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Patients may ask about a study showing that older adults with spinal stenosis are more frequently undergoing complex (and more hazardous and expensive) surgery.

Writing in JAMA, researchers detail an investigation using Medicare claims data between 2002 and 2007. During that period, the overall number of lumbar stenosis operations declined slightly, while use of the most complex approach increased some 15-fold.

In examining 2007 data, the researchers found that more complex fusion operations had double the rate of major medical complications and double the 30-day mortality of decompression alone. The average hospital charge for the more complex procedure was some $80,000 — versus $24,000 for decompression.

An editorialist concludes that “conflicting economic incentives are clearly at work,” noting that a surgeon’s reimbursement for the more complex approach can be ten times that of simple decompression. Current financial incentives and market forces in medicine, he says, amount to “a formidable economic and social problem.”

79 year old man gets relief from chronic pain in 3 treatments! Listen to this!

 Archives of Internal Medicine article (Free)

Archives of Internal Medicine commentary (Subscription required)

American College of Physicians/American Pain Society guideline on managing low back pain (Free)

General practitioners rarely follow guidelines when managing new episodes of low back pain, reports the Archives of Internal Medicine. (The analysis was conducted in Australia, but the guidelines assessed match those in the U.S.)

 Researchers examined data on some 1700 visits to GPs for new low back pain from 2005 to 2008, after national guidelines for treating musculoskeletal pain were released. Among the findings:

 Although guidelines recommend acetaminophen as a first-line analgesic, it was prescribed for only 18% of patients. NSAIDs and opioids were prescribed for 37% and 20%, respectively.

• One fourth of patients were referred for imaging, despite guidelines advising against routine referral.
• Only one fifth of patients received advice and education as recommended.

 These findings were similar to those from the period before guideline publication.

 The authors conclude: “The results indicate that in most cases, usual care is not evidence-based care and so is not likely to provide the best outcomes.”

Effect of phototherapy on delayed onset muscle soreness.Douris P, Southard V, Ferrigi R, Grauer J, Katz D, Nascimento C, Podbielski P.
Department of Physical Therapy, School of Health Professions, Behavioral and Life Sciences, New York Institute of Technology, Old Westbury, New York 11568-8000, USA. pdouris@nyit.edu

OBJECTIVE: The purpose of this study was to investigate the effects of phototherapy on delayed onset muscle soreness (DOMS) as measured using the Visual Analog Scale (VAS), McGill Pain Questionnaire, Resting Angle (RANG), and girth measurements.
BACKGROUND DATA: Previous research has failed to prove the beneficial effects of phototherapy on DOMS.
METHODS: This was a randomized double-blind controlled study with 27 subjects (18-35 years) assigned to one of three groups. The experimental group received 8 J/cm2 of phototherapy each day for five consecutive days using super luminous diodes with wavelengths of 880 and visible diodes of 660 nm at three standardized sites over the musculotendinous junction of the bicep. The sham group received identical treatment from a dummy cluster. The controls did not receive treatment. The study was completed over five consecutive days: on day one baseline measurements of RANG and upper arm girths were recorded prior to DOMS induction. On days 2-5, RANG, girth, and pain were assessed using VAS and the McGill Pain Questionnaire.
RESULTS: The experimental group exhibited a significant decrease in pain associated with DOMS compared to the control (p=0.01) and sham groups (p=0.03) based upon the VAS at the 48-h period. The McGill Pain Questionnaire showed a significant difference in pain scores at the 48-h period between the experimental and the sham groups (p=0.01). There were no significant differences day to day and between the groups with respect to girth and RANG.
CONCLUSION: The results of this study provide scientific evidence that phototherapy as used in this study provides a beneficial effect to patients who may experience DOMS after a novel exercise session.

PMID: 16875447 [PubMed - indexed for MEDLINE]

Effect of 655-nm low-level laser therapy on exercise-induced skeletal muscle fatigue in humans.Leal Junior EC, Lopes-Martins RA, Dalan F, Ferrari M, Sbabo FM, Generosi RA, Baroni BM, Penna SC, Iversen VV, Bjordal JM.
Laboratory of Human Movement, University of Caxias do Sul, Caxias do Sul, RS, Brazil. ecplealj@ucs.br

