Gardasil
This is a big breakthrough for women's health and for cancer prevention.
--Anne Schuchat, MD, National Center for
Immunizations and Respiratory Diseases

Investigators took a swing at the human papilloma virus (HPV), and now their best shot is on the market.

Yesterday, the CDC's Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend Gardasil, a vaccine against the strains of HPV most commonly at the root of cervical cancer, as part of routine care for girls 11 and 12. In addition, they issued guidelines for girls and women between 13 and 26 to receive the shot as a 'catch-up' immunization.

For more information on the viral/cancer connection, see
The Human Papilloma Virus vs. The Cervix.

"A whole bowl full of sour cherries

I hate to belabor this cherry thing, but many of you have written me to ask just how many cherries are needed to get the antioxidant and anti-inflammatory benefits of the tart little cuties.

Dr. Muralee Nair writes in the Journal of Natural Products that about 20 tart cherries will do the job. That daunting pile of sour fruit (have you ever eaten a tart cherry much less twenty without a pie around it?) delivers the 12-25 mg. of anthocyanins known to deliver the cherry goods to you. Dr. Nair hopes that one day the anthocyanins will be out of the cherry and into a pill. The Michigan State University researcher had these final words:

Then people can pop a pill instead of eating a whole bowl full of sour cherries. That's pretty hard to do.

Popping a pill or eating the cherries?

Price breaks

Generic Zocor has been given the nod by the FDA and will show up in US pharmacies almost immediately. Merck, which manufactures the real deal, dropped the price of brand name Zocor, and that will remain the preferred drug on the United Healthcare formulary.

The patent expires on the antidepressant Zoloft next week. Generic versions should be available in the months to come.

Minding hormonal matters

I am particularly interested in getting all parts to the finish line intact--both mine and yours. You may have noticed many postings here and in my newsletter about bringing the brain along for the entire ride. Unfortunately, hormones have gotten such bad press in the last few years, women tend to discount the potent benefits of estrogen and progesterone on the brain. Consider these little tidbits:

UK Investigators checked out the hormonal status of youngish women (less than 50) with multiple sclerosis (MS) compared with similar women free of neurological troubles. They found that women using oral contraceptives were 40% less likely to carry a diagnosis of MS whereas women in the 6 months after giving birth--a time where estrogen and progesterone levels plummet--were at 3 times greater risk of developing the disease.

In rodent news, mice with head injuries (what? no helmets?) had far less damage to brain tissue adjacent to the injury site if they were on progesterone or received the hormone shortly after their 'accidents.' Trauma surgeons at Emory University are now testing progesterone in humans after brain injuries to see if this protective effect will hold true across species. They expect it will given the many known benefits of progesterone on neurons.

Silence the cellphone during a storm

Participants in Denver's Avon Breast Cancer Walk got an up-close and personal look at a typical Colorado summer afternoon on Saturday. A wild thunderstorm dumped freezing rain and hail on walkers just settling into their tents and some still out completing the course. While those of us in the medical tent were spared hailstones to heads--they were, instead, blowing in sideways through the flaps--we were in the highest structure in Clement Park, complete with metal scaffolding. The danger to all of a lightning strike was huge.

Many in the tent pulled out their cellphones as the storm picked up strength to send pictures of the mess to those dry at home. A recent report from the British Medical Journal warns that this is a bad strategy. The case cited in the journal describes a 15 year old girl in a London park struck by lightning as she chatted on her phone.

The cellphone pressed to her ear, which was made of electrically conductive materials such as metal and wiring, appears to have acted as a conduit allowing the lightning energy to enter her body, resulting in the significant morbidity and disability she experienced.

The article cites other cellphone strikes in Asia, then recommends to all of us that we hang up and get out of the rain.

(see *comments below)

Melanocortin receptor agonists

Here's an entirely different avenue of brain research on the melanocortin system which regulates energy balance. All kinds of energy! Drugs that stimulate these receptors (agonists) may effectively treat obesity, eating disorders, and sexual dysfunction. Drugs that block these receptors may be a wonderful boon to persons losing lean body mass due to cancer or AIDS.

