NEW MELANOMA DRUG IS PROMISING

Yervoy, a new medication approved for advanced stages of melanoma, is being released by Bristol-Myer-Squibb.
It has a very dramatic effect on patients with advanced disease, nearly doubling their survival time, with some patients achieving remarkable results.
The medication is just approved, but will be available very soon.
It works by boosting the body’s immune system and helping it fight the cancer more actively.
Under research for many years, it is finally gained clinical approval.

SHINGLES VACCINE AGE LOWERED TO 50

Recent recommendations about the safety and effectiveness of the shingles vaccine (Zostavax) www.Zostavax.com show benefits and cost effectiveness

Now, in addition to that safety information, the age recommendation for Zostavax has been lowered to 50 years old.
Although Shingles tends to be more severe the older a person is when they contract it, it still is worthwhile considering the vaccination at age 50.
Please contact our office if you are interested in getting your vaccine.

SURGEONS-IN-TRAINING CAN SAFELY ASSIST IN YOUR CARE

A large study published out of UCLA Medical School looked at outcomes in more than 500,000 surgeries. The study was designed to see if surgeons-in-training assisting at surgery resulted in a worse surgical outcome and danger to the patients.
The study showed that although the patients who had surgery in training hospitals had a minimal increase in surgical complications, they had a lower risk of dying from their surgeries. Slightly more minor complications, slightly less major complications.
This is data that has been much-needed. The general impression that surgeons-in-training would lead to inferior results is an obvious belief and strongly held by patients. Even surgeons themselves were uncertain if this led to increased issues, but still they recommended patient participation as this is the only way to develop adequately trained surgeons.
This data reassures patients, surgeons, and their trainees: the system works, patients get good care, and patient results are virtually equivalent at such hospitals when surgeons-in-training are involved.

RADIATION FROM JAPAN:POTASSUIM IODIDE NOT NECESSARY IN AZ

With the events unfolding in Japan there is understandable concern about exposure to radioactive material.

As a result, I decided to search the internet for valid information only to find out that there is very little to be had. Thus, I requested information from a patient of mine who has a great deal of insight into the nuclear dilemma facing the Japanese. In summarizing his comments he included important information on the use of Potassium Iodide.

So…to help you understand the health issues involved for us in Arizona, I am copying his e-mail to me. Needless to say, I will leave this person’s identity unstated, but do know that this is a person with my absolute confidence in his insights and knowledge. His commentary is straightforward and useful. Please read:

Doug;

Yes, it is a very serious event. Very difficult to assess exactly what’s happening because there’s little credible information coming out of Japan and even some of that is contradictory.

The press is making a mess out of it. Don’t be overly alarmed because of things that you read or hear.
There are several disciplines involved in the recovery effort and experts in one area don’t necessarily know
other areas well. I’ve heard some “experts” say very inaccurate things. Also, just because someone holds a
high government position doesn’t mean that they know what they are talking about.

Before you get concerned about radiation effects in the US, remember that there have been quite a few nuclear
detonations around the world through the last 70 years or so (Chernobyl, nuclear devices in Nevada, Japan, India,
Pakistan, China, the Pacific islands).* Yes, radiation levels were observed to
rise all over the globe as a result but they have been insignificant compared to the background radiation that we are
all exposed to day in and day out.
Irradiation levels from those were comparable to or less than you may get from a transatlantic flight or from solar
flares. *Note: Not Three Mile Island. Whatever else you may have read or heard, releases from the TMI accident
were very small and most definitely not health significant.

Next, potassium iodide. Iodide tablets are given to those who may be in a position to inhale significant amounts
of Iodine 131 release from a nuclear accident. In other words, those in the immediate vicinity of the accident.
Nobody else should be taking it. It can have very serious side effects, particularly in minors. Don’t do it.

It is likely that two of the reactors are close to full meltdown. The spent fuel pool is about the size of an Olympic
swimming pool, only 40 feet deep. The pool in question for Unit 4 would likely have about 2000 fuel assemblies
(each assembly is 12 feet tall and 1 foot square). The pool has been out of water for hours and hours. There
would be substantial melting, and open to the outside. Putting water on it by helicopter was a total waste. At
some point they need to dump thousands of tons of sand on the Unit 4 spent fuel
pool, by air.

PSA….CONTROVERSIAL, BUT STILL WORTHWHILE WHEN USED WITH PERSPECTIVE

In the past, the total PSA value over 4.0 was considered suggestive of prostate cancer. Subsequent experience has shown this to be inadequate as an absolute cut-off.

