September 2013 global health tribune by Global Health Tribune

C OMPLIMEN TA RY C OPY - TA K E ON E

Blood test can tell if you are suicidal

Insomniacs' brains lose focus, scans suggest

What Is Scoliosis? Should I Be Worried?

Global Health SEPTEMBER ISSUE - 2013

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Sleep 'boosts brain cell numbers'

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Mammograms should begin at age 40, researcher says

ew breast cancer research reveals a significant death rate among women under 50 who forgo regular mammograms and casts doubt on recent screening guidelines from a U.S. panel of experts. The findings support the merit of regular mammograms, especially for younger women, said study researcher Dr. Blake Cady, professor emeritus of surgery at Harvard Medical School and Massachusetts General Hospital in Boston. "I would propose that women start screening at age 40," Cady said. Younger women tend to have faster-growing, more aggressive tumors, experts say. When mammograms should start and how often they should be repeated has been a controversial subject. In 2009, the U.S. Preventive Services Task Force, a

panel of experts that makes recommendations about health practices, said women aged 50 to 74 should get screening mammograms every two years. Women under 50, the panel said, should talk to their doctors and decide whether to be screened based on potential benefits, such as early detection, and harms, including over-treatment and anxiety caused by false-positive results. The American Cancer Society and other organizations, however, have continued to recommend annual screening beginning at age 40 for women at average risk. More than 40,000 women die of breast cancer in the United States each year. For the new study, published online Sept. 9 in the journal Cancer, researchers evaluated more than 600 breast cancer deaths, looking back at mammography records and other

details. Seventy-one percent of the deaths occurred among unscreened women, most of them younger, Cady found. Half of all the breast cancer deaths occurred in women under age 50, while only 13 percent of the women who died of breast cancer were 70 and older. For the study, Cady and his colleagues tracked invasive breast cancer cases from their diagnoses, between 1990 and 1999, until 2007. Patients were treated at Partners HealthCare

hospitals in Boston. The researchers had access to mammography use, surgery and pathology reports, and dates of death. Cady's team used a technique called "failure analysis," in which scientists look back to see what might have gone wrong. "It's the converse of a randomized trial, which starts at point A and follows people until the end of the study," Cady said. "We follow people who have died and go backward to their original diagnosis and find out the details." Women were described as unscreened if they had never had a mammogram or it had been more than two years since their last mammogram. The findings confirmed the benefits of earlier screening, some experts said. "[The study] presents a very compelling argument in favor of screening beginning at age 40 on

an annual basis," said Dr. Barbara Monsees, chairwoman of the American College of Radiology Breast Imaging Commission, who was not involved in the research. "It corroborates what we have known for a long time." Overall, the study also showed an increase in breast cancer survival coinciding with the emergence of mammography. Half of women diagnosed with breast cancer in 1969 died within 13 years after diagnosis, compared to about 9 percent of those diagnosed between 1990 and 1999 who were included in this study. Although some experts have credited the decline in breast cancer death rates to improved treatments, the study shows that's not the whole story, Monsees said. "This paper shows the decline is primarily due to earlier detection and better screening," she said. GLOBAL HEALTH TRIBUNE P.O. Box 213424 Royal Palm Beach, FL 33421

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September 2013

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MEDICAL NEWS

Sleep 'boosts brain cell numbers'

BBC News Health

Myelin ensheaths nerves to protect them and speed up their signalling.

cientists believe they have discovered a new reason why we need to sleep - it replenishes a type of brain cell. Sleep ramps up the production of cells that go on to make an insulating material known as myelin which protects our brain's circuitry. The findings, so far in mice, could lead to insights about sleep's role in brain repair and growth as well as the disease MS, says the Wisconsin team.

The work is in the Journal of Neuroscience. Dr Chiara Cirelli and colleagues from the University of Wisconsin found that the production rate of the myelin making cells, immature oligodendrocytes, doubled as mice slept. The increase was most marked during the type of sleep that is associated with dreaming - REM or rapid eye movement sleep and was driven by genes. In contrast, the genes involved in cell death and stress responses

were turned on when the mice were forced to stay awake. Precisely why we need to sleep has baffled scientists for centuries. It's obvious that we need to sleep to feel rested and for our mind to function well - but the biological processes that go on as we slumber have only started to be uncovered relatively recently. Growth and repair Dr Cirelli said: "For a long time, sleep researchers focused on how the activity of nerve cells differs when animals are awake versus when they are asleep. "Now it is clear that the way other supporting cells in the nervous system operate also changes significantly depending on whether the animal is asleep or awake." The researchers say their findings suggest that sleep loss might aggravate some symptoms of multiple sclerosis (MS), a disease that damages myelin.

Gut bacteria 'may be obesity weapon' By James Gallagher

health and science reporter, BBC News

acteria living in our guts seem to be affecting our waistlines and harnessing them could lead to new ways of shedding the pounds, US research suggests. The human body is teeming with thousands of species of microbes that affect health. A study showed that transplanting gut bacteria from obese people into mice led to the animals gaining weight, while bacteria from lean people kept them slim. The findings were published in Science. Researchers at the Washington University School of Medicine, Missouri, took gut bacteria from pairs of twins - one obese, one thin.

Bacteria - the next weapon in the war against obesity?

The bacteria were then put into mice which had grown up in completely sterile environments and had no gut bacteria of their own. Mice with the obese twin's bacteria became heavier and put on more fat than mice given bacteria from a lean twin - and it was not down to the amount of food being eaten. There were differences in the number and types of bacteria species from the lean and obese twin.

Overall it seemed those from a lean twin were better at breaking down fibre into short-chain fatty acids. It meant the body was taking up more energy from the gut, but the chemicals were preventing fatty tissue from building up and increased the amount of energy being burned. One of the researchers, Prof Jeffrey Gordon, told the BBC's Science in Action programme: "We don't dine alone, we dine with trillions of friends - we have to consider the microbes which live in our gut." However, the diet was also important for creating the right conditions for the lean twin's bacteria to flourish. A bacterial obesity therapy seems unlikely to work alongside a a diet of greasy burgers.

E-cigarettes 'as effective' as nicotine patches By James Gallagher

health and science reporter, BBC News

lectronic cigarettes appear to be at least as effective as nicotine patches in helping people to give up smoking, research suggests.

The devices, which are rapidly growing in popularity, produce a vapour containing nicotine.

The findings, presented at the European Respiratory Society, showed similar numbers quitting with e-cigarettes as patches, but more had cut down. There was a call, however, for long-term data on safety.

As well as giving a nicotine hit, the e-cigarettes also mimic the sensory sensations of smoking. This has led to speculation that they may be a useful tool for people trying to quit. A team at the University of Auckland, in New Zealand, conducted the first clinical trial comparing the devices with nicotine patches in 657 people. The results published in the Lancet showed 7.3% using ecigarettes had quit after six months compared with 5.8% using patches. However, the study did not involve enough people to definitively prove which is the better option.

After six months, however, the 57% of e-cigarette users had halved the number of cigarettes smoked each day compared with 41% in those using patches.

