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March 2008 News Archives
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March 2: GIZMO PUTS TEENS OUT ON THEIR EARS, New York Post
By SUSANNAH CAHALAN
The Mosquito has landed - and the city's teens and 20-somethings are about to get bitten.
A pesky new security device aims to clear out young troublemakers from their hangouts in apartment-building lobbies and foyers by emitting an irritating high-frequency screech that can only be heard by young ears.
The message: Buzz off.
The British-made Mosquito, used in 3,500 locations in the UK, costs $1,400, weighs five pounds and looks like an innocuous wall-mounted speaker. But its obnoxious 85-decibel drone ranges as far as 60 feet and registers as a constant screech to most people between the ages of 13 and 25.
It's almost silent to those older, according to Mike Gibson, whose company, Moving Sound Technologies, sells the device in the United States.
"It's like fingernails on a chalkboard to people who can hear it," Gibson said.
High-pitch frequencies often become inaudible as people age because hair cells at the base of the inner ear, or cochlea, that are responsible for picking them up become damaged over time.
Local youths felt the sting last week, after the landlord of a vandalism- and drug-plagued apartment building in Jamaica, Queens, became the first New York City address to install the siren.
Sean Mann, property manager of the 78-unit building at 114-05 170th St., said he was desperate to curtail chronic loitering, vandalism and even drug use in the building's lobby.
"I look at this as an active deterrent . . . I'm skeptical - because I can't hear it," he said.
But, he added, "over the past few days, we haven't seen any kids hanging out there. They're moving to different floors to avoid the sound.
"But now that we know it works, we'll keep installing more."
The Post put the gadget to the test in Washington Square Park and Midtown.
"It's obnoxious, high-pitched and painful," said 19-year-old Kristin Hankins with a wince.
"It's just awful," cried Jackie Lewis, 19, covering her ears. "I was wondering what that was. It's so annoying!"
But Jesus Parra, 46, was mystified. "Am I going deaf? I don't hear nothing," he said.
Dr. Pamela Roehm, assistant professor of otolaryngology at NYU, warns that more studies should be done before people install these devices.
"Eighty-five decibels is a little extreme," she said. "There is the possibility that long periods of exposure to this sound could cause damage."
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March 3: Long Workweeks Keeping Americans Up Late, AP
NEW YORK (AP) -- Hey you! Dozing at your desk! Wake up, go home and get more sleep! That could be the message from a survey released Monday by the National Sleep Foundation. The survey of 1,000 people found participants average six hours and 40 minutes of sleep a night on weeknights, even though they estimated they'd need roughly another 40 minutes of sleep to be at their best.
Roughly one-third of those surveyed said they had fallen asleep or become very sleepy at work in the past month.
Just how big a deal that is depends, of course, on your job. Last week, the chairman of the Nuclear Regulatory Commission acknowledged it should have done more to investigate a tip that security guards routinely took naps while on the job at a Pennsylvania nuclear plant.
It wasn't until a videotape of guards sleeping in a "ready room" at the Peach Bottom plant in south-central Pennsylvania surfaced several months after it got the tip that the NRC announced in September a special investigation.
While sleepy workers know they're not performing as well as they could during the day, work is what's keeping them up nights, according to the survey, which found workdays are getting longer and time spent working from home averages close to four-and-a-half hours each week.
It seems people are also trying to squeeze in more time for themselves and their families, even if it means less sleep. The average wake up is at 5:35 a.m. and it's followed by about two hours and 15 minutes at home before heading out to work, according to the survey. Average bedtime is 10:53.
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March 4: Ban on gifts to doctors sought, Boston Globe
By Megan Woolhouse
Globe Staff
Senate President Therese Murray proposed a total ban on all gifts and freebies to doctors from pharmaceutical companies, a move that would make Massachusetts the first state in the country to ban such gifts outright.
The measure is part of a set of healthcare reform measures Murray filed in a bill yesterday that also includes requiring all doctors statewide to adopt electronic medical records by 2015, allowing patients to choose nurse practitioners as primary care providers, and forcing public reviews of any insurance company efforts to boost annual premiums by more than 7 percent.
