For Men with Prostate Cancer, Emotional Distress May Lead to More Aggressive Treatment

Newswise, January 14, 2017 – The anxiety many men experience after being diagnosed with prostate cancer may lead them to choose potentially unnecessary treatment options, researchers from the University at Buffalo and Roswell Park Cancer Institute report in a new study.

“Emotional distress may motivate men with low-risk prostate cancer to choose more aggressive treatment, such as choosing surgery over active surveillance,” said UB’s Heather Orom, the lead author on the study, published in the February issue of the Journal of Urology.

“It underscores what we have been pushing a long time for, which is, ‘Let’s make this decision as informed and supported as possible.’ If distress early on is influencing treatment choice, then maybe we help men by providing clearer information about prognosis and strategies for dealing with anxiety. We hope this will help improve the treatment decision making process and ultimately, the patient’s quality of life,” added Orom, PhD, associate professor of community health and health behavior in UB’s School of Public Health and Health Professions.

The study involved 1,531 men with newly diagnosed, clinically localized prostate cancer, meaning the disease hadn’t spread to other parts of the body.

Researchers measured participants’ emotional distress with the Distress Thermometer, an 11-point scale ranging from 0 (no distress) to 10 (extreme distress). The men were assessed after diagnosis and again as soon as they had made their treatment decision.

The majority of study participants had either low- or intermediate-risk disease, and were more likely to have been treated with surgery, followed by radiation and active surveillance.

“Men’s level of emotional distress shortly after diagnosis predicted greater likelihood of choosing surgery over active surveillance,” the researchers report.

“Importantly, this was true among men with low-risk disease, for whom active surveillance may be a clinically viable option and side effects of surgery might be avoided.”

While prostate cancer is a major disease in the U.S., it is not a death sentence, according to the American Cancer Society, which estimates there are nearly 3 million prostate cancer survivors alive today.

However, overtreatment is a concern, and surgery and radiation therapy have side effects that include erectile dysfunction and incontinence, which, for the majority of men diagnosed with low-risk prostate cancer, can be avoided by instead choosing active surveillance to monitor the cancer and considering treatment if the disease progresses.

“There’s an interest in driving the decision-making experience to prevent overtreatment and ensure that men have full information about all the side effects so they can make a choice that’s preference and value driven,” Orom said. “We don’t want men to make a decision that they’ll regret later on.”

“The goal of most physicians treating men with prostate cancer is to help their patients and family members through a difficult process and help their patients receive appropriate treatment,” said Willie Underwood III, MD, MS, MPH, an associate professor in Roswell Park’s Department of Urology, and a paper co-author.

“To do so, it is helpful for physicians to better understand what is motivating men’s decisions and to address negative motivators such as emotional distress to prevent men from receiving a treatment that they don’t need or will later regret,” Underwood added.

Caitlin Biddle, a PhD candidate in community health and health behavior at UB, is also a co-author on the paper.

Cedars-Sinai Neurologist Warns of Increased Risk of Strokes During and after the Holidays

Stroke Expert Explains How to Recognize Symptoms and Prevent Life-Threatening Complications by Acting Quickly

Newswise, January 3, 2017 — Along with increased cheer and festivities during the holidays comes an increased risk of stroke, one of the leading causes of death and disability in the U.S.

Patrick D. Lyden, MD, chair of the Cedars-Sinai Department of Neurology, said he sees a significant increase in stroke incidents during December and January, particularly on Christmas Day and New Year’s Day.

Lyden attributes the surge to holiday stress, sleep deprivation, dehydration, smoking, overindulging, and seasonal colds and influenza. He also says that changes in barometric pressure and lower temperatures can play a role.

“Holiday strokes can be an unexpected and even fatal problem because they often arrive with little warning,” said Lyden, director of the Cedars-Sinai Stroke Center. “The good news, however, is that with advanced tools and technology available to us, we may prevent life-threatening complications and even reverse the effects of a stroke if we administer treatment within six hours.”

Lyden says the number of stroke cases treated at Cedars-Sinai rises to about 100 from about 80 per month during the winter season. Stroke is the fifth-leading cause of death in the U.S. and a leading cause of disability, according to the American Stroke Association.

To recognize symptoms, leading stroke experts recommend memorizing an easy-to-remember acronym: FAST!

Face (drooping of the face)
Arm (arm weakness)
Speech (slurred speech)
Time (time counts -- call 911 immediately)

To reduce the risk of strokes, Lyden recommends that individuals reduce stress, eat and drink in moderation, be vigilant about taking prescribed medications, exercise, get rest and stop smoking.

“Studies show that 80 percent of strokes can be prevented,” said Lyden. “But if it occurs, the key is calling 911 fast. Every minute a stroke is untreated, the average patient loses about 1.9 million brain cells.”

Cedars-Sinai has been designated a Comprehensive Stroke Center by The Joint Commission, an independent, not-for-profit organization that accredits and certifies nearly 21,000 health care organizations and programs in the United States.

This advanced certification for comprehensive stroke centers recognizes the significant resources in staff and training that these centers must have to treat complex stroke cases. Cedars-Sinai was proud to be among the first five hospitals in the nation, and the first in Southern California, to receive this designation.

