Florida Health News - February 2010 by Global Health Tribune

www.floridahealthnews-online.com

No. 10 • FEBRUARY • 2010

THE BEST INFORMATION IN YOUR HANDS

S e r v i n g P a l m B e a c h G a r d e n s , R o y a l P a l m B e a c h , We l l i n g t o n , L a k e Wo r t h , L a n t a n a , B o y n t o n a n d B o c a R a t o n

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ways to make over your relationship with food so it's happier, healthier, and guilt-free

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Reducing Opioid Deaths in Palm Beach County: Time to Help the Florida Board of Medicine Save Lives..............................2 Michelle Obama rallies US to push back child obesity ......................................3 Scientists Pinpoint Area of Brain That Fears Losing Money ................4 Being bored could be bad for your health .................................................5 Erectile dysfunction: Viagra and other oral medications ...............................6 Soft Drinks Could Boost Pancreatic Cancer Risk .............................7 Center for Wound Care And Hyperbaric Medicine with new Center Director...................................8 Dieters Beware: Calorie Counts Are Frequently Off .....................................9 10 ways to make over your relationship with food so it's happier, healthier, and guilt-free............................................10 Case Studies: ''Simple'' Problems That Could Be The Tip of an Iceberg...............11 2010 Komen Race for the Cure. More Than 22,000 attend the Annual Event........................................................12 Poor Circulation .......................................13 Cyndi Lauper, Lady Gaga Put Spotlight on Women and HIV ..................14 Rapid Flu Test Most Accurate for Young Kids...............................................15

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Mom's Lifestyle in Early Pregnancy Affects Baby's Size

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Reducing Opioid Deaths in Palm Beach County: Time to Help the Florida Board of Medicine Save Lives

But at the end of January, Palm Beach County officials found that halting the spread of illicit pain clinics is easier on paper than in execution. It is now clear that the zoning moratorium can't easily be applied. The Zoning board is unable to deny zoning approvals across the board for medical offices. If a new clinic states it also offers other services, such as weight control, or addiction treatment, it can appear to be a normal doctors office and must be approved.

By Dr. Mark Schor

Dr. Schor is Board Certified in Internal Medicine and works for U.S. Hospitalists.

piates are the most commonly prescribed medication in the United States, and opioid overdose is among the most common causes of death. It has been known that many opioid deaths are from medications that people have obtained without a prescription, but the January 2010 Annals of Internal Medicine now reports the shocking conclusion that many deaths are from prescribed opioids.

In 2006 in our county, over 200 unintended drug overdose deaths were reported, and the the rate of prescription drug overdose in Palm Beach County in the first half of 2009 remained steady compared to the same period last year, according to a state medical examiner's report. "It is evident in this report that the abuse of prescription drugs continues to be a lethal problem in our state," said Gerald Bailey, commissioner of Florida's law enforcement department, in a statement that accompanied the report.

Authorities say the rising rates of prescription drug abuse is fueled primarily by the spread of unscrupulous pain clinics in Broward and Palm Beach counties. The The Palm Beach Post identified at least 30 clinics that have opened in Palm Beach County since 2007. Those running the clinics include convicted drug dealers and serial criminals. Some pain clinics offer legitimate services, but most are "rogue clinics putting out pills for cash," according to a grand jury report.

To deal with this problem Palm Beach County commissioners ordered a moratorium against issuing occupational licenses to new pain clinics. Sen. Dave Aronberg, D-Greenacres, plans to file a bill that would bar felons from owning pain clinics. And this month local police have joined with federal agencies, such as the FBI and IRS to form a task force directed against pain clinics.

After being open, if there is a suspicion. The clinic or doctor would then have to be investigated. However there is a shortage of investigators. “Making a successful case against a physician requires a tremendous amount of time and resources, search warrants and the seizure of records“, said Maj. James Stormes of the Palm Beach County Sheriff's Office. "We have to prove that the doctor is breaking the law," said Stormes, who oversees the sheriff's detective bureaus. "That's what I think is very challenging. Can this doctor make the case that what he's doing is for medical purposes? And if he can, we can't charge him." Florida law states cases against doctors must be closed in 6 months. So, even with the zoning and anti-felon laws, given the shortage of investigators and complexity of examining the evidence, pain clinics now stand a good chance of remaining open. What has been done in our county so far won’t work because pain clinics can operate without a felon who owns them, can easily skirt around zoning laws, and investigation by large task forces is unnecessarily complicated and time consuming.

Pain clinics cannot operate without a physician with a Florida license and DEA number who signs the script. So, the actual solution is with the state regulation of doctors. Simply go after the unscrupulous physicians who have used their Florida license and DEA number to write large amounts of controlled medications. Clearly the Florida Board of Medicine needs more investigators who can be dedicated to examine the records of the clinics. The expense of extra investigators can come from fines paid by the doctors. The DPR needs an extention of the usual time of closing an investigation from 6 months to 12 months when investigating a pain clinic. And, most importantly, there needs to be an easily used data base so investigators can immediately tell which Florida doctor has written how many controlled prescriptions.

New study sharpens focus on problems of obesity

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Florida Health News is a newspaper published every month in Broward, Palm Beach, and surrounding areas. Copyright 2009, all rights reserved by SEA Publications, Inc. Contents may not be reproduced in any form without the written consent of the publisher. The publisher reserves the right to refuse advertising. The publisher accepts not responsibility for advertisement error beyond the cost of the portion of the advertisement occupied by the error within the advertisement itself. The publisher accepts no resposibility for submitted materials. All submitted materials are subject to editing.

Finnish firm to market cancer-prevention capsule

Cardiovascular disease linked to obesity may be worse than thought while health problems associated with being underweight may have been overstated, according to a study published by the British Medical Journal (BMJ).

he paper, written by doctors in Britain and Sweden, seeks to finetune a well-known tool -- the body mass index (BMI) -- which is used to measure obesity and ill-health. BMI entails taking one's weight in kilos and dividing it by the square of one's height, in metres. A BMI of 25-30 is generally considered overweight. while a figure of above 30 indicates obesity. Previous studies have already found a big link between BMI and higher risk of death from cardiovascular disease, diabetes and some cancers. In contrast, a low BMI -- in other words, people who are very skinny -- is associated with increased mortality from respiratory disease and lung cancer. But many experts have questioned the findings about low BMI, arguing that the figures could be skewed by something called reverse causality. For instance, diseases such as lung cancer, which cause weight loss, are being factored in as low BMI, they argue. And smoking and poor socioeconomic circumstances may also cause bias. Seeking to find out more, specialists from

An overweight woman. Cardiovascular disease linked to obesity may be worse than thought while health problems associated with being underweight may have been overstated, according to a study published by the British Medical Journal.

Britain's University of Bristol and the Karolinska Institute in Sweden set out to get a wider view of the BMI benchmark. They measured BMI and mortality among more than a million pairs of Swedes, comprising mother-and-son pairs and fatherand-son pairs, over 50 years. They found strong patterns of mortality and BMI. The link was especially noticeable in cardiovascular disease -- for which prevailing estimates may be "substantially underestimated" -- as well as diabetes and kidney cancer. But there was no evidence of an association between low BMI and an increased risk of respiratory disease and lung cancer mortality. The findings are important, because they imply that obesity programmes could yield major health benefits, says the study. "Suggestions to the contrary are probably misguided," it adds.

cetaldehyde is produced from alcohol and sugar by microbes in the mouth. The gastric acid of a healthy stomach generally kills these microbes, but they can survive in an acid-free stomach and continue to produce acetaldehyde there. "It is clear that acetaldehyde is a class one carcinogenic, or a cancer-causing factor of the worst kind, and it is clear that an acidfree stomach is a risk factor for stomach cancer," Biohit chief executive Osmo Suovaniemi said. He said the capsule, developed by Biohit in collaboration with researchers from the University of Helsinki, neutralised acetaldehyde when taken with meals or alcohol and could, therefore, help prevent the development of cancer. "How many cancer cases it may prevent in the future remains to be seen," Suovaniemi said, adding it would take years to determine the capsule's cancer-preventing impact. Suovaniemi said the drug had received the approval of medical authorities after undergoing clinical testing.

