Here are the signs of peripheral arterial disease, and how to reduce your risk

Many of the estimated 12 million Americans who have peripheral arterial disease don’t realize they have the condition, says Dr. Jihad Mustapha, an endovascular interventionist at Metro Health.

Knowing the signs of PAD and getting screening can lead to early detection and treatment. As the condition progresses, it can lead to severe pain and immobility.

Here are facts about PAD, according to the American Heart Association:

Risk factors

• A person’s risk for PAD increases with age and is affected by family history. But the risk for PAD can be lowered by taking the following steps:

• Don’t smoke

• Lose weight if you are obese

• Keep moving – Exercise programs are one of the treatments for PAD

• Manage cholesterol levels

• Manage blood pressure

Symptoms of PAD

Painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising is the most common sign of PAD. Many people have no symptoms or mistake the symptoms for arthritis, sciatica or stiffness from getting older.

Signs of severe PAD include –

• Leg pain that does not go away when you stop exercising

• Foot or toe wounds that won’t heal or heal very slowly

• Gangrene

• A marked decrease in temperature in the lower leg or foot, particularly compared to the other leg or rest of the body

Diagnosis

• A physical exam for PAD includes checking for a weak pulse in the legs.

• Ankle-brachial index – blood pressure readings are taken in the ankles and compared to the blood pressure measured in the arms

More information

To learn more about the risks, symptoms and treatments for peripheral arterial disease, go to the American Heart Association.

Younger men with goiter at higher risk for thyroid cancers

More than one-fourth of men under age 50 undergoing surgery for benign goiter were found to have thyroid cancers, based on a chart review performed at the University of Pennsylvania.

The overall incidence of thyroid cancers in the patient series was 12%. Among men under age 45, the rate was "surprisingly" 28%, said Douglas R. Farquhar, a medical student at the University of Pennsylvania School of Medicine in Philadelphia.

Although thyroid goiters have traditionally been thought to be associated with a low risk for malignancy, recent studies have suggested otherwise. "In the literature we have seen published rates of up to 35%, which is much higher than we all had anticipated," Mr. Farquhar said at the annual Society of Surgical Oncology Cancer Symposium.

To get a better handle on the preoperative and patient characteristics associated with incident thyroid cancer and characterize the types of thyroid cancer discovered incidentally, Mr. Farquhar and his colleagues reviewed charts on all patients who underwent either total thyroidectomy or thyroid lobectomy for goiter at the center from 2004 through 2012.

Many cases of goiter can be medically managed, but surgery may be indicated in cases of pressure symptoms, cosmesis, or suspicion of malignancy, the investigators noted.

They excluded from their study patients with preoperative fine-needle aspiration pathology findings of Bethesda level III-VI (follicular lesion of undetermined significance, follicular neoplasm, suspicious or positive for malignancy).

Among 418 patients undergoing goiter surgery, 367 had goiter only, and 51 (12%) had an incident thyroid cancer. In all, 38 (75%) had papillary carcinomas, 10 (20%) had follicular carcinomas, 3 (6%) had Hürthle cell carcinomas, and 2 (4%) had thyroid lymphomas (two patients had multiple thyroid cancers, explaining the percentage greater than 100). An additional 67 patients (16%) were found to have micropapillary lesions.

Looking at the population as a whole, the investigators found that patients with thyroid cancer tended to be younger, with a mean age of 49.5 vs. 54.6 years (P = .012). There was a trend toward more cancers among men than women, but it was not significant.

Vitals

Key clinical point: Men under age 50 undergoing surgery for benign goiter are at elevated risk for thyroid cancer.

Major finding: Among men under 45 undergoing goiter surgery, the rate of incidentally discovered thyroid cancers was 28%.

Data source: A case series of 418 consecutive patients undergoing surgery for goiter.

Disclosures: The study was internally funded. Mr. Farquhar and his coauthors reported having no relevant financial disclosures.

There were no significant differences in any preoperative factors between patients with cancers and those with goiter only, including number of nodules, site of dominant nodule (right, left, or isthmus), thyroid function, thyroid weight, or fine-needle aspiration results (percentage deemed benign or nondiagnostic).

In a multivariate analysis, male sex was associated with a more than twofold risk for thyroid cancer (odds ratio, 2.39; 95% confidence interval, 1.152-4.978). There were also trends toward a lower risk of cancer with each additional decade of life, and a higher risk among patients who had undergone thyroid lobectomy, but these were nonsignificant associations.

"Knowledge of these associations may prove to be useful for both patient counseling and surgical decision making," Mr. Farquhar said.

The study was internally funded. The senior author was Dr. Douglas L. Fraker, chief of the division of endocrine and oncologic surgery at the University of Pennsylvania.

Mr. Farquhar and his coauthors reported having no relevant financial disclosures.

Thyroid cancer survivor sees education as key

Doug Bentz prefers to tackle each situation head on, one at a time. But in 2011, he had something come up that would test that method many times over.

On the day of the annual Wrightsville Beach holiday flotilla, he was shaving and felt something like a swollen gland in his neck. After a series of scans and biopsies, Bentz, at 42, was diagnosed with Stage 4 papillary thyroid cancer.

He had the battle of his life ahead of him.

“So many thoughts rush to you when they confirm that you have cancer, your mind almost goes nuts.” he said.

His first thought was that his father, Bob Bentz had died of thyroid cancer a decade before. For the Bentz family, that was alarming.

His younger brother, Chris, soon had his thyroid checked, and doctors found nodules that would likely have turned cancerous. He underwent surgery he hopes will prevent cancer in the future.

Doug Bentz’s case, like his father’s, was unusual and rare. After much research into thyroid cancer, he and his partner, Ted, traveled to the Georgia Health Sciences University in Augusta (now the Georgia Regents University), where they met with

Dr. David Terris, a specialist in thyroid related cases.

“By January of 2012, the cancer was in the lymph nodes, so I had to have a thyroidectomy and what is called a radical neck dissection,” Bentz said.

The basis of the surgery is to remove everything that is cancerous. Next would be a process of denying the thyroid cancer cells iodine.

Then after several weeks of no iodine, Bentz would take a radioactive iodine pill to see if any hidden cancer cells would “come out of hiding.”

Becoming radioactive was not fun.

“I was under quarantine for five days,” he recalled. “Everything including my clothes, pillows, books I was reading all had to be thrown away afterwards.”

Although his cancer counts went down, the cancer had not gone away completely. He would face more surgeries in 2012 to remove 38 more lymph nodes.

This time, Bentz was fighting as hard as he could against the cancer, and winning. He soon entered remission.

For Bentz’s mother, Carolyn, the reality was beyond frightening. She had already watched her husband fight and lose the battle. Watching her son go through it was heartbreaking.

“It was everything we had been through already but there is nothing worse than the thought of losing your children,” she said.

She says there is nothing to do but go with it and take each day as it comes, and she believes that a positive attitude in the fight is key.

Bentz believes now, if the information available today had been available 20 years ago, his father would still be alive.

He received news on Father’s Day that he was officially cancer-free and now only returns every six months for a checkup.

Bentz said the website thyca.org, operated by the Thyroid Cancer Survivors’ Association, helped educate him about living with thyroid cancer through the testimonials of others battling it.

Bentz feels that as a survivor, it’s his duty to educate others about it now.

“I don’t want my life to be defined by cancer,” he said. “But right now, out there in Wilmington, there is someone who might have it. And if I can help educate through my battle, they too, may become a survivor.”

Certain Thyroid-Related Diseases May Vary by Race

Race appears to be a factor in determining a person's risk of developing autoimmune thyroid conditions such as Graves' disease or Hashimoto's thyroiditis, a new study says.

African Americans and Asians are much more likely to develop Graves' disease than whites are, according to the study published in the April 16 issue of the Journal of the American Medical Association.

