Which blog to blog upon, that is my question? In case you haven't noticed, I have two of them, one for general medical knowledge and one specific to the process of aging. One of my passions is brain preservation, an important undertaking for all of us who are or will be aging. I post some of it here, some of it there, so if you want to do right by your noggin, check 'em both out.

Melatonin

I am eagerly awaiting my supply of jellyfish pills. Meanwhile, I reread the three chapters in Protective Strategies for Neurodegenerative Diseases (I could use a good novel!) and wanted to make sure that those of you who are interested in getting your brain intact to the finish line consider taking melatonin.

Melatonin is a hormone naturally secreted by the pineal gland deep within the brain. It is particularly important in setting biorhythms based on dark/light cycles in the environment. It also has the ability to prevent the accumulation of molecular junk that gums up neurons as a result of natural aging and degenerative diseases such as Alzheimer's and Parkinson's.

Mice are raving about their ability to complete crossword puzzles well into their second year as a result of the routine use of melatonin, and lab data strongly supports its antioxidative and neuroprotective properties. While human data is sparse, studies do show that melatonin is effective in decreasing 'sun-downing' in Alzheimers (a night-time increase in dementia symptoms) and in improving sleep in AD patients.

While not everyone finds melatonin useful as a sleep aid, I get a great night's sleep on 3 mg., and it definitely enhances dreaming. I think I'd take it whether or not it helped with sleep considering its many cellular benefits.

Years ago, my Great-uncle M died unexpectedly in his sleep at a ripe old age. No dwindling, no surgery, no ICU stays, no chemo, no nursing home, just alive and well one day and dead the next morning. But what the family, including his wife, found remarkable was that this old fellow, best known for his sour disposition, had such a peaceful death. Aunt I felt forced to reconsider the possibility that he was a really good man after all.

Few of us meet a sudden death at an advanced age. Many of us will live some time with a serious illness, and all of us hope that we can live well to the end despite the health challenges we will face.

So here's good news indeed. An extraordinary woman who's been there, doing that has written a book about navigating through the world of serious illness and thriving on the journey. Tiffany Christensen was born with cystic fibrosis, survived two double lung transplants, and said final goodbyes to her loved ones on several occasions. At times when she scarcely had the breath to open her dresser drawer much less pull out her clothes or put them on, she discovered a rich inner landscape of emotional growth.

Her book Sick Girl Speaks!: Lessons and Ponderings Along the Road to Acceptance is a must-read for all of us who are facing or will face life-threatening illnesses, or who care personally or professionally for someone else in that situation. Think about it, that's all of us.

Check out her blog Sickgirl Speaks and her web-site, or order her book at Amazon.com.

Reflected glory

If they look good, I look good. I always get a warm glow from comments such as "I want to thank you for sending me to Dr. X. He/she was fantastic." So here's some of the specialists who made me look like a hero this past week:

Oncologists Drs. Kerry Fisher and Deb Cook (both of whom get the special award for that 'send 'em right over' attitude), dermatologist Dr. Migs Muldrow, Dr. Raj Bazaz who must be the world's nicest person as well as an excellent orthopedist as everyone loves him, and surgeon Dr. Stephanie Miller. And a special mention to neurologist Dr. Don Smith who not only saw one of my patients very promptly but sent me a four page consultation report complete with a discussion from the latest medical literature as to why he was recommending that which he recommended!

That which makes jellyfish glow in the deep...

May save your aging brain. Since I wrote this article over a year ago, Quincy Bioscience has brought Prevagen to market as an over-the-counter supplement to light up your faltering circuits. I will have samples in the office soon and plan to try it myself. Read on for more information.

After all, have you ever seen a demented jellyfish? The phosphorescent protein that lights up their quivering goo has a potent neuroprotective effect, at least in doddering old rats. Here's why it may light up your intellect as well.

