Booster Shots

Oddities, musings and news from the health world

Category: injuries

Driving dementia patients off the road: Neurologists weigh in

April 13, 2010 | 10:51 am

Taking the car keys away from an aging parent or spouse whose mental faculties are slipping is one of the most difficult decisions a loved one confronts. But sometimes, it must be done. And knowing what checklist neurologists use might help both to back up your judgment and take some of the sting out of the decision for all parties.

Fortunately, the American Academy of Neurology has just issued new practice parameters for physicians that take account of the most recent findings on cognitive impairment and driving. This is the group's first update of the document in a decade.

Among patients who have recently been diagnosed with mild dementia, 76% can still pass an on-road driving test. Clearly, some with mild dementia can continue for some time to drive safely, but not all.  

The stakes for guessing which ones should not are high. But "there is no test result or historical feature which accurately quantifies driving risk," the academy says. The neurologist's most useful tool for gauging dementia is called the mini-mental state exam, but a patient's score on that test alone is not a good predictor of an older driver's ability to drive safely.

The academy recommends that, beyond a patient's performance on the mini-mental state exam, a physician should consider the patient's past driving record, his or her level of aggressiveness and impulsiveness, and whether the patient acknowledges avoidance in his or her driving patterns -- reporting, for instance, that he stays away from driving on highways or at night. When the driver acknowledges such avoidance behavior, that's a more useful clue than when she doesn't; some patients don't respond to declining driving performance by scaling back.

In the same vein, eliciting a caregiver's view of a patient's driving safety is most useful to a physician in cases where the caregiver rates the patient's driving as marginal or unsafe. Recent research suggests that caregivers routinely overestimate the driving performance of a loved one with dementia -- a fact that loved ones should consider when they begin to have doubts. 

And taking a patient's word for it is clearly not useful. The practice guidelines took note of research finding that in a group of patients with mild Alzheimer's disease, 94% identified themselves as safe drivers, while only 41% could actually pass an on-road driving test. Another study found of drivers diagnosed with mild Alzheimer's found that all of those who had failed the on-road driving exam had rated themselves as good drivers. 

Sadly, there are no proven interventions -- classes, medications, strategies -- that can reduce driving risk for those with dementia. One study suggested that requiring those over 85 years of age to come in and apply for a license in person reduced fatal crashes among this population.

Are you facing this difficult decision? Here's a very useful article on the subject, and here's a state-by-state list of alternative transportation available to seniors and patients with disabilities.

-- Melissa Healy


A stem cell booster from the supplements world: too good to be true?

April 9, 2010 |  5:29 pm

Impressed with how well your (insert any nutritional supplement here) supports your metabolic function, your bone, brain, breast or prostate health, your energy level? The Journal of Translational Medicine -- an open-access publication of the respected British medical publisher BioMedCentral -- this week carries a study involving a natural-products concoction that might kick your nutritional supplement's butt. The study suggests that a product containing a fermented combination of green tea, astralagus, goji berry extracts and the kinds of live cultures found in yogurt significantly boosted circulating levels of the kinds of reparative stem cells produced by bone marrow.

Those stem cells play a key role in the body's effort to heal itself in the wake of tissue injury. But cancer doctors have known for decades they can also be mobilized and harvested, and used to rebuild the immune system of a patient who's undergone aggressive chemo and/or radiation therapy. To do that, either the patient herself or a matched stem-cell donor must undergo a course of medication -- "stimulating factor" -- to increase production of those hematopoietic stem cells and send them out into the bloodstream, where they can be captured.

But that medication is very costly, and its use over time can increase a person's risk of blood clots. Perhaps a cocktail of cheap ingredients found in plants and everyday foods could do the same thing more cheaply and safely? This study suggests there may be at least one that can.

"To our knowledge, this is the first study demonstrating profound mobilization effect with possible clinical significance by a food supplement-based approach," the authors wrote, after demonstrating that 14 days of supplementation with Stem-Kine, by several measures, increased production of hematopoietic stem cells and their appearance in the bloodstream of subjects. 

Too good to be true, as so many accounts of nutritional supplements are? It surely does not inspire confidence that the study was supported in part with a grant from the maker of the supplement, and that the lead author, who designed the experiment, interpreted data and prepared the manuscript, is a shareholder of the company that makes the stuff.