On the other hand, whites have an increased risk of Hashimoto's thyroiditis when compared to other ethnic groups, the researchers found.

The findings are based on analysis of medical records from all United States active duty military personnel aged 20 to 54 from 1997 through 2011.

"These stark race differences in the incidence of autoimmune thyroid disease raise the important question of why?" said lead author Donald McLeod, an endocrinologist and researcher at the QIMR Berghofer Medical Research Institute in Queensland, Australia. "If we can work this out, we may unlock the mechanisms of autoimmune thyroid disease, and potentially yield insights into other autoimmune disorders."

The thyroid gland plays a crucial role in regulating the body's metabolism, influencing how quickly a person burns calories, how fast their heart beats, and how alert they feel.

Graves' disease occurs when the immune system begins producing an antibody that tricks the thyroid into producing too much hormone. It's the most common cause of hyperthyroidism, and affects about one in every 200 people, according to the U.S. National Institutes of Health (NIH).

Hashimoto's thyroiditis happens when the immune system attacks the thyroid gland itself, causing hormone production to fall and causing hypothyroidism. Hashimoto's affects as many as 5 percent of adults, according to the NIH.

Both conditions are chronic illnesses but can be treated with medication. Left untreated, people with Graves'-related hyperthyroidism can become nervous or irritable and suffer hand tremors, a rapid and irregular heartbeat, and weight loss. Hypothyroidism caused by Hashimoto's has almost the opposite effect on the body, causing people to experience fatigue, difficulty concentrating, a slowed heart rate and mild weight gain.

The analysis found that, compared to whites, black women are about twice as likely and black men are about two and a half times more likely to have Graves' disease.

Asian/Pacific Islander women had a 78 percent increased risk of Graves' disease compared to whites, while Asian/Pacific Islander men had a more than threefold increased risk, the study noted.

But the risk of Hashimoto's in both blacks and Asian/Pacific Islanders was much lower than the risk among whites, ranging from 67 percent to 78 percent less, the findings showed.

"The findings are striking, that there are so many more African Americans and Asian individuals who are coded as having Graves'," said Dr. James Hennessey, director of clinical endocrinology at Beth Israel Deaconess Medical Center in Boston. He was not involved with the new research.

Study author McLeod demurred when asked about how a person's race could influence their thyroid function.

"Our current study can't answer whether racial differences in autoimmune thyroid disease incidence are due to genetics, environmental exposures or a combination of both," McLeod said. "Further work needs to be performed to find the underlying mechanisms of thyroid autoimmunity."

In the paper, the researchers rule out one potential environmental influence -- smoking.

Smoking is associated with an increased risk for Graves' and a decreased risk for Hashimoto's. But whites have the highest smoking rates in the U.S. military, which runs counter to their increased risk for Hashimoto's and lower risk for Graves', the study authors added.

Hennessey of Beth Israel said he suspects that genetics are a likely culprit.

"Both of these conditions are autoimmune conditions that are known to be influenced by genetic factors, and those genetic factors may be clustered more in people depending on their race," Hennessey said.

Continue reading below...

The results of the study mirror other reports that have found elevated levels of thyroid-stimulating hormone in whites, Hennessey said. This hormone is produced by the pituitary gland and prompts the thyroid to release its own hormones into the blood.

"It sort of explains some findings we already had known, that thyroid function tests are different depending on race," he said.

However, Hennessey noted one problem with the study that may have caused researchers to undercount cases of thyroid disease.

The researchers relied on medical coding to identify cases of either Graves' disease or Hashimoto's thyroiditis. However, they did not include cases more generally coded as hyperthyroidism or hypothyroidism, and there's a chance the doctor who made the diagnosis overlooked Graves' or Hashimoto's as the underlying cause, he said.

Thyroid Symptoms in Women are Hard to Catch, But They Sure Messed Up My Life

I distinctly remember my worst day with thyroiditis. I kept praying over and over, please don't let me pass out, please don't let me pass out as I walked through the corridor to the train that would take me to my job in New York. My brother had been kind enough to drop me off at the train station, and during our drive north on the New Jersey Turnpike, I kept sinking lower and lower in the passenger seat, unable to muster enough energy to hold myself up properly.

As I walked to work, I didn't think I'd make it across the two avenues to my job.

Later, it reminded me of a scene in the Catcher in the Rye:

Every time I came to the end of a block and stepped off the goddam curb, I had this feeling that I'd never get to the other side of the street. I thought I'd just go down, down, down, and nobody'd ever see me again. Boy, did it scare me. You can't imagine...Then it would start all over again as soon as I got to the next corner. But I kept going and all. I was sort of afraid to stop, I think -- I don't remember, to tell you the truth.

Another day, I woke up, got dressed, blow-dried my hair and promptly fell back into bed out of pure exhaustion. My mom discovered me a little while later and asked, "Adrienne, what is wrong with you?" urging me to go to work since I'd taken so many sick days already. I simply responded, "I don't know."

It all started in November 2012, when I developed a cold that I thought was a response to being without heat for a few days in the aftermath of Hurricane Sandy. Even though I was on antibiotics, I never got better. I complained to my general doctor, a gastroenterologist, an allergist and an ENT that I felt extremely tired all the time, that I frequently experienced chills, that I wasn't able to focus and that I couldn't seem to get rid of the mucus in my throat. I was constantly shaky and weak.

I was prescribed three rounds of antibiotics, which wreaked havoc on my digestive system. I felt constantly nauseous and started regurgitating food after eating breakfast. Worst of all, I lost about 10 pounds, plummeting my already small self to a mere 95 pounds.

I cried to everyone -- my parents, my doctors, my best friend -- because I was so scared and simply didn't have a clue what was wrong with me.

After extensively conducting my own research (which will make anyone become a hypochondriac, believe me), I became convinced that I had a thyroid issue. I literally had to beg my doctor to test my thyroid. And guess what? I was right. In March, my blood test results showed that my TSH hormone levels were nearly negligible.

I was never put on synthetic thyroid medicine, because by the time I found a good endocrinologist (they are in high demand, since they treat diabetes patients, too), my TSH levels had returned back to normal, according to my blood tests.

My doctor explained to me that I had experienced thyroiditis, or swelling of the thyroid. Since the butterfly-shaped thyroid gland regulates metabolism, my body basically couldn't perform anything but basic functions. He told me that my case affects about four of his patients per year.

Upon receiving the diagnosis, I felt angry, relieved and nervous at the same time. I'd suffered through months upon months of uncertainty and extreme discomfort, racked up some hefty medical bills, missed out on fun times with friends and family and gotten laid off from my job (even though they told me it was due to budget cuts).

After my appointment, I simply broke down and cried alone in my car. But they were happy tears: At last, I was finally getting some answers. Finally, someone believed me.

My symptoms more closely aligned with hyperthyroidism, which causes weight loss, rapid heartbeat, weakness, anxiety and trouble sleeping. Because there's such a wide range of problems, thyroid conditions are tricky to diagnose.

About 20 million Americans have some sort of thyroid condition, but women are five to eight times more likely to develop thyroid disease, according to the Cleveland Clinic. Other estimates put those numbers at 30 million diagnosed -- along with 15 million undiagnosed cases. Women are 10 times more likely to have thyroid problems.

So, why are women such easy targets? Doctors haven't quite solved that puzzle yet. They pinpoint a variety of reasons, such as genetics, autoimmune attacks, stress, nutrition and, of course, hormones -- especially when we get pregnant. Women with a baby on board already have naturally higher thyroid levels and a slightly enlarged thyroid, so it's even more difficult to diagnose additional problems.

Back in 2011, Women's Health published an article about thyroidism, noting that many young women were running to their doctors just to be checked, even if they showed no persistent symptoms.

