Early care helps frozen shoulder
Tue, 11 Dec 2007 02:10:22 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Wake up to find your shoulder killing you but don't recall an injury? It could be the start of frozen shoulder, a curse of middle-aged women and one of the most puzzling joint conditions.
The shoulder's normally smooth lining becomes so inflamed it resembles cherry Jell-O. That leads to scar tissue, making the shoulder too stiff to move.
Known medically as adhesive capsulitis, it's a fairly common ailment — estimated to strike between 2 percent and 3 percent of the population, the vast majority women ages 40 to 60. Yet too few sufferers get diagnosed in time for a simple shot that could cut an astounding year or more off recovery time.
In fact, doctors can easily confuse early symptoms with a rotator cuff injury — and the wrong physical therapy can worsen a frozen shoulder-in-progress by further irritating it.
So Dr. Jo Hannafin of New York's Hospital for Special Surgery is excited when patients show up after only two to three months of shoulder pain. She injects cortisone deep into the joint and 15 minutes later lifts and twists it.
"If the range of motion is now full, I've hit a home run," says Hannafin, a leading expert on the condition. "I've caught a patient in the first stage."
That early treatment means they'll be healed in about a month. "This is going to be gone."
But usually patients show up months later. Wait too long, and recovery can take two years or more.
"You must be a patient patient," says Dr. Gregory Nicholson, a shoulder specialist at Chicago's Rush University Medical Center. "I tell my patients they got roped into the most stubborn and misunderstood condition. Sometimes it just wears you down."
Why the mystery? Nobody knows just what triggers frozen shoulder. It seems to strike out of the blue.
Diabetics are at higher risk; up to 20 percent get it. Having an underactive thyroid also is a risk factor. Trauma sometimes precedes a frozen shoulder.
Add the fact that 70 percent of patients are middle-aged women, and specialists say hormones clearly play some role but they don't know what.
Beyond that, it's hard to predict who will get adhesive capsulitis, or how severe a case. It doesn't strike the same shoulder twice, but at least 15 percent of patients eventually suffer a bout in the opposite shoulder.
Surrounding the ball of the shoulder is a thin stretchy sac, or capsule. Inflammation in that lining is the start of frozen shoulder, and it causes immense pain.
When the pain starts to wane, that's bad news. It means the capsule is thickening with excess collagen, a sort of scar tissue, that further stiffens the shoulder. Eventually, the body can mostly recover on its own. But it takes so long that most late-stage patients find themselves undergoing painful physical therapy or even surgery to break apart the collagen and spur thawing.
Only in recent years have studies proven that a cortisone injection in the earliest stages can prevent collagen buildup and spur dramatically faster recovery, sometimes in mere months.
Now the challenge is to get more sufferers treated early. Key signs: Pain at night and at rest, along with gradually increasing stiffness. Movement problems typically begin with reaching back and up, like into a back pocket or to unfasten a bra. An exam should include the doctor attempting to lift and rotate the arm; problems with this so-called passive movement are another tipoff.
Rush's Nicholson says it's not uncommon for patients to seek him out after initially being told they had another shoulder injury and unknowingly aggravating their frozen shoulder with too-aggressive physical therapy. It takes gentle stretching to supplement the cortisone, he cautions.
"The biggest problem is the patients who ... just didn't know they were supposed to see a doctor," Dr. Beth Shubin Stein of the Hospital for Special Surgery told a recent seminar by the American Academy of Orthopaedic Surgeons. "Now they're out of that window where they're treatable with that steroid."
A New York drug company is funding research to tell if injecting another substance — a collagen-digesting enzyme called collagenase — might someday help those later-stage patients, but it's too soon to tell.
Debbie Karlitz knows the frustration: She's had the condition in each shoulder.
A cortisone injection and physical therapy brought relief in a few months to the first shoulder. But Karlitz's second bout has lasted over a year. Pain wakes her at night, and hinders such movement as donning a coat. Cortisone this time wasn't enough, so she's scheduled for surgery to clean out the scar tissue.