"There's going to be a climate change, and there has to be a climate change; otherwise our healthcare reform will implode, just under the costs," Murray said at a press conference at the University of Massachusetts Medical School yesterday.
The ban forbids the pharmaceutical industry from giving - and doctors, their families or employees from receiving - gifts from drug companies. Gifts include payments, entertainment, meals, travel, honorariums, subscriptions, even a pen with a drug company logo.
The legislation would continue to permit distribution of drug samples to doctors for the exclusive use of their patients. Anyone who violates the ban could be fined $5,000, face two years imprisonment, or both, under the proposal.
Other states have passed laws attempting to limit the pharmaceutical industry's influence. In Minnesota, legislators enacted a ban on gifts in excess of $50 from pharmaceutical companies. In Vermont, legislators have passed laws requiring pharmaceutical company representatives to disclose the dollar value of gifts over $25 to doctors. Peggy Kerns, director of the ethics center at the National Conference of State Legislatures in Denver, said Murray's legislation is the first attempt at an outright ban on gifts to doctors that she had heard of.
Kerns said that many states are considering or have passed bans on gifts from lobbyists and industries to elected officials. "I think it's legitimate and I'm sure the legislators are doing it for the public good," she said. "I've just never heard of it, and it seems like the place to start would be within their own ranks."
Massachusetts law already prohibits gifts to legislators and other public officials of "anything of substantial value," or anything worth more than $50.
The ban on drug and device company gifts to physicians was first proposed in 2005 by state Senator Mark C. Montigny, a New Bedford Democrat, who said yesterday by phone that he was "very pleased" to see it included in Murray's proposal. Montigny said he grew concerned about the cost of drugs bought through state-sponsored healthcare programs as chairman of the Senate's Healthcare Committee.
He said he was disturbed to see drug companies hire salespeople including "former beauty queens and cheerleaders" who wine and dine doctors and encourage them to prescribe drugs that may not be the most cost-effective.
"You would not believe the conflict of interest here," Montigny said. "Of all the nasty manipulation that's gone on, there's no more effective group at getting more than they deserve at the expense of the taxpayer than the pharmaceutical industry." He said the state continues to overpay for drugs.
Julie Corcoran, deputy vice president of the Pharmaceutical Research and Manufacturers of America, a trade organization based in Washington D.C., said the industry's sales people are "highly educated and trained by their companies." The group opposes any ban, saying the pharmaceutical industry is already heavily regulated by the Food and Drug Administration. "I'm not aware of any kind of evidence or studies that link promotional or marketing materials with the cost of healthcare," she said.
Mike Webb, chairman of the Massachusetts Biotechnology Council, said in a statement issued via e-mail yesterday that he applauded the scope of Murray's healthcare proposal, but was "concerned about any measures, such as bans on interactions with physicians, which could negatively impact information flow to practitioners and ultimately hurt patient care."
The proposed ban is also more strict than the current policy proposed by the American Medical Association. That policy bans cash gifts, but allows doctors to receive textbooks, modest meals, and "other gifts that serve a genuine educational function." The association also allows doctors to receive drug samples for personal or family use.
Money for Murray's proposal to spend $25 million annually to implement electronic health records reform would come from a House-proposed $1 cigarette tax hike. Murray estimated the new tax would produce up to $175 million in new revenue.
Governor Deval Patrick and House Speaker Salvatore DiMasi did not immediately embrace the gift ban or any other specific provisions of her bill.
Patrick said he had discussed the plan with Murray and reviewed a bullet-point summary of the bill. He said yesterday: "There's a lot of really good ideas in there, and I look forward to working with her on that."
David Guarino, a spokesman for House Speaker Salvatore F. DiMasi, said in an e-mailed statement that DiMasi "wholeheartedly agrees with the principals put forward . . . in the bill and shares concerns about keeping healthcare costs from rising at double-digit rates."
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March 7: Hearing loss is silent epidemic in U.S. troops, AP
Soldiers coming home with permanent hearing damage and ringing in ears
SAN DIEGO - Large numbers of soldiers and Marines caught in roadside bombings and firefights in Iraq and Afghanistan are coming home with permanent hearing loss and ringing in their ears, prompting the military to redouble its efforts to protect the troops from noise.