Biohit aims to make the over-the-counter capsules available in Finnish pharmacies during the first half of this year and to start marketing them internationally during 2011 at the latest. Biohit shares surged on the news and were up by 120 percent at 3.36 euros in late afternoon trading on the Helsinki stock exchange.

Finnish medical biotechnology group Biohit said Monday it had developed a capsule that could help prevent stomach and throat cancer by neutralising the cancer-causing compound acetaldehyde.

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Michelle Obama rallies US to push back child obesity

First Lady Michelle Obama teamed up with athletes, farmers, doctors, the food industry and media to take on the childhood obesity "epidemic" that affects a staggering one in three American youngsters.

We're determined to finally take on one of the most serious threats to their future, and that's the epidemic of childhood obesity in America today," the first lady said at the launch of the "Let's Move" campaign. The initiative aims to rally families, communities, schools, urban planners, politicians and the media to "solve the problem of childhood obesity in a generation so that children born today will reach adulthood at a healthy weight," she said. She pointed to the urgency of taking action today, at a time when there are already three times more obese children in the United States than 30 years ago. Because of obesity and the many illnesses and chronic conditions it spawns, health experts have predicted that this generation of American children could be the first to have shorter lifespans than their parents, said TV personality Tiki Barber, a former professional American football star. Judith Palfrey, president of the American Academy of Pediatrics, blamed the "alarming rise" on lack of exercise and a diet heavy in fat and sugar and light on fresh fruits and vegetables. The United States is in the unenviable position of having the highest number of obese children in the developed world, said Palfrey. Nearly one in five US kids aged six to 19 are obese, which in technical terms mean

First Lady Michelle Obama, alongside members of the 2009 National Championship Pee-Wee football team, the Watkins Hornets, speaks about her initiative, "Let's Move," a campaign to help combat childhood obesity, during an event in the State Dining Room of the White House in Washington, DC.

they have a body mass index -- calculated by dividing a person's weight in kilograms by their height squared in meters -- greater than 30. In health terms, it means they are at greater risk for a whole host of maladies, ranging from high blood pressure to diabetes, heart disease and stroke. "Our military leaders report that obesity is now one of the most common disqualifiers for military service. Economic experts tell us we are spending outrageous amounts of money treating obesity-related conditions," Obama said. US medical costs associated with excessive weight soared from around 78 billion dollars a year in 1998 to around 147 billion dollars annually in 2006, a study released last

year showed. Will Allen, who has been a farmer for 50 years, said a major culprit was lack of access to good food. US inner cities, home to many of the nation's poor, are "food deserts," where healthful food is rare and people live on cheaper processed meals "that would not be recognized as being food by our grandmothers," the towering farmer, dressed in a flat cap and tweed sweater, said at the launch. Among steps to beat back obesity are an initiative to bring grocery stores that sell healthy food to inner cities, a rewards system for schools that offer healthy meals and regular physical education classes, and local efforts to build safe areas where children can play.

"This initiative has to deal with talking to parents in a way that makes sense, eliminating the accessibility and affordability issues in this country so that when we start talking about solutions, they are solutions that all families can access -- and not just the lucky few," Obama said in an interview with public television after the launch. She also told CNN's "Larry King Live" that she had discussed the need for a healthier diet with her own daughters and involved them in monitoring their food choices. "We talked about processed foods, so they caught on pretty quickly once they understood the point of it all," she said. The first lady has set a healthy example herself by planting a vegetable garden on the White House grounds, which local schoolchildren helped to cultivate. Private industry has backed the first lady's campaign, with Sodexo, which serves more than 2.8 million school meals daily to children in the United States, pledging to include more fruit, juice, vegetables, whole grain and milk options in lunches. The Walt Disney Company has said that every series it produces, including the wildly popular "Hannah Montana" show, will include an episode with a healthy lifestyle theme. Grassroots environmental organization the Sierra Club praised the first lady for her commitment to creating "safer outdoor spaces for children, like sidewalks, parks and community gardens -- initiatives that would reconnect them with the world outside." Hours before his wife launched the initiative, President Barack Obama signed an executive memorandum setting up a task force that includes members of his cabinet and other officials, who have 90 days to draw up a master plan to combat childhood obesity.

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Drinking Milk While Pregnant Autism risks detailed in May Lower Kids' MS Risk children of older mothers

A woman's chance of having a child with autism increase substantially as she ages, but the risk may be less for older dads than previously suggested, a new study analyzing more than 5 million births found.

Children born to mothers who drink lots of milk and have a high dietary intake of vitamin D during pregnancy have a much lower risk of developing multiple sclerosis later in life, researchers say.

he new study included 35,794 U.S. nurses whose mothers provided information about their experiences and diet during pregnancy. The nurses were followed for 16 years, and 199 of them developed multiple sclerosis (MS) during that time period. "The risk of MS among daughters whose mothers consumed four glasses of milk per day [during pregnancy] was 56 percent lower than daughters whose mothers consumed less than three glasses of milk per month," Dr. Fariba Mirzaei, of the Harvard School of Public Health in Boston, said in a news release from the American Academy of Neurology. "We also found the risk of MS among daughters whose mothers were in the top 20 percent of vitamin D intake during pregnancy was 45 percent lower than daughters whose mothers were in the bottom 20 percent for vitamin D intake during pregnancy," Mirzaei added. The study findings were released online Feb. 9 and will be presented in April at the

annual meeting of the American Academy of Neurology in Toronto. "There is growing evidence that vitamin D has an effect on MS," Mirzaei said. "The results of this study suggest that this effect may begin in the womb." The three most important sources of vitamin D are fortified milk, fatty fish such as salmon and exposure to sunlight.

Although fathers' age can contribute risk, the risk is overwhelmed by maternal age," said University of California at Davis researcher Janie Shelton, the study's lead author. Mothers older than 40 were about 50 percent more likely to have a child with autism than those in their 20s; the risk for fathers older than 40 was 36 percent higher than for men in their 20s. Even at that, the study suggests the risk of a woman over 40 having an autistic child was still less than 4 in 1,000, one expert noted. The new research suggests the father's age appears to make the most difference with young mothers. Among children whose mothers were younger than 25, autism was twice as common when fathers were older than 40 than when dads were in their 20s. The findings contrast with recent research that suggested the father's age played a bigger role than the mother's. Researchers and other autism experts said the new study is

more convincing, partly because it's larger. Older mothers are known to face increased risks for having children with genetic disorders, and genes are thought to play a role in autism. Maureen Durkin, a University of Wisconsin researcher who also has studied the influence of parents' age on autism, said it's important to note that the increased risks are small and that most babies born to older mothers do not develop autism. Catherine Lord, director of the University of Michigan's Autism and Communication Disorders Center, said the study is stronger than previous research focusing on paternal age, and "gives us a fuller picture of what is going on." Autism is a developmental disorder that involves mild to severe problems with behavior, communication and socializing.

Scientists Pinpoint Area of Brain That Fears Losing Money

Researchers say they've pinpointed the area of the brain responsible for the fear of losing money, a finding that offers insight into human economic behavior.

he neuroscientists concluded that the human aversion to losing money is tied to the amygdala, a structure that registers rapid emotional reactions and plays a role in depression, anxiety and autism. The study included two people with amygdala damage caused by a rare genetic disease and a control group of volunteers without amygdala damage. All the participants were asked if they were willing to accept a variety of gambles involving small amounts of money. The two people with amygdala damage

accepted risky gambles much more often than those in the control group and showed no aversion to money loss.