'Increasing popularity' Prof Chris Bullen, from the University of Auckland, said: "While our results don't show any clear-cut differences between e-cigarettes and patches in terms of 'quit success' after six months, it certainly seems that ecigarettes were more effective in helping smokers who didn't quit to cut down. "It's also interesting that the people who took part in our study seemed to be much more enthusiastic about e-cigarettes than patches.

"Given the increasing popularity of these devices in many countries, and the accompanying regulatory uncertainty and inconsistency, larger, longer-term trials are urgently needed to establish whether these devices might be able to fulfil their potential as effective and popular smoking cessation aids."

Regulations around the world are catching up with the surge in the popularity of e-cigarettes. The EU and the UK are both working towards regulating e-cigarettes in the same way as medicines. The products also divide opinion with some arguing they normalise smoking and others saying they may help people to give up.

Prof Peter Hajek, the director of the Tobacco Dependence Research Unit at Queen Mary University of London, described the study as "pioneering". "The key message is that in the context of minimum support, ecigarettes are at least as effective as nicotine patches.

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September 2013

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THE FORGOTTEN FOOT

Heal that wound, Save Your Leg, Save Your Life

Arthur Hansen DPM, M.S.

o you or someone you know have a stubborn sore that just will not seem to heal?

Perhaps it’s a scratch, blister, open wound, or any area that seems to bleed when you knick it, but doesn’t seem to heal. If so, you may have a chronic wound. With the constant development of new treatments, new drugs, earlier diagnoses, and preventive education, we as a population are living longer even with diseases and maladies that in the past would have shortened our life span. Most chronic wounds are associated with systemic disease processes that inhibit the wound healing. Therefore, since our population is living longer with these systemic disease processes, the chronic wound care population is increasing. A chronic wound is a wound that fails to heal or show significant improvement within a certain

time frame, usually four weeks. It can present to the wound care physician in a number of ways. Wounds can present as open draining sores, a break in the skin that just does not heal, a recurring blister or open area that bleeds, or an open draining sore. Chronic wounds without appropriate treatment are likely to become infected and unfortunately, many will lead to leg amputations. Following a below knee amputation, mortality rates of the patient increase significantly over the next 5-15 years.

When developing a treatment plan we always consider the following:

Pressure Ulcers • Reduce pressure--select appropriate pressure reduction support surface Some characteristics of common chronic wound factors that we identify when first developing a treatment plan are outlined below: for both chair and bed. • Minimize skin exposure to moisture from incontinence, perspiration, or wound drainage. • Minimize environmental factors leading to drying of skin, such as exposure to cold. Chronic Venous Insufficiency • Surgical obliteration or ligation of veins • Valvular repair • Compression therapy • Elevation

The wound care physician must first determine expected outcomes of any wound. The outcome is healing. However, many factors influence the outcome measurement of a chronic wound; therefore, a comprehensive assessment is the significant starting point. The patient's health history is the first critical indicator of one's ability to heal. Disease processes such as peripheral arterial disease, pulmonary disease, diabetes, immune deficiencies, poor nutrition, collagen vascular diseases, and malignancies are all known to impede wound healing and must be identified and addressed.

Arterial Ulcer • Measures to improve tissue perfusion: surgical revascularization • Hyperbaric oxygen • Pharmacologic options Non-Wound Specific • Optimize nutrition/hydration • Glucose control • Measures to support tissue oxygenation • Smoking cessation

At LA Podiatry, we view healing wounds as a priority. Our physicians offer services at three local wound care centers and have working relationships with other specialists that aid in wound healing. As wound care specialists, we know that healing wounds – save legs and save lives.

Therefore, determining the cause of the wound is first and foremost followed by identifying any complicating factors

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September 2013

HEALTHCARE NEWS

Copper linked to Alzheimer's disease

lifetime of too much copper in our diets may be contributing to Alzheimer's disease, US scientists say. However, research is divided, with other studies suggesting copper may actually protect the brain. The latest study in Proceedings of the National Academy of Sciences showed high levels of copper left the brain struggling to get rid of a protein thought to cause the dementia. Copper is a vital part of our diet and necessary for a healthy body. Tap water coming through copper pipes, red meat and shellfish as well as fruit and vegetables are all sources of dietary copper. Barrier The study on mice, by a team at the University of Rochester in New York, suggested that copper interfered with the brain's shielding - the blood brain barrier. Mice that were fed more copper in their water had a greater buildup of the metal in the blood vessels in the brain. The team said this interfered with the way the barrier functioned and made it harder for the brain to get rid of a protein

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called beta amyloid. One of the hallmarks of Alzheimer's disease is the formation of plaques of amyloid in the dying brain. Lead researcher Dr Rashid Deane said: "It is clear that, over time, copper's cumulative effect is to impair the systems by which amyloid beta is removed from the brain." He told the BBC that copper also led to more protein being produced: "It's a double whammy of increased production and decreased clearance of amyloid protein. "Copper is a very essential metal ion and you don't want a deficiency and many nutritious foods also contain copper." However, he said taking supplements may be "going overboard a bit".

Mixed evidence Commenting on the latest findings, Chris Exley, professor of bioinorganic chemistry at Keele University, said there was "no true consensus" on the role of copper in Alzheimer's disease. His research on human brains reached the opposite conclusion: "In our most recent work we found evidence of lower total brain copper with ageing and Alzheimer's. We also found that lower brain copper correlated with higher deposition of beta amyloid in brain tissue. "He said at the moment we would expect copper to be protective and beneficial in neurodegeneration, not the instigator, but we don't know. "The exposure levels used mean that if copper is acting in the way they think it does in this study then it must be doing so in everyone." Dr Eric Karran, from Alzheimer's Research UK, said: "While the findings present clues to how copper could contribute to features of Alzheimer's in mice, the results will need replicating in further studies. It is too early to know how normal exposure to copper could be influencing the development or progression of Alzheimer's in people. "

Blood test can tell if you are suicidal ONDON: A simple blood test can now identify people most prone to committing

suicide. Scientists from Indiana University School of Medicine researchers have found a series of RNA biomarkers in blood that may help identify who is at risk for taking their on life. Researchers said the biomarkers were found at significantly higher levels in the blood of both bipolar disorder patients with thoughts of suicide as well in a group of people who had committed suicide. Researchers now believe the results provide a first "proof of principle" for a test that could provide an early warning of somebody being at higher risk for an impulsive suicide act. "Suicide is a big problem in psychiatry. It's a big problem in the civilian realm, it's a big problem in the military realm and there are no objective markers. There are people who will not reveal they are having suicidal thoughts when you ask them, who then commit it and

there's nothing you can do about it. We need better ways to identify, intervene and prevent these tragic cases," said investigator Dr Alexander B Niculescu, director of the Laboratory of Neurophenomics at the Institute of Psychiatric Research at the IU School of Medicine. Over three years, Niculescu and his colleagues followed a large group of patients diagnosed with bipolar disorder, completing interviews and taking blood samples every three to six months. The researchers conducted a variety of analyses of the blood of a subset of participants who reported a dramatic shift from no suicidal thoughts to strong suicidal ideation. They identified differences in gene expression between the "low" and "high" states of suicidal thoughts and subjected those findings to a system of genetic and genomic analysis called Convergent Functional Genomics that identified and prioritized the best markers by cross-validation with other lines of evidence.