"The problem with routine screening is that a lot of women may be borderline hypothyroid, and though they have no symptoms, their doctors put them on unnecessary medicine that could eventually result in hyperthyroidism," says endocrinologist Jeffrey R. Garber, M.D., a professor at Harvard Medical School. The article also noted that thyroid cancer cases were rising sharply, and that 75 percent of those cases were in women.

"Twenty-one percent of women who undergo surgery for thyroid cancer at our center are under the age of 35," endocrine surgeon Keith Heller told the magazine.

According to a new study, doctors are now saying there's an over-diagnosis of thyroid cancer cases. Since 1975, the number of people diagnosed with thyroid cancer has tripled, though the number of people dying from the cancer has remained flat. Women are four times more likely than men to be diagnosed with thyroid cancer. The culprits? Tiny tumors less than two centimeters wide, which some experts say don't have to be removed by a costly and painful procedure. Since they are so slow-growing, some say to not act in haste, but rather to wait and monitor them.

"We're in the midst of an epidemic here, but it's largely an epidemic of our own creating," says Dr. Gilbert Welch, a professor of medicine at Dartmouth's Geisel School of Medicine.

As for me, I can honestly say that I'm a completely a different person now than I was before my thyroid got all out of whack. Even though I got another job -- one that I actually liked -- I would experience bouts of dizziness, exhaustion and an inability to concentrate that lasted for nearly an entire year.

Because my thyroid problems were compounded by stomach and digestion issues, I still have to stay away from acid-inducing foods and alcohol (basically, all the most delicious things in the world). I still suffer from anxiety that sometimes hinders my everyday life, which I never really experienced prior to thyroiditis. I'm trying to rebuild my confidence, but it hasn't been easy. I've regained all my weight and then some, which I'm quite proud of. I'm doing the best I can.

But even now, whenever I get the least bit dizzy or fuzzy-headed, I'm immediately rocketed back to the mindset of the person I was, the one who struggled to walk through Newark Penn Station on a cold day. But as Holden Caulfield said, I kept going and all.

Images: Flickr/allnightavenue, giphy, Tumblr

Vitamin D can treat and prevent breast cancer

A recent study conducted by Dr. Cedric F. Garland, a professor in the University of California, San Diego, School of Medicine’s Department of Family and Preventive Medicine recently reported that those suffering from breast cancer have an increased rate of survival if there are high levels of vitamin D present in the blood.

“We were interested in doing this study, said Garland, because we and others have shown that vitamin D deficiency is associated with a high risk of developing breast cancer.”

Garland said the findings will radically alter the future of breast cancer care, and it will soon become routine to give every woman with breast cancer vitamin D3 in addition to standard care.

Though vitamin D is not a replacement for standard care, it can reduce mortality greatly above what is currently being achieved at present with standard care, he said.

“If women would take enough vitamin D3 we will have far less breast cancer, with dosage being the critical factor,” said Garland. “The only way to determine the optimal dosage is for the woman to have her 25-hydroxy vitamin D tested annually.”

Mint condition with herbs

Peppermint has been shown to have potent health benefits, and is particularly beneficial to those suffering from abdominal problems. Peppermint oil has been found to ease the symptoms of irritable bowel syndrome, which includes cramping, bloating, diarrhea and constipation.

Additionally, pregnant women are often advised to drink peppermint tea, which safely reduces nausea and vomiting. Studies have also shown that peppermint can be used to alleviate irritating itching caused by insect bites, poison ivy or skin conditions such as eczema.

Many other herbs have also been shown to offer health benefits. They include:

•Oregano, which contains antioxidants, which fight the aging and disease processes.

•Rosemary, which has rosmarinic acid as well as essential oils which have been shown to produce anti-allergic, anti-inflammatory, anti-fungal and antiseptic effects.

Sources: www.healthnews.com; www.nutrition-and-you.com

Blood Test Aims to Predict Breast Cancer's Return

A new blood test may one day help predict the recurrence of breast cancer and also a woman's response to breast cancer treatment, researchers report.

"We are able to do this with literally a spoonful of serum [blood]," said study co-author Saraswati Sukumar, who is co-director of the breast cancer program at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, in Baltimore.

Once a patient's blood is collected, the researchers isolate circulating tumor DNA. The genetics test then detects any of 10 breast cancer-specific genes that have undergone what experts call hypermethylation.

In the hypermethylation process, the activity of some genes that keep cancers in check is turned off, and that may signal a return of the cancer.

The new study is published April 15 in the journal Cancer Research.

The test, called the cMethDNA, is at least five years from being available on the market, Sukumar predicted.

Using this test, researchers could use the gene activity as an indication that the cancer had returned, and could also use it to see if treatments are working, Sukumar said. The blood test seems to indicate recurrences earlier than they could be found by imaging, she added.

Other blood tests are on the market with the same aim, but are considered unreliable, said Sukumar and another breast cancer expert.

Doctors typically rely on patient complaints, along with imaging studies, to determine if a cancer has returned after treatment.

The new test was given to 55 healthy women and 57 who had breast cancer that had spread.

"The test is able to detect [accurately] more than 90 percent of those who have recurrent cancer," Sukumar said. About 9 percent of cancer recurrences were misread as a negative result, she said.

Dr. Joanne Mortimer, director of women's cancer programs at the City of Hope Comprehensive Cancer Center, in Duarte, Calif., said, "There is reason to be optimistic, and to study this further."

However, Mortimer, who was not involved with the new research, said the study only included a small number of patients and more study is needed.

"This is incredibly needed," she added, as other tests on the market aren't very reliable.

According to Mortimer, the worst part of being treated for early stage breast cancer for patients is the period after treatment is over. "Then they live with this uncertainty. They may be cured, they may not. And only time will tell."

Uptick in Abdominal Aortic Aneurysms Calls for Greater Screening

Most people with Abdominal Aortic Aneurysms (AAA) are not even aware they have the condition, resulting in more than 30,000 deaths in the United States each year. This winter alone, Apostolos K. Tassiopoulos, MD, Chief of the Division of Vascular Surgery, Stony Brook University Hospital (SBUH), has seen the greatest increase of AAA cases in his entire 15 year career.

“This winter the cold weather could indirectly lay blame on this increase,” said Tassiopoulos, “Although the exact mechanism is not known, multiple studies have pointed out a spike in AAA ruptures during the winter months. And a number of possible explanations have been entertained.”

Tassiopoulos says, lower barometric pressure, smoking and increases in blood pressure are proven factors contributing to aortic aneurysm rupture. “During the winter months periods of low barometric pressure are more common and exposure to smoking is higher as time spent indoors increases. Blood pressure also increases with exposure to cold weather."

And with the cold weather came a lot of snow this winter. “With strenuous weather-related activities, such as snow removal, and the possibilities of missing scheduled medical appointments due to outdoor conditions, patients are more vulnerable to ruptures,” said Tassiopoulos.

But there is hope. Tassiopoulos points out, with better awareness and greater screening, these potentially fatal ruptures could be prevented.

An abdominal aortic aneurysm is an enlargement of a segment of the aorta, the main blood vessel that carries blood away from the heart, associated with a significant weakness of the wall in the dilated area. A normal aorta is less than 1 inch in diameter. An aneurysm can grow significantly without warning symptoms and when its size exceeds 2 inches the risk of rupture increases substantially. The larger the aneurysms the more likely it is to burst.

Rupture presents with severe pain in the abdomen or back and results in massive internal bleeding. Unless immediately treated, it can result in sudden death. Less than 20% of all patients who have a burst aneurysm will eventually survive and this is the reason these aneurysms are considered a serious health condition.

“Abdominal aortic aneurysms seldom give warning signs,” said Tassiopoulos, “Many people don’t know they have an aneurysm until it ruptures. As the population ages, the prevalence of AAAs increases and the lack of organized screening programs coupled with the low disease awareness in patients and primary care providers can result in an increase in aortic rupture emergencies.”

