Nuns leave their brains to science
Sat, 22 Dec 2007 01:35:26 GMT
By STEPHANIE REITZ, Associated Press Writer
WILTON, Conn. - When Sister Kathleen Treanor's soul ascends to heaven, her brain will go to a less ethereal realm: a medical lab in Kentucky. Two decades ago, Sister Treanor and 677 other members of the School Sisters of Notre Dame granted a young researcher's request to test them each year in order to track the progression of Alzheimer's disease and other age-related brain disorders.
The 61 surviving nuns recently completed their last round of intellectual and physical tests for the Nun Study, one of the world's most comprehensive neurological research projects.
One final sacrifice remains: When they die, their brains will be taken for further study, joining a collection of hundreds of other brains donated by the the nuns who died before them.
Sister Treanor, a 93-year-old former school principal who is one of the last of the volunteers at a Wilton convent, looks at her participation as service, not sacrifice.
"I've tried to do good while I'm alive, and I liked the idea that I could do something good after death," she said.
With the modesty of their calling, the nuns attribute the study's success to researcher Dr. David Snowdon, downplaying their own countless hours of interviews and testing over the decades.
"I never minded having my brain checked out. It kept me out of trouble," said 96-year-old Sister Antoine Daniel.
Researchers say Snowdon's work already has produced interesting results, including a finding that people who challenge themselves intellectually can apparently delay or prevent the onset of Alzheimer's symptoms.
Snowdon's work also suggests that in people predisposed to Alzheimer's, a stroke or head trauma can speed the disease's progression — an argument for wearing seat belts, helmets and other protective gear.
He also has researched the levels of folic acid in the blood of deceased nuns with and without dementia; why nuns with positive attitudes and creative verbal skills tend to live longer than their glass-half-empty peers; and other questions.
"We'll continue to learn from the sisters for many, many years to come," Snowdon said.
Snowdon was a nervous young epidemiology professor at the University of Minnesota when he approached the first group of nuns in 1986 at the School Sisters of Notre Dame order in Mankato, Minn.
Although Pope Pius XII had declared in 1956 that donating organs was acceptable in the Roman Catholic faith, asking nuns to leave their brains to science for post-mortem testing was a delicate task. That was especially true for Snowdon, who had attended Catholic school and still viewed nuns with a mix of reverence and intimidation.
Yet getting them to donate their brains was critical because the only indisputable diagnosis of Alzheimer's comes from examining a patient's brain after death.
"At that time, it was hard enough just to get families of Alzheimer's patients to agree to donate the brain of a loved one with the disease," he said. "What we found is that because the sisters had been teachers, they looked at this as a way to keep teaching even after they die."
Snowdon expanded his study over the years, recruiting more nuns at other School Sister convents nationwide and joining the University of Kentucky to devote himself fully to the project. By 1992, he was giving annual memory and cognitive tests to 678 nuns ranging in age from 75 to 102.
One reason the nuns are such a valuable research tool is that as members of the same religious order, they all had decades of similar medical treatment, diets, reproductive histories and preventive care. Almost nine out of 10 had been teachers.
In the general population, finding such a uniform pool of test subjects is difficult.
About half the nuns in the study developed Alzheimer's disease or other forms of dementia before they died, about similar to the general population.
"It's such a cool study. People who study aging love to have these longitudinal perspectives because we think the early life experiences probably do have an impact on exceptional longevity," said Dr. Thomas Perls, a Boston University professor and Alzheimer's specialist who directs the New England Centenarian Study, which focuses on people 100 and older.
Of the seven remaining Nun Study participants based at the Wilton convent, several still recall their first memories as toddlers, can recite lengthy poems they learned in elementary school or tell vivid stories of classes they taught at schools around the U.S.
The Connecticut sisters say that while God gets their souls when they die, they are comfortable — comforted, even — knowing Snowdon has dibs on their brains.
"I think of the overall picture of what good could come out of it," said Sister Alberta Sheridan, 92. As for the possibility of developing Alzheimer's, she is sanguine: "If it happens, it happens. It's part of God's plan."
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On the Net:
The Nun Study: http://www.mc.uky.edu/nunnet
698pound man dies after stomach surgery
Sat, 22 Dec 2007 01:51:58 GMT
GUATEMALA CITY - A man who weighed 698 pounds died Friday of heart failure after undergoing an operation to remove 80 percent of his stomach in a desperate effort to reduce his weight.
Carlos Marroquin, 47, was so heavy at the time of Thursday's operation that hospital workers used a forklift to place him on the operating table, surgeon Isaias Sandigo, who participated in the procedure, told The Associated Press.
"He had two heart attacks in 20 minutes, there was nothing we could have done for him," Sandigo said. He said Marroquin's heart and kidneys had begun failing even before the procedure.
Marroquin's family checked him in to the San Juan de Dios Hospital's obesity clinic for treatment after they were told that nothing more could be done for him at a local hospital in his home town of Santa Lucia Cotzumalguapa, southwest of Guatemala City.
