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Asthma in Women: Gender Differences Are Important

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I recently interviewed Dr. Cliff Bassett about asthma in women and he gave some interesting insights into gender differences associated with this disease. I’ve summarized our conversation below – or you can listen to it here.

The CDC reports that 9% of women have asthma compared to 5% of men. I think that’s a very important finding and I’m not sure if women know that they’re at higher risk than men. The good news is that asthma is completely treatable, although sadly we have as many as 4000 deaths per year in this country attributed to asthma. We’re doing a better job identifying those with severe asthma, and the death rates are decreasing.

Women need to understand that even a small amount of weight gain (as little as 5 pounds) can add up to a much higher risk of death for women with severe asthma. So weight management is very important for those with more challenging asthma symptoms.

Women are more likely to be hospitalized due to an asthma attack than men. And interestingly, up to 40% of women report that their asthma symptoms get worse just before and after menstruation. So for women it’s important to keep a symptom diary, so that if there’s a regular worsening of asthma during menstruation, they might need to be treated more aggressively (perhaps with steroids or other medications) during that time of the month.

The new asthma guidelines (from the NIH) emphasize understanding asthma triggers as the foundation of prevention. It’s much safer to avert an asthma attack than to have to treat a full blown one. So it’s really important for women with asthma to figure out what might trigger their symptoms, and avoid those triggers as much as possible.

Now that it’s winter time, most environmental triggers are of the indoor variety. Over 100 million US households have pets. The most common pet is the cat, and up to 10% of people with allergies develop specific allergies to cats. If an individual suspects that she has a pet allergy, she should see an allergist to get tested to confirm that. Avoidance measures are important, though there are medications and allergy immune therapy (allergy shots) that can help with pet allergies.

Cold dry air can be an asthma trigger in some individuals, especially if they’re engaging in outdoor physical activity. Warm ups and cool downs can help to head off an asthma attack in the cold, though it’s always a good idea to have a rescue inhaler handy.

**Listen To Podcast***This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Finding Your Calling

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I recently spent some time with Dr. Kevin Means, Chairman of the Department of Physical Medicine and Rehabilitation at the University of Arkansas in Little Rock. I asked Dr. Means about his life, how he chose his specialty, and how he came to Little Rock from New York City. This is his story:

Kevin Means grew up on Long Island and attended college in Binghamton, NY. The summer after his first year of college he began looking for work to help him pay his way through school. Jobs were few and far between, and only “undesireable” work remained for college students. Kevin heard about a position as a physical therapy assistant at a facility for the disabled. They were having a difficult time recruiting and retaining candidates due to the strenuous work requirements – heavy lifting, assisting patients with exercises, and moving imobile (and sometimes obese) individuals around was not feasible for many people. But Kevin was a tall, strong, African American man – undaunted by the challenges.

The first few days filled him with sadness – young men with spinal cord injuries, elderly people recovering from severe strokes, amputees with traumatic brain injuries – all doing what they could in the gymnasium. Kevin surveyed the patients and took to heart the individual tragedies that had brought each of them there. He observed the physical therapists as they encouraged movement in the imobile, taught people how to use shriveled limbs, and helped amputees use new prostheses to walk again. Over time, he began to see that each life was a beautiful story of triumph over adversity, and his initial sadness melted as he witnessed the daily victories of recovery.

Slowly, Kevin began taking on more responsibility at the facility. He would sometimes offer additional therapy sessions to patients and stayed late in the evening to make sure that everyone had a full day of exercise. Although he had no formal training as a physical therapist, he grew to understand and practice their techniques, and was dearly loved by the patients.

One day Kevin was offered an office job that paid substantially more than the PTA position. He accepted it gladly, but in the afternoons found himself thinking about his friends at the rehab facility. He wondered if the patients were being cared for correctly, if they were recovering well, and if the nurses were strong enough to help the therapists transfer the patients safely. These nagging questions burned in his mind as he filed paperwork and made phone calls. He just couldn’t stop worrying about them.

A few days later, Kevin returned to his position as a PTA in the rehab facility. He had learned that working with disabled men and women was more fulfilling to him than an office job. He spent the next 3 years working there part-time, and developed long lasting friendships with the patients and staff.

When it came time to go to medical school, Kevin promised his friends that he would do all he could to sharpen his therapy skills and research new ways to help them become independent in their daily lives. For this reason, he chose PM&R as his specialty and attended residency at the top-ranked Rehabilitation Institute of Chicago (RIC). When I asked Kevin why he didn’t stay on at RIC after his residency, he simply said that they didn’t need him. They had plenty of bright, talented physicians who could help to advance the field. Kevin wanted to go where needs were greater, and where his work might bring new hope to those who had very little.

And so Kevin went to Little Rock, Arkansas in the mid ’80’s – to help to build a PM&R program there. He was single – a fact that his friends in Chicago and New York must have called to his attention. But he forged ahead on faith, assuming that he would meet his wife in good time.

Over the past two decades, Kevin has worked tirelessly to grow and establish the PM&R department at UAMS as a center of excellence in rehabilitation medicine. He met his (now) wife while she was working a second job as a clerk at a department store in Little Rock (she is a teacher), and they have 2 lovely children. Kevin took me on a tour of the UAMS facilities which span 3 modern buildings equiped with 2 large swimming pools, beautiful gardens and multiple gymnasiums.

I watched his face as he looked out onto a team of 30+ therapists assisting disabled adults with their goals in a gym. He smiled at the physical therapists and PTAs and I had to wonder if the scene reminded him of his days in Binghamton, and the friendships that gave him the first glimpse of his calling as a physician.

Kevin never did lose sight of his first love: advocating for the needs of the disabled. His career path has taken him from Binghamton to Little Rock – as he steadfastly fulfills his calling as a nurturing healer, working in places where needs are great, and workers are few.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Diabetes Treatment: Is Compliance more Important than Research?

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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.

Women and Allergies: An Update with Cliff Bassett, MD

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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.

The Future of Medical Imaging: An Interview With Richard Robb, PhD

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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.

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