Although any adult can develop AAA, the risk is higher for men, adults age 60 and older, those who have a family history of AAAs, current or former smokers, and people with obesity, diabetes, heart disease, high blood pressure or high cholesterol.

“If you have any combination of these risk factors, we suggest you talk to your primary care physician, cardiologist or vascular specialist about getting screened,” said Tassiopoulos, "Screening helps diagnose an aneurysm and treat it electively to prevent rupture.”

Abdominal ultrasound is the best tool used to screen for AAAs. This non-invasive test is painless and takes just a few minutes, and the benefits could be life-saving.

Recognizing the significant benefit and the low level of awareness, the Aortic Center of Stony Brook Medicine is organizing free screening events year round. The next scheduled screening is in the end of June. Patients considered to be at risk based on their health profile receive a duplex ultrasound and information materials about the condition, including strategies to decrease their individual risk.

“Screening is important and can save lives,” said Tassiopoulos, “This is just one more way Stony Brook is staying on the forefront of keeping our community healthy. Our goal is to make patients aware of this silent killer and help them understand their risk and how to minimize it.”

More than 80% of all aneurysms today can be treated with minimally invasive techniques, often without incisions. These procedures have a very low complication rate and are particularly well tolerated even by at risk population.

“We hope that we can identify some patients with aneurysms in early stages but also educate our patients and physician community about the condition so we can improve its detection rate.

Procedure to open blocked carotid arteries tested

Doctors at Washington University School of Medicine in St. Louis are investigating a minimally invasive procedure to open blocked carotid arteries in patients whose poor health or advanced age makes the traditional open surgery too risky.

The clinical study, taking place at Barnes-Jewish Hospital, is part of a global, multicenter trial evaluating the safety and effectiveness of a new technique and device designed for high-risk patients with carotid artery disease, a condition that restricts blood flow to the brain and increases the risk of stroke.

The two carotid arteries, in the neck, supply blood to the brain and can become clogged with plaque in the same way that arteries in the heart can become blocked. More than 300,000 people in the United States are diagnosed with carotid artery blockages every year. Left untreated, blockages can stop blood flow, and plaque debris can dislodge to the brain, causing a potentially disabling stroke.

The current surgical or “open” procedure used to clean out a clogged carotid artery is generally considered safe and effective but requires a large incision along the patient’s neck. The procedure is usually done under general anesthesia and carries surgical risks that may make it unsuitable to high-risk patients.

While a less invasive alternative has been available for years, it carries a risk of stroke. Called carotid artery stenting, the procedure involves inserting a mesh stent through an artery in the groin and threading it into the carotid artery to hold the vessel open. Since the stent can knock plaque loose, a tiny umbrella-like filter is first inserted through the blocked artery to catch this debris and stop it from entering the brain. But the filter itself still carries a risk of stroke because it, too, can dislodge plaque.

“The new technique and device system may reduce the chances of these complications,” said vascular surgeon Jeffrey Jim, MD, who performs the procedure. The procedure is called transcarotid stenting with dynamic flow reversal.

“The term ‘transcarotid’ refers to the technique of delivering a stent directly into the carotid artery from a small incision in the neck,” said Jim, an assistant professor of surgery. “It is a shorter and potentially safer route than the traditional minimally invasive method of stenting via the groin. And it can be done using local anesthetic.”

The “dynamic flow reversal” part of the procedure refers to a device that temporarily reverses blood flow in the blocked artery, diverting it away from the brain and into tubing set up outside the body. Filters in this tubing remove any plaque debris knocked loose during placement of the stent. The tubing then directs the blood back into the body through a vein near the groin. Since blood enters the brain through multiple arteries, patients are not adversely affected by this temporary flow reversal in a single vessel.

“Temporarily reversing the flow ensures that the patient’s brain is protected at all times,” said Jim. “This procedure holds the potential to optimize treatment for our older, high-risk patients. Because it is less invasive, there likely is a lower risk of cardiac complications, and patients can recover faster.”

Washington University School of Medicine is one of 25 centers around the world participating in the clinical study, which is expected to enroll 140 patients.

The study is funded by Silk Road Medical, developers of the transcarotid stenting with dynamic flow reversal system.

Editor’s note: Patients who have had the procedure are available for media interviews.

A Vegan Diet (Hugely) Helpful Against Cancer

If you're anything like me, the "C" word leaves you trembling. But today there is very good news to report: Research suggests you can improve your odds of never getting cancer and/or improve your chances of recovering from it. Not with a drug or surgery, although those methods might be quite effective. This is all about the power on your plate, and it's seriously powerful.

A 2012 analysis of all the best studies done to date concluded vegetarians have significantly lower cancer rates. For example, the largest forward-looking study on diet and cancer ever performed concluded that "the incidence of all cancers combined is lower among vegetarians."

That's good news, yes. But what if we're looking for great news? If vegetarians fare so much better than meat-eaters, what about vegans? Is that an even better way to eat? We didn't know for sure until now.

A new study just out of Loma Linda University funded by the National Cancer Institute reported that vegans have lower rates of cancer than both meat-eaters and vegetarians. Vegan women, for example, had 34 percent lower rates of female-specific cancers such as breast, cervical, and ovarian cancer. And this was compared to a group of healthy omnivores who ate substantially less meat than the general population (two servings a week or more), as well as after controlling for non-dietary factors such as smoking, alcohol, and a family history of cancer.

Why do vegans have such lower cancer risk? This is fascinating stuff: An elegant series of experiments was performed in which people were placed on different diets and their blood was then dripped on human cancer cells growing in a petri dish to see whose diet kicked more cancer butt. Women placed on plant-based diets for just two weeks, for example, were found to suppress the growth of three different types of breast cancer (see images of the cancer clearance). The same blood coursing through these womens' bodies gained the power to significantly slow down and stop breast cancer cell growth thanks to just two weeks of eating a healthy plant-based diet! (Two weeks! Imagine what's going on in your body after a year!) Similar results were found for men against prostate cancer (as well as against prostate enlargement).

How may a simple dietary change make one's bloodstream so inhospitable to cancer in just a matter of days? The dramatic improvement in cancer defenses after two weeks of eating healthier is thought to be due to changes in the level of a cancer-promoting growth hormone in the body called IGF-1. Animal protein intake increases the levels of IGF-1 in our body, but within two weeks of switching to a plant-based diet, IGF-1 levels in the bloodstream drop sufficiently to help slow the growth of cancer cells.

How plant-based do we need to eat? Studies comparing levels of IGF-1 in meat-eaters vs. vegetarians vs. vegans suggest that we should lean toward eliminating animal products from our diets altogether. This is supported by the new study in which the thousands of American vegans studied not only had lower rates of obesity, diabetes, and hypertension, but significantly lower cancer risk as well.

This makes sense when you consider the research done by Drs. Dean Ornish and Nobel Prize winner Elizabeth Blackburn; they found that a vegan diet caused more than 500 genes to change in only three months, turning on genes that prevent disease and turning off genes that cause breast cancer, heart disease, prostate cancer, and other illnesses. This is empowering news, given that most people think they are a victim of their genes, helpless to stave off some of the most dreaded diseases. We aren't helpless at all; in fact, the power is largely in our hands. It's on our forks, actually.

Cancer Drug That Shrinks All Tumors Set To Begin Human Clinical Trials

Researchers are one step closer to uncovering a cancer treatment that could be applicable across the board in killing every kind of cancer tumor.

After successful trials in mice, the cancer drug that so far has shrunk or cured all types of tumors it has been tested against will now move to human clinical trials, thanks to a $20 million grant.