Calcium is, as we know, a good thing. In particular, it holds up our joints and activates our nerves. When neurons are stimulated by a passing impulse via a transmitting molecule called glutamate, they open up their pores and let the calcium trickle in. Not pour in, mind you, just trickle. If they get over-goosed with glutamate, a situation called excitoxicity, too much calcium enters the cells which upsets it unto death.

Enter aequorin. Scientists have long called on the jellyfish protein as a 'calcium reporter.' In other words, add aequorin to a cell preparation in a laboratory, the aequorin hooks up with the calcium, and bingo! that which is calcium-laden within the cell lights up like a jellyfish.

Mark Underwood of Quincy Bioscience figured out that giving aequorin to rats through the golden months of their lives helped them hang onto the ability to perform tricks despite their advancing age. Rats normally get less tricky as they age because they lose their calcium-binding proteins, allowing free calcium to ravage their brains, which lets the tricks leak out. But rats plus jellyfish protein equals peak performance at mazes and bells throughout the lifespan.

Think about what we could accomplish with a little bread and jellyfish!

Hypocretin

This sounds like the ultimate insult, labeling someone a cretin but not even a very good example of one. Not an epithet at all, this one, but rather a little protein that explains in part why some of us pop out of bed even before the alarm goes off while others snooze on. Persons with narcolepsy are short on hypocretin secreting neurons (a condition that could be called hypohypocretinism).

California neuroscientists* twiddled around with these hypocretinergic neurons in a group of volunteered mice. Dialing up the hypocretin meant the mice rose before the lab alarm clock sounded, knocking it out left those lazy mice abed through breakfast.

Neuroscientists enthused that this research may have a future impact on the life of insomniacs. Those night owls who have hyperhypocretinism may someday take a medication that can tone down their jazzed up hypocretinergic neurons, allowing them to get to sleep at a reasonable hour.
_____
*Adamantidis, A et al. Nature. 2007 Oct 17; [Epub ahead of print]

Call me a sap or a loser, but this one actually brought tears to my eyes:

The Inner Life of the Cell.

Cold and dry. That's Denver in winter as opposed to the summer when it is hot and dry. Now New York virologists have an explanation as to why influenza virus plagues us here--and throughout the US--in the winter and not in the summer.

No new news that flu flogs us in winter. Epidemiologists have theorized that this may be due to crowding indoors, decreased human host immunity, or environmental factors during the colder months. Drs. Peter Palese et al* used guinea pigs to prove that prevailing temperature and relative humidity are critical to the flu's successful spread.

They found that infected guinea pigs most easily shared influenza with their colleagues when housed in cooler labs (41 degrees F) at the relatively low humidity of 25-30%. The sickened pigs shed the virus for 40 hours longer at this level than when the lab temperature was raised to 68 degrees, and no well pigs sickened when the thermostat was set at 86 degrees. The investigators found no difference in the animals' immune response at the varying temperatures suggesting that the virus itself had better survival and transmissibility under cold and dry conditions.

So do we lower indoor temperatures and jack up the humidity to stay well through winter? Cooler temperatures may be healthier, but microbiologist Dr. Raymond Tellier worries that raising humidity may raise crops of other bad actors for human health, noting: "You don't want to reduce one infectious disease only to increase another."

_____
*Lowen AC, Mubareka S, Steel J, Palese P (2007) Influenza Virus Transmission Is Dependent on Relative Humidity and Temperature. PLoS Pathog 3(10): e151 doi:10.1371/journal.ppat.0030151

Tune in, turn on...and I forget the rest

Sure, we're getting older, and the occasional fumble-mouthed moment in search of the right word is to be expected. Some overindulgent baby boomers, however, may find that their short-term memory is slipping away much faster than it should. If you picked up the marijuana habit in your youth--and never put it down--you'd better read on before your mind drops out.

