I was speaking with Revolution Health expert Dr. Zach Bloomgarden about advances in diabetes care, and I suddenly realized that enhancing compliance with lifestyle measures is more important than researching treatments.  In other words, we have the power to cure many cases of type 2 diabetes already - without any new research/treatments. The challenge is sticking with diet and exercise programs. Perhaps the same could be said of many diseases.

I thought I’d share this audio clip of Zach explaining that we already have the tools to radically improve diabetes outcomes and virtually eliminate this disease.

Listen Here

I hope that the new community groups at Revolution Health will help us all work together to get to a healthier place. I’m still struggling along with my diet team. I’m proud of those who have had great success already!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Dr. Cliff Bassett is an allergy specialist in New York City. We recently discussed the differences between men and women when it comes to allergies. You can listen to our conversation or read on for a synopsis of the discussion.

**Listen To The Podcast**

Seasonal Allergies & Women

Women don’t always realize that nasal stuffiness may be a sign of an underlying medical condition or a side effect of medications. Low thyroid (hypothyroidism), taking oral contraceptive pills, or frequent use of aspirin or NSAIDs (such as Motrin), can actually increase the risk for nasal stuffiness. Some studies also suggest that hormone fluctuations can increase nasal congestion and allergy sensitivity. So women in particular need to be aware of their unique allergy triggers and get treatment from an allergy specialist when necessary.

Food Allergies & Women

A recent study suggested that women are twice as likely to have seafood allergies than men (4% versus 2%). The reason for this difference is unclear, and it may be related to increased vigilance on the part of women to get tested and diagnosed. However, food allergies are certainly on the rise in this country. I suspect it might have to do with the increasing use of stomach acid blockers. The medicines change the pH (or acidity) of the stomach environment and may influence the way that proteins are being broken down and absorbed by the body. Another theory is that dieting can lead to increasing food allergies - as women eat more protein and fewer carbohydrates, they become exposed to more protein allergens and develop intolerances to them. Ultimately we don’t know for sure what’s contributing to the increase of food allergies in this country, but the good news is that you can easily get tested and treated for them.

Drug Allergies & Women

Some studies suggest that penicillin allergies are more common in women than men. Anyone who has an allergic parent is at higher risk for having an allergic condition. If both parents are affected, your chances are 50-75% that you’ll have a similar allergic profile.

Moms: Be a Label DetectiveA law was passed in 2006 that requires all food products to be carefully labeled regarding whether or not they contain any of the 8 most common food allergens. Moms need to become familiar with all the possible names of ingredients that are related to their (or their child’s) food allergen. So for example “casein” is a form of milk protein, and should be avoided if the allergic individual has milk sensitivities. Also, be very wary of hidden sources of allergens - the glaze on pastries may contain egg proteins and traces of nuts may be hidden in cakes and breads. When dining out it’s always good to carry an allergy card for the chef so he/she can make sure that the food you order doesn’t contain any offending ingredients. The website foodallergy.org has a great list of tips for avoiding exposure to food allergens. I highly recommend it as a resource for women taking care of food allergic children.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

My former mentor, Dr. Richard Robb, is Director of the Biomedical Imaging Resource Center at the Mayo Clinic, Rochester, Minnesota. I first met Dr. Robb as a Summer Undergraduate Research Fellow (SURF) in the Department of Biophysics at Mayo in 1994. Behind his reserved exterior is a man who is bursting with enthusiasm about the amazing technological advances that are making it possible for us to see cells, tissues, and organs in ways barely conceived of several decades ago. Dr. Robb admits that his passion for improving the quality of anatomical visualization is a response to a challenge once given him by a neurosurgeon colleague: “If I can see it, I can fix it.” Dr. Robb’s life’s work is to enable physicians and surgeons to be more effective healers through direct visualization of anatomy and physiology.