A study published March 2012 discusses researchers' find that the one-for-all antibody drug successfully blocks a specific protein, CD47, from tricking the body's immune system into not destroying harmful cells. Though this protein is present on the surface of healthy blood cells, the team from Stanford University's School of Medicine determined that CD47 levels were significantly higher in all cancer cells.

The single antibody treatment works by blocking the protein's signal, thus instructing the body's immune system to attack the cancer cells.

"What we've shown is that CD47 isn't just important on leukemias and lymphomas," Stanford Professor of Pathology and lead study author Dr. Irving Weissman told Science NOW, referring to his previous research that inspired the most recent study. "It's on every single human primary tumor that we tested."

After publishing their findings in the Proceedings of the National Academy of Science, the team tested the drug treatment on mice with seven different types of human cancer tumors -- breast, ovary, colon, bladder, brain, liver and prostate. By either killing or shrinking each tumor, the innovative antibody drug prevented the cancer from spreading to other parts of the body.

"Blocking this ‘don’t-eat-me’ signal inhibits the growth in mice of nearly every human cancer we tested, with minimal toxicity," Weissman said in a statement released by Stanford in 2012. "This shows conclusively that this protein, CD47, is a legitimate and promising target for human cancer therapy."

Funded by a four-year, $20 million grant from the California Institute for Regenerative Medicine, Weissman and his team will now prepare for the first phase of human clinical trials.

This Surgery for Colon Cancer May Benefit Seniors

Seniors who have minimally invasive laparoscopic surgery for colon cancer are much less likely to end up in a nursing home after being discharged from the hospital than those who have open surgery, a new study finds.

One expert not connected to the research said the study adds valuable information for patients.

"Laparoscopic surgery offers many advantages when compared to similar procedures performed through a large open incision," said Dr. Jerald Wishner, director of colorectal surgery at Northern Westchester Hospital in Mount Kisco, N.Y.

"Patients undergoing a laparoscopic approach experience less pain, earlier return of intestinal function, earlier ambulation [walking ability], shorter hospitals stays and earlier return to their baseline activities," he said. "These advantages can be particularly important to the elderly."

In the new study, a Canadian team of researchers reviewed data on more than 9,400 patients over the age of 70 who had colon cancer surgery in the United States between 2009 and 2010. Of those patients, more than 5,700 had open surgeries, while about 3,700 had less-invasive laparoscopic procedures.

Patients who had open surgery were much more likely than those who had laparoscopic surgery to be sent to a nursing home after leaving the hospital, the team found, at 20 percent versus 12.5 percent, respectively.

The study is scheduled for presentation Tuesday at the annual Clinical Congress of the American College of Surgeons in Washington, D.C. Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

"There is evidence that laparoscopic surgical treatment for colon cancer is similar to an open operation in terms of outcomes from a cancer treatment point of view," study author Dr. Richard Liu, a general surgery resident at Dalhousie University in Halifax, Nova Scotia, said in a college news release.

According to the U.S. National Cancer Institute, three-year survival and cancer recurrence rates are comparable for patients who have laparoscopic or open surgery for any stage of colon cancer.

Age also affected the risk of ending up in a nursing home after colon cancer surgery. The lowest risk was for those aged 70 to 75, while the risk was four times higher among those aged 80 to 85 and eight times higher among those over 85, the researchers said.

Liu's team also found that patients who had other diseases -- such as diabetes, high blood pressure or heart disease -- were more likely to require nursing home care after leaving the hospital.

For colon cancer patients in their early 70s who do not have advanced cancer or other major health problems, laparoscopic surgery may help prolong their lives and also preserve their quality of life, the researchers concluded.

Wishner agreed. "The improvement in mobility and reduction in post-operative pain allows [patients] to leave the hospital sooner and without assistance, making them less likely to require discharge to a nursing home," he said. "In addition, early ambulation and the shorter hospital stay reduces the risk of post-operative complications such as pneumonia and venous thrombosis [blood clots], which would increase the need for longer-term care in a nursing home."

Another expert believes that laparoscopic colon surgery is still underused.

The procedure "is not new," said Dr. Julio Teixeira, a general surgeon specializing in minimally invasive surgery at Lenox Hill Hospital in New York City. "In fact, it was first done 20 years ago. However, the techniques had difficulty gaining acceptance among surgeons because of the concern over the safe and proper performance of cancer surgery and the challenging skill sets required."

Teixeira added that "ample evidence has now accumulated that minimally invasive surgery for colon cancer can be both safe and effective in treating the cancer. However, even most recent surveys show that only 15 to 20 percent of the nation's surgeons use laparoscopic techniques for colorectal surgery."

That's unfortunate, he said, since "the patients that stand to gain the most from minimally invasive surgery are often the weaker physiological reserve such as the elderly, the obese and those with significant problems such as pulmonary [lung] and cardiovascular disease."

Colon surgery at busier hospitals may lead to faster recovery

People who have colon surgery at high-volume hospitals are more likely than patients at smaller ones to go straight home for recovery without needing special care, according to a large new study.

There are many ways to gauge the success of a surgery. Being able to perform daily activities and get around independently after the procedure is as important as surviving and avoiding complications, senior author Dr. Daniel Anaya told Reuters Health.

Recovery often takes a while after colorectal surgery, and understanding the recovery process is important to making it better, said Anaya, from Baylor College of Medicine in Houston.

"Our goal is to identify what the high-volume hospitals are doing differently from other hospitals that lead to improved outcomes," lead author Dr. Courtney J. Balentine, also from Baylor, said.

"Once we figure out why some hospitals do better than others, we can help every hospital adopt the practices that really work so that all patients get the best outcomes no matter where they have the operation."

The researchers divided more than 1,000 U.S. hospitals into thirds based on how many colon surgeries were performed at each facility in 2008. They called the top tier "high-volume" hospitals and the bottom tier "low-volume."

The surgeries included operations for colon cancer and for non-cancerous polyps or blockages, for instance.

Three quarters of the 280,000 patients included in the study were operated on at high-volume hospitals. They tended to be younger, have higher incomes and have private insurance more often than their low-volume counterparts.

Less than half of all patients had complications following surgery, regardless of where they were treated.

At busier hospitals, 86 percent of colon surgery patients were discharged straight home, compared to 76 percent of those treated at less busy hospitals.

Twenty percent of high-volume hospital patients ended up using home healthcare services and 14 percent went to skilled rehab facilities instead. At low-volume hospitals, the reverse was true: more patients used skilled recovery facilities than home healthcare after surgery.

Heading home after surgery indicates recovery is going well, and most patients prefer to return home as soon as possible, Balentine told Reuters Health.

Previous studies have found patients at high-volume hospitals tend to do better in a number of areas than those at low-volume hospitals, the researchers noted in JAMA Surgery. For instance, a smaller fraction of patients die during the month after surgery at busier hospitals.

Patients have a lot to think about when approaching surgery, Dr. Farhood Farjah, associate medical director of the Surgical Outcomes Research Center at the University of Washington in Seattle, said. He was not involved in the new study.

"People who need to have colorectal surgery should ask their surgeon several important questions," Farjah said, like about the risks and benefits of surgery, ways to mitigate risks and potential alternatives.

They should also ask about typical recovery patterns and what they can do leading up to surgery to maximize their chances of getting home afterward, he told Reuters Health.

"Examples of things to do include stop smoking and increase activity and exercise," he said. "Also, patients should consider what support they have in terms of family and friends in the event that they need care when they go home."

The new results don't mean patients should only choose busy hospitals for their surgeries - skilled surgeons can be found anywhere, Anaya said.

"Just because your surgeon works at a hospital that doesn't do many colorectal procedures, it doesn't mean that your surgeon isn't qualified or won't do a good job," he said. "We just showed that, overall, hospitals with higher volumes of colorectal surgeries tend to produce better outcomes, in regards to the postoperative recovery process."