Study Details Molecular Roots of Alzheimer’s

Credit: Daniel L. Kober

A new study at Washington University School of Medicine in St. Louis details the structure of TREM2, a protein involved in Alzheimer's disease and other neurodegenerative disorders

Cellular 'housekeeping' molecule’s structure linked to neurodegeneration

Newswise, January 3, 2017 — Scientists at Washington University School of Medicine in St. Louis have detailed the structure of a molecule that has been implicated in Alzheimer’s disease.

Knowing the shape of the molecule — and how that shape may be disrupted by certain genetic mutations — can help in understanding how Alzheimer’s and other neurodegenerative diseases develop and how to prevent and treat them.

The idea that the molecule TREM2 is involved in cognitive decline — the hallmark of neurodegenerative diseases, including Alzheimer’s — has gained considerable support in recent years.

Past studies have demonstrated that certain mutations that alter the structure of TREM2 are associated with an increased risk of developing late-onset Alzheimer’s, frontal temporal dementia, Parkinson’s disease and sporadic amyotrophic lateral sclerosis (ALS).

Other TREM2 mutations are linked to Nasu-Hakola disease, a rare inherited condition that causes progressive dementia and death in most patients by age 50.

“We don’t know exactly what dysfunctional TREM2 does to contribute to neurodegeneration, but we know inflammation is the common thread in all these conditions,” said senior author Thomas J. Brett, PhD, an assistant professor of medicine.

“Our study looked at these mutations in TREM2 and asked what they do to the structure of the protein itself, and how that might impact its function. If we can understand that, we can begin to look for ways to correct it.”

The analysis of TREM2 structure, completed by first author, Daniel L. Kober, a doctoral student in Brett’s lab, revealed that the mutations associated with Alzheimer’s alter the surface of the protein, while those linked to Nasu-Hakola influence the “guts” of the protein. The difference in location could explain the severity of Nasu-Hakula, in which signs of dementia begin in young adulthood.

The internal mutations totally disrupt the structure of TREM2, resulting in fewer TREM2 molecules. The surface mutations, in contrast, leave TREM2 intact but likely make it harder for the molecule to connect to proteins or send signals as normal TREM2 molecules would.

TREM2 lies on the surface of immune cells called microglia, which are thought to be important “housekeeping” cells. Via a process called phagocytosis, such cells are responsible for engulfing and cleaning up cellular waste, including the amyloid beta that is known to accumulate in Alzheimer’s disease.

 If the microglia lack TREM2, or the TREM2 that is present doesn’t function properly, the cellular housekeepers can’t perform their cleanup tasks.

“Exactly what TREM2 does is still an open question,” Brett said. “We know mice without TREM2 have defects in microglia, which are important in maintaining healthy brain biology. Now that we have these structures, we can study how TREM2 works, or doesn’t work, in these neurodegenerative diseases.”

TREM2 also has been implicated in other inflammatory conditions, including chronic obstructive pulmonary disease and stroke, making the structure of TREM2 important for understanding chronic and degenerative diseases throughout the body, he added.

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This work was supported by the National Institutes of Health (NIH), grant numbers R01-HL119813, R01-AG044546, R01-AG051485, R01-HL120153, R01-HL121791, K01-AG046374, T32-GM007067, K08-HL121168, and P50-AG005681-30.1; the Burroughs-Wellcome Fund; the Alzheimer’s Association, grant number AARG-16-441560; and the American Heart Association, grant number PRE22110004. Results were derived from work performed at Argonne National Laboratory (ANL) Structural Biology Center. ANL is operated by U. Chicago Argonne, LLC, for the U.S. DOE, Office of Biological and Environmental Research, supported by grant number DE-AC02-06CH11357.

Kober DL, Alexander-Brett JM, Karch CM, Cruchaga C, Colonna M, Holtzman MJ, Brett TJ. Neurodegenerative disease mutations in TREM2 reveal a functional surface and distinct loss-of-function mechanisms. eLife. Dec. 20, 2016.

Washington University School of Medicine‘s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

Protecting Your Vision: An Overview Of Diabetes And Eye Health

Blood sugar control is key for eye health in patients with diabetes, says David Benderson, M.D., an ophthalmologist with Valley Medical Group in Ridgewood, NJ.

Newswise, November 30, 2016 — Loss of vision is one of the many dreaded complications of diabetes. Over 5.3 million Americans suffer from diabetes-related retinal disease or diabetic retinopathy. After 20 years of living with diabetes, nearly all type 1 diabetics will have some degree of diabetic retinopathy, as will approximately 60 percent of type 2 diabetics. Some of these patients will experience significant vision loss.

If you think of the eye as a camera, the retina is the film. This important structure translates images into electrical signals, which are then sent to your brain for processing. High blood sugar levels associated with diabetes damage small blood vessels throughout the body, including the retina. Advanced diabetic retinopathy can cause a devastating form of glaucoma due to growth of unhealthy blood vessels on the iris (neovascular glaucoma). 

Elevated blood sugar can also result in swelling of the lens, which can temporarily change a patient’s glasses prescription, resulting in blurry vision.