A melanocortin receptor agonist known thus far as Bremelanotide is in phase 2 clinical studies for both male and female sexual dysfunction. This substance is administered via a nasal spray. 67% of those women who snorted the real deal reported increased sexual interest at home vs. 22% of the ladies who sniffed at placebos. Better yet, 72% in the active treatment group had genital stirrings compared with 39% in the control group.

Meanwhile, Arizona researchers are exploring the benefits of Melantan-II, another melanocortin receptor agonist. They used RigiScan monitoring to check out the effects on a group of men with erectile dysfunction. Those who used the drug scanned significantly stiffer than those who did not, with the treatment group maintaining tip rigidity for 38 minutes compared to a limp 3 minutes for the control group. The men on the drug suffered, however, from nausea and yawning significantly more than the control group. Small price to pay for the benefits?

*I actually found a picture of the RigiScan scanning, but felt it inappropriate for a family-friendly blog. Suffice it to say that if study participants scan rigid with this thing on, this is definitely a good drug!

African dancing and Cherry juice

I'm always on the lookout for new ways to get aerobic exercise without the tedium of the treadmill. Thanks to Claire M. of Denver for putting me on to the weekly African dance class Saturday mornings at the 6th Avenue United Church.

The class is one and a half hours of crazy good aerobic exercise done to a chorus of drumbeats from drop-in drummers on the stage of the church gym. Fortunately, I still had a vintage flower print wrap around skirt from my wrap around skirt days--the very outfit over a pair of gym shorts for a fledgling dancer in the know. If it weren't for my inability to do many of the steps, I would've blended right in to this friendly group.

So what's this got to do with cherry juice? Those of you who receive my health newsletter already know that cherry juice is a top-notch source of antioxidants. These phenols are the very thing apparently for over-exercised muscles, significantly decreasing the loss of strength and soreness associated with a vigorous workout. When a group of young fellows downed 24 ounces per day for two weeks, they bested their buddies (on Kool Aid placebos) at bursts of biceps busting weight routines.

24 ounces...that's a boatload of cherry juice. Would the same recipe hold for a fifty-something woman with quivering quadriceps at the end of an African dance class? Would I need proportionately more juice--say 2 and 1/2 times as much as I am 2 and 1/2 times older than the gents juiced in the study?

I'd like to stick with this activity, but what's good for the aging soul is not so compatible with falling arches. Can cherry juice boost the feet as well as the biceps?

Joining the world of the undepressed

A thirtyish woman was in my office this week. New to my practice, she was once again seeking relief from lifelong depression after numerous unsuccessful attempts at therapy with various antidepressants. We devised a strategy based on a new possibility that she was, in fact, bipolar, and that previous treatments hadn't addressed this specific problem. She asked me "How will I know if I'm better?"

How does someone who has really never not been depressed know when the depression has lifted? I've likened depression to "looking at the world through black-colored glasses," dreading the day when there's no particular reason to feel that way. The undepressed, on the other hand, look forward to the hours ahead though nothing special is planned. I told her she'd know if the new meds were working if she made it through the day without thinking in an unhappy self-concious way about herself.

Here's an excerpt from a poem by a man successfully on Paxil, undepressed for the first time in his life:

I feel more like myself,

a feeling that can hardly be true

after 60 years of prowling

outside the fence, with the gates

locked, or scarier still, open,

swinging and I would stand there

paralyzed, afraid to step in

my feet starved for affection

and serotonin shooting itself

in the foot each time a foot perked up

and started to dance. But that can

hardly be true, the way I feel today,

so vividly myself, so grounded

you might say the first draft is done.

I'm in the process of revision.

Yentl Syndrome

Think Barbara Streisand dressed as a Polish boy in search of a Talmudic education in that vintage gender-bending film. Now think of a woman with coronary artery disease who must present symptoms like a man in order to get the same treatment. First described in 1991, Yentl Syndrome highlights the differences between men and women with respect to heart attack (myocardial infarction or MI) treatments and outcomes.

Studies suggest that women receive less intensive treatment than do men. They are less likely to be referred for testing, and once identified with heart disease, they are less likely to receive certain standard therapies such as daily aspirin, beta-blockers, and cholesterol-lowering drugs. As a result, fatality rates for women after MI are higher both in the hospital and in the year that follows.