It also doesn't help that the authors acknowledge that "the mechanism" of this mobilization of stem cells "remains unknown" -- or that they don't openly wonder which of this busy cocktail's many ingredients might be active in affecting that mobilization.

But publication by BioMedCentral does confer some respectability on this study. So does the final line of the study: After suggesting that the nutritional supplement-stem cell link might "offer significant benefit in treatment of a wide variety of degenerative diseases," the authors write this: "Given commercial pressures associated with this largely unregulated field, we propose detailed scientific investigations must be made before disease-associated claims are made by the scientific community." 

-- Melissa Healy  


Obesity may not count as a cushion in a car crash

April 4, 2010 |  6:00 am

Some people believe obesity provides a cushioning effect in car crashes, with the extra padding helping to protect people against severe trauma. A few researchers set out to see if that's true, using crash test dummies in simulated frontal crashes.

Kybqgenc But they didn't use just any crash test dummies. The researchers used three obese and five normal-weight cadavers, since, according to the study, obese crash test dummies don't exist. Who knew?

The dummies were put into a simulated mid-size car that crashed at about 30 mph, to see how they responded to the force. The obese test subjects, who wore seat belts but had no air bags, had greater maximum forward pitch than their non-obese counterparts before being stopped by the seat belt.

Also, parts of their body experienced different trajectories--the obese dummies' hips slid forward more, allowing their torsos to not fall forward as much. That may protect obese people's heads from hitting the inside of the car, but may also cause more injury to the ribs and lungs, since the load is concentrated on the lower part of the thorax, closer to the abdomen. Since the hips move forward more, the lower extremities might also be more vulnerable.

So no, obese people don't seem to have a definite advantage in car crashes. In another study, obese men had worse outcomes in sustaining upper body injuries in car crashes versus normal-weight men. So buckle up, everyone.

The study, done by researchers at the University of Virginia and Autoliv Inc. in Sweden, appears in the April issue of the journal Obesity.

-- Jeannine Stein

Photo credit: Thomas Whisenand / AP


Feel the burn, but be careful--weight training injuries have gone up

March 31, 2010 | 12:34 pm

Weight training can be great exercise, building muscle and helping to prevent bone loss. But as it's gotten more popular, injuries have increased, according to a new study.

EnenibgyResearchers examined data on emergency room cases involving weights. The study, published online in the American Journal of Sports Medicine, found that from 1990 to 2007 there were 25,335 weight training injuries in 100 U.S. hospitals with a 24-hour emergency department, which researchers correlate to about 970,801 injuries nationwide.

From 1996 to 2007 overall injuries increased 48.4%, with men sustaining the most injuries at 82.3%. But women weren’t exempt--although their numbers were smaller, their injury rate increased 63% from 1996 to 2002, signaling that their presence in the weight room is growing. People age 13 to 18 had the highest number of injuries, again indicating that more young people are strength training.

The upper trunk was the most commonly injured part of the body, followed by the lower trunk and hand. Women had more foot and leg injuries compared with men. The most frequently diagnosed injuries were sprains and strains, followed by soft tissue damage.

As to how these injuries happened, the No. 1 reason was dropping a weight on some part of the body. Coming in second was a body part being smashed or crushed between weights, and third was hitting yourself. Other methods of harm included overexertion, loss of balance or falling, and lifting or pulling. The vast majority of equipment-related injuries--90.4%--happened while using free weights.

Though these statistics may make you think lifting weights is an accident waiting to happen, injuries can be prevented, said Dawn Comstock, the study's co-author and principal investigator in the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio. In a news release, she said, "Before beginning a weight training program, it is important that people of all ages consult with a health professional, such as a doctor or athletic trainer, to create a safe training program based on their age and capabilities. Getting proper instruction on how to use weight lifting equipment and the proper technique for lifts, as well as providing trained supervision for youths engaging in weight training, will also reduce the risk of injury."

Nationwide also offers this video about the study.

-- Jeannine Stein

Photo credit: Lawrence K. Ho / Los Angeles Times


So what does knee replacement look like? Valve repair? Vasectomy reversal?