Once the blood sugar is controlled, the lens swelling resolves. Additionally, diabetics are at a higher risk for developing cataracts, or permanent clouding of the lens.

A multi-pronged approach is necessary to prevent and treat diabetic eye disease. To begin with, it is essential that diabetics work closely with their primary care physician and, in many cases, endocrinologist, to keep their blood sugar under good control.

Other health care providers, such as nurse educators and nutritionists serve an essential role in diabetes management. Large studies have shown that tight control of blood sugar reduces the risk of diabetic complications, including retinopathy.

Furthermore, diabetics should undergo a complete eye examination, including dilation (in order to view the retina and other structures) on a yearly basis. If a diabetic patient develops diabetic retinopathy, more frequent examination may be necessary.

If macular edema or proliferative diabetic retinopathy develop, early diagnosis and treatment is essential to preserving vision. Conversely, if a diabetic patient waits until they have vision loss to visit the doctor, treatment may be less effective.

Ultimately, prevention is the best tool to combat diabetic eye disease. Effective control of blood sugar and blood pressure, maintaining a healthy and balanced lifestyle, and regular follow-up with a primary care physician and ophthalmologist are key elements in avoiding vision loss from diabetes.

Is More, Better? Finding The Balance Between Nutritional Supplements And Eye Health

Excess Lutein Supplements Linked to Formation of Crystal Deposits in the Eyes

Newswise, November 19, 2016— In the past decade, ophthalmologists have been prescribing nutritional supplements to be taken daily to prevent or slow vision loss from age-related macular degeneration (AMD). Now, using nutritional supplements for eye health has become more common. But does increasing the recommended dose increase your protection? 

A case report appearing online in JAMA Ophthalmology from the Moran Eye Center at the University of Utah reveals what can happen when a patient takes more of a supplement than their body needs.

In the article, Crystalline Maculopathy Associated with High-Dose Lutein Supplementation, principal investigator Paul Bernstein, M.D., Ph.D., describes a patient with no AMD or vision problems who was referred to the retinal clinic for crystal deposits in the macular region of the retina in both eyes.

With physician follow-up, it was learned that for the past eight years, the patient took a daily lutein supplement (20 mg) in addition to a diet rich in lutein, which included a broccoli, kale, spinach, and avocado smoothie every morning; she was therefore consuming much more than twice the recommended dose of lutein for an AMD patient (10 mg per day).

Lutein is part of the AMD prevention supplement regimen that was created based on results from the AREDS2 (Age-Related Eye Disease Study 2) clinical trial.

In that trial, researchers found that patients at high risk for visual loss from AMD who took lutein (10 mg) and zeaxanthin (2 mg) supplements reduced their risk of progressing to late stage AMD. Lutein and zeaxanthin are carotenoids—antioxidants made by plants—that are believed to neutralize light-induced damage in the eye.

Humans don’t make carotenoids, so they can only be added to the body by eating plants or taking supplements.

“When we looked at the patient’s carotenoid levels in serum, skin, and the retina, all measurements were at least two times greater than carotenoid levels in patients not taking nutritional supplements,” said Bernstein.

 “The patient quit taking the lutein supplement, but maintained her diet rich in lutein, and, after seven months, the crystals in the right eye disappeared.”

While AREDS2 supplements are recommended to patients at higher risk for AMD, there has also been increased use in the general population. Bernstein’s advice for his patients is that “everyone should eat an ‘eye-healthy’ diet rich in colorful fruits and vegetables, and individuals should take an AREDS2 supplement if their ophthalmologist detects signs of AMD.”

This case report must followed up by a larger clinical trial before the results can be considered conclusive but it serves as an indicator that there may be negative effects from consuming lutein considerably higher than the recommended AREDS2 dose.

Saving Sight In Glaucoma: Why The Brain May Hold The Key

Retinal fibers from ganglion cell neurons (circles) stream through the optic nerve head on their way to brain.

Newswise, November 19, 2016 — What causes vision loss in glaucoma? There are two common answers that at first may seem disparate: the first is pressure, as in elevated ocular pressure, and the second is damage to the optic nerve, which is the structure that sends visual information to the brain. Both answers are correct.

Glaucoma involves sensitivity to ocular pressure (not just elevated pressure) that is translated or transduced to stress that degrades the optic nerve over time.

Current glaucoma therapies lower pressure using eye drops, surgery, or both in order to reduce stress transduced to the optic nerve. This approach is effective for many patients. But for those who continue to lose vision, where should we turn for new clinical therapies?

One idea is to consider where ocular pressure exerts its influence: the optic nerve head. This structure in the back of the eye defines where nerve fibers leave the retina and enter the optic nerve.

The nerve head contains lateral structures that support these fibers but also couple the nerve to the rest of the eye. In this way, pressure in the front of the eye can cause stress to the optic nerve.

While we do not understand precisely how this stress is conveyed, we do know that aging of the nerve head is likely to contribute to its susceptibility. By addressing age-related factors, new research might reveal therapies based on reducing the sensitivity of the nerve head to pressure.

What about the optic nerve itself? Like the brain, the optic nerve and retina are part of the central nervous system. Once damaged beyond a certain point, these structures cannot heal.