"Monetary-loss aversion has been studied in behavioral economics for some time, but this is the first time that patients have been

reported who lack it entirely," study first author Benedetto de Martino, a University College, London, neuroscientist who is a visiting researcher at the California Institute of Technology, said in a news release from Caltech. "We think this shows that the amygdala is critical for triggering a sense of caution toward making gambles in which you might lose," a function that may be similar to the amygdala's role in fear and anxiety, said Colin Camerer, a professor of behavioral economics at Caltech. "Loss aversion has been observed in many economic studies, from monkeys trading tokens for food to people on high-stakes games shows, but this is the first clear evidence of a special brain structure that is responsible for fear of such losses," he added. The study appears in this week's issue of the Proceedings of the National Academy of Sciences.

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Being bored could be bad for your health

In a commentary to be published in the International Journal of Epidemiology in April, experts say there's a possibility that the more bored you are, the more likely you are to die early.

nnie Britton and Martin Shipley of University College London caution that boredom alone isn't likely to kill you — but it could be a symptom of other risky behavior like drinking, smoking, taking drugs or having a psychological problem. The researchers analyzed questionnaires completed between 1985 and 1988 by more than 7,500 London civil servants ages 35 to 55. The civil servants were asked if they had felt bored at work during the previous month. Britton and Shipley then tracked down how many of the participants had died by April 2009. Those who reported they had been very bored were two and a half times more likely to die of a heart problem than those who hadn't reported being bored. But when the authors made a statistical adjustment for other potential risk factors, like physical activity levels and employment grade, the effect was reduced. Other experts said while the research was preliminary, the link between boredom and increased heart problems was possible — if not direct. "Someone who is bored may not be motivated to eat well, exercise, and have a hearthealthy lifestyle. That may make them more likely to have a cardiovascular event," said Dr. Christopher Cannon, an associate professor of medicine at Harvard University and spokesman for the American College of Cardiology.

Cancer care begins with us.

He also said if people's boredom was ultimately linked to depression, it wouldn't be surprising if they were more susceptible to heart attacks; depression has long been recognized as a risk factor for heart disease. Cannon also said it was possible that when people are bored, dangerous hormones are released in the body that stress the heart. Britton and Shipley said boredom was probably not in itself that deadly. "The state of boredom is almost certainly a proxy for other risk factors," they wrote. "It is likely that those who were bored were also in poor health." Others said boredom was potentially as dangerous as stress. "Boredom is not innocuous," said Sandi Mann, a senior lecturer in occupational psychology at the University of Central Lancashire who studies boredom. She said boredom is linked to anger suppression, which can raise blood pressure and suppress the body's natural immunity. "People who are bored also tend to eat and drink more, and they're probably not eating carrots and celery sticks," she said. Still, Mann said it was only people who were chronically bored who should be worried. "Everybody is bored from time to time," she said.

Too Much Mercury in Canned Tuna -- Or Is There?

A report last week that more than half of samples of brand-name canned tuna contained more mercury than deemed safe by the U.S. Environmental Protection Agency (EPA) raised concern among tuna lovers everywhere.

et the same report found that only 5 percent of canned tuna samples contained mercury levels that exceeded the U.S. Food and Drug Administration's (FDA) standards for safety, which are less stringent than the EPA's. The question for consumers is: What gives? And is it OK to keep eating that tuna sandwich? "We never say, 'Don't eat tuna,'" said lead study author Shawn Gerstenberger, a professor of environmental and occupational health at the University of Nevada Las Vegas. "We are saying if you are in a high-risk

group and are worried about mercury exposure, there are some easy consumer choices you can make to limit exposure." In the study, published in the February issue of Environmental Toxicology & Chemistry, researchers tested more than 300 samples of canned tuna and found "white" tuna, or albacore, consistently had higher concentrations of mercury than "light" tuna. Fish generally accumulate mercury in two ways: either by absorbing it through their skin or scales from the water itself, or by eating other organisms that contain mercury. Since albacore is a larger species that's higher up on the food chain than light tuna species, it generally contains more mercury, Gerstenberger explained. According to the EPA and the FDA, highrisk groups, including pregnant women, nursing mothers, women who may become pregnant and young children, should limit their weekly tuna consumption to no more than 12 ounces (two meals) of light tuna a week, or up to 6 ounces of albacore. While the federal agencies agree on their consumption guidelines, the FDA and the EPA differ on one significant issue: standards for how much mercury is safe for tuna to contain in the first place. The FDA sets a standard of no more than 1.0 parts per million (ppm) of mercury for commercially caught fish. Most of the tuna sold in U.S. grocery stores is commercially caught and therefore subject to the FDA standards.

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Erectile dysfunction: Viagra Advance Toward and other oral medications Test for Aggressive Prostate Cancer

Wondering about drugs to treat erectile dysfunction? Find out how Viagra, Levitra and Cialis compare with each other.

iagra, Levitra and Cialis are often the first treatment tried for erectile dysfunction — the inability to achieve or sustain an adequate erection for sexual activity. For most men with erectile problems, they work well and have few side effects.

Harvard researchers report what they say is a major advance toward the longsought goal of a genetic test that can distinguish between aggressive prostate cancers that require urgent treatment and slow-growing tumors that can safely be left alone.

oday, many men diagnosed with prostate cancer are treated with radiation or chemotherapy even though most of those cancers will grow so slowly that they are not dangerous. It is the cancers that metastasize -- spread outside the prostate gland -- that typically are life-threatening.

"For the first time, we showed in a mouse model that when you take a gene out, you get metastasis and when you put it back in you don't get metastasis," said study author Karen Cichowski, an assistant professor of medicine in the division of genetics at Harvard's Brigham and Women's Hospital. "It looks like the entire pathway is driven by this one gene, the cascade that drives metastasis."

Studies of human prostate cancers have shown the same effect, she said: "We have looked at the genetic pathway in a large number of human tumors, and have found it to be deregulated in more advanced prostate cancers."

The finding could lead to better treatment of prostate cancer, because the molecule whose production is governed by the gene can be a target of drug therapy, Cichowski said.

The molecule, designated EZH2, is an enzyme, and "enzymes are always good potential therapeutic targets," she said. "Many companies are working to develop EZH2 inhibitors." The Brigham and Women's pro-

gram is one of a number being carried out in competitive fashion at several U.S. medical research centers. They are looking at a cluster of genes whose connection with prostate cancer was first described in 2002 by Jer-Tsong Hsieh, a professor of pathology and urology at the University of Texas Southwestern Medical Center at Dallas. "We complement each other; our findings are very similar," Hsieh said of the Harvard work. "I am a cell biologist and look for the protein. She uses a genetic approach." Hsieh's group has published several papers on the research, one as recent as last month. One current effort is to develop a chemical reagent that can detect the enzyme, he said.

Another researcher in prostate cancer genetics is Dr. Arul Chinnaiyan, a professor of pathology and urology at the University of Michigan.

The newly reported study "provides a nice mechanistic link as to why EZH2 leads to metastatic cancer," Chinnaiyan said. "It is exciting because there is a lot of interest in the biotechnology world in developing inhibitors of EZH2."

All three medications improve erectile function in the same basic way, but the effects of tadalafil (Cialis) last longer. This and a few other minor differences among these medications may make one a better choice over another for some men.

Viagra, Levitra and Cialis increase levels of nitric oxide, a chemical produced by your body during sexual stimulation that causes blood vessels in the penis to relax and open. This allows you to achieve and maintain an erection. These medications don't automatically trigger an erection; sexual arousal is needed to start the whole process.

Which is best for you?

Viagra, Levitra and Cialis each have a slightly different chemical make up. These minor differences affect the way they work, such as how quickly they take effect and wear off; how they interact with other medications; and side effects. Your doctor will consider these factors when deciding if one of these medications is a good choice for you.