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By Dr. R. Sabates CLS, CME

here have been some exciting advances in fat removal. Liposuction is now faster, cheaper and safer. Non-invasive fat removal techniques are the latest rage. If liposuction is not for you, this article is to help explain and simplify the confusing array of competing systems.

There are basically four competing non-invasive medical techniques that advertise localized fat and cellulite removal. They consist of; laser light, cold exposure, heat with radiofrequency, and cavitation with ultrasound. Don’t get confused with the name brand equipment since they all use the same basic four technologies. The difference is in having a few more bells and whistles (i.e. price). Then there is the equipment imported from China of which has not been approved by the FDA and being sold on the internet. They simply do not work. My story:

For numerous health reasons, I finally decided to lose that unwanted weight that was making me miserable. Under a doctor’s care, I chose to use a controversial quick weight loss method that uses hormone

September 2013

HEALTHCARE NEWS

Page 5

Cavi-Lipo News

injections and a strict 800 calorie diet. Due to a good bit of desperation and dedication, I lost 37 lbs. in about three months. Surprisingly enough, I did this without going hungry or exercise. I kept the weight off for four months, but couldn’t lose the love handles or lax skin folds - even with exercise.

Liposuction was not for me, so for personal and professional reasons, I decided to study and evaluate the various non-invasive techniques that claimed to magically remove fat deposits without surgical intervention.

After reviewing the techniques, I wanted to share my results and conclusions with you. Here is the short version of a roundtable medical convention that I attended in Orlando which was sponsored by the ASLM. It featured experts within the four technologies. Here were their opinions. 1. Laser light does not work. At least in 80% of patients in one study. It required diet, exercise and vibratory massages.

2. Cold exposure works, but it is expensive, cumbersome, painful, and it doesn’t work on cellulite.

3. Radiofrequency (RF) and ultrasound were rated the best by the panel with about the

same efficacy. RF uses heat from electric currents and had more discomfort with more side effects than ultrasound. Ultrasound uses radio wave is painless and appeared to have more long lasting effects.

4. All manufacturers claimed to have the best machines that give permanent results by damaging the fat cells ability to store fat.

I tried the last two and chose to try Cavitation ultrasound, since I didn’t like the torture.

Ultrasound has only recently been approved by the FDA (2012). Out of all the equipment I have researched, I chose to use a machine called CAVI-LIPO. My decision was based on the good long term reviews from the European and Asian markets.

As you can see from my before and after photos, so far, after

only seven treatments - the results have been dramatic! I spaced my treatments one week apart, did not lose any additional weight and really did not exercise. I was so impressed with the results, that I could not wait to send my family and friends the before and after photos. Now, I am happy to share my good news and photos with you as well. My good fortune can now be your good fortune!

The CAVI-LIPO is currently available in all nine Tropicalaser Centers in South Florida. They specialize in the latest in hair and tattoo removal, facial rejuvenation, and now have added the CAVI-LIPO Body Sculpting as well! Since putting them in all of the centers, the feedback from patients has been 100% positive. The one thing that everyone has noticed and a key element with this procedure

is the immediate measurable results after the first treatment. There is nothing more satisfying than seeing a difference in your appearance after just one visit.

CAVI-LIPO is not a weight-loss formula and is only indicated for patients that have 10-20lbs. left to lose. It’s for those patients that have stored fat in areas that exercise and weight loss just doesn’t seem to touch. Personally, I highly recommend it for that extra fat in the belly, love handles, upper arms, and cellulite of the thighs.

The news for non-invasive painless fat removal is good and it keeps getting better every day.

For additional information about CAVI-LIPO, or any of our other procedures, please visit our website at www.tropicalaser.com or call 561-753-3336.

Page 6

Upcoming Charity, Medical or Fundraising Events September 2013 September 14

Families Against Drunk Driving (FADD). PGA Champion National Course, Palm Beach Gardens. The shotgun starts begins at 8:00am and the cost is $125.00 per person or $475.00 for a foursome. For additional information, contact John Nelson at 772- 285-5828 or john@famadd.org.

September 19

SOS Children’s Village. Spirit of Home Luncheon. Boca West County Club, Boca Raton. This event begins at 11:00am. Tickets are $65.00 and the proceeds benefit the foster boys and girls that are growing up at SOS. For additional information, contact Julie Selvaggi at 954-420-5030, ext. 117, or at jselvaggi@sosflorida.com. You can also visit their website at www.sosflorida.com.

September 20

Cystic Fibrosis Foundation. “Pipeline for a Cure” at Jupiter Beach Resort, Jupiter. This event begins at 6:30pm and includes cocktails, dancing, auction, and appetizers. For additional information, contact Chandra Fuller at 561-683-9965 or cfuller@cff.org. Send us your information at events@globalhealthtribune.com

September 2013

HEALTH & WELLNESS

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Could A Daily Dose Of Red Wine Reduce One's Risk Of Depression?

By Alice G. Walton

life has been well illustrated to reduced depression risk, and could easily influence the results seen here.

The author is a Forbes contributor.

n enticing new study from BMC Medicine reports that people over 55 who drink a little alcohol, averaging about a glass – generally of wine – per day, are less likely to be clinically depressed than those who drink more and those who don’t drink at all. The study comes in direct contrast to many earlier studies that have found an opposite effect: That drinking is more often associated with increased risk for depression. While are some legitimate reasons that wine could have some slight beneficial effects on depression risk, before you go picking up the habit if it’s not already there, it’s important to understand not only the reasons behind the connection, but also the risks involved. The new study followed 5,000 Spanish men and women between 55 and 80 for about seven years, periodically querying them about their lifestyle habits via questionnaires and doctor visits. No one suffered from depression or alcohol use disorders at the beginning of the study. At the end of the seven years, about 443 people had become depressed.

It turned out that low-tomoderate alcohol consumption was linked to reduced risk of depression: People who drank between two and seven glasses of wine per week seemed to derive the greatest benefit, having a third the risk of being depressed as people who did not drink. Moderate drinkers also had lower risk of depression, but it wasn’t as large as the low-to-

moderate group. The results held true even after multiple lifestyle factors were controlled for, such as smoking, marital status, age, physical activity level, and diet, which can all influence depression risk. Heavy drinkers seemed to have an increased risk of depression, although there were too few of these people in the study to say for sure.