For patients who have lost substantial optic nerve tissue in glaucoma, the hope of regenerative medicine is to restore connectivity with the brain by introducing new nerve fibers or inducing damaged ones to regrow.

Another area of promise that may be forthcoming leverages the idea that increasing brain activity in some cases increases its resistance to stress. Catalyst for a Cure (CFC) research has demonstrated a "window of structural persistence" in which connectivity between the optic nerve and brain remains even when glaucoma affects visual function.

During this "window," optic nerve fibers attempt to boost their electrical activity through natural self-repair mechanisms.

New research by CFC investigators shows that enhanced activity can also help optic nerve fibers regenerate. Perhaps the best approach to a new type of nerve-based glaucoma treatment would combine optic nerve regenerative techniques with those that promote intrinsic repair in the brain.

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Article by David J. Calkins, PhD, the Director of Vanderbilt Vision Research Center, Vice-Chairman and Director for Research at The Vanderbilt Eye Institute, and the Denis M. O'Day Professor of Ophthalmology and Visual Sciences at The Vanderbilt University Medical Center.

Act Your Age When It Comes To Skin Care

 Dermatologists share tips for women 

Newswise, November 15, 2016— People experience many changes as they age, and that includes changes in their skin. The body’s largest organ evolves over time, so it’s important for one’s skin care routine to evolve with it.

Although dermatologists’ skin care recommendations for each patient will depend on that patient’s age, there are a few core steps dermatologists advise virtually every woman to take:

1. Select products tailored to your skin type — for example, special formulations for sensitive skin, moisturizing products for dry skin, and oil-free or noncomedogenic options for oily skin.

2. Protect your skin from exposure to ultraviolet radiation from the sun and indoor tanning beds, which can lead to skin cancer and early skin aging. The American Academy of Dermatology recommends that you shield yourself from the sun’s harmful UV rays by seeking shade, wearing protective clothing and using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.

3. Use a retinoid, unless it dries out or irritates your skin. Retinoids increase cell turnover to exfoliate clogged pores and reduce the appearance of fine lines, which means they can effectively treat both acne and wrinkles.

While these steps form the foundation of most skin care regimens, each individual’s skin care routine should be based on her age and her skin’s specific needs. To kick off National Healthy Skin Month, three board-certified dermatologists discuss the top skin care concerns of women in their 20s, 30s and 40s, and provide skin care tips for each age group.

Women in their 30s: At the crossroads of prevention and treatment

Dark spots
When women in their 30s come into her Augusta, Ga., private practice to seek treatment for dark spots, board-certified dermatologist Lauren Eckert Ploch, MD, MEd, FAAD, always provides them with tips for prevention. “If you have dark spots at this point in your life, you’re at risk for getting more as you grow older,” she says.

Because UV exposure causes dark spots, Dr. Ploch reminds her patients in their 30s about the importance of sun protection. When applying their SPF 30 sunscreen each morning, she says, it’s vital for women in this age group to make sure they cover their neck and chest in addition to their face, especially if they commute.

“Because UVA rays can travel through window glass, you need to make sure you’re protected if you’re spending a lot of time in the car or on a train,” she says.

Women who received unprotected UV exposure when they were younger may start to see dark spots on their temples and cheeks when they reach their 30s, Dr. Ploch says, and these spots may be mistaken for melasma, a condition that causes brown patches to appear on the face.

While lightening agents like hydroquinone are a good option for melasma, she says, they usually aren’t effective in treating dark spots.

Instead, Dr. Ploch recommends that patients with dark spots follow a multipronged treatment plan. In addition to sun protection, she says, topical vitamin C and retinoids may be used for both treatment and prevention.

 Laser surgery and cryosurgery are also options for reducing the appearance of dark spots, she says, but these procedures should only be performed by a dermatologist or another experienced medical professional.

Wrinkles
Dr. Ploch estimates that about half of her patients in their 30s are dealing with both wrinkles and acne.

As a result, she says, many patients in this age group may not be able tolerate wrinkle treatments designed for more mature skin because these heavier formulas can aggravate acne or cause milia, small cysts that occur when dead skin cells become trapped at the surface of the skin.

Dr. Ploch recommends women in their 30s use a retinoid to address both wrinkles and acne.

“Retinoids are my go-to wrinkle treatment for women in this age group,” she says. “In addition to improving your skin’s current appearance, they also help build collagen, which can lead to more voluminous skin in your 40s and 50s.”

Dr. Ploch also suggests that women in their 30s use a light antioxidant serum to protect their skin from the elements and improve signs of early skin aging, and she says those who are concerned about wrinkles also may want to consider botulinum toxin and hyaluronic acid fillers.

A low dose of botulinum toxin can minimize muscle movements that lead to future wrinkles, she says, and hyaluronic acid fillers can restore volume loss, reducing the appearance of lines around the mouth.

Spider veins
While spider veins are one of the most common problems for women in their 30s, Dr. Ploch says, they’re also one of the least-addressed problems in this age group.

Many women believe that treatment would be too invasive or expensive, she says, so they leave the condition unaddressed, allowing it to get worse as they get older.