Not safe for everyone

Although these erectile dysfunction medications can help many people, not all men can safely take them. Viagra, Levitra and Cialis may not be a good choice if you have:

Heart problems, including a recent heart attack, heart pain (angina) during sex, heart failure, heart rhythm problems (arrhythmias) High or low blood pressure (hypertension or hypotension) that isn't controlled A history of stroke within the last six months Relatives with retina disorders, including retinitis pigmentosa Sickle cell anemia, leukemia or other health conditions that can cause an erection that won't subside (priapism)

Sexually Transmitted Diseases Detection and Prevention

What are sexually transmitted infections?

Sexually transmitted infections (STIs) are infections you can get by having sex with someone who has an infection. These infections are usually passed by having vaginal intercourse, but they can also be passed through anal sex, oral sex or skin-to-skin contact. STIs can be caused by viruses or bacteria. STIs caused by viruses include hepatitis B, herpes, HIV and the human papilloma virus (HPV). STIs caused by bacteria include chlamydia, gonorrhea and also syphilis.

Am I at risk for having an STI?

His laboratory is working on such inhibitors, Chinnaiyan added.

If you've ever had sex, you may be at risk for having an STI. Your risk is higher if you have had many sex partners, have had sex with someone who has had many partners or have had sex without using condoms. Some common symptoms of STIs are listed in the box below.

"This is the first study to definitively show not only the gene but also the pathway that drives metastasis in prostate cancer," Cichowski said. "Now that we know this pathway, there are many ways to target it."

Itching around the vagina and/or discharge from the vagina for women Discharge from the penis for men Pain during sex or when urinating Pain in the pelvic area Sore throats in people who have oral sex Pain in or around the anus for people who have anal sex Chancre sores (painless red sores) on the genital area, anus, tongue and/or throat A scaly rash on the palms of your hands and the soles of your feet Dark urine, loose, light-colored stools, and yellow eyes and skin Small blisters that turn into scabs on the genital area

"Chinnaiyan showed that this gene for EZH2 is highly expressed in advanced prostate cancer," Cichowski said. "Hsieh showed that a second gene in this genetic pathway was a target of EZH2 and could be silenced by EZH2. It was one of 250 genes targeted by EZH2. We showed that in a mouse model the gene is the primary target of EZH2 in prostate cancer." That gene, DAB2IP, is suppressed in human prostate cancer, and the degree of suppression correlates with the aggressiveness of a cancer, the journal report said.

Viagra, Levitra and Cialis: How they work

Common signs/symptoms of STIs

Swollen glands, fever and body aches Unusual infections, unexplained fatigue, night sweats and weight loss Soft, flesh-colored warts around the genital area

Should I be checked for STIs?

See your doctor if you're at risk for having an STI, if you have any of the symptoms listed above, or if you have concerns about whether you have one. STIs can cause serious healthy problems if left untreated. For example, chlamydia can lead to problems that can cause women not to be able to have children (infertility). HPV can lead to cancer of the cervix or penis, and syphilis can lead to paralysis, mental problems, heart damage, blindness and even death.

How are STIs diagnosed?

Most STIs can be diagnosed through an exam by your doctor, a culture of the secretions from your vagina or penis, or through a blood test.

Can STIs be prevented?

Yes. The only sure way to prevent STIs is by not having sex. If you have sex, you can lower your risk of getting an STI by only having sex with someone who isn't having sex with anyone else and who doesn't have an STI. You should always use condoms when having sex, including oral and anal sex.

Do condoms prevent STIs?

Male latex condoms can reduce your risk of getting an STI if used correctly (see the box below). Be sure to use them every time you have sex. Female condoms aren't as effective as male condoms, but should be used when a man won't

use a male condom. Remember, though, that condoms aren't 100% safe and can't protect you from coming in contact with some sores (such as those that can occur with herpes) or warts (which can be caused by HPV infection).

What else should I do to prevent STIs?

Limit the number of sex partners you have. Ask your partner if he or she has, or has had, an STI and tell your partner if you have had one. Talk about whether you've both been tested for STIs and whether you should be tested. Look for signs of an STI in your sex partner. But remember that STIs don't always cause symptoms. Don't have sex if you or your partner are being treated for an STI.

Wash your genitals with soap and water and urinate soon after you have sex. This may help clean away some germs before they have a chance to infect you.

Should I use a spermicide to help prevent STIs?

No. It was once thought that spermicides with nonoxynol-9 could help prevent STIs much like they help prevent pregnancy -- by damaging the organisms that cause the diseases. New research has shown that nonoxynol-9 can irritate a woman’s vagina and cervix, actually increasing the risk of STI infection. Be sure to check the ingredients of any other sex-related products you own, such as lubricants and condoms. Some brands of these products may have nonoxynol-9 added to them. If you are unsure if your spermicide or any other product contains nonoxynol-9, ask your doctor before using it.

FEBRUARY â&#x20AC;˘ 2010

FLORIDAHEALTHNEWS-ONLINE.COM

Soft Drinks Could Boost Pancreatic Cancer Risk

People who down two or more soft drinks a week may have double the risk of developing deadly pancreatic cancer, compared to non-soda drinkers, new research suggests.

ut the overall number of people developing the malignancy remains low, with the U.S. National Cancer Institute (NCI) estimating 42,470 new cases last year. "Soft drinks are linked with a higher risk of pancreatic cancer," said Noel Mueller, lead author of a study appearing in the February issue of Cancer Epidemiology, Biomarkers & Prevention. "We can't speculate too much on the mechanism because this is an observational study, but the increased risk may be working through effects of the hormone insulin." Still, the report should not cause undue alarm, some say. "The study was well designed but smaller than some previous studies that did not find a link between sugar-sweetened soft drinks and pancreatic cancer," noted Eric Jacobs, strategic director of pharmacoepidemiology at the American Cancer Society. "Direct evidence linking sugar-sweetened soft drinks to pancreatic cancer remains limited." And adult soda drinkers may also engage in other lifestyle habits, such as smoking, which could contribute to the elevated risk. "It's an interesting finding but if you look at the people who had the high soft drink intake, they also had other issues that may also predispose you to pancreatic cancer," said Dr. Colin D. Weekes, assistant professor of medicine at the University of Colorado Denver. "It's hard to make any true as-

sociations from this. "We could argue that smoking could be the issue here and not the soda intake." Although the study didn't differentiate between regular and diet soda, it was conducted in Singapore, where most soda consumed is regular, Mueller said. The study was a collaboration between the University of Minnesota and National University of Singapore. Mueller, formerly at Minnesota, has since joined Georgetown University Medical Center in Washington, DC, as a research associate. The analysis involved more than 60,000 middle-aged or older Chinese Singaporeans. Researchers calculated how much juice and soda the participants drank on average and followed them for 14 years to see how many developed cancer of the pancreas. Those who drank two or more sodas a week

were 87 percent more likely to develop this kind of tumor than individuals who didn't consume any soda. Researchers found no link between juice consumption and cancer risk, perhaps because fruit juice has less effect than sugary sodas on glucose and insulin levels, the authors noted. Previous research in U.S. and European populations has suggested an association between sweetened sodas and juices and pancreatic cancer. This is the first study to examine the association in an Asian population, although the authors feel the findings can be extrapolated to Western nations. "We believe that because Singaporean adults have a lot of the same mannerisms as Western countries, which is a tendency to eat fast food and also go shopping, one could say that these findings may be gener-

alizable to other Western countries," said Mueller. "Genetically they are very different from Caucasians, however their lifestyle is similar to Western countries." The findings are biologically plausible. Type 2 diabetes, a disorder of blood sugar levels and insulin under-activity, has also tentatively been linked to pancreatic cancer. The researchers speculate that elevated blood sugar levels associated with sodadrinking and the associated increase in insulin levels prompt pancreatic cells to divide abnormally. "Drinking sugar-sweetened soft drinks has been linked to weight gain, obesity and diabetes. Both obesity and diabetes are associated with higher risk of pancreatic cancer, one of the leading causes of cancer death in the United States," Jacobs said. The soft drink industry disputed the findings, however. "The [study] authors are skipping several steps in trying to connect soft drinks with pancreatic cancer, including an allegation regarding an increase in insulin production," Richard Adamson, a consultant to the American Beverage Association and former scientific director of the NCI, said in a statement. "The fact remains that soft drinks do not cause cancer, nor do any authoritative bodies, such as NCI, name soft drinks as a risk factor for pancreatic cancer," he added. "You can be a healthy person and enjoy soft drinks. The key to a healthy lifestyle is balance -- eating a variety of foods and beverages in moderation along with getting regular physical activity," Adamson added. Others took a more cautious view. "The bottom line is that limiting consumption of sugar-sweetened soft drinks can help in maintaining a healthy weight, which in turn will reduce risk of many types of cancer and other serious diseases," Jacobs said.