Researchers studied brain function, specifically the ability to learn, retain, and retrieve new information, in nearly 150 adults. Over 100 of these subjects regularly inhaled, and we're not talking tobacco. The other folks smoked nothing illegal at all. Compared to the abstinent, long-term users, averaging 24 years of illicit highs, performed significantly worse on all tests. Shorter-term users, smoking 10 years or less, performed quite normally on most mental tasks. Along with the long-term users, however, they displayed a distorted sense of time passing as they puzzled over a problem.

If you want to remember your engagements, and arrive there on time, best stub out the joints.

Me: Do you exercise?

Pt: I almost started to do that several times.

A little extra time, a lot of important information

I find it harder and harder to stay on schedule these days as I look beyond the 'chief complaint' to see what's really going on in my patients' lives.

Yesterday, a 38 year old woman finally came in for a blood pressure check. We'd been nagging her for months to come in for follow-up (she'd request med refills; we'd okay the refill but sent increasingly strong messages through the pharmacist that this was last, last last, or last last last refill without her personal appearance at office.

She showed up one week out of her meds, BP crazy high. I discovered that she'd been unemployed, out of insurance, and she is the sole caretaker for her fifty-something year old mother disabled from a stroke. A fate that my patient is heading straight for with her uncontrolled blood pressure. I hope her graveyard shift cleaning at the airport will provide income and insurance to ease her life, but oy those hours and that fast food at midnight, what's that going to do for the blood pressure?

My Aunt Charlotte used to ask me at every family gathering "So Judy, ven (this said in Hungarian accent) are you going to start vearing lipstick?" Good thing that I was a hippie back then who never really figured out how to talk and wear lipstick at the same time given the latest scoop on lip paint.

The Campaign for Safe Cosmetics found that the majority of brand-name red lipsticks tested had detectable amounts of lead. If you chew off your lipstick--and how else does it disappear and require re-application throughout the day?--think of all that lead consumed over a lipsticked lifetime? Maybe that's why Aunt Charlotte, while staying tall and strong well into her 80s, completely lost her marbles by the end of the line.

Speaking of lead and the life you lead, I noticed in this morning's paper that thrift stores have seen a huge jump in toy donations of the banished variety. If you can't let your kid keep it, at least you can take it as a tax deduction.

Our best shot

Flu vaccination season is here. Some people queue up without a prompt, others decline the offer, citing "I never get the flu," or "The flu shot always makes me sick." To the former I'd say "Well don't push your luck," and to the latter "It's an inactivated vaccine, it can't possibly give you the flu."

Influenza viruses are rarely virulent enough to kill a healthy patient. The only patient of mine who ever died primarily of flu was a thirty-something year old severe anorectic who barely had the strength to walk across the room much less battle her final viral load. Indeed, most flu deaths occur in such compromised hosts, or as a result of a secondary bacterial invasion of flu-weakened airways.

A notable exception was the dreadful flu of 1918 that killed tens of millions of people around the world, many of them in the prime of life. Investigators know that not only did this strain of flu cause a fatal primary pneumonia all on its own, it also opened the door for easy bacterial access to the lungs and fatal secondary pneumonia.

Tennessee researchers discovered a deadly viral protein--PB1-F2--that causes such a dreadful inflammatory mess in the lungs of mice that 100% of infected animals either die of primary viral pneumonia or secondary bacterial infections. They induced an otherwise ordinary variety of flu to express this protein, engineered to be identical to the nasty molecule the 1918 strain produced.

Virologist Dr. Jonathan McCullers concluded: "This is one of the big reasons 1918 was so bad, because PB1-F2 allowed bacteria to cause more problems due to lung inflammation and damage." Scientists can use this information to spot super-flus before they spot us.

Why yoga makes me nervous

I find that a challenging yoga class brings a little thrill of fear to me which is not necessarily a pleasant sensation. Before you think me a total loser, check out this new study whose fancy brain-imaging techniques may explain the connection.