The College of Cardiology has issued Guidelines Applied in Practice (GAP) to standardize post-MI care. These recommendations include a discharge document that forces a thoughtful process while releasing MI patients from the hospital. For example, physicians following each step in the GAP procedure must either prescribe aspirin, beta-blockers, angiotensin-converting enzyme inhibiotrs, and cholesterol-lowering drugs or supply a reason why these agents were not used. A GAP usage study in Michigan found the death rate post-MI for women in the program dropped by over 50%, but the tool was used slightly less often in women than in men!

Doctors in Europe found a "Reverse Yentl Syndrome" operative in osteoporosis prevention and treatment. We now know that any fracture in a woman of age--think broken wrist after a roller-blading fall--should trigger an investigation of bone density. These investigators found that none of the old dudes who fell and fractured in the study were warned of the risk of osteoporosis, scanned for loss of bone mass, nor offered bone protective treatment. A study author commented, "Men accounted for 17 percent of presentations but the complete absence of advice and appropriate investigation and treatment of osteoporosis among males is striking."

'The Dean of Melatonin Research'

Why is this doctor wearing a tie with cherries on it? Check out "Tart is Smart".

Wind, wound, water, and walk

The med student's mantra for working up a post-operative fever. Look for pneumonia, surgical site abscess, kidney infection, or a blood clot in the leg. So when my patient came in this week with a temperature above 102 three weeks after her total hip joint replacement, I checked all four possibilites.

No cough, lungs clear, no redness or tenderness at the hip, legs non-tender and no swelling. But oy, the urine. Full of bacteria and white cells. I put her on the standard big-time antibiotic for pyelonephritis--Levaquin-- and sent her home, and her urine went off to the lab for culture.

Double oy. This E coli in her urinary tract was a bacteria so bad it made the infectious disease consultant flinch. ESBL no less, extended spectrum beta-lactamase producers. That means they eat penicillin for breakfast and look for fluoroquinolones such as Levaquin for dessert. The only antibiotics these bad boys run from are the carbapenems as in IV only, REALLY big guns.

The antibiotic resistance problem is here, now. Some sixty years after penicillin was pressed into service during World War II, that antibiotic is all but useless, and many of the latest and greatest new drugs are also falling to bacterial enzymes. An increasing number of carbapenemase producers (these are bacteria that produce an enzyme that chops carbapenem antibiotics into useless shreds) are being described around the world.

While you are more likely to pick up one of these New Age hideous bacteria in the hospital, they are present in livestock and showing up in community-acquired infections. When possible, forego the antibiotics. We're creating microbial monsters here!

Stressed out vaginas

Just one more thing to fret about when you're feeling overwhelmed--bad vagina days. Researchers checked out 3,614 women on a quarterly basis to see who was stressed and how their vaginas were holding up under the pressure. In particular, they checked for signs of bacterial vaginosis (BV), a condition of bacterial imbalance where the good little lactobacillus critters are crowded out by malodorous gram-negative invaders.

The participants underwent a pelvic exam every three months and filled out a Perceived Stress Scale quiz at the same visit. Those women with troubled vaginas were more likely to exhibit psychic trouble as well. Their PSS scores averaged 2.71 compared with a mellow 2.63 for those with calmer crotches.

Were the women stressed out by the prospect of having a pelvic exam yet again? Were they fretting over the fishy smell emanating from their nether parts? What will researchers research next?

Don't put any words in the mouth of a dizzy person under any circumstances.
---Dr. Martin Samuels

Open-ended questions. They're at the heart of the medical interview. They're also the death of my schedule. Dr. Samuels assures me that the avoidance of leading questions during the clinical interview will help me with the diagnostic challenge that is the dizzy patient.

There are four types of dizziness per Dr. Samuels, a professor of neurology at Harvard Medical School: vertigo (the illusion of motion when there is no motion), near syncope (impending faint), dysequilibrium (problems with walking or standing), and ill-defined light-headedness.

What's a physician to do when faced with a dizzy patient? Again from Dr. Samuels: "Your job is to sit there in your chair and weigh each of the four types." He adds: "If you mess this up, this person could be fixed for life in an undiagnosable morass--not to put too much pressure on you."