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8 FEBRUARY â&#x20AC;˘ 2010

Cell Phones, Video Games Don't Spur Teen Headaches

ell phones, televisions and computer games aren't giving teenagers headaches, researchers say, but listening to one or two hours of music daily may make their heads throb. The authors of a study published online Feb. 9 in the journal BMC Neurology looked at a group of 13- to 17-year olds - 489 who said they had headaches and 536 who didn't. No association was seen between electronic media devices and headaches. "Excessive use of electronic media is often reported to be associated with longlasting adverse effects on health, like obesity or lack of regular exercise, or unspecific symptoms like tiredness, stress, concentration difficulties and sleep disturbances," said study co-author Astrid Milde-Busch of Ludwig-MaximiliansUniversity Munich in Germany. "Studies into the occurrence of headaches have had mixed results and for some types of media, in particular computer games, are completely lacking". As for a link between music-listening and headaches, it's not clear if listening to music causes the headaches or is something teens do to soothe themselves when they get a headache.

FLORIDAHEALTHNEWS-ONLINE.COM

Center for Wound Care And Hyperbaric Medicine with new Center Director On February 10th the Center for Wound Care and Hyperbaric Medicine welcomed it's new Director Susan Gauthier.

The center is affiliated with Wellington Regional Medical Center. If you need information regarding services provided by the center's multidisciplinary team please call 561 753-2680.

Pressurized Chambers to give Hyperbaric Oxygen Therapy to patients.

From left to right: Dr. Steven Goff, M.D., Susan Gauthier, Center Director; Dr. Thomas Scott, Dr. Arthur Hansen, D.P.M., M.S. and Dr. Lori Lane.

Dr. Thomas Scott, Quinn King, R.N., Beth Giovannelli, R.T. and Anne Lewis, M.D.

Nancy Paez, Program Director Coral Springs Medical Center; Debbie Lipscomb, Program Director Boca Raton Community Hospital and Mike Markey, Area Vice President Diversified Clinical Services.

FEBRUARY • 2010

FLORIDAHEALTHNEWS-ONLINE.COM

Dieters Beware: Calorie Counts Are Frequently Off

Space Available LAKE WORTH - LARGE OFFICE in suite of 3 offices with private waiting room for Mental Health or other Professional available immediately. Internet ready, Full or part time, extremely reasonable, check it out.

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When you buy a car with a sixcylinder engine, you expect to get six cylinders. When you buy a dress in a size 10, you expect a size 10. And when you buy a burger at a fast-food joint that's listed on the menu as containing 500 calories, you jolly well expect 500. But you may be getting a lot more than that. The same may be true of the omelet and the pasta you get at a sit-down restaurant — and of the frozen dinner with the label you read so carefully before you tossed it in your supermarket basket and took it home.

ccording to a new study published in the Journal of the American Dietetic Association, prepared foods may contain an average of 8% more calories than their package labels own up to and restaurant meals may contain a whopping 18% more. Worse still, as far as Food and Drug Administration regulations are concerned, that's perfectly O.K.

The findings are the result of work conducted by Susan Roberts, professor of nutrition at Tufts University, and Jean Mayer, of Tufts' USDA Human Nutrition Research Center on Aging. It was Roberts who initiated the study, and it was her own struggles with weight that got her started. Author of the book The Instant Diet, she was working on new recipes for the paperback version (retitled The "i" Diet) and, as was her practice, used herself as a guinea pig. As a rule, she lost weight on the menu plans she recommended to readers, but when she redeveloped some of the meals using what were supposed to be calorically equivalent supermarket or restaurant foods, the pounds stopped dropping off. Just as suspiciously, she always felt full. "I went into the lab and said, 'I don't believe these calorie numbers,' " she says. "So we went out and started collecting foods and sampling their contents."

In all, she studied 29 restaurants and 10 frozen-food products, taking care to select foods that dieters would be likely to choose, which meant that they were said to contain

500 calories or fewer and that, in restaurants, they were among the lowest-calorie items on the menus. Back in the lab, Roberts' tests revealed the high-calorie truth, and the numbers were even more troubling than ordinary dieters would appreciate.

No one would deny that the 18% calorie overload on restaurant menus is a problem. The additional 8% in frozen foods sounds less serious; in a 500-calorie entree, after all, 8% adds only 40 calories. That, however, is in a single meal. Over the course of a year, consuming just 5% more than you need in a 2,000-calorie diet can mean a 10-lb. weight gain. "The 18% and 8% figures are just what you need not to lose weight," says Roberts.

In her book, Roberts reformulated menus to correct for the problem, but there's a big, fattening world out there that isn't taking such remedial steps. Federal regulations are strict about the accuracy of the net weight of a package of prepared food, which must be at least 99% of the advertised weight. When it comes to calories, the count can be a far bigger 20% off. The Federal Government plays no role in checking the calorie claims in restaurants, which means it's up to the states to handle the job — with the predictable patchwork results. "It really is the Wild West when it comes to this," says Roberts. "And when state inspectors do visit, they have other issues to worry about — like making sure there are no mouse droppings in the kitchen."

Even a restaurant whose published numbers are accurate down to the last calorie still may not give customers a truly realistic sense of what they're consuming. Every item on the menu, after all, has a separate calorie count, but many people pay attention mostly to the main course, piling on side dishes as something of an afterthought. Five of the restaurants in the survey even provided side dishes at no extra cost, and these added up to an average of 471 extra calories — exceeding the 443-calorie average of the entrees. "What they should be telling consumers," Roberts says, "is what actually comes on the plate." That seems like a fair requirement. It's hard enough to maintain your weight in the allyou-can-eat buffet that is the modern world. The least the health-conscious should be able to expect is a fair reading of what they're eating — and they can take responsibility from there.

• Dr. Chandra Venugopal • Dr. Jean Foucauld • Dr. Amarnath Vedere • Dr. Neerav Shah • Dr. Mauricio Melhado • Dr. Elizier Hernandez

3347 State Rd. 7 Suite 203 Wellington, FL 33449

(561) 793-6100 • Fax (561) 793-1974 941 S.E. First Street Belle Glade, FL 33430

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10 FEBRUARY • 2010

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ways to make over your relationship with food so it's happier, healthier, and guilt-free too long to eat and then overdo it? By connecting the way you eat with how you feel, you can notice patterns and, if necessary, change them.

As someone who loves food, I get really irritated when people chide, "Do you live to eat? Or do you eat to live?" Food is a celebratory part of our culture, and it can be the part of every day when we get to reconnect with people we love, and feed our weary bodies and minds. But when the hustle and bustle of daily life takes over, these positive aspects of eating are usually the first to go -- we're swinging around drive-thrus, eating in the car, bingeing late at night, and hurrying through a meal in front of the TV. So if your relationship with food has turned into an abusive one (and let's be real -- this is a relationship with ups and downs) here are 10 ways to get back on the right track. Just reading that sentence might have sent you into a panic. Relax -- I'm not telling you to forget everything you know about healthy eating, I'm asking you to change your perspective. Diets are temporary ("I want to lose weight for my wedding."). Diets are about numbers ("I want to lose 10 pounds."). Diets are a metaphor for what we really want in life ("When I lose weight, I'll finally be happy.") Let go of these ideas. Instead, think about the long haul ("I want to be able to play with my grandchildren someday."). Think about how you feel ("Eating quinoa gave me so much energy!"). Think about what you really want out of life ("I want to run a 10K."). The tools, tricks, and mentality of dieting won't fix your life or solve your problems, but thinking about what you want out of life and making decisions based on that will.