Researchers at the University of Manchester used PET scan imaging to see what parts of the brain lit up when people ached in their arthritic old knees. This technique involves injecting a person with a tagged sugar molecule called F-fluorodeoxyglucose or FDG. FDG is concentrated in neurons as they suck up sugar while at work reacting to the task at hand.

Neurobiologists already know which brain pathways activate when volunteers are pinched or kicked or however it is that researchers induce experimental pain. This same 'pain matrix' is also activated by arthritic pain. These UK scientists were surprised, however, to find that pain from degenerative joints "was associated with increased activity in the cingulate cortex, the thalamus, and the amygdala. These areas are involved in the processing of fear, emotions, and in aversive conditioning."

So if yoga induces pain in degenerating knee joints--and despite all those gentle adjustments from the instructor, I find it often does--aging yoginis might feel fear.

New statin news

I find patients are reluctant to begin statins because they fear these drugs (Lipitor, Zocor, pravastatin and others) will harm their livers. In fact, statins have a strong safety record with respect to liver problems.

Two new reports suggest some interesting non-cardiovascular benefits associated with statin use. German researchers(1) compared a group of colorectal cancer (CRC) patients to a cancer-free group with respect to their use of low-dose aspirin, statins, or both. Regular use of low-dose aspirin reduced risk of CRC by 23% whereas statin use diminished risk by 35%. Use of both therapeutic strategies, as would be commonly seen in patients at high risk for cardiac disease, dropped cancer risk 37%, and use for more than 5 years of the double treatment plunged risk by 62%.

Both smokers and ex-smokers also benefited from statin use with respect to progression of cigarette-related lung disease. Old Oklahoma vets demonstrated a slower decline in lung function and fewer urgent visits for respiratory issues if on statins. The study authors(2) speculated that the anti-inflammatory effects of statins were responsible for the favorable effects on lung function.
_____
(1)Int J Cancer 2007;121:1325-1330.
(2) Chest Published online October 1, 2007.

The pit and the parabens

I just glanced at the ingredients on my deodorant's label, and it reads like the contents of a well-stocked biochemistry lab. Can this arsenal of armpit aromatizers contribute to breast cancer risk or is this just another urban myth? In case you need one more thing to worry about, read on for the evidence linking deodorant use to breast cancer.

Scientists from the UK noted that the majority of breast cancers are found in the upper, outer quadrant of the breast, nearest the armpit. They wondered if underarm hygiene habits, particularly the application of deodorant, contributed to this skewed tumor distribution. On sorting through 20 breast tumor samples, they found high concentrations of para-hydroxybenzoic acids (parabens) in 18 of the cancers.

Parabens are used as preservatives in cosmetics. Unfortunately, they are xeno-estrogens, meaning that they are molecules whose structure is similar enough to estrogen that they can occupy the estrogen receptor sites on cells. Korean scientists added butyl-parabens to mutant yeast cells (that had somehow been induced to express human estrogen receptors) and found that the parabens not only bound to the receptors, but also exhibited an additive estrogenic effect when administered along with estradiol. The yeast approved of their supple cell membranes and decreased hot flashes, but the investigators were concerned about the implications for human exposure to parabens.

Male rats, however, were not amused when their testosterone levels fell after they were exposed to parabens at levels equivalent to the "upper-limit acceptable daily intake of parabens in the European Community and Japan." Cultured breast cancer cells positive for estrogen-receptors increased their growth rate under the influence of parabens. But a population-based study in Seattle that randomly dialed for deodorant habits amongst breast cancer survivors and cancer-free controls found no association between armpit applications and breast tumors.

Molecular biologist Philippa Darbre was so appalled by her research results that she quit using cosmetic products some years ago. As I review the chemical stew in my Tom's of Maine deodorant, I can rejoice because it's parabens free. Likewise, the yummy-smelling stuff from Avalon Organics. Crocky or no, there's no reason to bother the breasts with the likes of parabens.

This is not cool. The bird flu virus (H5N1) strains in Africa and Europe are demonstrating a mutation that make them more infectious to humans.