March 16, 2010 |  3:32 pm

Basketball Knee replacement and hip resurfacing don't have to mean the end of that go-go-go lifestyle, as Jeannine Stein reported earlier Tuesday on Booster Shots. But promises of an active existence aside, not knowing what to expect from the surgery can make even the most pain-riddled patients reluctant to say goodbye to the joints with which they were born.

Time for a visit to the surgery video library! (If you dare....) The ever-reliable MedlinePlus offers a variety of surgical videos from which to choose. Each has interviews, medical explanations and, of course, scenes of the procedure in question. There are 10 in the knee replacement category alone (here's one), but why stop there?

You can also watch a hip replacement (complete with hammer pounding away at the joint), mitral valve repair, laparoscopic adrenalectomy, vasectomy reversal, living donor kidney transplant .... 

These are not videos for those easily made squeamish. But they are enlightening.

As for that go-go-go lifestyle, here's the earlier blog post. Assuming you can watch the video of your choice without losing the desire to get off the couch, much less play sports, it's yours for the taking.

 -- Tami Dennis

Photo: Want to do this again? Time to learn what's required... 

Credit: Associated Press


Washing hands is a smart preventive; so is washing trauma patients

March 15, 2010 |  5:29 pm

Ambulances Swabbing down trauma patients with disposable, antiseptic-laced cloths appears to pay off in terms of infection control. 

Doctors at Harborview Medical Center in Seattle found that patients given a daily antiseptic wipe down were much less likely to develop a catheter-related bloodstream infection than patients who received a daily, non-antiseptic wipe down. They were also much less likely to develop either a MRSA or Acinetobacter infection.

Here's more on those catheter infections, MRSA and Acinetobacter from the Centers for Disease Control and Prevention.

The full study results, released online Monday, were published in the March issue of Archives of Surgery. Here's a news release from Infection Control Today, plus the abstract. And here's the Reuters health story with a disturbing twist at the end.

If you're interested in the antiseptic used, here's information on chlorhexidine from Mayo Clinic. For at-home use, soap and water should suffice.

-- Tami Dennis

Photo: The trauma's bad enough, but then can come the infections...

Credit: Allen J. Schaben / Los Angeles Times


Chicago's handgun ban: A 2nd Amendment issue? A public health issue?

February 24, 2010 | 11:29 am

Guns Most Americans may not be looking at Chicago's ban on handguns through a health and medical prism. But the American Public Health Assn. is.

With the challenge to the law now before the U.S. Supreme Court, the association has weighed in, coming down strongly on the side of ...

(Do you have to ask?)

Here's an excerpt from the organization's statement about its recent friend-of-the-court brief:

"APHA has long supported comprehensive measures to reduce and prevent premature injury and death from handguns, including limiting access to handguns, creating a national database to facilitate research on handgun-related fatalities and developing community- and school-based programs targeting the prevention of handgun injuries, suicides, homicides and assaults."

And here's a previous L.A. Times story on the case that explains how this 2nd Amendment and public-health issue can affect a community near you. It begins:

"The Supreme Court's decision Wednesday to hear a 2nd Amendment challenge to Chicago's handgun ban could open the door to similar lawsuits in cities and states across the nation."

For a related editorial, also from the L.A. Times, click here. And, if you're so inclined, some explainers of "friend-of-the-court brief" and docket information on McDonald vs. Chicago.

-- Tami Dennis

Photo: The Los Angeles Police Department displays some of the handguns turned in last year in exchange for supermarket gift cards.

Credit: Brian Vander Brug / Los Angeles Times


Another FDA warning, this time about ear candles. Ear candles?

February 18, 2010 |  1:51 pm

Here's a really stupid idea: ear candles, fabric tubes soaked in beeswax or paraffin, inserted in the ear, and set on fire. The candles are being marketed as treatments for a variety of conditions, including ear wax buildup, sinus infections, hearing loss, headaches, colds, flu and sore throats. Astonishingly, some companies are even claiming the devices are appropriate for use on chldren.

Some ear candles are even offered as products that purify blood, strengthen the brain or even cure cancer.Earcandle

The Food and Drug Administration and its Canadian counterpart, Health Canada, are saying, Wait a minute!  The agencies are issuing import alerts about the products, warning the manufacturers, issuing injunctions and seizing shipments.