7. Ask yourself what you really want.

You know when you're not even hungry anymore, but dinner was good, and the lure of a second plate is right there within reach? You find yourself shrugging and thinking, "Ah, why not?" Instead of going for the second helping of food you don't really want, ask yourself what you really want. Do you want a piece of dark chocolate? Do you want to get up from the table and go back to your kitting? Do you really, really want a pair of skinny jeans? Let what you actually want inform your decisions.

1. Stop dieting.

Can we all just agree that you were not "bad" if you had a piece of cake? That you were not "good" if you resisted seconds? These words are laden with the kind of judgment that's the last thing you need when you are trying to learn how to approach food from a healthier point of view. You made a choice that either supported your

2. Change your vocabulary.

When your boss tells you your TPS reports weren't up to snuff and you still made it through the day without tears, it's tempting to treat yourself to a bag of chocolate-covered pretzels. But is this really a treat? Or is there a chance that deep down, you know you'll feel worse-off than you did before? Think about treats that will actually make you feel better: a new lipstick, painting your nails, stopping to pet every puppy you pass on the street.

8. Reconsider "treats."

health goals or it didn't --- but that choice doesn't make you "bad" or "good."

3. Think, shop, and eat like a French woman.

There's a reason why French Women Don't Get Fat became a runaway bestseller, and it's not because we all wanted to figure out how to be skinny and eat croissants for breakfast. With our focus on restrictive diets and punishing workouts, we've completely divorced food from pleasure. On the list of great pleasures in life, food is up there right after sex. So when you're in the grocery store, really appreciate the sensory aspects of the food on sale: the colors, smells, the feel of the wet spinach leaves between your fingers. Visit a farmer's market and chat with the growers about how they like to cook their crops. Taste your food and experience the deep delight of eating something delicious.

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it just boredom? If it's hunger, by all means, eat up! But be aware if your desire to munch away is fueled by something else. If find yourself about to cuddle up with a box of chocolate cookies and you know it's not because you're hungry, try to just pause for a minute. Whatever the feeling is you're attempting to eat away, sit with it. Feel all its discomfort. It feels bad doesn't it? (No wonder we eat to get away from it!) Instead of masking those feelings with a binge, write down how you're feeling or call an understanding friend. The feeling is still going to be there after a snack attack, but if you confront your emotions head on, you'll find a better way to ease the pain.

5. Sit with a feeling.

Most of us have no idea what we eat in a day or how much. Start writing down what you eat, not necessarily as a way to lose weight, but just to see how what you eat makes you feel. After each meal or snack, jot down your post-eating sensations: Do you feel like you need a nap? Did you wait

6. Start a food journal.

Dinner with friends after work is one way to catch up, but there are so many other options that don't involve food and that annoying dessert tug-of-war. Go to a yoga class, bundle up and take a walk through the park, see that art exhibit that's about to close, or bond over your embroidery and a cup of tea.

9. Nix peer pressure.

When I am so hungry that I am literally wolfing down my food, I'll notice that I'm practically holding my breath. The same mindful breathing that can get you to relax is absent from hurried eating. Slow down. Take a bite. Take a breath. Pay attention to what's happening right now: the tastes, the smells, the textures, the conversation you're having over dinner. Take it all in mindfully and slowly...and enjoy!

10. Slow down.

We all have to eat every day, so you're all experts on this subject, too. What else have you tried that's given you a healthy perspective on food and eating?

FEBRUARY • 2010

FLORIDAHEALTHNEWS-ONLINE.COM

Case Studies: ''Simple'' Problems That Could Be The Tip of an Iceberg fection and gets treated with antibiotics. His headaches continue to get worse.

Shekhar V. Sharma, M.D. Board Certified in Internal Medicine

An elderly gentlemen comes in to my office with an ear ache. After examining his ears I come to the conclusion of a diagnosis of TMJ syndrome which is totally unconnected to his complaint of an ear ache. TMJ syndrome is when the joint between the two jaws gets inflamed and causes pain.

patient with severe headache gets a CAT SCAN of the brain and the result is normal. He goes to the ER due to the severe headaches. He is thought to have a sinus in-

Zygomatic Arch (cheekbone)

He then comes to me and based on his lab tests I find out that he has a pituitary problem in the brain. I then order a MRI of the brain which reveals a mass in the brain that causes the severe headaches. He is readmitted to the hospital and is found have a lung mass. It was later found out that the lung mass was cancer and that it had spread to the brain in the form of metastasis. Just remember that when this patient had come in to my office all he had was a headache.

A female patient comes in with heartburns She asks me for medication for heartburns saying it is acid from the stomach that is causing it. I insisted that she get an EKG done and see me immediately in the office. She refused to see me saying she was in a hurry to leave town on a business trip. It turned out that she had a heart attack the next day. A simple symptom of heartburn can be quite deceiving.

A young lady after child delivery had pain and weakness of the right arm. She went to two different neurologists. No one could diagnose the condition. This symptom went on for months. In fact one doctor even told her it was in her mind and that it was psychological. She then came to me. After exa-

Mandible Temporomandibular Joint

mination and taking a detailed history I found out that she had an unusual condition called Brachial Plexopathy. To confirm the diagnosis I sent her to the Neuro Muscular Department of the University of Miami. The professor in that department confirmed my diagnosis. Please remember if a simple problem occurs

in your health, do not take it lightly. Consult your physician so an exact diagnosis can be made on time.

Dr.Sharma is a Board certified Internist that has been in practice for the past 19 years. His office is accepting new patients and for an appointment please call 561-795-9087.

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12 FEBRUARY • 2010

FLORIDAHEALTHNEWS-ONLINE.COM

2010 Komen Race for the Cure. More Than 22,000 attend the Annual Event

Hospice of Palm Beach County provides care to all who need and want it, regardless of insurance or financial status. Donations, grants and proceeds from fundraising events supplement the insurance reimbursement to ensure that cost for services is never an issue for our patients or their families. Nearly 900 highly trained employees and more than 600 caring volunteers make this a program that excels in innovative care and quality service to our community.

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Race Grand Marshall, Olivia Newton-John and Susan G. Komen Founder and CEO Ambassador Nancy G. Brinker lead the survivors during the Survivor Ceremony

More than 22,000 people gathered on January 30 along the waterfront in downtown West Palm Beach in celebration of local breast cancer survivors and participants of the 2010 Susan G. Komen South Florida Race for the Cure®— including honored guest and Race Grand Marshall Olivia Newton-John and Susan G. Komen for the Cure founder and CEO, Ambassador Nancy G. Brinker.

This was our largest-attended Race to date and we are so thrilled to have surpassed our fundraising goals," said Patti Abramson, 2010 Race chair. "Our sponsors' and participants' true dedication to the cause has brought us closer to finding a cure."

After the coed 5k competitive run, co-ed 5k walk, kids and tots races and the Family Fun Walk, the morning culminated with a moving Survivor Ceremony on stage at the Meyer Amphitheater. There, more than 1,600 breast cancer survivors were led on stage by the Palm Beach County Firefighters Pipe and Drum Corp to be honored by everyone in attendance.

"Being a part of the Susan G. Komen South Florida Race for the Cure was an honor and such a moving and inspiring experience for me," said Olivia Newton-John, Grand Marshall of the Susan G. Komen South Florida Race for the Cure. "Speaking to so many breast cancer survivors and hearing their amazing stories gave me more hope that we will find a cure and beat breast cancer for good— early detection is key to survival."