According to Dr. Ploch, however, laser surgery and sclerotherapy are two accessible and noninvasive treatment options that women in their 30s may want to consider if they have spider veins. She also suggests that women in this age group take preventive measures against the emergence and progression of this condition.

Pregnancy and frequent standing are two risk factors for spider veins, Dr. Ploch says, and the condition takes several years to develop, which is why it often appears in women when they reach their 30s.

To help relieve the pressure that causes spider veins, she recommends that women wear compression socks, elevate their legs when possible and exercise, especially if they work in a field that requires prolonged standing, like health care or education.

Women in their 40s: Improvement through noninvasive interventions

Skin laxity
As people age, their skin begins to lose collagen and elastin, making it thinner and looser, without the resilient, springy quality of youthful skin, says board-certified dermatologist Anne M. Chapas, MD, FAAD, a clinical instructor of dermatology at Mount Sinai Medical Center in New York.

Skin laxity is most prevalent on the face and neck, she says, but it can occur anywhere on the body, including the arms, abdomen and thighs.

Everyone will experience some amount of skin laxity as they get older, Dr. Chapas says, but the degree of laxity depends on many factors, including sun damage, exposure to pollution, diet, weight fluctuations and lifestyle factors such as smoking.

“Women likely will start to notice skin laxity in their 40s, but they may not want to undergo an invasive procedure to correct it,” she says. “Fortunately, there are noninvasive options ideally suited for women in this situation.”

According to Dr. Chapas, energy-based treatments such as microfocused ultrasound and radiofrequency microneedling can help improve skin laxity by promoting the production of collagen and elastin to create firmer skin.

 “Imagine wrapping your loose skin in shrink wrap to pull everything tighter — that’s the kind of effect these energy devices can have,” she says.

Dr. Chapas says filler injections also can improve skin laxity by replacing lost collagen and elastin. “If you picture your skin as a tablecloth, then you can think of fillers as a sturdier table for it to rest on,” she says.

Volume changes
In addition to losing collagen and elastin as they age, Dr. Chapas says, women also lose fat in areas like the face and hands, resulting in a loss of skin volume. As a result, she says, women in their 40s may experience sagging skin, as well as prominent bones and veins.

According to Dr. Chapas, noninvasive treatments with dermal fillers and energy devices can help restore lost volume in addition to improving skin laxity. These treatments also may be combined to provide the best possible results, she says.

In addition to seeking treatment for lost collagen, Dr. Chapas also recommends that women in their 40s take steps to preserve the collagen they still have.

“It’s important to continue protecting your skin from the sun and the elements as you age,” she says, “and you also should consider incorporating topical growth factors and peptides into your skin care routine.”

Unwanted fat
Women in their 40s may have unwanted body bulges as the result of a slowing metabolism, pregnancy or other lifestyle changes, Dr. Chapas says. Even if women exercise regularly and are otherwise fit, she says, it may be difficult for them to eliminate fat in areas where the body is designed to store it, including the torso and the legs.

According to Dr. Chapas, women in their 40s who have isolated pockets of fat are ideal candidates for noninvasive body sculpting procedures like focused ultrasound, thermal energy treatment and cryolipolysis, all of which create areas of damaged fat that the body gradually removes.

While these treatments can be performed anywhere on the body, the waistline and thighs are the most commonly treated areas, Dr. Chapas says, while the neck and bra spillover area are currently gaining popularity.

Dr. Chapas says interest in these body sculpting treatments has surged in recent years because the procedures are noninvasive, quick and effective, with little downtime for patients.

Although liposuction remains the gold standard for fat removal, she says, other body sculpting procedures can provide subtle results for women who want to address problem areas without undergoing an invasive procedure.

No matter your age or skin concern, a board-certified dermatologist can answer your questions about skin health and help you develop a skin care plan that’s right for you.

In their own words: Dermatologists share their skin care secrets
Dr. Nada Elbuluk
“I wash my face twice a day with a mild cleanser and use a morning moisturizer with SPF 30 or higher. If I’m having an acne breakout, I use an acne spot treatment, typically with benzoyl peroxide and clindamycin. I also avoid the urge to pick or squeeze at any acne, as I know this will cause more inflammation and subsequent scarring. In the evening after cleansing, I use an eye cream and facial cream with retinol and antioxidants. During the day, if I know I will be outside for extended periods, I carry sunscreen in my bag so I can reapply. I also keep an eye out for any new growths or changes I see on my skin. Following these guidelines has helped my skin stay healthy, acne free, skin cancer free, youthful and radiant.”

Dr. Lauren Ploch
“Each morning, I apply an antioxidant serum that contains vitamin C. I follow this with a zinc oxide-containing sunscreen. I apply a retinoid product three to four nights per week, which is as often as I can tolerate it without irritation. I attribute my even, acne-free complexion to my retinoid — it’s the one skin care product I could not go without.