First of all, the FDA believes there is "no valid scientific evidence for any medical benefit" from their use, said Dr. Eric Mann of the agency's Division of Ophthalmic, Neurological, and Ear, Nose and Throat Devices.

Secondly, they are very hazardous. Among injuries that have been reported burns to the face, ear canal, eardrum and middle ear; injury to the ear from dripping wax; ears plugged by candle wax; bleeding; and puncture of the eardrum. Fires have also been reported. Moreover, people who use them often delay seeking treatment for their original illnesses. The two agencies believe that injuries caused by the devices are underreported.

The devices could be particularly hazardous for children, officials said, because they are likely to squirm, which increases the likelihood of injuries from fire, dripping wax and punctures.

-- Thomas H. Maugh II

An ear candle being burned, an indication of their size, and part of a box label showing a candle in use on an adult in a sitting position. Credit: FDA


You say concussion, I say brain injury. Let's call the whole thing serious

January 18, 2010 | 10:50 am

The terms concussion and mild traumatic brain injury pretty much mean the same thing. But which term a parent hears from the doctor makes a big difference in the seriousness with which the injury is treated, a new study finds.

Injured kids whose parents hear the word "concussion" spend less time in the hospital, go back to school and other activities earlier, and run greater risks to their cognitive health than do kids whose parents are told their child has sustained a "brain injury."

The study, published today in the journal Pediatrics, tracked 268 kids admitted to a hospital in Ontario, Canada after a head trauma. Doctors there gave a third of them a diagnosis of "concussion," while the rest got some variant of traumatic brain injury -- sometimes shortened to TBI. In the days following their injuries, those with a diagnosis of concussion were 1 1/2 times as likely to be discharged from the hospital as those with a "mild TBI" diagnosis -- even though there was significant overlap between the two groups in terms of the severity of their head injuries. There was a 2 1/2 times greater likelihood that the kids diagnosed with "concussion" would go back to school early as well.

"Our study suggests that if a child is given a diagnosis of a concussion, the family is less likely to consider it an actual injury to the brain," said the study's lead author, Carol DeMatteo, an occupational therapist and childhood disability researcher at McMaster University, in a news release accompanying the article. "These children may be sent back to school or allowed to return to activity sooner, and maybe sooner than they should. This puts them at greater risk for a second injury, poor school performance, and wondering what is wrong with them."

Physicians' alertness to a concussion's potentially lingering effects -- including hearing loss, dizziness, memory problems, headaches, depression -- is growing, the result of the U.S. military's burgeoning experience with personnel in Iraq and Afghanistan who are showing signs of brain trauma. As described in a recent article in The Times, the challenge of caring for troops with brain injuries sustained in battle has brought new money and attention to the study of brain injury and its aftermath.

The world of professional sports, which has had years of experience with concussions, has much to contribute to the effort. But organizations such as the National Football League have shown reluctance to acknowledge what is increasingly clear to medical researchers: that patients with repeated concussions, especially those who go back to strenuous activity before their brain has healed, run a high risk of negative effects long after sustaining a bump to the head.

-- Melissa Healy 


Plasma injection for Achilles tendon found ineffective

January 12, 2010 |  1:00 pm

Heel Injecting plasma into the Achilles tendon is not helpful in reducing pain or increasing mobility, according to a study published today in the Journal of the American Medical Assn.

Injection of platelet-rich plasma for chronic Achilles tendinopathy is increasingly popular. The injury is an overuse disorder that often affects athletes but also inactive middle-aged people. The platelet-rich plasma injection is thought to release growth factors that assist in tissue repair. The study, by researchers in the Netherlands, was a randomized, blinded clinical trial that assigned 54 patients with the disorder to either exercise with the plasma injection or exercise with a saline injection (the placebo treatment). The participants were given questionnaires to gauge pain and activity levels at weeks six, 12 and 24 of treatment. But participants in both groups improved significantly after 24 weeks. There was no additional benefit from receiving the plasma injection.

The treatment should not be recommended, said the authors of the study.

"The reason why both treatment groups show clinical progress in our study, but also in other studies on platelet-rich plasma, is likely due to the fact that exercises were performed," they wrote.

- Shari Roan

Photo credit: Ricardo DeAratanha  /  Los Angeles Times



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