"I had never heard of it, I didn't know what adhesive capsulitis was," Karlitz, of New City, N.Y., says of that first diagnosis. "I would advise anyone with shoulder pain to not wait, and get it checked out immediately."
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EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
N.J. nears mandated preschool flu shots
Tue, 11 Dec 2007 02:34:22 GMTBy LINDA A. JOHNSON, Associated Press Writer
TRENTON, N.J. - New Jersey moved toward becoming the first state to require flu shots for preschoolers on Monday after a health advisory board backed new vaccine mandates over the opposition of worried parents.
The Public Health Council voted to require New Jersey children attending preschool or licensed day care to get annual flu shots, and to get three additional vaccines for youngsters starting Sept. 1, 2008.
No other state requires preschool, day care or older students to get flu shots, according to the American Academy of Pediatrics.
State health officials want preschoolers to get the flu shots because their immune systems are not as developed as older kids and because they are more likely to transmit the flu virus.
The state's health commissioner, Dr. Fred M. Jacobs, has until Dec. 18 to sign off on the mandates, though they have already been approved by Gov. Jon S. Corzine. Health Department spokesman Tom Slater said Jacobs was expected sign off on the proposal.
Besides the flu shots, New Jersey also will require preschoolers to get a pneumococcal vaccine and sixth-graders to get a whooping cough booster shot and a meningitis shot.
"Implementation of these rules will save lives and prevent disease and suffering in children, their families and the community," deputy health commissioner Dr. Eddy Bresnitz told the council Monday.
The Council voted in favor of the requirements 5-2 with 1 abstention, with member Dennis San Filippo saying he would like to see studies done on whether it's safe for young children to get so many doses of different vaccines.
All four vaccines are recommended by the federal Centers for Disease Control and Prevention, the American Academy of Pediatrics and other medical groups.
Parents concerned about possible dangers of the new vaccines and government intrusion in family medical decisions have been trying to block the new shots.
They note that flu vaccines contain trace amounts of mercury, a toxic heavy metal, and that mercury-free shots can be difficult to obtain.
According to the CDC and other scientific groups, there's no convincing evidence the trace amounts of mercury in flu shots cause harm.
Following the vote on Monday, concerned parents said they will keep urging support for a bill that would give parents a right to a "philosophical objection" to vaccine mandates, as many other states have.
The new vaccines will be available for free for low-income families through the federal Vaccines for Children program, and private insurers generally will cover the cost, Bresnitz said.
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On the Net:
New Jersey Alliance for Informed Choice in Vaccination: http://www.NJAICV.org
Calif. board suggests study of caffeine
Tue, 11 Dec 2007 02:39:29 GMTBy SAMANTHA YOUNG, Associated Press Writer
SACRAMENTO - A state advisory board on Monday called for a study to determine if sodas and energy drinks containing caffeine pose a risk to pregnant women.
The review could lead to warning labels on the drinks under Proposition 65, a 1986 ballot measure that requires the state to identify chemicals that could cause cancer or birth defects.
"If I were a pregnant woman or a woman thinking about being pregnant, I would want to know, should I be avoiding caffeine?" said Renee Sharp, a senior analyst with the Environmental Working Group, an environmental research organization that's based in Washington D.C. "It's a really important question, and I think people are looking for answers."
The advisory panel, the Science Advisory Board Developmental and Reproductive Toxicant Identification Committee, also requested an immediate review of Bisphenol-A, which could lead to warning labels on plastic baby bottles, water bottles and reusable food containers. The chemical Bisphenol-A has been shown to affect hormonal levels.
It was unclear Monday whether the state would follow the board's advice.
"This is a nonbinding recommendation; however, we will give it heavy weight because this is a panel of scientific experts," said Sam Delson, spokesman at the Office of Environmental Health Hazard Assessment.
If the office agrees to conduct the reviews, it would hold public hearings and do a more extensive review of existing research over the next year, Delson said. The board would then decide whether to require warning labels on caffeine and Bisphenol-A products similar to labels now used on potato chips and alcohol.