Hearing damage is the No. 1 disability in the war on terror, according to the Department of Veterans Affairs, and some experts say the true toll could take decades to become clear. Nearly 70,000 of the more than 1.3 million troops who have served in the two war zones are collecting disability for tinnitus, a potentially debilitating ringing in the ears, and more than 58,000 are on disability for hearing loss, the VA said.
"The numbers are staggering," said Theresa Schulz, a former audiologist with the Air Force, past president of the National Hearing Conservation Association and author of a 2004 report titled "Troops Return With Alarming Rates of Hearing Loss."
One major explanation given is the insurgency's use of a fearsome weapon the Pentagon did not fully anticipate: powerful roadside bombs. Their blasts cause violent changes in air pressure that can rupture the eardrum and break bones inside the ear.
Sudden blasts
Also, much of the fighting consists of ambushes, bombings and firefights, which come suddenly and unexpectedly, giving soldiers no time to use their military-issued hearing protection.
"They can't say, `Wait a minute, let me put my earplugs in,'" said Dr. Michael E. Hoffer, a Navy captain and one of the country's leading inner-ear specialists. "They are in the fight of their lives."
In addition, some servicemen on patrol refuse to wear earplugs for fear of dulling their senses and missing sounds that can make the difference between life and death, Hoffer and others said. Others were not given earplugs or did not take them along when they were sent into the war zone. And some Marines weren't told how to use their specialized earplugs and inserted them incorrectly.
Hearing damage has been a battlefield risk ever since the introduction of explosives and artillery, and the U.S. military recognized it in Iraq and Afghanistan and issued earplugs early on. But the sheer number of injuries and their nature — particularly the high incidence of tinnitus — came as a surprise to military medical specialists and outside experts.
The military has responded over the past three years with better and easier-to-use earplugs, greater efforts to educate troops about protecting their hearing, and more testing in the war zone to detect ear injuries.
The results aren't in yet on the new measures, but Army officials believe they will significantly slow the rate of new cases of hearing damage, said Col. Kathy Gates, the Army surgeon general's audiology adviser.
Considerable damage has already been done.
For former Staff Sgt. Ryan Kelly, 27, of Austin, Texas, the noise of war is still with him more than four years after the simultaneous explosion of three roadside bombs near Baghdad.
Ears still ringing
"It's funny, you know. When it happened, I didn't feel my leg gone. What I remember was my ears ringing," said Kelly, whose leg was blown off below the knee in 2003. Today, his leg has been replaced with a prosthetic, but his ears are still ringing.
"It is constantly there," he said. "It constantly reminds me of getting hit. I don't want to sit here and think about getting blown up all the time. But that's what it does."
Sixty percent of U.S. personnel exposed to blasts suffer from permanent hearing loss, and 49 percent also suffer from tinnitus, according to military audiology reports. The hearing damage ranges from mild, such as an inability to hear whispers or low pitches, to severe, including total deafness or a constant loud ringing that destroys the ability to concentrate. There is no known cure for tinnitus or hearing loss.
The number of servicemen and servicewomen on disability because of hearing damage is expected to grow 18 percent a year, with payments totaling $1.1 billion annually by 2011, according to an analysis of VA data by the American Tinnitus Association. Anyone with at least a 10 percent loss in hearing qualifies for disability.
From World War II and well through Vietnam, hearing damage has been a leading disability.
Despite everything that has been learned over the years, U.S. troops are suffering hearing damage at about the same rate as World War II vets, according to VA figures. But World War II and Iraq cannot easily be compared. World War II was a different kind of war, waged to a far greater extent by way of vast artillery barrages, bombing raids and epic tank battles.
Given today's fearsome weaponry, even the best hearing protection is only partly effective — and only if it's properly used.
Some Marines were issued a $7.40 pair of double-sided earplugs, with one side designed to protect from weapons fire and explosions, the other from aircraft and tank noise. But the Marines were not given instructions in how to use the earplugs, and some cut them in half, while others used the wrong sides, making the devices virtually useless, Hoffer said. Today, instructions are handed out with the earplugs.