“I have treated my dark spots with various lasers and found them to be very effective as long as I protect myself from the sun after treatment. For wrinkles, botulinum toxin has ensured that I don’t have any! I started getting the occasional botulinum toxin injection in my mid 20s but began regularly injecting myself every four to six months in my early 30s. I prefer injecting smaller doses over the span of a few weeks to ensure that I always retain some natural expression. I also had a hyaluronic acid filler treatment last year and plan to follow up with additional treatments as necessary to restore volume lost over the past decade.

“Because I work long hours on my feet, compression socks are a must. I also wear them when traveling long distances, as sitting on a plane can lead to swelling and increased pressure in the legs. I prefer laser therapy to sclerotherapy for my small spider veins, and I elevate my legs at rest whenever possible to prevent their recurrence.”

Dr. Anne Chapas
“I’ve had noninvasive radiofrequency tightening treatments and dermal fillers regularly over the last few years. I also really like laser resurfacing, which removes damaged skin cells and replaces them with new ones. I think that smaller, regular, preventive in-office treatments, in addition to sun protection and topical retinoid use, have helped to maintain my youthful, healthier looking skin.

“Patients always comment on how ‘natural’ I look after I explain the treatments that I’ve personally received. I think it serves as an example that aesthetic treatments should look natural and healthy, not like you’ve had a lot of ‘work done.’ As dermatologists, we are experts in what healthy skin should look like and are the best-trained physicians to help patients to achieve this goal.”

54-Year-Old ‘Nonbeliever’ Gets His Flu Shot After Close Call With H1N1

ECMO technology saves patient’s life

Newswise, November 15, 2016 — Like many people his age, Jerry Lucier, 54, of Northville, never got the flu shot.

Then, in April, he almost died as a result of an H1N1 flu infection and was transferred by medical helicopter to the ECMO unit at Beaumont Hospital, Royal Oak.

ECMO stands for extracorporeal membrane oxygenation. H1N1 is a flu strain especially aggressive in individuals aged 25 to 64.

“I didn’t used to believe in the flu shot,” said Lucier, who has no underlying medical issues.

Lucier’s condition deteriorated rapidly when his flu turned into pneumonia, filling his lungs with fluid, making it nearly impossible for him to breathe.

Not even a ventilator could save him.

“Now, I tell everybody: ‘You’ve got to get the vaccine’,” said Lucier, who spent four months in the hospital. “’Otherwise, you might die.’”

For Lucier, early transfer to a hospital that provided ECMO, was key.

Beaumont, Royal Oak is one of three Extracorporeal Life Support Organization hospitals in Michigan providing ECMO to adult patients. This technology helps patients unable to breathe on their own take in oxygen.

“People die every year from the flu. And while the groups most likely to be affected are the very young and the very old, there’s a bit of randomness in how and who it strikes,” said Felicia Ivascu, M.D, medical director of the ECMO program at Beaumont, Royal Oak said. “That’s what makes the flu so scary.”

Getting an annual flu vaccine is still the first and best way people age 6 months and older, can prevent getting the flu in the first place.

“Even if you don’t think you need the protection the vaccine offers,” Dr. Ivascu said. “It’s important to protect those around you. Especially if they include vulnerable populations.”

For optimum results, vaccinations should be administered just before cases start appearing, which is in October or November, explained Dr. Matthew Sims, director of Infectious Disease Research for Beaumont Hospital, Royal Oak.

“A few cases of the flu have already been reported, so it’s good timing to get the vaccine right now,” Dr. Sims said. “If you get it too early in the year, August for example, you might not be protected the entire season.”

As long as new cases continue to flare, it’s not too late to get the vaccine, Dr. Sims said, adding the flu season usually peaks in February and lasts until May. 

“Just remember, it takes about two weeks from when you get the shot to be protected by it,” Dr. Sims said. “And some years we run out.”

Now, six months after diagnosis, Lucier is still working hard to get back to his old self.

He’s lost 58 pounds, uses oxygen parts of each day and recently registered for another round of physical and occupational therapy to regain strength and stamina.

If things go as planned, Lucier will finally return to his job as an electrician for Ford Motor Co. in April 2017.

“I’m feeling better every day,” said Lucier, who looks forward to going back to work and the gym and spending time out with his wife, Minwa, their family and friends.

“And yes, I’ve already received my seasonal flu shot. I hope everybody gets one.”

FLU Facts

• For the 2016/2017 flu season, only injectable flu shots are recommended.
• You cannot get the flu from the vaccine.
• If you get the vaccine and still catch the flu, it wasn’t all for naught. Experts say you likely would have been sicker, longer without the vaccine’s protection.
• Because flu strains are constantly changing, previous vaccinations won’t protect you against a new season of flu bugs.
• Egg-free vaccinations are available for those who may be allergic.

Queen Latifah And UCLA Cardiologist Discuss Why Heart Failure Is A Family Affair

Queen Latifah and UCLA's Dr. Karol Watson joined together on World Heart Day to educate the public on living with heart failure. Latifah's mother suffers from the condition.

 Newswise, October 31, 2016 — More than 6 million Americans live with heart failure. Including Queen Latifah’s mother.

That’s why the award-winning actress, singer, songwriter and producer recently joined UCLA cardiologist Dr. Karol Watson and the American Heart Association on World Heart Day for a Facebook Live event held at UCLA.