OBJECTIVE: To investigate if development of skeletal muscle fatigue during repeated voluntary biceps contractions could be attenuated by low-level laser therapy (LLLT).
BACKGROUND DATA: Previous animal studies have indicated that LLLT can reduce oxidative stress and delay the onset of skeletal muscle fatigue.
MATERIALS AND METHODS: Twelve male professional volleyball players were entered into a randomized double-blind placebo-controlled trial, for two sessions (on day 1 and day at a 1-wk interval, with both groups performing as many voluntary biceps contractions as possible, with a load of 75% of the maximal voluntary contraction force (MVC). At the second session on day 8, the groups were either given LLLT (655 nm) of 5 J at an energy density of 500 J/cm2 administered at each of four points along the middle of the biceps muscle belly, or placebo LLLT in the same manner immediately before the exercise session. The number of muscle contractions with 75% of MVC was counted by a blinded observer and blood lactate concentration was measured.
RESULTS: Compared to the first session (on day 1), the mean number of repetitions increased significantly by 8.5 repetitions (+/- 1.9) in the active LLLT group at the second session (on day 8), while in the placebo LLLT group the increase was only 2.7 repetitions (+/- 2.9) (p = 0.0001). At the second session, blood lactate levels increased from a pre-exercise mean of 2.4 mmol/L (+/- 0.5 mmol/L), to 3.6 mmol/L (+/- 0.5 mmol/L) in the placebo group, and to 3.8 mmol/L (+/- 0.4 mmol/L) in the active LLLT group after exercise, but this difference between groups was not statistically significant.
CONCLUSION: We conclude that LLLT appears to delay the onset of muscle fatigue and exhaustion by a local mechanism in spite of increased blood lactate levels.

PMID: 18817474 [PubMed - indexed for MEDLINE]

Effects of low-level laser irradiation on rat skeletal muscle injury after eccentric exercise.Liu XG, Zhou YJ, Liu TC, Yuan JQ.
Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China.

BACKGROUND AND OBJECTIVE: The effect of photobiomodulation on delayed onset muscle soreness remains unknown. This study represents the first investigation of this treatment using an animal model.
METHODS: Seventy-two Sprague-Dawley rats were randomly divided into five groups: sedentary control group, exercise control group and three exercise-plus-laser groups. Downhill running was used to induce muscle injury in the gastrocnemius muscle. He-Ne laser irradiations were administered to the injured muscles immediately and at 18 and 42 h after exercise in the three exercise-plus-laser groups at 12, 28, and 43 J/cm2, respectively. Histological examination and serum creatine kinase (CK), muscle superoxide dismutase (SOD) and malondialdehyde (MDA) analyses were done at 24 and 48 h after exercise.
RESULTS: The exercise control group exhibited a marked inflammation in the gastrocnemius muscle and significant elevations in serum CK activity and muscle MDA level after downhill running. He-Ne laser irradiation at 43 J/cm2 inhibited muscle inflammation, significantly enhanced muscle SOD activity and significantly reduced serum CK activity and muscle MDA level at both 24 and 48 h after exercise, whereas the irradiation at 12 or 28 J/cm2 slightly inhibited muscle inflammation and significantly reduced serum CK activity at 48 h after exercise only (P < 0.05).
CONCLUSIONS: Low-level He-Ne laser therapy could exert therapeutic effects on eccentric exercise-induced rat muscle injury through enhancing muscle anti-oxidative capacity and reducing the inflammatory reaction. The photobiomodulation was dose-dependent, and the 43 J/cm2 dose was the most efficient among the doses used.

PMID: 19697999 [PubMed - in process]

The FDA has approved liraglutide (Victoza) to help control blood sugar in adults with type 2 diabetes. The drug is not recommended as a first-line treatment.

Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist and will be available as a once-daily injection.

Results of clinical trials of liraglutide suggested an increased risk for pancreatitis, compared with other diabetes medications. The most frequent side effects included headache, nausea, and diarrhea. Animal studies showed an increased risk for tumors of the thyroid gland, but it is not clear whether the drug also causes thyroid problems in humans.

As part of the drug’s approval, the company must conduct additional studies on cardiovascular safety and other adverse effects.

FDA news release (Free)

FDA Q&A on liraglutide safety (Free)

The side effects are worse than the disease. Why not try a natural approach to control your blood sugar, which includes eating right (probably not what you’ve ever been told), proper supplements and exercise? Too hard? Easier to just take a pill or shot? Take control of your health today.

Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2008-0798

Celiac Disease
Thyroid Diseases

Related Collections

Thyroid

Autoimmunity

The Journal of Clinical Endocrinology & Metabolism Vol. 93, No. 10 3915-3921
Copyright © 2008 by The Endocrine Society

Risk of Thyroid Disease in Individuals with Celiac Disease
Peter Elfström, Scott M. Montgomery, Olle Kämpe, Anders Ekbom and Jonas F. Ludvigsson
Department of Pediatrics (P.E., J.F.L.) and Clinical Research Centre (S.M.M.), Örebro University Hospital, SE-701 85 Örebro, Sweden; Clinical Epidemiology Unit (S.M.M., A.E., J.F.L.), Department of Medicine, Karolinska Institutet, Karolinska University Hospital, SE-17176 Stockholm, Sweden; Department of Medical Sciences (O.K.), Uppsala University, University Hospital, SE-75123 Uppsala, Sweden; and Department of Primary Care and Social Medicine (S.M.M.), Charing Cross Hospital, Imperial College, W6 8RF London, United Kingdom

Address all correspondence and requests for reprints to: Peter Elfström, Department of Pediatrics, Örebro University Hospital, SE-701 85 Örebro, Sweden. E-mail: peter.elfstrom@orebroll.se.

Background: It has been suggested that celiac disease is associated with thyroid disease. Earlier studies, however, have been predominately cross-sectional and have often lacked controls. There is hence a need for further research. In this study, we estimated the risk of thyroid disease in individuals with celiac disease from a general population cohort.

Methods: A total of 14,021 individuals with celiac disease (1964–2003) and a matched reference population of 68,068 individuals were identified through the Swedish national registers. Cox regression estimated the risk of thyroid disease in subjects with celiac disease. Analyses were restricted to individuals with a follow-up of more than 1 yr and with no thyroid disease before study entry or within 1 yr after study entry. Conditional logistic regression estimated the odds ratio for subsequent celiac disease in individuals with thyroid disease.

Results: Celiac disease was positively associated with hypothyroidism [hazard ratio (HR) = 4.4; 95% confidence interval (CI) = 3.4–5.6; P < 0.001], thyroiditis (HR = 3.6; 95% CI =1.9–6.7; P < 0.001) and hyperthyroidism (HR = 2.9; 95% CI = 2.0–4.2; P < 0.001). The highest risk estimates were found in children (hypothyroidism, HR = 6.0 and 95% CI = 3.4–10.6; thyroiditis, HR = 4.7 and 95% CI = 2.1–10.5; hyperthyroidism, HR = 4.8 and 95% CI = 2.5–9.4). In post hoc analyses, where the reference population was restricted to inpatients, the adjusted HR was 3.4 for hypothyroidism (95% CI = 2.7–4.4; P < 0.001), 3.3 for thyroiditis (95% CI = 1.5–7.7; P < 0.001), and 3.1 for hyperthyroidism (95% CI = 2.0–4.8; P < 0.001).

Conclusion: Celiac disease is associated with thyroid disease, and these associations were seen regardless of temporal sequence. This indicates shared etiology and that these individuals are more susceptible to autoimmune disease.

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B6 Toxicity
An overdose of pyridoxine can cause a temporary deadening of certain
nerves such as the proprioceptory nerves; causing a feeling of
disembodiment common with the loss of proprioception. This condition
is reversible when supplementation is stopped.[12]
Because adverse effects have only been documented from vitamin B6
supplements and never from food sources, this article only discusses
the safety of the supplemental form of vitamin B6 (pyridoxine).
Although vitamin B6 is a water-soluble vitamin and is excreted in the
urine, very high doses of pyridoxine over long periods of time may
result in painful neurological symptoms known as sensory neuropathy.
Symptoms include pain and numbness of the extremities, and in severe
cases difficulty walking. Sensory neuropathy typically develops at
doses of pyridoxine in excess of 1,000 mg per day. However, there have
been a few case reports of individuals who developed sensory
neuropathies at doses of less than 500 mg daily over a period of
months. None of the studies, in which an objective neurological
examination was performed, found evidence of sensory nerve damage at
intakes of pyridoxine below 200 mg/day. In order to prevent sensory
neuropathy in virtually all individuals, the Food and Nutrition Board
of the Institute of Medicine set the tolerable upper intake level (UL)
for pyridoxine at 100 mg/day for adults. Because placebo-controlled
studies have generally failed to show therapeutic benefits of high
doses of pyridoxine, there is little reason to exceed the UL of 100 mg/
day.

http://women.emedtv.com/vitamin-b6/vitamin-b6-toxicity.html

http://www.arupconsult.com/Topics/Vitamins.html