If the connection really does exist, one explanation might have to do with the neuroprotective effects of the antioxidants in wine, like resveratrol, which has gotten a lot of attention in recent years. “Lower amounts of alcohol intake might exert protection in a similar way to what has been observed for coronary heart disease,” said author Miguel A. Martínez-González in a statement. “In fact, it is believed that depression and coronary heart disease share some common disease mechanisms.” The mechanisms MartínezGonzález mentions have to do with inflammation, which is known to be a central cause of

heart disease, and there is increasing evidence for its role in depression as well. The polyphenol antioxidants in wine could help repair inflammatory damage to the brain that has contributed to depression. “Previous investigations suggest that the hippocampal complex may play a role in the development of major depression,” say the authors.

“This neuroprotection applied to the hippocampus may prevent moderate wine drinkers from developing depression.” Another explanation, which is unrelated to the content of wine, might have to do with social factors, which have long been known to influence depression risk. People who enjoy a glass of wine or two might be more likely to be doing so in a crowd of people. Write the authors, the study’s cohort “includes an older, traditional Spanish Mediterranean population, that consumed chiefly wine, and mainly in a context of socialization with family or friends.” Enjoying a rich social

Finally, also important to keep in mind is the large body of evidence suggesting that alcohol and depression are linked adversely, with one increasing the risk of the other. It may also be the case that some people, because of genes and environment, are predisposed to problems with both – so in essence there could be a third variable at play, which might increase one’s likelihood of alcohol use and of depression. For all of these reasons, the results should be taken with caution. This is especially true since they were, after all, derived from a relatively restricted sample of people in a Spanish Mediterranean population, none of whom had ever had depression, and who were all over 55 years old. So how the results would relate, if at all, to a more inclusive sample is largely unknown.

As with most studies looking at a particular ingestible item – wine, coffee, sugar, fat – to look for a single answer is perhaps naïve. Alcohol does not likely reduce the risk of depression across the board, since there are so many other variables, like quantity, type, and existing health and mental health conditions. So the best advice might be that if you enjoy a glass of red wine every now and then, you might do well to continue for the health of your heart and brain. But if you’re not a fan, it’s not worth picking up the habit, since it carries with it a number of risks that just aren’t worth messing around with.

Regulate Pot? Uruguay's been there, with whisky MONTEVIDEO, Uruguay (AP) — The government of Uruguay makes Scotch whisky. It also makes and sells rum, vodka and cognac, and has done so for nearly a century. Many people consider this sideline of the state to be an historical accident — a wasteful and even eccentric contradiction.

But President Jose Mujica says Uruguay's long experience at the center of the nation's liquor business makes it more than capable of dominating another substance: marijuana.

Final Senate approval of Uruguay's marijuana law is expected by late September, and the government plans to license growers, sellers and users as quickly as possible thereafter to protect them from criminal drug traffickers, ruling party Sen. Lucia Topolansky, who is also Uruguay's first lady, told The Associated Press in an interview.

The law specifically creates a legal marijuana monopoly, making the government alone responsible for importing, producing, obtaining, storing, commercializing, and distributing a drug still considered illegal around the world.

A state entity will license producers and control marijuana's distribution and sale through the same neighborhood

pharmacies that sell prescription medicines and toothpaste. Purchases by licensed users will be limited to 40 grams (1.4 ounces) a month. Pot-growing cooperatives will be encouraged, using government-approved seeds, and people registered with the state will be able to grow up to six plants at home for personal use, as long as they harvest no more than 480 grams (17 ounces) a year.

The project passed the House by just one vote, and while the ruling Broad Front coalition has an easier majority in the Senate, Mujica has been campaigning actively for its passage, reminding Uruguayans that their government has been controlling the market for addictive substances ever since the beginning of the 20th century, when President Jose Batlle y Ordonez wanted the state to monopolize alcohol production. "Don Jose Batlle y Ordonez had courage," Mujica said in one of his folksy nationwide radio talks, which sound much like the "fireside chats" that President Franklin Delano Roosevelt used to broadcast to Americans. "The state grabbed it and made a monopoly of alcohol, because it couldn't stop the booze, and he said "at least don't poison the people — the booze should be good."

Batlle y Ordonez was ahead of his time in promoting social change in Latin America, from the separation of church and state to the eight-hour workday and maternity leave. And he had several goals for alcohol: He wanted the whisky to generate government revenues and guarantee a profit stream for farmers, funding the production of a national fuel so that Uruguay's cars and trucks wouldn't need imported gasoline. Uruguay wasn't alone in that fight: In 1925 Henry Ford was promoting alcohol as the fuel of the future, and it was being blended with gasoline from France to the Philippines. But like many other countries, Uruguay never achieved this energy independence. Oil companies won an intense global campaign to focus on fossil fuels, a trend that held until Brazil started using alcohol blends in the 1980s.

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September 2013

Page 7

HEALTHCARE NEWS

'Molecular basis' for jet lag found

BBC News

cientists believe they have figured out why it takes us so long to adapt when we travel to new time zones.

Insomniacs' brains lose focus, scans suggest

rain scans of people who say they have insomnia have shown differences in brain function compared with people who get a full night's sleep. Researchers at the University of California, San Diego, said the poor sleepers struggled to focus part of their brain in memory tests. Other experts said that the brain's wiring may actually be affecting perceptions of sleep quality. The findings were published in the journal Sleep.

People with insomnia struggle to sleep at night, but it also has consequences during the day such as delayed reaction times and memory.

The study compared 25 people who said they had insomnia with 25 who described themselves as good sleepers. MRI brain scans were carried out while they performed increasingly challenging memory tests.

One of the researchers, Prof Sean Drummond, said: "We found that insomnia subjects did not properly turn on brain regions critical to a working memory task and did not turn off 'mindwandering' brain regions irrelevant to the task.

"This data helps us understand that people with insomnia not only have trouble sleeping at night, but their brains are not functioning as efficiently during the day." A sleep researcher in the UK, Dr Neil Stanley, said that the quality of the sleep each group was having was very similar, even though one set was reporting insomnia.

He said: "What's the chicken and what's the egg? Is the brain different and causing them to report worse sleep?

"Maybe they're perceiving what happened in the night differently; maybe what is affecting their working memory and ability to focus on the task at hand is also causing insomnia."

Researchers at Oxford University say they have found the "molecular brakes" that prevent light resetting the body clock when we fly - causing jet lag. Experiments, reported in the journal Cell, showed "uncoupling" these brakes in mice allowed them to rapidly adapt. Researchers hope the discovery will help find new drugs for jet lag and mental health treatments. The body clock keeps us in tune with the pattern of day and night. It means we sleep at night, but also affects hunger, mood and blood pressure. Light acts like a reset button to keep the clock to time, but when we fly around the world it takes time for our body clocks to adjust. The resulting fatigue, which can last for days, is known as jet lag.

Master clock The research team, funded by The Wellcome Trust, was trying to figure out why people do not instantly adapt. They looked in mice as all mammals have the same core body clock mechanisms. They focused on the "master clock" in a part of the brain, which keeps the rest of the body in sync, called the

suprachiasmatic nuclei. They were looking for sections of DNA that changed their activity levels in response to light.