Birds are literally hot; their body temperature is 106 degrees compared with our normal 98.6. Our airways are cooler still at an average of 91.4. This new flu change allows the little buggers to live well in cooler climes...such as our upper airways.

While the current influenza vaccine, of course, does not protect against bird flu, the fewer opportunities that H5N1 has to mix its genetic material with usual flu thriving in ordinary people, the better. Do consider getting a flu shot this year and every year.

Panic attacks: False biological alarms

Panic, which is the most dramatic form of acute anxiety, is the cry for life.
---Eric Griez, University of Maastricht, the Netherlands

If you've never had one, you cannot imagine how compelling and physical they are. The feeling is not a 'Hoo-boy am I anxious' one, but rather a 'Dear heaven I am not getting enough oxygen and I may pass out or die' sort of experience. Until I experienced one myself, I put some patients with panic attacks through pulmonary, cardiac, or GI work-ups. Now I often spot them coming based on their chief complaints of 'trouble breathing' as listed on my daily schedule.

I was instantly drawn, then, to an article in an October issue of PLoS One* regarding altered sensitivity to carbon dioxide as the basis of panic attacks. Scientists previously noted that individuals prone to panic have panic-attackish sorts of episodes if exposed to inhaled gases heavy on the carbon dioxide. The panic response to rising levels of carbon dioxide makes evolutionary sense, but an overactive, internal suffocation monitor can lead to unwarranted alarm.

Dr. Griez et al invited 64 panic-free volunteers down to the lab to suck a little air with varying concentrations of carbon dioxide. As carbon dioxide content rose, so did the volunteers' feelings of fear, depersonalization, and a loss of sense of reality. The authors are hopeful that this laboratory model of induced panic attacks may lead to better opportunities to study drug therapy for patients with panic disorder as well as for chronic pulmonary patients dealing with behavorial panic resulting from their high body levels of CO2.

My situational panic disorder developed after I was in a car accident. Although I was not injured, in the moments before the impact my best guess assessment was that I would die. I subsequently became scarcely able to breathe while driving and assumed (what internist wouldn't?) that I had a mid-chest tumor pressing on my trachea. Once I identified my difficulties as panic, the road back to carefree driving was a long strange trip through various medications and behavioral therapy.

If you suffer from panic attacks after in intense experience such as mine where you perceive your life is in danger, check out Crash Course. Dr. Heller's techniques were the most helpful to me in my recovery.
_____
*Griez EJ, Colasanti A, van Diest R, Salamon E, Schruers K (2007) Carbon Dioxide Inhalation Induces Dose-Dependent and Age-Related Negative Affectivity. PLoS ONE 2(10): e987.

Oh dear, do those of you who 'fessed up as fans of For Better or Worse, and Funky Winkerbean feel a little drained this a.m.? What a way to start the day: tragicomics!

Exercise that is good for the heart is not detrimental to the knee joint.
---Flavia M. Cicuttini, PhD and colleagues*

Well that's good news. I was just debating tonight whether to take my right knee to step aerobics tomorrow or not. One deep knee bend over the sprinkler system three weeks ago left me with screaming pain from the lateral meniscus. It's much better now--who knows why--and I wondered if it was sheer folly to step out to a little music much needed by me for the heart and the soul.

Dr. Cicuttini et al studied nearly 300 adults over 10+ years. At study's end, their knees were, on average, 58 years old. The investigators correlated their activity logs with the amount of cartilage still clinging to the top of their tibiae on the bottom of their knee joints. Those who particpated in more frequent vigorous exercise in the years prior to the study had a significantly larger chunk of residual cartilage compared with those who sat out the decade on the couch. And the best predictor of defect-free cartilage was each individual's current participation in vigorous exercise.
_____
*Racunica TL, et al "Effect of Physical Activity on Articular Knee Joint Structures in Community-Based Adults" Arthritis Rheum 2007; 57: 1261-1268.