Study MDs mum on breast cancer options
Fri, 21 Dec 2007 22:47:55 GMT
By MARILYNN MARCHIONE, AP Medical Writer
Most doctors don't talk about breast reconstruction with women before cancer surgery, depriving them of key information that can sway their decision about whether to have the whole breast or just a lump removed, new research suggests.
Only one-third of the roughly 1,200 women in the study said surgeons discussed cosmetic remedies with them in advance. When the topic did come up, women were four times more likely to choose the more drastic operation, mastectomy.
That could be because they liked the breast reconstruction options, which include implants that are not available for fixing odd-shaped defects left after lumpectomies. But mastectomies can be a dubious choice because breast-conserving lumpectomies usually suffice.
"Our point is not to say that one decision is better than another, but that women need to know all their options," said Dr. Amy Alderman, the University of Michigan plastic surgeon who led the study. "There are positives and negatives to both. We shouldn't be paternalistic and tell patients, 'This is what you need.'"
Dr. H. Kim Lyerly, a breast surgeon and director of Duke University's Comprehensive Cancer Center, agreed.
"This is an important issue," he said. "We clearly need to be better at it."
The study was published online Friday by the journal Cancer and will be in the Feb. 1 issue.
It is the second report in recent days to call attention to the often-neglected cosmetic consequences of cancer surgery. Studies at last week's San Antonio Breast Cancer Symposium highlighted some of these, including the limited options for millions of women left with dimpled or cratered breasts after lumpectomies.
Doctors say the latest study, done in more than 100 hospitals in the Detroit and Los Angeles areas, may overstate the doctor-patient communication problem, but they acknowledge that one exists.
"I would bet that we have been so obsessed with treatment that this quality-of-life issue is one that we just haven't focused on," said Dr. Otis Brawley, chief medical officer of the American Cancer Society.
Breast cancer is the most common major cancer in American women. More than 178,000 new cases are expected this year in the U.S., and more than 1 million worldwide.
For cancer that has not widely spread, most women have a lumpectomy, but some need or prefer a mastectomy. Alderman studied whether knowing about breast reconstruction swayed which treatment women chose.
Researchers surveyed 1,178 women three months after breast cancer surgery, from 2001 to 2003. Two-thirds said reconstruction never came up in discussions with general surgeons before their operations.
Younger women were more likely to have had this talk than older ones . More educated women also were more likely to discuss it. Who brought up the topic — patient or doctor — was not asked.
The National Cancer Institute paid for the study.
Women who see breast specialists rather than general surgeons may be more apt to get plastic surgery consultations, Lyerly said. Many women want to conserve breast tissue, and a surgeon must make sure that medical issues are not outweighed by body image concerns.
"If we provide too much information, that's also not the more effective way of communicating either," he said. "It could be that they're so fixed on other issues that two sentences on breast reconstruction totally was not heard."
However, treatment guidelines do not spell out what doctors should say and when, so "this study is likely to get some traction for that very reason," Brawley said.
Dr. Sameer Patel, a reconstructive surgeon at the Fox Chase Cancer Center in Philadelphia, said some doctors are too focused on the medical part of the decision about what operation to have.
"They're trying to take care of the cancer, and that takes a back seat," he said.
Debbie Horwitz, 35, of Raleigh, N.C., encountered that attitude three years ago, when she found a cancerous lump. Her mother had died of breast cancer and her grandmother also had the disease, so when tests showed she had a mutated gene raising her risk of future tumors, she had a double mastectomy.
"I was really frustrated to find out there were no process pictures of what the reconstruction process would be like," she said. "It's a months-long process. There were a lot of before and after pictures, but there's a lot that happens in between."
She formed a support group and wrote a book featuring more than a dozen photos graphically depicting her own reconstruction — "Myself: Together Again" — sold on Amazon and other outlets.
If doctors do not discuss reconstruction options in advance, "it's unfair and I think it's unethical," she said. "If you were going to take off somebody's arm, or a leg had to be amputated, you would talk to them about prosthetics. I don't understand how doctors can leave that part out."
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On the Net:
Mastectomy support group: http://www.myselftogetheragain.org
Cancer Society: http://www.cancer.org
FDA warns of deaths from fentanyl patch
Fri, 21 Dec 2007 22:49:10 GMT
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Improper use of patches that emit the painkiller fentanyl is still killing people, the government said Friday — its second warning in two years about the powerful narcotic.
Some of the deaths came after doctors prescribed the patches to the wrong patients, the Food and Drug Administration said.
The drug is only for chronic pain in people used to narcotics, such as cancer patients, and can cause trouble breathing in people new to this family of "opioid" painkillers. Yet the FDA found cases where doctors prescribed it for headaches or post-surgical pain.
The FDA said patients also accidentally overdose by using the patches wrong, such as putting on more than prescribed, replacing them too frequently or getting them too hot.