They found a huge numbers of genes were activated, but then a protein called SIK1 went round turning them all off again. It was acting as a brake by limiting the effect of light. Experiments to reduce the function of SIK1 meant the mice could rapidly adjust their body clock when it was shifted six hours - the equivalent of a flight from the UK to India.

Reset Prof Russell Foster told the BBC: "We reduced levels by 5060%, which is big enough to get a very, very big effect. What we saw was the mice would actually advance their clock six hours within a day [rather than taking six days for untreated mice].

"We've know there's been a brake on the clock for some time, but we had absolutely no idea what it is, this provides a molecular basis for jet lag and as a result new targets for potentially

developing new drugs." He said some mental health disorders including schizophrenia were linked to an out-of-tune body clock, so these findings may open up new areas for research.

The brakes are likely to be in place to prevent the body clock from becoming erratic and being reset by artificial or moon light. Dr Akhilesh Reddy, a specialist in the body clock, at the University of Cambridge, was very confident that treatments would follow as "it is a very

drugable target and I would suspect there are lots of potential drugs already developed". He told the BBC: "We have known a lot about the basis of jet lag and why it occurs. "This shows how you can get into the brain and manipulated the clock, which is why this study is important. "We have drugs which can make the clock shorter or longer, what we need is to shift it to a new time zone and that is what they have done.

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September 2013

ONCOLOGY NEWS

Cancer Related Fatigue

Is CRF common? Yes. CRF is estimated to affect up to 90% of patients that are treated with radiation and up to 80% of those treated with chemotherapy.

What can be done to help manage CRF? There are several ways to treat CRF. For most people, slowly increasing exercise is one of the most effective methods. Initially, the exercise plan may need careful planning and monitoring by a therapist. Your physician can help you decide if such a program is right for you now.

Can exercise really help me when I already feel so tired? Yes! There have been many experimental studies that have asked this same question and the results have been very good. In fact, exercise appears to be one of the most effective treatments when compared to all other “non-pharmacologic” (or nonmedicine) interventions for CRF. These studies have also shown that exercise is safe for most people who have or have had cancer.

What is Cancer-Related Fatigue? Cancer-related fatigue, or CRF, is very different from “everyday” tiredness. Individuals with cancer-related fatigue experience an overwhelming sense of tiredness, or exhaustion that is out of proportion to the activity they have undergone. CRF interferes with normal day to day functioning. What are the symptoms of CRF? • A lack of energy or interest in

Page 9

• American College of Sports Medicine (ACSM) Cancer Certified Exercise Trainers • State of the art fitness center with easy access and front-door designated parking for participants in the CRF Program. Lockers are also available

doing everyday basic activities, such as eating, bathing and dressing • Spending more time in bed and more time sleeping • Feeling exhausted, even after sleeping • Inability to work

What causes CRF? Although the causes are not fully known, CRF is related to cancer treatment, such as radiation and chemotherapy. There are many contributing factors, such as low red blood cell counts (anemia), improper nutrition, lack of sleep, too little exercise and possibly changes in the “power-plants” of the body’s cells.

What can I expect from the Cancer-Related Fatigue Program at Palm Beach Atlantic University? • A Comprehensive physical therapy evaluation • An individualized exercise program based on your specific needs • A six-week program, meeting 3 times weekly • Physical Therapist supervised • A specialized cancer rehabilitation health care practitioner is available to initially evaluate you and monitor your progress in the program

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Continuous communication with your referring physician in order to adjust your program when changes in your medical regimen

How can I get started in an exercise program? It is recommended that you are medically cleared by your physician. If your physician feels that you are ready to start exercise, the CRF Program at Palm Beach Atlantic University can help. You can also be evaluated by the CRF Program doctor (see below). What is the cost? The Cancer-Related Fatigue Exercise Program at Palm Beach Atlantic University is offered at no cost. Our mission at Palm Beach Atlantic University is to reach out to members of our community and offer needed services that may not be available elsewhere, or may be unaffordable.

Contact Information Feel free to contact us anytime with any questions, for a consultation, or to arrange for a tour of our facility. Stephen Sylvester, DPT, CSCS, CCET Assistant Professor Exercise Science/Director CRF Program Email: Stephen_Sylvester@pba.edu Phone: (561) 346-1773

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September 2013

HEALTHCARE NEWS

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What Is Scoliosis? Should I Be Worried? that there is quite a bit of confusion about what scoliosis is, and how it can affect your child's health. Many people remember going into the school nurse's office every so often and get a scoliosis test where they bend down from their waste and touch their toes.

Dr. Jonathan Chung is a Doctor of Chiropractic who focuses on Structural Correction and is primarily concerned with Structural Shifts of the spine. He graduated from the University of Central Florida with a B.S. in Microbiology and Molecular Biology. Dr. Chung then went on and received his doctorate from Life University's College of Chiropractic. Dr. Chung is certified in pediatrics from the International Chiropractic Pediatric Association, and is a Structural Chiropractic Researcher who has been published in scientific peerreviewed journals.

By Jonathan Chung, DC

s school starts around the country, many parents have concerns about backpacks and scoliosis screenings. What's the truth? As I speak to more and more patients, I've come to a realization

But what is scoliosis? Scoliosis involves a curved deformity in the spine. When you look at someone from front to back, the bones that make up the spine (vertebrae) should stack up nice and straight. When there is a scoliosis present, the vertebrae will deviate to the side and form a curved C or S shape. Now very few people are perfectly straight, but when the curve exceeds 10 degrees, it is usually deemed a scoliosis.

Many people can have a scoliosis and never feel any effects or symptoms from it. Others may experience more common symptoms like back pain, neck/shoulder tension, and posture/cosmetic problems. In rare cases, the curvature can become large enough (50 degrees or more), that it can compress the chest cavity causing respiratory and cardiac problems, and become a surgical issue. Scoliosis comes in 2 main forms. There are is a functional scoliosis which is typically named idiopathic scoliosis, and there is a scoliosis called structural/anatomical scoliosis.

• A structural/anatomical scoliosis is caused by a malformed vertebra which can force the spine to a curved position as it seeks to get back to

center. This type of scoliosis cannot be fully corrected and it can also lead to larger curvatures depending on how malformed the vertebra is.

• A functional/idiopathic scoliosis is named as such because there is typically no medically known cause. This is the most common type of scoliosis. These types of curvatures can be corrected and reduced significantly through conservative means when caught before a person is fully developed.

The real question is, should you be worried?