I caught up with Dr. Robb (at the Society for Women’s Health Research briefing on imaging and women’s health) and asked him a few questions about the future of medical imaging. Here are some excerpts from our interview:

Dr. Val: What is micro CT and what information does it give doctors?

Dr. Robb: Micro CT is a specialized kind of scanner that works on the same principles as regular CT scanners but it can capture images at much higher resolution. Structures as small as 5-10 microns in size can be seen. Although this is an emerging technology used primarily for research purposes, it has tremendous potential and implications for the future. With such resolution, we’ll be able to do “virtual biopsies” of suspicious tissue that we find with a regular CT and then zoom in with the Micro CT to get a close look at microscopic detail without having to do a biopsy to study them.

Dr. Val: What is SISCOM and who benefits from it?

Dr. Robb: SISCOM is an acronym for “Subtraction Interictal Spect COregistered to Mri.” It is used to pinpoint small parts of the brain that cause epileptic seizures, so that surgeons can effectively remove the diseased tissue.  SISCOM uses radioactive tags that are absorbed by the parts of the brain that are over-active during a seizure, and they glow like a lightbulb on SPECT brain scans that are subtracted and registered onto MRI scans. The radiologist can pinpoint the exact focus of the abnormal epileptic discharges and then show the surgeons exactly where they need to resect the tissue. This technique allows surgeons to cure many patients who suffer from seizures that don’t respond to medications.

Dr. Val: What is the most exciting new imaging technology under development and how will it impact health?

Dr. Robb: The most exciting future technologies will allow us to visualize tissue functions at a chemical level. In the next 10 years we’ll see major advancements in image resolution and micro imaging techniques, and eventually we’ll be able to see individual molecules. This technology could actually eliminate the need for surgical biopsies, replacing them with “virtual or digital biopsies”, including close up images of cells and chemical reactions, such as diffusion, all in the context of surrounding macro-sized structures.  The effect of the chemical actions and reactions will be expressed visually at the organ function level.

Also, in the next 10-20 years the development and clinical use of “nanobots”, or tiny robotic elements, that can be ingested or injected into the body will become manifest.  These may be used with special biomarkers – substances that preferentially label tissue types and pathology within the body.  These traveling nanobots can, for example, either go to the biomarkers or expore intelligently certain anatomic domains, taking pictures inside GI tracts, pulmonary airways, or even blood vessels.  They will then analyze these images for detection and characterization of abnormalities (like a polyp) followed by administering treatment to the abnormality (e.g., remove it by ablation or radiation or chemicals). The nanobot will remain in the body until it has removed or repaired the targeted pathology or trauma, then it will exit through natural means or “self-destruct” in a safe way. Nanobots could reduce the need for more invasive surgeries, and dramatically improve clinical outcomes with very low risk and morbidity.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

I have been concerned for some time about the potential risks associated with organic solvents. Previous research linked chronic exposure to nail polish remover with impaired attention spans, and potential harm to babies in utero. And now, new research seems to suggest that exposure to benzene, toluene, and xylene

can cause growth restriction in unborn babies.

Where do you find these chemicals?

Benzene can be found in gasoline, industrial fumes, certain glues, paints, and detergents, and cigarette smoke. Toluene is used in making paints, paint thinners, fingernail polish, lacquers,
adhesives, and rubber and in some printing and leather tanning processes. Xylene is widely used as a
degreasing agent and as a thinner and solvent in paints, inks, adhesives, and
many other products. It is commonly found as a solvent in pesticide products.

Who is at particular risk?

Women who work in factories, mining, or construction seem to be at the highest risk, but nurses, pharmacists, embalmers, and nail salon workers are also commonly exposed to these chemicals.

How much is dangerous?

We don’t know for sure. It’s clear that some women in all of the above professions have suffered effects from chemical exposure, so at current occupation levels, they are a hazzard. There is a clear dose-response relationship associated with exposure (the more exposure, the more likely one is to suffer effects), so the bottom line is that the less exposure, the better.

