HEALTHOUGHTS
Osteoarthritis, the most common form of joint disease, is caused by ordinary wear and tear on the surfaces of bones. For athletes who have injured or stressed their knees, it can start at an early age. Older adults may find the swelling, stiffness and pain in their knees increases as they age.Doctors are adding new alternatives to the fight against osteoarthritis and looking for more, says C. Thomas Vangsness, Jr., M.D., co-director of the USC Center for Athletic Medicine. Various options are available to deal with the pain-from drugs to surgery.
To begin with, Vangsness says, reducing the weight the knee must carry also reduces the stresses on it. (Physical therapy and exercise keep the muscles strong around the knee, but do not help the cartilage.)
Along with weight reduction, over-the-counter analgesics may offer relief. "People often start with aspirin or acetaminophen (Tylenol), or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen," says Vangsness. "New NSAID drugs called COX-2 inhibitors reduce pain and swelling like ibuprofen but are meant to eliminate the stomach irritation often associated with that drug."
A new drug therapy of injectable gels uses hyaluronic acid, an extract from rooster combs, to treat the pain. One drug called hyaluronan (Hyalgan) is injected into the knee once a week for five weeks, while another, called hylan G-F20 (Synvisc), is injected three times over 15 days. Vangsness says pain relief may last six months.
Osteoarthritis sufferers living outside of the U.S. have used two natural alternatives, glucosamine and chondroitin, for years. Sold as nutritional supplements and not regulated by the U.S. Food and Drug Administration, they are touted as protective products that help rejuvenate arthritic joints. The National Institutes of Health is currently funding a large clinical trial of glucosamine and chondroitin. Vangsness agrees that further research is needed to better determine how and if they work, but says, "In spite of the lack of regulation, I occasionally recommend alternative supplements to my patients."
If these measures fail to alleviate the pain, surgery may be the final option. Surgeons can now harvest a patient's cartilage cells, grow the cells outside the body in a lab, and reinsert the cells into the patient's cartilage defect. Surgeons also may transplant parts of a knee from a cadaveric donor, or may partially or completely resurface the knee using synthetic parts.
Every year, about 500,000 people around the world are diagnosed with the "wet" form of macular degeneration (AMD), the leading cause of blindness among people over the age of 50.But there is good news: the U. S. Food and Drug Administration has approved Visudyne therapy for the treatment of this often devastating disease.
"This is very exciting news for more than 200,000 Americans each year who develop this condition and lose their vision," says Jennifer Lim, M.D., USC associate professor of ophthalmology, and one of the lead investigators in the clinical trials leading to the approval of Visudyne therapy. "Until now, we have had no effective treatment for this devastating disease, which destroys the patients' central vision and leaves them unable to read, drive, or recognize faces."
Wet AMD is characterized by the formation of abnormal blood vessels that grow across the central part of the retina, called the macula. These vessels leak fluid and eventually cause scar tissue, which destroys central vision.
Visudyne therapy is a two-step procedure that can be performed in a doctor's office. First the Visudyne drug is injected intravenously into the patient's arm, says Lim. The drug is then activated by shining non-thermal laser light into the patient's eye. The activated drug causes closure of the abnormal blood vessels.
Despite the high prevalence of AMD, a recent study showed that only 30 percent of American adults are familiar with the disease.
"Lack of awareness of macular degeneration is a serious concern," says Lim. "Patients who are diagnosed early have the best chances for successful treatment. We encourage everyone over the age of 50 to follow the American Academy of Ophthalmology's recommendation and see their eye care professional once a year for a check up."
Visudyne is being co-developed by CIBA Vision Corporation, the eye care unit of Novartis AG, and QLT Photo Therapeutics Inc.
No Sweat
"Pleased to meet you."Ordinarily, the phrase prompts you to reach out and shake someone's hand. But for people with palmar hyperhidrosis-excessive sweating of the palms of the hand-those words may be among the most dreaded.
About one of every 100 people suffers from hyperhidrosis, which may also be associated with excessive perspiration of the hands, face,
soles of the feet, armpits, chest or back.
"As a consequence of this disorder, patients often suffer from embarrassment, social isolation or difficulty at work," says Jeffrey Hagen, M.D., USC assistant professor of surgery.
Treatments include lotions, antiperspirants, medications and biofeedback. Yet for some, these remedies were not enough and their only alternative was open surgery. But today, medical advances have made a less invasive surgical treatment available.
Doctors know the symptoms of hyperhidrosis result from an overactive sympathetic nervous system. This system is responsible for regulating body temperature and controlling production of sweat in glands throughout the body.
Key parts of this nervous system run along each side of the spine, where the nerves branch out to the arms and legs. Interrupting these nerve fibers helps cure hyperhidrosis. In the past, surgery for hyperhidrosis required entering through the chest or both sides of the neck. When operating through the chest, surgeons had to spread or separate the ribs, and the patient remained in the hospital for up to a week. The patient also had a second operation for the other side of the body.
Now, a minimally invasive procedure called endoscopic transthoracic sympathectomy allows surgeons to divide the sympathetic nerves, resulting in low risk, short recovery time and minimal pain. The surgeon inserts a tiny video camera with a telescope through inch-long incisions behind the patient's armpits. The surgeon then identifies the nerve chain responsible for excessive sweating and divides the nerves. "The benefits of the procedure are immediate and most patients can return home on the day of surgery," Hagen says. "And because the procedure is minimally invasive, both sides can usually be done the same day, eliminating the need for two separate operations."
You have excruciating pain in your back or side that brings you to your knees. You have a kidney stone.
Kidney stones form when certain natural chemicals in urine, such as calcium, crystallize and clump together. They usually form in the center of the kidney, on the ends of tiny collecting tubes. These tubes lead into the ureter, the larger tube that drains urine to the bladder.
Most kidney stones pass out through the urine after a day or two, says USC urologist Jeffry Huffman, M.D. But the pain is so agonizing that those afflicted often end up in emergency rooms. Huffman recommends that people passing kidney stones see a doctor to be monitored, get help with pain until the stone passes and make sure no infection is present.
Stones more than 5 mm across can get stuck in the ureter as they move toward the bladder, and are too big to pass on their own, Huffman says. Two to three people of every 10 with kidney stones have this problem.
"The good news is that there are excellent treatments available," he says. Most people can undergo lithotripsy, a non-invasive surgical procedure usually done in outpatient centers. They use an X-ray to help locate the stone and then aim high-frequency sound waves at it, pulverizing the stone. The small particles then pass through with the urine.
For the one of every five people who cannot be helped by lithotripsy, there is urologic endoscopy. In this procedure, a physician snakes an endoscope, a thin tube with a light and miniature camera equipment on the end, through the urethra and bladder or through a small perforation in the skin directly to the kidney. Using a video monitor, the urologists locate the stone and use a tiny claw device to grab it, detach it and remove it.
Physicians may analyze the stone to understand its cause. They may also analyze blood and urine to look for abnormalities in metabolism, leading to recommendations on diet and medications to try to deter stones from forming in the future.
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