The truth is, if you're just worried about pain, then probably not. Many times, scoliosis is asymptomatic, especially in children. In fact, most people will probably go through their childhood with no knowledge that it is even there. For the category of idiopathic scoliosis, it is often the secondary result of a structural shift in one or more bones in the spine or pelvis... Most doctors are concerned when the curvature surpasses 20 degrees and begin watching the curve for progression. As the curve approaches 30 degrees, bracing becomes a common recommendation, and cosmetic concerns become more

obvious, especially for teenage girls where image is everything. When the curve grows 40 degrees, surgery starts to become a real option for treatment to prevent compression of the heart and lungs. The key is catching these curves early. Scoliosis is most commonly found in girls during adolescence, which is a great window of opportunity for structural correction. No matter how small the curve may be, a conservative approach to correction may be in a young person's best interests. Just like how a bent frame of a car can create suspension problems and tire wear/tear, a bent spine can increase the damage the spine experiences throughout life. I've seen x-rays of people well into their 40's and 50's who have never experienced spine pain, but will show a scoliotic spine with disc degeneration and bone spurs in the exact pattern that the structural alignment would dictate. As the spine shows early wear and tear, the nerves can get damaged, and symptoms of damage into the muscles, ligaments, and even the vital organs of the body can start to show. As a worried parent, what can you do? Here are a few tips:

1. Get a spinal check up by someone who is focused on the health of the spine! Nurses and general practitioners do a great job of identifying major curvatures using basic screening tools, but these will typically identify cases of scoliosis that are excessively large and may be candidates for surgery. A chiropractor focused on structural

correction instead of pain relief can recognize smaller deviations and provide tools to correct them if necessary.

2. Avoid the one shoulder back pack routine. It may look cooler and be more comfortable, but extra forces on a spine that isn't optimally positioned can increase scoliotic curves. 3. Stay active. Movement is life and a spine that moves early and often has more pliability and flexibility than one that is sedentary and stiff.

4. Keep the weight down. If you had a crooked house and you add more weight to it, what happens to the house? It breaks down faster. The same thing happens to the body. If you build more mass on top of a crooked structure, it will lead to earlier degeneration. Stay fit.

If the scoliosis is large but not correctable, the best thing a parent can do is provide love and emotional support. Though it's not typically cause pain or serious illness, it can be a label that wears on the psyche of a teenager or young adult because other young people and gym class bullies may poke fun of their condition. Adolescence is a psychologically trying period for any young person, and another label is the last thing they need, especially if major surgery may be one of the options on the table. Providing your child with a strong base of confidence and self-esteem, along with proper management of scoliosis can help ensure a happy and healthy school year.

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September 2013

Page 11

PRACTICE TRENDS

ZZZZZZzzzzzz!

realize that the symptoms I just mentioned in the first paragraph of this article could be all related to lack of sleep?

go to sleep. They start reading and responding to emails or send text messages to friends or their business partners. This late night communication ritual could be quite stressful and should not be done before bed. Personally, I would exchange that late night communication for the morning hours before going to work, so as to avoid sleeping with a heavy mind or heart. My recommendation is to switch off your cell phones and computers before bedtime.

So, what makes one not sleep well at night?

Have you ever really dissected the reasons in your mind? Well, let me take this opportunity to give you many different reasons why one cannot sleep well at night.

First, you could be getting up multiple times at night to urinate. You may have an overactive bladder, uncontrolled diabetes mellitus which makes one urinate more often than usual, or possibly one can have a urinary tract infection or prostatic enlargement. Other reasons may be chronic pain, such as low back pain, various joint pains, and last but certainly not least is that it could be a condition called sleep apnea.

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

ave you ever experienced complaints from a family member or close friend about how bad they feel during the day and are unable to focus at their job? They complain about feeling sleepy during the day, having fatigue along with several other issues, such as depression and headaches which for the layman, could just spell out another bad day. But, have you ever stopped to think about what a doctor would think about these symptoms?

Most often, people that I have seen in my practice that have difficulty sleeping either have severe depression, a lot of stress in their life, some sort of an allergy, chronic nasal congestion, or seem to be a bit of a worrywart. The next thing I have to decipher is what to do next. During the exam, I have to ask many complex questions in order to get the answers that will help me to determine what the

When a patient comes into the office for a brief visit with those same complaints and possibly more, we know there may be many medical conditions that are often related to some other disease or ailment. Do you

problem is and what should one do about it. It is not always easy to treat insomnia as you have seen in the case of singer, Michael Jackson. He had such severe insomnia and resorted to taking an intravenous anesthetic in order to fall asleep and get some rest. Of course, this is not the way to go about treating your insomnia.

People that have insomnia, sleeplessness, or have experienced an impaired sleep pattern have a lack of concentration and focus during the day. They struggle with headaches, moodiness,

depression, and if they have a condition called sleep apnea, this could lead to various medical disorders like hypertension, diabetes mellitus type 2, which can also lead to various cardiovascular complications. In this article, it would be difficult for me to tell you how I go about diagnosing those underlying conditions leading to insomnia, because each individual is different.

There is one thing that I have experienced to be quite common in insomniacs - they get into their email or phones before they

Lastly, I recommend avoidance of heavy late night dinners, alcohol consumption, and drinking excessive amounts of liquids before bedtime, especially caffeinated drinks like coffee and tea.

I would like to share a quote with you by the great Mahatma Gandhi who said, “Each night, when I go to sleep, I die. And the next morning, when I wake up, I am reborn.” Now that is what a good night sleep can make him feel the next morning. My quote would be “When you sleep, it should be deep, so the next day could be sweet”.

If you are experiencing sleepless nights, give my office a call and I would be happy to find out exactly what the cause is so you too can start to get a peaceful night of sleep.

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September 2013

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HEALTHCARE NEWS

Polio breaks out amid militant threats in Pakistan By Rasool Dawar and Sebastian Abbot

in 2011 under the guise of an immunization program. The threats have left residents like the shopkeeper Wali, who lives in the town of Miran Shah, with the difficult decision of whether to defy the militants by smuggling the vaccine in for his children from the main northwest city of Peshawar.

PESHAWAR, Pakistan (AP) — Syed Wali desperately wants to immunize his three young children against polio but fears the Islamic militants who banned the vaccine from this remote area in northwest Pakistan will catch him if he tries to smuggle it in.

"I can afford to bring the vaccine for my children, but what answer will I give the Taliban if they recover the vaccine bag from my possession?" Wali asked. Wali's fears are shared by many in the North Waziristan tribal area as health authorities recently confirmed five new polio cases there and suspect there are many more. It's one of a series of outbreaks this year in parts of the country where security threats have kept out vaccination teams.

Officials worry these outbreaks — inflamed by militant threats and attacks on vaccination teams — could worsen and spread to other parts of Pakistan, especially since the country is entering the high season for virus transmission. "It's not like a pot of boiling water where you see bubbles coming from everywhere, but there is steam coming out from specific areas," said Dr. Elias Durry, emergency coordinator for polio eradication in Pakistan for the World Health

Organization. "Our fear is that the virus from these areas can go out and seriously jeopardize the success in fighting polio that has been achieved in the past couple of years." Pakistan — one of only three countries left where polio is endemic — had 198 confirmed cases in 2011, the highest number of any nation in the world. Pakistan was able to bring that number down to 58 in 2012 through a vaccination program that is supported by the United Nations.

But the militant threats could reverse that progress. There have been 27 confirmed polio cases in Pakistan so far this year — the third highest total in the world after Somalia and Nigeria. Seventeen of them have occurred in the country's semiautonomous tribal region, the main sanctuary

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for Taliban and al-Qaida militants, Durry said.