He and others are in the process of investigating what it is about the infrastructure or process at higher-volume hospitals that leads to better recovery. Once they have figured out the answer, Anaya thinks it will apply to all patients, from young to old and urban to rural. But elderly patients may benefit the most, since they are most likely to end up in rehab facilities.

Smokers Have Higher Complication Risk After Colon Surgery, Study Finds

Smoking increases the risk of complications and death following colorectal surgery, a new study says.

The study is based on an analysis of data from 47,000 patients in the United States who had major, non-emergency colorectal surgery. Researchers from the University of Rochester Medical Center in New York found that smoking raised the risk of complications such as pneumonia and other infections by about 30 percent.

"Anecdotally, we know that many patients don't take the opportunity to quit or join a smoking cessation program before surgery," study lead author Dr. Fergal Fleming, an assistant professor in the department of surgery, said in a university news release.

"We want to find out what motivates patients, how can we make them a major player in their own care, and how can we as physicians do a better job of explaining issues like this to patients," Fleming explained.

The study, published in the August issue of the journal Annals of Surgery, looked at 26,000 patients who had surgery for colorectal cancer, 14,000 operated on because of diverticular disease (small, inflamed pockets that form along the colon wall), and 7,000 who had surgery for inflammatory bowel disease.

Twenty percent of the patients were current smokers, 19 percent were former smokers and the rest had never smoked.

After taking age, body fat, alcohol use and other health conditions into account, the researchers concluded that current smokers still had an estimated 30 percent higher risk of dying or developing complications following colorectal surgery compared to those who never smoked.

Current smokers -- who were younger than ex-smokers and never-smokers -- had the highest rates of pneumonia and infection, were more likely to require additional surgery and had much longer hospital stays, the researchers said.

They also found the rates of all complications and the risk of death were significantly higher in patients who smoked two packs a day for more than 30 years.

More information

The American College of Surgeons has more about smoking and surgery.

Copyright © 2013 HealthDay. All rights reserved.

SOURCE: University of Rochester Medical Center, news release, Sept. 24, 2013

Deep vein thrombosis: Don't ignore symptoms of silent killer

My wife almost lost her leg a few weeks ago. Then she almost lost her life. The symptoms didn't seem life-threatening at the time, so we almost made a fatal mistake by delaying seeking medical treatment. Since then, we've learned about the dangers of another "silent killer" you might not be familiar with: Deep vein thrombosis (DVT).

My wife developed severe leg cramps while she was out walking one day, but they went away after she rested. So she just thought she'd overdone the exercise, and she cut back on her walking. A few days later, her foot became numb, tingly, pale and very cold. We were concerned, so we called her doctor to make an appointment. The doctor wasn't in that day, and as we discussed whether or not to wait until her doctor returned, on a hunch we decided to call a family friend who is also a doctor.

"Go to emergency right away!" was our friend's response upon hearing the symptoms. "You might have a blood clot, and you can lose your leg!" She then directed us to our local trauma center; if my wife indeed had a clot, they'd be best equipped to deal with it.

Sure enough, she had a few blood clots in her leg that were cutting off her blood circulation -- hence the numb, tingly, pale, cold foot. An interventional radiologist inserted a catheter in one of her arteries to spray the clot with anticoagulants, or blood thinners. The clots began clearing up, and we thought we were out of the woods, when she developed internal bleeding from the anticoagulants.

As a result, her blood pressure and heart rate dropped precipitously, so the medical staff switched from saving her leg to saving her life. They stopped the anticoagulants, her blood started clotting again, and they performed emergency surgery to remove the cyst that was causing the blood clots and clean up the existing clots in her arteries.

Once things settled down, we learned about the dangers of DVT, or deep vein thrombosis. This condition results from blood clots in the veins due to blood pooling in the legs from prolonged inactivity. According to one report, it strikes 2 million people per year and kills about 200,000. A well-publicized example involved news correspondent David Bloom, who died in 2003 as a result of blood clots forming while he was confined in a tank covering the war in Iraq.

DVT can develop if you're sitting still for a long time -- such as when traveling in a car or plane -- or if you have certain medical conditions that affect how your blood clots, the Mayo Clinic notes. Air travelers' blood clots have been nicknamed "economy class syndrome," but 2012 guidelines released by the American College of Chest Physicians emphasized the overall risk remained low for healthy travelers -- about two cases per every 1,000 long-haul travelers.

The cause of my wife's condition was much more rare than DVT. While prolonged sitting didn't cause her blood clots, we became well aware of the dangers of DVT, which shares many common symptoms with my wife's condition.

Other symptoms of DVT include swelling and warmness of the skin (the opposite of my wife's cold feet). Left untreated, blood clots can travel to the lungs or pulmonary arteries, the latter causing a pulmonary embolism. Either condition can be fatal.

Lesson learned: Don't sit absolutely still for hours. If you're flying long distances or have been on bed rest, get up whenever possible to stretch your legs and let the blood flow. In particular, don't ignore recurring leg cramps and numb, tingly, pale, cold feet, or warm, swollen feet.

The Mayo Clinic adds that obesity, smoking and high blood pressure all raise risk for DVT, and lifestyle changes could help stave off the potentially deadly condition.

Another lesson: I continuously stayed with my wife in the hospital for two days and nights, serving as her cheerleader and advocate. We're convinced it made a critical difference during the darkest moments of her crisis. We're very glad we weren't too shy to ask the nurses if I could stay; fortunately, they recognized the help that a loving family member can provide.

While you're at it, read here to learn more about the symptoms of the well-known "silent killers" -- heart attacks, strokes and cardiac arrest.

Although my wife's complete recovery will take weeks, we're very grateful that she escaped relatively unscathed. This is yet another story about the preciousness of life. If reading her story helps just one reader, this post will be a success.

© 2013 CBS Interactive Inc. All Rights Reserved.

Oddly, runners may be susceptible to deep vein blood clots because of efficient vascular systems

Dear Running Doc:

I just participated in the Las Vegas Rock 'n' Roll Marathon last weekend. I, like many, had lots of nausea and vomiting after the race. Then I flew home to NYC and had leg pains and saw my doctor and he found deep vein blood clots in my legs. I have run 6 matathons a year for 20 years and I am just 40 years old and healthy. Was it the dehydration or are runners more susceptible to these clots? Stephen G., NYC, NY.

Dear Stephen: I've been wondering the same thing. In the past year, I have had 10 runners with no risk factors experience the same thing. There is nothing written linking running, dehyration and deep vein thromboses (DVTs), but given what I've observed, I do have some ideas.

DVTs are blood clots that develop in the deep vein of the leg. This can be very serious because the clot can break off, travel to the lung, and cause severe breathing difficulty and even death. Treatment includes initial hospitalization, anti-clotting meds by IV, then a regimen of anti-clotting meds for months out of the hospital until the clot is totally dissolved.

Usually DVTs form after prolonged inactivity. Runners just may be the most active people we know, so initially it does not make sense that there would be an increased frequency amongst traveling runners. Physicians recognize such risk factors for DVTs as long flights of inactivity, bed rest after surgery, birth control pills, clotting disorders, cancer, smoking, heart disease, obesity, family history of DVT, and pregnancy. Symptoms of DVT are pain and swelling. If you flex your foot upward and have calf pain, that is called a positive Homan's sign and indicative of a DVT. If in doubt, you should be checked by a physician immediately and get venous studies to look for this serious problem.

The runners I mentioned earlier had none of the risk factors except the long flights, which one would think they could handle from their running. Could runners' bodies be more susceptible?

I truly think it is possible. Runners' bodies adapt to running by making their leg vascular system more efficient: larger veins and arteries. So if you sit for a long time and are scrunched in an airplane seat, the blood can pool in your larger leg veins, and clot. That-- coupled with the edge of the seat pushing on the back of your knee, preventing or slowing venous return--could be all you need to set up a clot.