The goal? Raise awareness of the AHA’s “Rise Above Heart Failure” campaign and talk about how patients and caregivers can help manage the disease.

Heart failure is a condition in which the heart can’t pump efficiently to get enough blood to the organs. Symptoms include difficulty breathing, fatigue and swelling of the feet, ankles and legs.

“Once we got over the shock of my mom’s diagnosis, we started to learn that there are a lot of things we could do,” said Latifah, whose mother, Rita Owens, was in her early 50’s when she was diagnosed with heart failure ten years ago.

“We learned about medications she could take and how we could make simple lifestyle changes. We became educated and changed our entire family’s lifestyle and her heart began to improve.”

Watson, a professor of medicine/cardiology at the David Geffen School of Medicine at UCLA, noted that heart failure doesn’t affect just one person, it affects the whole family.

“But the good thing is that there are so many proactive steps that patients can take, like managing salt, diet and activity. Having family rally around the patient to support them is important,” said Watson, who is also co-director of the UCLA Program in Preventive Cardiology, and director of the UCLA Barbra Streisand Women’s Heart Health Program.

Whether it’s a family member or yourself, here are some key things about managing heart failure that Latifah and Watson discussed:

Notice a change? Get it checked out by your doctor.

People don’t always notice the signs of heart failure or they may mistake them as signs of other conditions or simply old age.

“A lot of people mistake the signs of heart failure as just getting older; I know my mom did,” Latifah said.

“But if you have symptoms like feeling short of breath when you bend down to put on your shoes, or have trouble sleeping at night without a bunch of pillows – don’t think ‘old age’. Think ‘heart failure’ and be sure to talk to your doctor.”

Watson added that if you see a definite change in your activity or if you’re not able to do the things you used to do, then definitely get it checked out.

“We are all at-risk for heart failure,” said Watson. “No one is untouched by this disease and we have to consider ourselves potentially at risk.”

Low-salt diet is important.

One of the biggest contributors to hear failure is too much salt in the diet, and it’s one of the first things a doctor will advise patients to cut back on.

“Too much salt makes us retain water and makes our heart have to work harder to try and get rid of it,” explained Watson.

For most heart failure patients, salt intake should be limited to one teaspoon, or no more than 1,500 milligrams, daily.

Latifah said she and her family had learned to use less salt.

“We find the flavor is in the food. Once you start to adjust, if you start putting salt on your food, everything will taste salty to you,” she said.

Watson noted the UCLA preventative cardiology program has a motto that encompasses the essential components to healthy heart and lifestyle: Move frequently, eat thoughtfully, connect deeply.

“We should all be physically active, including those with heart failure. We should strive to think about what we eat—we won’t always be perfect, but we can try to eat the right things and limit the bad,” said Watson, “And, it’s so important to maintain strong social connections with family and friends.”

Latifah summed it up by saying, “Our heart is our life and we need this thing to beat so we can live.”

Watch the video of the Facebook Live event with Latifah and Dr. Watson.

AHA’s Rise Above Heart Failure is nationally supported by Novartis Pharmaceuticals Corp. Latifah and her mother have joined the initiative to spread the word about heart failure and help others understand the symptoms and how to manage it.

Visit www.heart.ucla.edu for more information on UCLA Health’s heart services.

Alzheimer's Drug Discovery Foundation Launches Expanded Brain Health And Dementia Prevention Website

Site Features Science-Based Ratings of Options to Improve Brain Health, Help Consumers Make Informed Choices

Newswise, October 31, 2016— The Alzheimer’s Drug Discovery Foundation (ADDF) announced today the relaunch of CognitiveVitality.org, its brain health and dementia prevention website. The streamlined, easy-to-navigate site separates fact from fiction and empowers people to make smarter choices for their brain health.

“Americans are spending millions of dollars every year on supplements, drugs, and brain training games in the hope of staving off cognitive decline and dementia,” said Penny Dacks, PhD, director of Aging and Alzheimer's Prevention at the ADDF.

“Despite this massive investment, people are still unsure about what works and what doesn’t, and even about what is and isn’t safe. We developed CognitiveVitality.org to give consumers trustworthy information based on scientific evidence.”

At CognitiveVitality.org, neuroscientists from the ADDF review all of the available research and provide clear, unbiased ratings on the potential benefit, supporting evidence, and safety of options to improve brain health and potentially prevent dementia.

These options include food and drinks, drugs, and vitamins and supplements. Ratings may be viewed individually, or in a streamlined grid that allows users to compare options. New ratings are included, and previous ratings have been updated to include the latest scientific evidence.

“Science suggests there are steps people can take to lower their odds of getting dementia while other approaches are very unlikely to help. We want people to have the latest evidence on what they can do,” said Dr. Dacks.

Prior to posting, each rating is reviewed by two members of the independent Cognitive Vitality Clinical Advisory Board, which consists of nationally recognized leaders in epidemiology, neurology, geriatrics and gerontology, and related fields.

New Ratings of Supplements Provided

The relaunched site includes new ratings of the active ingredients in widely used supplements, including nicotinamide riboside and apoaequorin, which make brain health claims. Vitamins B6, B12, and folic acid—which are promoted for brain health—are also rated.