What should I do?

If you’re pregnant, or planning to become pregnant, please consider that these chemicals can be harmful to your baby. Avoid working with paint thinners, glues, gasoline products, nail polish, inks, etc. when you’re pregnant. And of course, you must not smoke when you’re pregnant (and best to quit for your own health too).

My bottom line is that although it’s impossible to avoid exposure to these chemicals completely (they’re even in polluted air that we breathe), we should do our best to minimize our exposure, especially if we’re pregnant or planning to become pregnant. Let’s keep our eyes on new research that may further clarify the risks.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

A recent article by Dr. Scott Haig has received attention by the New York Times, and a flurry of comments by advocacy groups and bloggers. In his article he describes an unpleasant patient interaction in which he felt that his privacy was violated, his expertise devalued, and his office turned upside down in some sort of self-indulgent doctor-shopping expedition. The patient’s constellation of personality disorder, abusiveness, and invasiveness was empowered somewhat by Internet search, and unfortunately the media has misrepresented the article as a paternalistic outcry against patients deriving information from Google.

First of all, I’m sure that this is not Dr. Haig’s thesis. What he describes is the challenge of working professionally with individuals who have emotional and psychological disorders that create an openly hostile therapeutic environment. Their main goal behind interviewing several physicians of the same specialty is not to come to a deeper understanding of their illness and be sure of their best course of action, but rather to pit physicians against one another, to create controversy where none may exist, and to play the victim. In the hands of such individuals (who are thankfully rare), the Internet can become a source of ammunition against healthcare professionals -  personal information is used with inappropriate boundaries, and scientific details are used to confound the conversation.

Second, a recent study in the British Medical Journal found that doctors were only able to correctly identify challenging diagnoses (based on case reports in the New England Journal of Medicine) using Google search ~50% of the time. If physicians themselves are unable to determine the diagnosis for a given set of symptoms outside of a full history and physical exam (and diagnostic testing), then how likely is it for a patient to get it right? Dr. Haig’s concern about Googling your way to a diagnosis is based upon a well founded fear of misdiagnosis. And because physicians see misdiagnoses with some regularity, they are familiar with the dangers of mistaking life-threatening illness for benign disease. Google can be a poor diagnostic tool, and should be used with caution.

And thirdly, many legitimate medical questions cannot be answered with Internet search. Let me give you three paraphrased examples from Revolution Health’s public forums:

I received a form letter from my radiologist in the mail after having a routine mammogram. The letter said that there was a “finding” on the exam and that I need to repeat the test. What does this form letter mean? Do I have breast cancer?

My mother has moderate Alzheimer’s disease but requires surgery for a possible cancer. She is in fair health, but the physicians say that she is at increased risk of death from the surgery. Is the risk worth the potential benefit?

I had a uterine polyp removed several years ago, and have been experiencing some recent bleeding. I am also on coumadin for a heart condition, and am only 42. Could the bleeding be due to a polyp and should I stop the coumadin?

These kinds of questions aren’t amenable to search answers, and if search were used to come up with answers, the results could be very misleading.

I believe that physicians genuinely care about their patients’ safety and wellbeing - and it is out of personal concern that they worry about them being misled by Internet search. Although Dr. Haig’s essay highlighted yet another limitation of search (the potential for privacy invasion and abuse of the provider), it was not meant as an attack on patient empowerment. In fact, a truly empowered patient is one who uses the expertise of a caring physician along with credible health resources, to become informed.

This is why I’m proud to be a part of Revolution Health - where patients can discuss their questions with physicians who can help them navigate to appropriate information. It’s free to the patient (advertising supports the interaction), and provides “guided search” - the most empowering form of information on the Internet. Clearly, guided search is not a form of diagnosis or treatment, and is not meant to substitute for the individual’s doctor-patient relationship. But in a pinch when you have questions like the ones I listed above, an expert’s insight can be just what the doctor ordered.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.