohn's disease is a major form of inflammatory bowel disease, along with ulcerative colitis.

Diagnostic imaging with CT does benefit patients with gastrointestinal tract disorders, especially those with Crohn's disease, who often require abdominal imaging to assess the extent of their disease and detect complications, the researchers noted.

However, CT uses higher levels of radiation than other imaging technologies and more widespread use of CT has led to increased patient exposure to radiation. This has raised concerns because radiation exposure may increase a person's lifetime risk of cancer, especially in younger patients.

More information

The American College of Radiology, Radiological Society of North America has more about radiation exposure in X-ray and CT examinations.

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'Superinfected' Patients Give Clues to Fighting HIV

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Silymarin Helps Type 2 Diabetic Patients

Healthy liver function is required for the proper storage, release, and overall metabolism of blood sugar.  Individuals with compromised liver function often develop type 2 diabetes, often in conjunction with weight gain and the development of fatty liver.  A new study shows that silymarin can help patients with liver problems who also have Type 2 Diabetes. 

The study showed that five months of silymarin reduced blood sugar levels of 8%.  Significant improvements also important measures of liver health (bilirubin was lowered 40%, SGOT was lowered 29%, SGPT was lowered 35%, and ALP was lowered 12%).  Such improvement in liver function is rather dramatic, as the general trend in the liver of diabetic patients is one of increased free radical damage and scar tissue formation, tending to lock in the problem of Type 2 Diabetes.

Any person gaining excess weight around their midsection is likely developing excessive fatty deposits in their liver with consequent impairment of liver function and risk for blood sugar problems.  This study shows that silymarin can help guard against the progression of serious liver deterioration, helping to give a person more time to fix their weight and metabolic issues.

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Rheumatoid Arthritis Patients Who Quit Statins May Face Raised Death Risk

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Should Cystic Fibrosis Patients Get So Many Antibiotics?

HealthDay – 3 mins 26 secs ago MONDAY, March 26 (HealthDay News) -- Antibiotics can prolong cystic fibrosis patients' lives, but the drugs also help treatment-resistant bacteria thrive in their lungs, a new, small study suggests.

The findings from the 10-year investigation suggest, but do not prove, that the current standard of aggressive antibiotic treatment for cystic fibrosis patients may not always be the best approach.

It's common to use antibiotics to control infection in cystic fibrosis patients' lungs, but maintaining a more diverse range of bacteria in the lungs may help some patients stay healthy longer, according to study senior author Dr. John LiPuma, a research professor of pediatrics and communicable diseases at the University of Michigan Medical School in Ann Arbor.

"The conventional wisdom has been that as patients with cystic fibrosis age and become sicker, as their lung disease progresses, more and more bacteria move in," he said in a university news release. "But our study -- which was the first to examine the bacterial communities in cystic fibrosis patients' lungs over a long period of time -- indicates that's not what happens."

Aggressive use of antibiotics actually lowers the diversity of lung bacteria, resulting in infections that are increasingly difficult to treat. A more diverse community of lung bacteria may help keep the most dangerous strains in check, the researchers noted.

"What we normally do is essentially carpet bombing with antibiotics," explained LiPuma. "However, what we found is that over time this ultimately helps treatment-resistant bacteria by getting rid of their competition."

He said the findings may be a first step toward developing new treatment methods, such as more focused use of antibiotics or even giving cystic fibrosis patients beneficial bacteria.

The study was published March 26 in the Proceedings of the National Academy of Sciences.

Cystic fibrosis is a chronic disease in which the body produces thick, sticky mucus that clogs the lungs. The accumulation of the mucus leaves people prone to serious, hard-to-treat and recurrent infections. Eventually, the repeated infections destroy the lungs.

In the study, researchers examined the bacteria from six patients collected over eight to nine years. Half of the patients had a relatively stable type of the disease and the others had the more typical, faster-progressing form. The investigators conducted DNA analysis on bacteria in 126 sputum samples.

Over time, the researchers found that bacterial diversity declined, yet the overall level of bacteria remained fairly constant. The study authors explained that this means a small number of organisms multiply to take the place of those that have been killed off by antibiotics.

More information

The U.S. National Heart, Lung, and Blood Institute has more about cystic fibrosis.

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Clot-buster Drug Injection Might Help Some Heart Attack Patients

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