What can you do to prevent a clot from forming? On flights of three hours or more:

* Do not sit in one position for more than an hour. Get up and walk every so often.

* Do calf stretches once an hour, standing and leaning against a bathroom wall.

* Stay well-hydrated. As I always say, check your urine color: you want lemonade color; not clear, and not brown like iced tea.

* Avoid crossing your legs at the knees and ankles.

* Wear graduated-compression stockings (the so-called TED stocking you can buy at your local pharmacy).

* If your doctor permits, take one baby aspirin four to six hours before your flight. It mildly prevents clotting as it does for heart patients.

If you do the above, you may prevent a clot in your well-adapted legs en route to your next race.

As to your nausea and vomiting after an evening race, that had nothing to do with your clot. In fact this is a very common complaint at all evening events, incuding Disney's Wine and Dine. The reason is that most do not practice eating and running a long run in the evening and are used to morning runs and morning eating habits. So waiting all day and having regular meals result in "something new" for your body during a long run. Next time you do an evening race, practice eating and training with evening runs, and I bet you won't feel nauseas again.

***

Lewis G. Maharam, better known as the Running Doc™, is the author of Running Doc's Guide to Healthy Running. He is the past medical director of the NYC Marathon and Rock 'n' Roll Marathon series and is Medical Director of the Leukemia & Lymphoma Society's Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.

Want your question answered in this column? Write to runningdoc@nydailynews.com or write your questions or comments in the comments section below.

Read more: http://www.nydailynews.com/sports/more-sports/oddly-runners-susceptible-deep-vein-blood-clots-efficient-vascular-systems-article-1.990275#ixzz2sHKQrOTe

Fiber May Not Prevent Diverticular Disease

A new study challenges the long-held belief that a high-fiber diet prevents the formation of small pouches in the colon wall that can lead to diverticular disease.

For decades, doctors have recommended high-fiber diets to patients at risk for developing the intestinal pouches, known as diverticula.

The thinking has been that by keeping patients regular, a high-fiber diet can keep diverticula from forming. But the new study suggests the opposite may be true.

Fiber Eaters Had More Pouches

People in the study who ate the least fiber were less likely to develop the pouches than people who ate the most.

Another surprise: Constipation was not associated with a higher risk of having diverticulosis, which had also been a long-held theory behind the disease. Diverticulosis is a condition in which multiple pouches form in the wall of the large intestine.

“Our study makes it clear that we don’t really understand why diverticula form,” says researcher Anne F. Peery, MD, a fellow in gastroenterology at the University of North Carolina School of Medicine at Chapel Hill.

“There are a lot of good reasons to eat a high-fiber diet, and this study doesn’t change that,” she says. “But it may not protect people from developing diverticula.”

Pouches May Lead to Diverticulitis, Other Complications

About half of Americans will have diverticula by the age of 60, and two-thirds will develop the pouches on the walls of their large intestine by age 85, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Many experience no symptoms, but 10% to 25% develop diverticulitis -- a potentially serious condition that occurs when the pouches become inflamed.

Diverticula can also lead to other potentially life-threatening complications, including infection and bleeding. According to one report, diverticular disease caused more than 300,000 hospitalizations and nearly 3,400 deaths in the United States in 2004 alone.

Although a low-fiber diet has long been implicated in the formation of diverticula, there is almost no scientific evidence to back up the association, Peery says.

This is also true for other suggested risk factors for diverticular disease, including eating a high-fat diet or a diet high in red meat, being physically inactive, and having frequent constipation.

In an effort to better understand the impact of these suspected risk factors on the formation of diverticula, Peery and colleagues from the University of North Carolina and the Albert Einstein College of Medicine in the Bronx recruited more than 2,100 adults between the ages of 30 and 80 for their study.

Fiber, Constipation, Red Meat Off the Hook?

All the participants had colonoscopies to confirm or rule out the presence of diverticula, and all were interviewed regarding their diets, bowel habits, and activity level.

Among the surprising findings:

• People with the lowest fiber intake were 30% less likely to develop diverticula than people whose diets included the most fiber.
• Constipation was not associated with an increase in risk. In fact, people who had more than 15 bowel movements a week were 70% more likely to develop the pouches than those who had fewer than seven a week.
• Neither lack of exercise nor eating a diet high in fat or red meat appeared to increase the risk for diverticula.

Expert: ‘Look Elsewhere for Cause’

Researcher Lisa L. Strate, MD, MPH, of the University of Washington School of Medicine in Seattle, called the study “important and provocative.”

Strate’s own research, published in 2008, also turned conventional wisdom about diverticular disease on its head, finding no merit to the prevailing wisdom that patients at risk for diverticulitis should avoid nuts, corn, and popcorn.

“We have been stuck on the idea that fiber is a major player in diverticular disease for too long without really being able to back it up,” she says. “This study tells us that we need to look at other potential risk factors.”

Digestive disease specialist David Bernstein, MD, agrees. Bernstein is chief of the division of gastroenterology at North Shore University Hospital in Manhasset, New York.

Diverticulitis Tied to Higher Risk of IBS

Diverticulitis patients had significantly elevated risks for irritable bowel syndrome (IBS) and mood disorders over time -- potentially suggesting a new disease class, researchers found.

Compared with patients without the inflammatory condition, patients with diverticulitis had an adjusted 4.7-fold hazard of developing IBS (95% CI 1.6-14.0, P=0.006) over up to 9 years of follow-up, as well as 2.4-fold (95% CI 1.6-3.6, P<0.001) and 2.2-fold (95% CI 1.4-3.5, P<0.001) adjusted hazards for a functional bowel disorder or mood disorder, respectively, according to Brennan Spiegel, MD, of the West Los Angeles Veterans Affairs Medical Center in California, and colleagues.

"We propose calling this disorder post-diverticulitis IBS," which "appears to predispose patients to long-term gastrointestinal and emotional symptoms after resolution of inflammation ... similar to post-infectious IBS," they wrote in the December issue of Clinical Gastroenterology and Hepatology.

The authors noted that patients with diverticulosis also frequently present with IBS. However, recent research has shown that progression from diverticulosis to diverticulitis is rarer than previously thought, particularly among older patients with diverticulosis. In addition, surgical treatments for diverticulitis are expensive and risky.

To study the incidence of diverticulitis with IBS, functional bowel disorders, and mood disorders, the authors conducted a retrospective analysis of 1,102 patients with diverticulitis and 1,102 matched controls over a mean 6.3 years of follow-up.

Participants were treated at the Veterans Affairs Greater Los Angeles Healthcare System. Case patients met the definition of diverticulitis or its complications -- diverticular abscesses and diverticular perforations -- as given in the International Classification of Diseases, 9th revision (ICD-9), and had a formal chart diagnosis of the condition. These patients received a course of oral or parenteral antibiotics.

The primary outcome was a diagnosis of "post-diverticulitis IBS" based on a new IBS diagnosis following enrollment or an index diverticulitis attack. Secondary outcomes included presentation of related functional bowel diseases, such as spastic colon, functional diarrhea, constipation, and abdominal pain, as well as new diagnoses of depression and related mood disorders based on ICD-9 criteria.

From baseline, there were 24 new cases of IBS, including 20 in the diverticulitis sample and four among controls. In addition, there were 146 new functional gastrointestinal diagnoses, including 95 in the cases and 51 in controls, as well as 98 new mood disorder diagnoses, including 63 case diagnoses and 35 control diagnoses.

The authors cautioned that "it is possible that diverticulitis patients in this study were simply misdiagnosed as having IBS, or vice versa," though they noted that the false negatives may be stymied by exclusion of those with pre-existing IBS and functional bowel diagnoses, as well as the presenting cases of mood disorders post-diverticulitis.