Two powerful Pakistani Taliban militants have banned vaccinators from North and South Waziristan over roughly the past year because of their opposition to U.S. drone strikes. Gunmen have also killed over a dozen vaccination workers and police guards in different areas of the country. Many suspect the Taliban of carrying out the murders, although the group has denied the allegation.

Militants have claimed the vaccine is meant to sterilize Muslim children and accused health workers of being U.S. spies. The allegation gained traction after the CIA used a Pakistani doctor to try to confirm the presence of Osama bin Laden

Some families couldn't afford to make the six-hour journey to get the vaccine from Peshawar, the capital of Khyber Pakhtunkhwa province, even if they wanted to take the risk. Health workers have stationed themselves at two checkpoints protected by the army in North Waziristan, where they are vaccinating children riding by in vehicles. But many people are afraid the militants will find out if they vaccinate their children at the checkpoints.

The polio virus, which usually infects children in unsanitary conditions, attacks the nerves and can kill or paralyze. It can spread widely and unnoticed before it starts crippling children. On average, about one in 200 cases will result in paralysis. Durry, the WHO official, said authorities have confirmed five polio cases in North Waziristan and three others in the nearby district of Bannu this year. The five cases in North Waziristan were confirmed since

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the beginning of August, two of them on Wednesday, said a local health official, speaking on condition of anonymity because he was not authorized to talk to the media. Officials are still investigating 20 suspected cases, he said.

There have been a total of 12 confirmed cases since the militant ban, the official said. Tribal elders sent to ask the militants to change their minds haven't been successful, said Jahan Mir, a senior government health official in Miran Shah. There also have been confirmed polio cases this year in the Khyber tribal area and the provinces of Khyber Pakhtunkhwa, Sindh and Punjab, Durry said. Health officials had planned to immunize 34 million children across the country, but 1.5 million have not received the vaccine because of security threats, he said.

Threats by al-Qaida-linked militants also have hampered vaccination efforts this year in Somalia, which has suffered the worst polio outbreak in the world. The country has confirmed 108 cases so far, more than all other countries combined, according to the Global Polio Eradication Initiative website. There have been at least 192 confirmed cases worldwide in 2013.

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September 2013

Page 13

AROUND TOWN

Another Successful Open House for Select Specialty Hospital

n an effort to educate and raise awareness about the Long Term Acute Care Hospital setting or LTACH, Select Specialty Hospital held their annual open house on Thursday, August 29. Although Select is open 365 days a year to the community, their “Vegas Night” themed party is held once a year to make it a little more exciting for healthcare professionals. It also gives them an opportunity to view and learn about the hospital in a fun

setting. This year’s event was a huge success and we truly appreciate all of those individuals that were able to attend. For those professionals that could not attend, we are extending an open invitation to tour our hospital and see for yourselves exactly what makes us stand out above and beyond all other hospitals. Posted below are a few photos from this year's event. All chips had zero monetary value and were given out free of charge.

Another standing room only event for Select Specialty Hospital.

Admissions Coordinator, Caitlin Mealing (left) and Clinical Liaison, Cheryl Stanley (right) welcome guests to Select Specialty Hospital's Vegas Night open house.

Director of Business Development, Mike Corvaia and CEO, Larry Melby pose for the camera at their 2nd annual Vegas Night themed open house held for Palm Beach Counties respected healthcare professionals.

Things are heating up on the Craps table.

Head of Plant Operations, Nick Sanders, deals a friendly game of blackjack at one of the three available gaming tables that evening.

Page 14

September 2013

HEALTHCARE NEWS

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Thimerosal and 2013-2014 Seasonal Flu Vaccines

Is thimerosal in vaccines linked to autism?

From the CDC

What is thimerosal?

Numerous studies have found no association between thimerosal exposure and autism. CDC places a high priority on vaccine safety, surveillance, and research. CDC is aware that the presence of the preservative thimerosal in vaccines and allegations of a relationship to autism have raised public concerns.

Thimerosal is a mercury-based preservative that has been used for decades in the United States in multi-dose vials (vials containing more than one dose) of some vaccines to prevent the growth of germs, bacteria and fungi, that can contaminate them. What are preservatives and why are they sometimes used in vaccines?

Preservatives have been used in vaccines for more than 70 years and are added to vaccines to prevent the growth of bacteria or fungi that could possibly make the vaccine in multi-dose vials unsafe. This may occur when a syringe needle enters a vial as a vaccine is being prepared for administration. Contamination by germs in a vaccine could cause serious infections. Do the 2013-2014 seasonal flu vaccines contain thimerosal?

The Food and Drug Administration (FDA) has approved several formulations of the seasonal flu vaccine, including multi-dose vials and single-dose units.

Since seasonal influenza vaccine is produced in large quantities for annual immunization campaigns, some of the vaccine is produced in multi-dose vials, and contains thimerosal to

safeguard against possible contamination of the vial once it is opened.

The single-dose units are made without thimerosal as a preservative because they are intended to be opened and used only once. Additionally, the liveattenuated version of the vaccine (the nasal spray vaccine), is produced in single-dose units and does not contain thimerosal. Is thimerosal being used in other vaccines?

Since 2001, no new vaccine licensed by FDA for use in children has contained thimerosal as a preservative, and all vaccines routinely recommended by CDC for children younger than 6 years of

age have been thimerosal-free, or contain only trace amounts of thimerosal, except for multi-dose formulations of influenza vaccine. The most recent and rigorous scientific research does not support the argument that thimerosal-containing vaccines are harmful. However, CDC and FDA continually evaluate new scientific information about the safety of vaccines.

Is thimerosal in vaccines safe? Yes. There is a large body of scientific evidence on the safety of thimerosal. Data from several studies show the low doses of thimerosal in vaccines do not cause harm, and are only associated with minor local injection site reactions like redness and swelling at the injection site.

Three U.S. health agencies (The Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH)) have reviewed the published research on thimerosal and found it to be a safe product to use in vaccines. Three independent organizations [The National Academy of Sciencesâ&#x20AC;&#x2122; Institute of Medicine, Advisory Committee on Immunization Practices (ACIP), and the American Academy of Pediatrics (AAP)] reviewed the published research and also found thimerosal to be a safe product to use in vaccines. The medical community supports the use of thimerosal in influenza vaccines to protect against potential bacterial contamination of multidose vials.

These concerns have made decisions surrounding vaccinations confusing and difficult for some people. Since 2001, no new vaccine licensed by FDA for use in children has contained thimerosal as a preservative and all vaccines routinely recommended by CDC for children younger than 6 years of age have been thimerosal-free, or contain only trace amounts of thimerosal, except for some formulations of influenza vaccine. Unfortunately, reductions in the numbers of children identified with autism have not been observed indicating that the cause of autism is not related to a single exposure such as thimerosal.

The federal government is committed to ensuring the safety of vaccines. This is achieved by FDA oversight of rigorous prelicensure trials and post-licensure monitoring by CDC and FDA. This commitment stems from scientific, medical and personal dedication.