The board's 4-3 vote calling for the caffeine study was part of a two-year review of 286 chemicals that state officials said might warrant speedy review under proposition 65. Caffeine and Bisphenol-A were among eight chemicals selected for the board's consideration.
In arguing for the caffeine review, board member Hillary Klonoff-Cohen said dozens of scientific studies have linked the stimulant to miscarriages, premature births and low birth weight. The evidence is more prevalent in animal studies.
The label requirement would not cover coffee and tea, which have much higher caffeine levels, because the stimulant occurs naturally in those beverages. Proposition 65 only applies to chemicals that are added to foods or products.
The distinction drew criticism from the American Beverage Association, which said the coffee exemption would confuse consumers and unfairly penalize the soft drink industry.
"To provide a Proposition 65 warning on soft drinks would communicate to women that moderate amounts of caffeine is not safe," said Gary Roberts, a Los Angeles attorney representing the beverage association.
A University of Southern California study that was commissioned by the American Beverage Association concluded that warning labels on soft drinks led women to falsely believe there is more caffeine in soda than coffee.
The College of Obstetricians and Gynecologists, the March of Dimes, the Mayo Clinic and other health organizations have said that moderate amounts of caffeine — about two cups of coffee a day or seven soft drinks a day — are safe for pregnant women.
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On the Net:
Office of Environmental Health Hazard Assessment: http://www.oehha.ca.gov
FDA reviews two major heartburn drugs
Mon, 10 Dec 2007 23:03:33 GMTWASHINGTON - Patients who suffer from heartburn are not at increased risk for heart problems as a result of taking Prilosec or Nexium, according to a review released Monday by the Food and Drug Administration.
The FDA and its Canadian counterpart began reviewing the drugs, used by tens of millions of people, back in May. The drug's manufacturer, AstraZeneca PLC, provided them with an early analysis of two small studies that suggested the possibility of a risk. The agency said its review of that study as well as 14 others indicated no increased risk for patients.
"FDA recommends that health care providers continue to prescribe, and patients continue to use these products as prescribed," the agency said.
Nexium is the world's No. 2 selling drug, with 2006 sales of $6.7 billion, according to health care research firm IMS Health.
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On the Net:
FDA release: http://www.fda.gov/cder/drug/early_comm/omeprazole_esomepazole_update.htm
Obesity linked to weaker immunity in animals study
Mon, 10 Dec 2007 23:55:12 GMTCHICAGO - Obese mice are less able to fight off bacterial infection than lean mice, according to a study released Monday that supports emerging evidence of a link between obesity and a dysfunctional immune system.
In a study on laboratory mice infected with a bug that causes periodontal disease, obese mice had a blunted immune response to the infection and increased susceptibility to gum disease compared to lean mice.
The obese mice also had much higher rates of bone loss.
When researchers examined the rodents 10 days after they were infected with the bacterium Porphyromonas gingivalis, the heavier mice had a 40 percent increase in alveolar bone loss than the lean mice.
The alveolar bone is the bone or ridge that contains the tooth sockets on the upper and lower jaw.
Previous studies have shown that obese people are more likely to suffer from periodontal disease than their leaner counterparts and this study provided some clues as to why that is.
Blood tests on mice that had been infected with the bacterium P. gingivalis revealed irregularities in the production of cytokines in the obese mice, compared to the &;control&; or lean mice.
Cytokines are proteins or peptides that signal immune cells such as T-cells and macrophages to travel to the site of infection.
Researchers also analysed the macrophages, the white blood cells that form a major line of antibacterial defense.
They found that levels of key signaling molecules were significantly lower in the macrophages from the obese rodents and the expression profile of inflammation-related genes was altered compared to the control mice.
The researchers said it's not clear how obesity compromises the immune system, but they suspect a particular signaling pathway involving a transcription factor NF-kB may be involved. NF-kB plays a key role in the immune response to infection.
The study appears in the journal, The Proceedings of the National Academy of Sciences, and was conducted by scientists in the School of Dental Medicine at the University of Boston Medical Center.