They also noted that the study did not prove that diverticulitis causes IBS, and that the study was limited by a low rate of IBS presentation in the sample overall.

The study was funded through a grant from Shire Pharmaceuticals.

The authors received support from Ironwood Pharmaceuticals, Prometheus, Takeda, Amgen, Ritter Pharmaceuticals, and Shire Pharmaceuticals.

Abdominal aortic aneurysms: new study tests medicine to prevent surgery

Simple and elegant: Use a well-known generic drug to prevent the need for surgery and its risks. A national multicenter clinical study, N-TA3CT (Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial), aims to do just that. It will test the use of a common antibiotic, doxycycline, against a placebo for stopping the growth of small abdominal aortic aneurysms. If successful, it has the potential of preventing or delaying the need for surgical repair, saving the patient and the health care system substantial risk, trauma and expense.

Two Washington University vascular surgeons at Barnes-Jewish Hospital play critical roles in the trial: John Curci, MD, is one of the principle investigators for the multicenter study; Robert Thompson, MD, will serve as the principle investigator for the Washington University site. Their basic research, conducted at Washington University since the 1990s, laid the groundwork for the trial. In fact, much of the knowledge that has been gained about the fundamental biological basis for aneurysms evolved from their work.

Building the Evidence

“When we started in the lab, the idea of a drug that could prevent a problem thought to be mechanical in nature seemed far-fetched,” Thompson says. “Everyone believed that aneurysms were a degenerative process that would continue until it required surgical correction. Then we noticed that aneurysm tissue showed significant inflammation in the aortic wall. It became apparent that there was a biological problem, as well,” he says.

Basic research at other institutions suggested that this inflammation might come from enzymes called matrix metalloproteinases (MMPs), which are capable of breaking down structural proteins of the aortic wall. Curci and Thompson demonstrated that human aneurysm tissue carried high levels of one of the MMPs—MMP-9—and they developed a mouse model showing that mice without active MMP-9 do not develop aneurysms.

“That’s when we started looking at drugs with a known capacity to block those enzymes,” Thompson says.

The surgeons turned to the tetracycline drug doxycycline, which had been used for years to inhibit MMP-9’s contribution to gingivitis. They gave doxycycline to mice that carried MMP-9 and were able to block the growth the aneurysms.

Ten years ago, Curci and Thompson first began using doxycycline in humans with aneurysms. They gave it for a week pre-operatively to 10 patients scheduled for aneurysm surgery, comparing this group to 10 controls who didn’t receive it. Then, after surgery, they measured MMP-9 in the removed aneurysm tissue and found MMP-9 was suppressed in the treated group. They later showed in a larger patient group that the drug was safe and well tolerated.

The N-TA3CT Study

“Usually, when we hear about a potential new treatment for an illness, we’re thinking about a new drug that’s expensive and has unknown side effects. That’s not the case with doxycycline. It’s cheap and generic, and we know its few minor side effects,” says Curci. Thompson adds that those facts created a problem in acquiring funding, because there was no big money to be made. That’s a plus, they say. If the therapy proves as useful as they think from their past work, it will help control costs for treating the potentially catastrophic disease.

This study will be among a relatively rare group of trials regarding a drug treatment to prevent surgery for a disease. Thompson and Curci expect to find even more effective drugs for the same purpose down the road, but for now, if drug therapy can help prevent or slow aneurysm growth, then patients who develop aneurysms in their 70s or 80s might never need surgical repair.

N-TA3CT will enroll nearly 250 patients over 16 sites in a double-blind placebo-controlled study, starting in March 2013. Participants will have a computed tomography (CT) scan to check for aneurysm growth and a blood test to analyze drug levels, presence of various chemical markers and MMP-9 enzyme levels every six months of the two-year study. Curci is in charge of collecting the specimens from all patients and setting up a data bank so that specimens and data can be used by future researchers.

At the end of the two-year study, they will assess which aneurysms grew enough to require surgery. “Small aneurysms are usually not a problem, but without intervention, most of them progress and eventually need surgery,” says Curci. “If we can keep them small by screening them with lower-cost ultrasound and treating them with an inexpensive drug, everyone wins.”

# # #

Funding for N-TA3CT came from the National Institutes of Health (NIH) National Institute of Aging.

Laparoscopic Gallbladder Surgery for Gallstones

Laparoscopic gallbladder surgery (cholecystectomy) removes the gallbladder and gallstones through several small cuts (incisions) in the abdomen. The surgeon inflates your abdomen with air or carbon dioxide in order to see clearly.

The surgeon inserts a lighted scope attached to a video camera (laparoscope) into one incision near the belly button. The surgeon then uses a video monitor as a guide while inserting surgical instruments into the other incisions to remove your gallbladder.

Before the surgeon removes the gallbladder, you may have a special X-ray procedure called intraoperative cholangiography, which shows the anatomy of the bile ducts.

You will need general anesthesia for this surgery, which usually lasts 2 hours or less.

After surgery, bile flows from the liver (where it is made) through the common bile duct and into the small intestine. Because the gallbladder has been removed, the body can no longer store bile between meals. In most people, this has little or no effect on digestion.

In 5 to 10 out of 100 laparoscopic gallbladder surgeries in the United States, the surgeon needs to switch to an open surgical method that requires a larger incision.¹ Examples of problems that can require open rather than laparoscopic surgery include unexpected inflammation, scar tissue, injury, or bleeding.

What To Expect After Surgery

You may have gallbladder surgery as an outpatient, or you may stay 1 or 2 days in the hospital.

Most people can return to their normal activities in 7 to 10 days. People who have laparoscopic gallbladder surgery are sore for about a week. But in 2 to 3 weeks they have much less discomfort than people who have open surgery. No special diets or other precautions are needed after surgery.

Why It Is Done

Laparoscopic gallbladder surgery is the best method of treating gallstones that cause symptoms, unless there is a reason that the surgery should not be done.

Laparoscopic surgery is used most commonly when no factors are present that may complicate the surgery.

How Well It Works

Laparoscopic gallbladder surgery is safe and effective. Surgery gets rid of gallstones located in the gallbladder. It does not remove stones in the common bile duct. Gallstones can form in the common bile duct years after the gallbladder is removed, although this is rare.

Risks

The overall risk of laparoscopic gallbladder surgery is very low. The most serious possible complications include:

• Infection of an incision.
• Internal bleeding.
• Injury to the common bile duct.
• Injury to the small intestine by one of the instruments used during surgery.
• Risks of general anesthesia.

Other uncommon complications may include:

• Injury to the cystic duct, which carries bile from the gallbladder to the common bile duct.
• Gallstones that remain in the abdominal cavity.
• Bile that leaks into the abdominal cavity.
• Injury to abdominal blood vessels, such as the major blood vessel carrying blood from the heart to the liver (hepatic artery). This is rare.
• A gallstone being pushed into the common bile duct.
• The liver being cut.

More surgery may be needed to repair these complications.

After gallbladder surgery, some people have ongoing abdominal symptoms, such as pain, bloating, gas, and diarrhea (postcholecystectomy syndrome).

What To Think About

Recovery is much faster and less painful after laparoscopic surgery than after open surgery.

• The hospital stay after laparoscopic surgery is shorter than after open surgery. People generally go home the same day or the next day, compared with 2 to 4 days or longer for open surgery.
• Recovery is faster after laparoscopic surgery.
• You will spend less time away from work and other activities after laparoscopic surgery (about 7 to 10 days compared with 4 to 6 weeks).

Complete the surgery information form (PDF) to help you prepare for this surgery.

Citations

1. Glasgow RE, Mulvihill SJ (2010). Treatment of gallstone disease. In M Feldman et al., eds., Sleisenger and Fordtran?s Gastrointestinal and Liver Disease, 9th ed., vol. 1, pp. 1121-1138. Philadelphia: Saunders.