Caffeine in diet supplements all over the map

What stood out to him was how common inaccurate labeling or lack of information was, across the board.

The amount of caffeine in diet supplements varies widely and product labels are often inaccurate or have no caffeine information at all, according to a new study of supplements sold on military bases. Although the caffeine doses probably wouldn't be a problem on their own, they may cause issues when the pills or powders are combined with energy drinks, coffee and other high-caffeine food and beverages, researchers said. Genevra Pittman

NEW YORK (Reuters Health) The amount of caffeine in diet supplements varies widely and product labels are often inaccurate or have no caffeine information at all, according to a new study of supplements sold on military bases.

Although the caffeine doses probably wouldn't be a problem on their own, they may cause issues when the pills or powders are combined with energy drinks, coffee and other high-caffeine food and beverages, researchers said.

"Consumers really have no idea when they're purchasing supplements what's in them, even if they carefully read the label,"

"When we look at the totality of products that have caffeine in them that are consumed on military bases, half the bushel is rotten," he told Reuters Health.

said Dr. Pieter Cohen from Harvard Medical School in Boston, who worked on the new study.

He and his colleagues analyzed the caffeine content of 31 dietary supplements sold on military bases that are known to have added caffeine or herbal ingredients that naturally contain caffeine.

Eleven of the supplements listed herbal ingredients, and all of those had no caffeine or only minimal traces, the research team reported this week in JAMA Internal Medicine.

Among the other 20 products, nine had labels with accurate caffeine information. Another five had varying caffeine

contents that were either much lower or higher than the amount listed on the label.

The remaining six products did not have caffeine levels on their labels, but had very high amounts according to the chemical analysis - between 210 and 310 milligrams per serving. In comparison, an eight-ounce cup of coffee has about 100 mg of caffeine.

Those levels are especially worrisome for military service members abroad, he said,

because side effects of caffeine such as tremors and anxiety may hit them extra hard due to the stressful environment. Too much caffeine, according to Cohen, "could push one over from just being a little on edge to having a full-blown panic attack." One limitation of the study was that the researchers only tested one of each supplement. Because of that, Cohen, who is also an internist at Cambridge Health Alliance, said it wouldn't be right to call out any single company on its products.

A spokesperson for GNC, which produces and sells diet and nutritional supplements, told Reuters Health in an email, "We believe that all GNC brand labeling is appropriate as to ingredients and dosage. GNC does, like many other retailers, sell third party products and questions on their labeling practices should be addressed directly to those manufacturers."

Cohen said the laws for regulating supplements are "inadequate," but that the U.S. Food and Drug Administration (FDA) also isn't doing a good enough job enforcing the labeling regulations that do exist.

The FDA public affairs office did not respond to requests for comment before press time. Cohen recommended that nonmilitary members also avoid supplements that list caffeine on the label - since it's hard to know just how much of it they actually contain.

www.GlobalHealthTribune.com

September 2013

Page 15

AROUND TOWN

Delray Medical Center Appoints New Assistant Chief Nursing Officer Delray Beach, Fla. (September 3, 2013) – Delray Medical Center is proud to promote Cheryl Wild from Director of Cardiac Telemetry and Regency Oncology to Assistant Chief Nursing Officer. In her new role, Wild will assist the Chief Nursing Officer, Jennifer Chiusano, in the operational responsibility of ensuring high quality nursing care at Delray Medical Center. As a key member of the nursing team, Wild will play a role in directing the nursing leadership team while emphasizing shared governance and leadership development. “We are extremely pleased to have Cheryl as our new

Cheryl Wild.

Assistant Chief Nursing Officer,” said Chief Executive Officer Mark Bryan. “Based on her many accomplishments in her previous roles, she will no doubt continue to be an instrumental asset to our team.” Wild’s career at Delray Medical Center began in July 2011 as the Director of Regency. She was

responsible for overseeing medical oncology and medical surgical services. During her tenure, Wild restructured the unit, supported the oncology certification for the registered nurses and facilitated the Cancer Committee. In Nov. 2012, her role expanded to Director of Cardiac Telemetry where she managed the daily operations of the cardiac telemetry/observation unit. Wild helped support the Cardiac Movement Plan and formulated the Cardiac Education Series. Wild received her Bachelor of Science in nursing from Trenton State College. She holds a Master’s in business administration with a management distinction from The Trinity College and University.

Dear Deborah

DEAR DEBORAH: This isn’t so much of a question, but an opinion. I have tried a few online dating sites and have settled on one that seems to have a classier selection of women. When I first put my profile up, I did not put an income and only received a few responses a week. Since I posted my annual salary and had it verified, I am getting several responses a day. Most of the responses come from women that could be my daughter or live outside the U.S. One might think it’s a sugar daddy service, but it’s not. To me, this was more a lesson than an opportunity to date these apparent gold diggers. - How much do you make?

Dear How much do you make: It’s always interesting when men first realize how truly powerful money can be when looking for a partner (online or offline). If you are looking for someone to have as young arm candy, you will often have to make a trade in one form or another. In most cases, it’s financial. If

DEAR DEBORAH: I went out to dinner with a guy I met online. We communicated for a few weeks prior to our first meeting and really got along well. Our dinner date was amazing and our chemistry was undeniable. However, he was texting periodically throughout the evening. The more drinks he had and the later it got, the more he was on his phone texting. The date lasted five hours with dinner, drinks, and eventually sitting outside. Once I left, I found myself annoyed with his behavior. I texted him the next day and told him how I felt. He responded with a terse apology and that was that, we never spoke again. Is there a way that I could have handled this differently? - Can you wait until you get home?

Dear Can I please have a second: There is no rhyme or reason when and if a man will contact you after a date. The best advice that I can give is NOT to sit and wait for him to contact you. If he is truly interested, he will contact you within the next day or two. If you had a good time, thank him after the date by telling him that you really enjoyed yourself and would like to get together again soon. If he does not get in touch with you after a few days… move on.

you want to find someone that will be interested in you and not your money – remove your income.

Dear Can you wait until you get home: I am so sorry it didn’t work out the way you would have wanted. I hate to be the bearer of bad news, but he was just not into you. Unless it’s something urgent, you should never be on your phone during a date, especially a first date. His priority was not you – it was whomever he was texting. If you felt that strongly, you could have addressed it on the date and perhaps he would have put his phone away. Whenever you go on a first date, YOU should be a priority and given 100% of his or her attention. If you cannot maintain their attention on the first date – you never will. If this situation comes up again, I suggest you end your date early and do not go out with that person again. Or, you can simply end your date after an hour or two, which will hopefully leave them wanting more.

Dear Deborah is a monthly advice column written by Deborah Lynn with a common sense approach to dating. If you have any questions or comments, please forward them to: questions@globalhealthtribune.com as we would love to help.

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DEAR DEBORAH: I have gone out on several first dates recently. Some went well and others did not. I was curious how long I should wait for my date to contact me after we go out? So far, it’s been between two days to never hearing from him again. What can I do to encourage my date to contact me? - Can I please have a second?

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