Among the ways we have changed our analysis of the PSA is looking at PSA velocity (change of PSA over time) with a rise in PSA over 0.5 per year as suggestive of cancer.

In this recent paper in the Journal of the National Cancer Institute the usefulness of the PSA velocity has been called into question. The PSA velocity, is itself inadequate and can be misleading.

With this information it is difficult to know the exact usefulness of this test, but still I think it is reasonable to use this test on interval basis (typically at a yearly physical), and then to put this number into perspective, with retesting, comparison with prostate exam, and cautious observation.

PSA’s are imperfect, but used as a general guide, and not an absolute arbiter, I will continue to use this test, as it has proven useful in too many instances in patients that I’ve cared for.

PLAVIX FOUND SAFE WITH PRILOSEC AND SIMILAR MEDICATIONS

A new large prospective study has cleared the use of Plavix & PPI medications (Prilosec, Protonix, Aciphex, Nexium, Dexilent). This is a reassuring finding and means that there is no need to worry or adjust medication for patients with stents who also require treatment for GERD.

This issue has been a hot topic of late and has caused much consternation among internists and cardiologists. Now, with this new study, we can feel confident in combining these medications without hesitation.

BUGGY WHIP FACTORY CLOSES

Coumadin may be a thing of the past….but not just yet.
A recent study in the New England Journal of Medicine, looked at Apixaban (a medication like Pradaxa…the new Coumadin replacement).
The new Coumadin-replacement was superior to aspirin in preventing stroke, and had a similar safety profile after 1 year of study in 5000 patients.
This medication will likely replace Coumadin as it will not require monitoring of blood levels, but the fact still remains that there is no ‘antidote’ for Pradaxa, while Coumadin has 2 antidotes (Vitamin K and plasma)
As a result, I am suggesting that patients continue to wait on the data, before switching away from Coumadin. Safety will be a major consideration, beyond convenience.
So…..don’t close the buggy whip factory just yet. Coumadin will be around for a while, but should Pradaxa prove safe (it is certainly effective)…..we’ll say good-bye to Coumadin and all that money that goes to University of Wisconsin (WARFARIN….Wisconsin Alumni Research Foundation)

DIZZINESS …..BOTHERSOME BUT NOT DANGEROUS

Dizziness is commonplace and when persistently bothersome or severe, leads patients to see the doctor or go to the emergency room.
I see approximately 2-3 people each week of the year with this complaint and fortunately it is rarely a sign of something serious.
A recent study of 30,000 patients with this symptom, who presented to the Emergency Room, found that very few people had anything serious wrong or developed serious issues over the ensuring several months.
This is consistent with my experience here in the office. Although vexing, dizziness rarely is a sign of something serious and treatment is generally supportive, with symptoms resolving spontaneously.
Treatment consists of Meclizine (medication for symptom relief) that can be obtained as a prescription or over-the-counter (Bonine is the product name.)
Beyond this, using head turning exercises can often be helpful.
For more information on this topic, you can read my write up in the PATIENT RESOURCES SECTION, in the Medical Library section under VERTIGO.

NEW TREATMENT FOR LICE…BETTER AND SAFE

Natroba Topical Suspension (spinosad 0.9%) has just been approved for treating lice. It’s easy to apply and does not require combing. In addition, it works better than Permethrin (the topical treatment we generally use.)
You may not realize this, but lice is very common nowadays and is rampant in the Scottsdale School District and in private schools as well. It’s nice to have a more effective, safe, and easy to apply treatment.
If you want to see a ‘nit picker’ in action, Mike Rowe of Dirty Jobs fame did a great piece on the topic….enjoy.
http://dsc.discovery.com/videos/dirty-jobs-thats-lice.html

FOSAMAX PREVENTS COLON CANCER

A recent study suggests that fosamax and other bone building medications (called bisphosphonates) have the ability to prevent colon cancer.
A 50% reduction was seen in patients on medication vs. those not taking these medications. The connection is unclear and there will be further study, but for now, it is encouraging to see some positive news about this group of medications.
Recently concerns have been raised about the long-term safety and benefits from the medications. Concerns have included problems with the esophagus (and esophageal cancer), reduced bone strength after many years or treatment, and issues with dental health (osteonecrosis of the jaw).
None of the issues are ‘deal-breakers’ as regards taking the medication, but it does indicate the need to be selective as to who is taking them. The benefits must be there. You need to know that your bones really do require some help with medication.
So….for now, there is some encouraging news about Fosamax and we will continue to monitor for more news (good and bad)