Eek, the pressure. Dr. S, you're making me some kind of dizzy!

Just a spoonful of jelly...

makes the medicine go down. The Dysphagia Research Society just slid down to Scottsdale for their annual meeting in search of better ways to swallow. Here's the latest:

Twenty elderly folks signed up for this study which involved swallowing big capsules filled with barium. Their skinny old torsos were then scanned to see if any barium which glows whitely on x-ray did not make it to their stomach in a timely fashion. Each volunteer swallowed six capsules in total, three with water, three with jelly. That's 120 hard-to-swallow pellets making their way down twenty aged esophagi (esophagusses?). Seven pills taken with water were 'retained in transit' as in stuck in the throat, whereas only two sent down with 'semisolid chasers--research code for jelly--didn't make it.

The lead author's conclusion? Anyone with even mild dysphagia or trouble swallowing should take pills with jelly or 'something similar.'

This is good news indeed. My guilty pleasure, well one of my guilty pleasures, is Smucker's Raspberry Preserves on Pepperidge Farm White Bread toast. There is nothing more likely to stick in an old esophagus than a wad of white bread unless it's steak or a barium pill. So the slidey pleasure of jam cancels out the nutritional worthlessness of white bread, and I am absolved of guilt in the early a.m.

1,460 old Australian ladies checked in. Those who actually took 600 mg. twice daily of calcium carbonate (as in TUMS, Viactive, and big chalky generic tablets) reduced their risk of fracture by one-third. Just another piece of evidence that confirms the use of daily calcium on an ongoing basis.

New news from the world of medicine:

1) The FDA is concerned, as am I, about the safety of the antibiotic Ketek. While I took a course of this drug for sinusitis earlier this year and was completely satisfied with my outcome, recent reports of dire side effects have taken it off my rx 'A' list. This from the FDA Office of Drug Safety:

How does one justify balancing the risk of fatal liver failure against one day less of ear pain? --Dr. Rosemary Johann-Liang, FDA official

2) French doctors have determined that drinking coffee makes you 3.7 times less likely to cross the line while driving late at night. Furthermore, taking a 30 minute nap before setting out in the wee hours means that you are nearly 3 times as likely to stay in your own lane compared to the napless. The investigators doubtless drew straws to see who would ride with the caffeine-free, sleep-deprived group. The study was criticized for lack of a 'placebo-nap' group(?!?).

3) The FDA has approved a 'non-antibiotic antibiotic' for the treatment of rosacea. This common skin disorder causes inflammation on the face and occasionally in the eyes, resulting in flaming red cheeks, small pustules unrelated to conventional acne, and red, irritated eyes.

For years, topical antibiotics such as MetroGel and oral antibiotics such as tetracycline have been used to successfully control rosacea. Scientists are concerned, however, about the overuse of antibiotics for chronic diseases as it contributes to global drug-resistance in bacteria.

Oracea is a 40 mg controlled-release doxycycline tablet which produces drug levels in the body below the antibiotic threshold of this drug. Doxycycline has several important anti-inflammatory actions in addition to its ability to kill bacteria. A recent study suggested that it actually can slow down the joint destructive inflammation associated with osteoarthritis. More on that in an upcoming issue of Femailhealthnews.

No more public toilets.

So says
P-Mate. Check it out. Try it? I'll publish your comments if you do!

Here's more in D news:

"In a study published last year, we looked at 1,500-plus community-dwelling, postmenopausal women receiving therapy to treat or prevent osteoporosis. We found that more than half of these women had a vitamin D inadequacy. Such a prevalence isn't surprising. With concerns about skin cancer and premature aging, our patients don't want sun exposure."

--Dr. Neil Binkley of the Osteoporosis Clinical Center and Research Program

Dr. Binkley goes on to say that vitamin D testing and supplementation must be part of a reasonable management strategy for bone health in aging women.

In another study, investigators mailed one capsule containing 100,000 units of vitamin D3 to men and women every four months for 5 years. By study's end, the incidence of fractures in the vitamin D group were reduced by 22% compared with the group who enrolled in the placebe-by-mail program.

Vitamin D levels should be 30 ng/ml. Ask your doctor about checking serum 25-hydroxyvitamin D levels.