Race sponsors included Presenting Sponsor, Florida Power &amp Light; Host Hospital, Martin Memorial Health Systems; Premiere Sponsor, The Gardens Mall; Good Samaritan Medical Center; Palm Beach Ford Dealers; La Croix; Panera Bread; Quarterdeck; Primary Care Specialists; Media Sponsors, WPTV NewsChannel 5, The Palm Beach Post, Palm Beach Illustrated, Palm Beach Daily News, KOOL 105.5 and WILD 95.5.

Komen for the Cure is the world's largest grassroots network of breast cancer survivors and activists. Komen South Florida Race for the Cure is the largest fundraiser for the South Florida Affiliate and has the distinction of being the first race of the year among all affiliates. The Affiliate is still accepting Race fundraising dollars through February 26. The Affiliate serves Palm Beach, Martin and St. Lucie counties.

Psychotherapy May Help Teen Girls Avoid Obesity

A psychotherapy program may work better than traditional health classes in preventing teenage girls at risk of obesity from becoming excessively fatter, researchers report.

he program "focuses on improving interpersonal relationships by targeting the underlying social and interpersonal difficulties that influence individuals to engage in maladaptive behaviors," said Marian TanofskyKraff, assistant professor in the Uniformed Services University's Department of Medical and Clinical Psychology, in a statement. She is co-author of a new study that looked at using the program to help teens control eating. It is "based on an assumption that binge eating occurs in response to poor social functioning and the consequent negative moods," she said.

The study authors randomly assigned 38 girls to attend psychotherapy sessions or standard health-education classes. Over a 12-month period, those who took part in the psychotherapy sessions were more likely to stabilize or reduce their body mass index, a measurement of obesity.

If the program "proves to be effective, we may be able to prevent not only excessive weight gain, but the development of related adverse health conditions in a subset of susceptible youth," Tanofsky-Kraff said. The study is published in the International Journal of Eating Disorders.

FEBRUARY • 2010

FLORIDAHEALTHNEWS-ONLINE.COM

Poor Circulation of poor circulation in your feet and legs can be as subtle as the loss of hair on your toes or swelling of the feet and ankles to as noticeable as painful leg cramping. In this article I'll discuss some of the signs of poor circulation to the legs and feet from the most subtle to the most noticeable.

By Dr. Arthur Hansen, D.P.M., M.S.

Do you know that the arteries in you feet and legs can develop the same pathologies that they do around your heart? While the end result of poor circulation in the legs and feet is not a heart attack, it can be devastating none the less. The chance of death increases each year following the loss of a leg.

s director of the Diabetic Foot Clinic at the Wellington Regional Medical Center Wound Care Center I am all to familiar with the difficulties and devastating end results of poor circulation not identified early and/or not treated.

Poor circulation could be the result of faulty arteries (vessels that deliver blood to the feet) or faulty veins (vessels that return blood from the feet to the heart). Indications

dangling over the bed. The pain is usually unsymmetrical and the legs show marked pallor on elevation and marked redness with dependency.

Hair follicles are some of the most sensitive types of cells in the body and therefore very susceptible to any changes in their environment. Without appropriate nutrients being delivered via bloodflow hair follicles fail to thrive and the result is a loss of visible hair growth. Hair growth on the toes is usually the first area affected followed by the feet and then the legs below the knees.

Many of my patients complain of cold feet and their inability to sleep or go without socks. Cold feet can be result of many different physiological processes but a lack of circulation will definitely lower the temperature gradient of you legs and feet as you move towards your toes.

Another obvious sign of poor circulation can be an ulcerated site on the legs, feet and/or toes that is not healing despite treatment, these lesions are painful and those that suffer from them usually find the most comfort with their legs dangling. They may even sleep in a chair all night because this position allows for optimum blood flow to the extremities.

Cramping in the calves and even the feet with walking and/or exertion is a more noticeable sign of poor circulation, if you repeatedly notice cramping after walking a certain distance that is relieved if you stop and rest for a few minutes is likely that the blood flow to your muscles is inadequate. When you exert the muscles in your legs and feet with walking they require more oxygen and nutrients that if they are resting. If the blood vessels are occluded or are not functioning properly then the muscles are not receiving adequate blood flow.

Symmetrical swelling of feet, ankles and legs can be a sign of poor venous circulation. That is, the veins are having trouble returning the blood from the feet and legs to the heart, therefore, the blood pools in the feet and ankles and swelling is obvious, the swelling is usually less in the morning as you have not been on your feet while sleeping.

It is important to realize that the signs and symptoms mentioned above may or may not be caused by poor circulation, for example, not everyone who lacks hair on their feet and toes or who has cold feet does not necessarily suffer from poor circulation. However, if any of the signs and symptoms mentioned above are consistent and prevent pain free standing and/or ambulation tests to rule out the poor circulation may be indicated.

There are many clinical tests that can be done to determine the existence and extent of circulatory problems. A doppler, or noninvasive vascular study, can be performed which can verify and sometimes quantify circulatory disorders.

Once poor circulation is diagnosed treatment can begin. Treatment options can range from the most conservative such as exercise and diet changes to prescription medications to possible surgical intervention.

I can not stress enough the importance of early detection of poor circulation to the feet and legs.

Varicose veins, painful or not, are a common finding especially among women, these represent faulty valves in the veins and could lead to bulging, painful varicosities and even to ulcerations.

Leg cramping can also occur when the muscles are resting. This "rest pain" is usually worse at night and relieved if the legs are

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14 FEBRUARY â&#x20AC;˘ 2010

Energy Drinks, Alcohol a Dangerous Mix

FLORIDAHEALTHNEWS-ONLINE.COM

Study found college students who drank both were more drunk, more likely to drive. ixing caffeine-laden energy drinks and alcohol is popular among young Americans, but it can lead to higher rates of drunkenness and impaired driving, a new study suggests. University of Florida researchers surveyed more than 800 college-age patrons leaving bars between 10 p.m. and 3 a.m. The participants were asked about their energy drink and alcohol consumption and then had their breath-alcohol concentration levels measured. The 6.5 percent of participants who said they'd been drinking alcohol mixed with energy drinks were three times more likely to be drunk than those who consumed alcohol only. The average breath-alcohol reading for those who consumed alcohol and energy drinks was 0.109, well above the legal limit of 0.08, the study authors noted. The researchers also found that bar patrons who mixed alcohol and energy drinks left the bar later, drank for longer periods of

time, and were four times more likely to say they planned to drive within the hour, compared to those who drank alcohol only, according to the report in the issue of the journal Addictive Behaviors. "There's a very common misconception that if you drink caffeine with an alcoholic beverage the stimulant effect of the caffeine counteracts the depressant effect of the alcohol, and that is not true," study co-author Bruce Goldberger, director of toxicology in the University of Florida College of Medicine, said in a news release from the school. Caffeine simply reduces the sleepy feeling caused by alcohol. This condition, described as "wide awake and drunk," can lead to risky behaviors, Goldberger explained. It's believed that as many as 28 percent of college drinkers consume alcohol mixed with energy drinks in a typical month. "This study demonstrates that there definitely is reason for concern and more research is needed," study author Dennis Thombs, an associate professor in the department of behavioral science and community health at the University of Florida College of Public Health and Health Professions, said in the news release.