“These ratings should be especially helpful to consumers, as nutritional supplements are not required to prove their efficacy or safety in the manner required of pharmaceuticals,” said Howard Fillit, MD, the ADDF’s Founding Executive Director and Chief Science Officer.

Cognitive Vitality Blog Featured
CognitiveVitality.org features a blog with in-depth articles on potential risks, lifestyle factors, and emerging science that may affect the brain. The relaunched site includes new posts on lifestyle choices and risks that may affect brain health, including hypertension, smoking, and anesthesia, organized into user-friendly categories to help people find exactly what they want.

About Cognitive Vitality
CognitiveVitality.org is an initiative of the Aging and Alzheimer’s Prevention program at the ADDF, which is directed by Dr. Penny Dacks. It was initially launched in 2014. In addition to ratings and the blog, CognitiveVitality.org includes a description of the types of evidence used to develop the ratings, and a list of relevant scientific publications.

About the Alzheimer’s Drug Discovery Foundation
Founded in 1998 by Leonard A. and Ronald S. Lauder, the Alzheimer’s Drug Discovery Foundation (ADDF) is dedicated to rapidly accelerating the discovery of drugs to prevent, treat and cure Alzheimer’s disease.

The ADDF is the only public charity solely focused on funding the development of drugs for Alzheimer’s, employing a venture philanthropy model to support research in academia and the biotech industry. Through the generosity of its donors, the ADDF has awarded over $90 million to fund more than 500 Alzheimer’s drug discovery programs and clinical trials in 18 countries.

 To learn more, please visit: http://www.alzdiscovery.org/.

New Hope For Recovery Of Hand Movement For Stroke Patients

Newswise, October 26, 2016 — Stroke patients are starting a trial of a new electronic device to recover movement and control of their hand.

Neuroscientists at Newcastle University have developed the device, the size of a mobile phone, which delivers a series of small electrical shocks followed by an audible click to strengthen brain and spinal connections.

The experts believe this could revolutionise treatment for patients, providing a wearable solution to the effects of stroke.

Following successful work in primates and healthy human subjects, the Newcastle University team are now working with colleagues at the prestigious Institute of Neurosciences, Kolkata, India, to start the clinical trial. Involving 150 stroke patients, the aim of the study is to see whether it leads to improved hand and arm control.

Stuart Baker, Professor of Movement Neuroscience at Newcastle University who has led the work said: "We were astonished to find that a small electric shock and the sound of a click had the potential to change the brain's connections. However, our previous research in primates changed our thinking about how we could activate these pathways, leading to our study

in humans."

Recovering hand control

Publishing  in the Journal of Neuroscience, the team report on the development of the miniaturised device and its success in healthy patients at strengthening connections in the reticulospinal tract, one of the signal pathways between the brain and spinal cord.

This is important for patients as when people have a stroke they often lose the major pathway found in all mammals connecting the brain to spinal cord. The team's previous work in primates showed that after a stroke they can adapt and use a different, more primitive pathway, the reticulospinal tract, to recover.

However, their recovery tends to be imbalanced with more connections made to flexors, the muscles that close the hand, than extensors, those that open the hand.

This imbalance is also seen in stroke patients as typically, even after a period of recuperation, they find that they still have weakness of the extensor muscles preventing them opening their fist which leads to the distinctive curled hand.

Partial paralysis of the arms, typically on just one side, is common after stroke, and can affect someone's ability to wash, dress or feed themselves.

 Only about 15% of stroke patients spontaneously recover the use of their hand and arm, with many people left facing the rest of their lives with a severe level of disability.

Senior author of the paper, Professor Baker added: "We have developed a miniaturised device which delivers an audible click followed by a weak electric shock to the arm muscle to strengthen the brain's connections. This means the stroke patients in the trial are wearing an earpiece and a pad on the arm, each linked by wires to the device so that the click and shock can be continually delivered to them.

"We think that if they wear this for 4 hours a day we will be able to see a permanent improvement in their extensor muscle connections which will help them gain control on their hand."

Improving connections

The techniques to strengthen brain connections using paired stimuli are well documented, but until now this has needed bulky equipment, with a mains electric supply.

The research published today is a proof of concept in human subjects and comes directly out of the team's work on primates. In the paper they report how they pair a click in a headphone with an electric shock to a muscle to induce the changes in connections either strengthening or weakening reflexes depending on the sequence selected.

They demonstrated that wearing the portable electronic device for seven hours strengthened the signal pathway in more than half of the subjects (15 out of 25).

Professor Stuart Baker added: "We would never have thought of using audible clicks unless we had the recordings from primates to show us that this might work.

Furthermore, it is our earlier work in primates which shows that the connections we are changing are definitely involved in stroke recovery."

The work has been funded through a Milstein Award from the Medical Research Council and the Wellcome Trust.

The clinical trial is just starting at the Institute of Neurosciences, Kolkata, India. The country has a higher rate of stroke than Western countries which can affect people at a younger age meaning there is a large number of patients. The Institute has strong collaborative links with Newcastle University enabling a carefully controlled clinical trial with results expected at the end of this year.