"While these products fill an important need, improper use and misuse can be life threatening," said FDA pain chief Dr. Bob Rappaport. "It is crucial that doctors prescribe these products appropriately, and that patients use them correctly."
The FDA first warned about improper patch use in 2005, when it announced it was investigating 120 deaths.
Although FDA has investigated the new reports for several months, Rappaport refused to say Friday how many additional deaths the agency has learned of since that first warning.
He called the number of reports small but concerning because "they are preventable."
Friday, the FDA said it had ordered patch makers to create special medication guides that will come with every box, spelling out proper use in easy-to-understand language.
What kind of mistakes are happening?
The consumer advocacy Institute for Safe Medication Practices highlighted some cases last summer. One patient died after being given a patch for post-surgery pain despite having pneumonia and being new to narcotics. Two others survived, an elderly man taken to the emergency room after being given a patch together with painkilling pills and an elderly woman who became delirious while wearing several patches at once.
The FDA's main message Friday: Do not prescribe fentanyl patches to anyone new to opioids, the painkiller family that includes morphine. Absorbing fentanyl through the skin is a powerful way to deliver the potent drug, and thus poses serious risk to anyone not already opioid-tolerant, Rappaport explained.
Doctors who aren't specially trained in pain management may not know that. But Rappaport said FDA isn't considering curbs on prescribing because there is a great need for the patches among the millions of chronic pain sufferers, few of whom get care from pain specialists.
Among the warnings:
_Fentanyl patches can cause severe trouble breathing. Get emergency help if you have trouble breathing or extreme drowsiness with slowed breathing; feel faint, dizzy, confused; or have other unusual symptoms. They can be signs that you were prescribed too high a dose or took too much.
_Fentanyl patches are only for round-the-clock pain that is moderate to severe and expected to last for weeks. They are not for sudden, occasional or mild pain, or pain after surgery.
_The patches should not be your first narcotic painkiller.
_Ask your doctor how often to apply the patch, whether to reapply one that has fallen off and how to replace it. Doing any of that wrong can cause an accidental overdose.
_Do not use heating pads, electric blankets, saunas or heated waterbeds, take very hot baths or sunbathe while wearing a fentanyl patch. Heat may increase the drug's absorption, causing a life-threatening overdose. Call a doctor right away if body temperature becomes higher than 102 degrees while wearing a patch.
The patches were first approved under the brand name Duragesic in 1990, but generic versions are sold by other manufacturers.
Moderate exercise may stall vascular dementia
Wed, 19 Dec 2007 21:29:48 GMT
NEW YORK -
Older adults who regularly walk
for exercise may help lower their risk of vascular dementia,
the second-most common form of this disorder after Alzheimer's
disease, a study published Wednesday suggests.
In a group of 749 adults who were 65 years of age or older,
the Italian researchers found that those who regularly walked
or got other forms of moderate exercise were less likely to
develop vascular dementia over the next 4 years.
Compared with their sedentary counterparts, active adults
had about one quarter the risk of developing vascular dementia.
Vascular dementia is caused by an impaired blood flow to the
brain. Blockages that narrow the blood vessels supplying the
brain or complete blockages that cause a stroke, may also lead
to vascular dementia. People with conditions that damage blood
vessels throughout the body -- such as high blood pressure or
diabetes -- are also at increased risk.
The new findings, published in the online edition of the
journal Neurology, build on evidence that lifestyle habits are
important in dementia risk. A number of studies have suggested
that the same habits that are good for the heart -- such as a
healthy diet and regular exercise -- may benefit the aging
brain as well.
Although moderate exercise had no effect on Alzheimer's
disease, the findings do not mean that exercise has no effect
on the risk of Alzheimer's, according to the researchers, led
by Dr. Giovanni Ravaglia of the University Hospital S.
Orsola-Malpighi in Bologna.
The study included Italian adults with no evidence of
mental decline at the outset. The patients were interviewed
about their physical activity levels, medical history and any
depression symptoms, among other health factors.
Over the next 4 years, 86 study participants were diagnosed
with dementia, including 27 with vascular dementia.
Ravaglia's team found that, compared with participants who
walked the least often at the study's start, those who logged
the most miles were 73-percent less likely to develop vascular
dementia.
Similarly, those who got the most moderate exercise of any
type -- such as gardening, bicycling and housework -- had a 76
percent lower risk of vascular dementia.
Exercise may benefit mental functioning for a number of
reasons, according to the researchers. Aside from improving
blood from improving the blood flow to the brain, it may also
stimulate the release of key brain chemicals, and enhance the
development of new nerve cells or the connections among those
cells.
It's also possible, Ravaglia and his colleagues note, that
an active lifestyle helps protect the aging brain by keeping
older adults mentally stimulated and socially active.
In general, experts advise that all healthy adults try to
accumulate at least 30 minutes of moderate exercise on most, if
not all, days of the week. Older adults who want to start a new
exercise routine should talk with their doctors first.
SOURCE: Neurology, online December 19, 2007.