Cyndi Lauper, Lady Gaga Put Spotlight on Women and HIV

Pop music star Cyndi Lauper believes that girls should still wanna have fun, they just shouldn't overlook their risk of HIV.

hat's why she and music sensation Lady Gaga are teaming up on a new campaign -- sponsored by MAC Cosmetics' nonprofit MAC AIDS Fund -- to remind women that the virus that causes AIDS remains a potent threat to women as well. "Fighting HIV/AIDS is not a one-woman job," Lauper told HealthDay. "Lady Gaga and I are using our voices as a call to action for women all over the world. I lost a lot of friends to AIDS before we even knew what it was. Today, across the world, women are more likely to become infected with HIV than men. Each one of us needs to do our part to fight for women impacted by HIV and AIDS." And while Lauper, 56, got involved in the fight against AIDS early in the epidemic, Lady Gaga -- the fashion-forward icon whose hits include "Just Dance" and "Pokerface" -- said she's on board for a new generation. "Anything I can do to help raise money for HIV/AIDS awareness -- that's what I'm here for, and I'm very honored to be a part of this," the pop star, 23, said in a statement. There does seem to be a need for better awareness if the results of a new MAC AIDS Fund-sponsored poll of 1,000 American women is any indication. The attitudes reflected in the survey belie the fact that HIV remains a major cause of illness and death for American women.

Among the survey's findings:

In fact, "the number of women living with HIV in the country has tripled since 1985 and it's the leading cause of death for black

Nearly three-quarters (73 percent) of women surveyed do not know their current HIV status.

Most (78 percent) say they've had unprotected sex, and 72 percent of those who had sex without a condom said they did so because they believed they were in an exclusive relationship.

Over half (55 percent) of women say they have never had an HIV test, and about four in every 10 women who were tested can't remember when their last test took place. The average woman who has been tested hasn't had an HIV test in over three years. Nearly six in 10 women (58 percent) say they don't get tested because they believe they are in a monogamous relationship.

One in every five women said there was nothing that would convince them now to get an HIV test, even if they had already had one in the past.

women ages 18 to 35," noted Nancy Mahon, executive director of the MAC AIDS Fund, which has earmarked more than $2.5 million to projects aimed at fighting HIV/AIDS.

The perception lingers that AIDS is "a gay disease," Mahon said. "While it's true that men who have sex with men remain the highest risk group, women are close behind," she noted.

One medical expert agreed.

"In a lot of communities, women still don't think of HIV as a woman's disease unless your boyfriend [turns out to be] gay, you're doing drugs or you're doing something out of the ordinary," said Dr. Shannon Hader, senior deputy director of the HIV/AIDS, Hepatitis, STD and TB Administration at Washington D.C.'s Department of Health.

Hader's team is partnering with the MAC AIDS Fund to increase awareness among residents of the nation's capitol, which has especially high rates of HIV infection. They've also collaborated on one of the first comprehensive efforts to spread awareness about the female condom, which could give women more power over decisions related to protected sex. Hader said too many women trust their partners to keep them safe from HIV, so they don't ask the necessary questions. "Do I know my own and my partner's HIV status? Is it only the two of us in this relationship? And should we use condoms? Relationships aren't always easy, and those aren't always questions that people really want to deal with," Hader said. Too many women also find it tough to get an HIV test, even when they ask for it. According to Mahon, "many women have told us, 'I go out and ask my doctor for a test and they say, well, what have you been up to?'" The solution, according to the experts, is easy: Make the HIV test a routine part of a woman's medical care. "A lot of women who aren't sure if they've been tested for HIV or maybe are complacent about it have been seeing health providers, getting reproductive health care, getting Pap smears, etc.," Hader noted. "So, if they haven't been offered an HIV test every time they have come in for a routine health exam, then it is like the medical community has said, 'This isn't important to you.'" Instead, doctors should, "offer [the test] as a 'no big deal' part of every exam," Mahon reasoned. Otherwise, "it becomes this big stigma point to ask for it." Changes like that will take time. In the interim, efforts like the MAC AIDS Fund's campaign aim to chip away at stereotypes and complacency. As part of the campaign, Lauper and Lady Gaga have each lent their names to a shade of VIVA GLAM lipstick, with 100 percent of the proceeds going to the MAC AIDS Fund. As Lady Gaga noted, women need only take a few simple steps to shield themselves from HIV. "Use protection, and be selective and strong about those you love," she said. "Your body is sacred, and it's OK to say no. Make your partners get tested, go together: it will only make your relationship stronger and healthier." Lauper agreed. "Be smart, be careful, protect yourself," she said in a statement. "And look out for your sisters to make sure they are doing the same."

FLORIDAHEALTHNEWS-ONLINE.COM

Rapid Flu Test Most Accurate for Young Kids

A widely available rapid influenza diagnostic test is good, but not perfect, in determining whether a child has the flu, a new study shows.

he findings are applicable to both the seasonal flu and the H1N1 flu that recently swept across the globe, said Dr. Andrea T. Cruz, an assistant professor of pediatrics at Baylor College of Medicine in Houston, and lead author of a report published in the journal Pediatrics. The study examined records of more than 2,600 children taken to the hospital with suspected influenza between May and September of 2009 and compared the results of a rapid influenza diagnostic test, which can give results in minutes, with two laboratory tests that require hours or days for diagnosis. A quick diagnosis is often desirable, but questions have arisen about the accuracy of the rapid diagnosis tests. The study used one of the 10 commercially available rapid tests approved by the U.S. Food and Drug Administration. It was done because "doctors have been basing clinical decisions on rapid influenza diagnostic tests that were not designed with H1N1 in mind," Cruz said. The study compared the test's sensitivity (the ability to determine whether someone has an infection) and specificity (the ability to rule out the presence of an infection) with a laboratory test. The rapid test was 45 percent sensitive and 98.6 percent specific, the study found.

"The rapid influenza diagnostic test is quite specific but lacks sensitivity," Cruz said. That means a positive rapid test result was "highly accurate" in diagnosing H1N1 infection, but a negative result did not rule out the possibility of infection, the study found. Sensitivity was significantly higher -- 55.5 percent -- in younger children, particularly those under 2 years old, a group more susceptible to flu complications. "Especially for high-risk children, such as those with other illnesses such as asthma, who present with flu-like symptoms, you should consider treating them despite the results of a rapid test," Cruz said. While reported cases of H1N1 influenza in the United States have dropped recently, the rapid-test study results "may help guide clinical decision-making when that third wave comes," Cruz said. The latest report from the U.S Centers for Disease Control and Prevention said no state reported widespread flu activity, but six states were seeing regional activity and 10 states reported local activity.

Mom's Lifestyle in Early Pregnancy Affects Baby's Size

Smoking, low folic acid, high blood pressure restrict fetal growth, study finds.

he lifestyle habits you bring into pregnancy can have lasting effects on your baby's health, new research shows. A Dutch study found that women who smoked, had high blood pressure or low folic acid levels in early pregnancy had babies that were smaller in the first trimester of pregnancy and had a higher risk of complications later. "Our study demonstrates that several maternal physical characteristics and lifestyle habits, such as smoking and non-use of folic acid supplements, affect first-trimester fetal growth," said study senior author Dr. Vincent Jaddoe, a pediatric epidemiologist at Erasmus Medical Center in Rotterdam, the Netherlands.

"First-trimester growth restriction is associated with higher risks of adverse birth outcomes and accelerated postnatal growth rates. Thus, the first trimester of pregnancy seems to be a very critical period for fetal growth and development. This is important, since it suggests that the fetus is already affected before pregnant women visit their midwife or obstetrician," he said. For the study, published in the Feb. 10 issue of the Journal of the American Medical Association, the researchers followed 1,631 pregnant women from their first trimester through their pregnancies. The growth of their offspring was assessed until the children were 2. The average age of the mothers was 31, and 71 percent were white. More than half had a higher than high school education. The average body mass index was 23.5, which is normal (over 25 is considered overweight). About one-quarter smoked at the start of the study. The researchers found that certain factors affected the likelihood that a fetus would have a small crown to rump length (a standard way to measure babies using ultrasound). Babies whose mothers smoked or had higher diastolic blood pressure readings (diastolic is the bottom number in blood pressure) were more likely to be smaller. Women who didn't use folic acid supplements and those with higher levels of red blood cells also had smaller babies, according to the study. A small size during the first trimester translated to a higher risk of certain complications later in the pregnancy, such as preterm birth and low birth weight.

FEBRUARY â&#x20AC;˘ 2010