In any case, hearing protection has its limits. While damage can occur at 80 to 85 decibels — the noise level of a moving tank — the best protection cuts that by only 20 to 25 decibels. That is not enough to protect the ears against an explosion or a firefight, which can range upwards of 183 decibels, said Dr. Ben Balough, a Navy captain and chairman of otolaryngology at the Balboa Navy Medical Center in San Diego.
The Navy and Marines have begun buying and distributing state-of-the-art earplugs, known as QuietPro, that contain digital processors that block out damaging sound waves from gunshots and explosions and still allow users to hear everyday noises. They cost about $600 a pair.
The Army also has equipped every soldier being sent to Iraq and Afghanistan with newly developed one-sided earplugs that cost about $8.50, and it has begun testing QuietPro with some troops.
'Hearing pill'
In addition, the Navy is working with San Diego-based American BioHealth Group to develop a "hearing pill" that could protect troops' ears. An early study in 2003 on 566 recruits showed a 25 to 27 percent reduction in permanent hearing loss. But further testing is planned.
And for the first time in American warfare, for the past three years, hearing specialists or hearing-trained medics have been put on the front lines instead of just at field hospitals, Hoffer said.
Marines and soldiers are getting hearing tests before going on patrol and when they return to base if they were exposed to bombs or gunfire.
"You have guys that don't want to admit they have a problem," Hoffer said. "But if they can't hear what they need to on patrol, they could jeopardize their lives, their buddies' lives and, ultimately, their mission."
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March 11: Factors behind head and neck cancer revealed, Reuters
WASHINGTON (Reuters) - There are two distinct culprits behind head and neck cancer -- the long-recognized heavy tobacco and alcohol use as well as a common sexually transmitted virus, researchers said on Tuesday.
The risk factors are so dramatically different in head and neck cancer in people infected with the human papillomavirus, or HPV, that it should be considered a separate disease from cases in which patients are not infected, researchers at Johns Hopkins University in Baltimore said.
Head and neck cancer includes tumors in the mouth, tongue, nose, sinuses, throat and lymph nodes in the neck.
"These are completely different cancers and we need to view them as such. They just happen to occur in the same place. The risk factors didn't appear to overlap at all, and there didn't appear to be any interaction between them," Dr. Maura Gillison, a professor of oncology and epidemiology, said in a telephone interview.
More than 35,000 people are diagnosed with head and neck cancer annually in the United States alone. If found early, such cancer may respond well to treatment with surgery, radiation therapy and chemotherapy.
Not only are the patient populations different in HPV-positive and HPV-negative head and neck cancer, but the tumors look different under a microscope, Gillison said. People with the viral-linked cancer also tend to respond better to treatment than those not HPV-infected, she added.
HPV is a common sexually transmitted virus. It is well known for causing cervical cancer and genital warts.
Since 2000, researchers have also known that HPV infection was linked to some cases of head and neck cancer, particularly in the upper throat and back of the tongue.
The new study, published in the Journal of the National Cancer Institute, focused on 240 people diagnosed with head and neck cancer between 2000 and 2006.
Nearly 40 percent of them had an HPV infection. Those patients did not have the well-known risk factors for head and neck cancer -- tobacco smoking, alcohol use and poor oral hygiene, the researchers found.
The people with viral-linked cancer cases had a completely different set of risk factors, including certain sexual behaviors and marijuana use, the researchers found.
Sexual behaviors linked to these patients included increasing numbers of lifetime sex partners including oral sex, and the presence of a sexually transmitted disease, they said.
Gillison said it is possible other behaviors linked with marijuana use could be responsible, but said chemicals in marijuana called cannabinoids could affect the immune system's ability to clear a viral infection.
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March 18: Coming Around to Ear Tubes, The Washington Post
Putting aside my general skepticism of alternative approaches -- I maintain a staunch, perhaps naive, faith in people who have made it through the rigors of medical school -- I weighed the feasibility of a few.
I soured on homeopathy when I learned this involved more than administering minute doses of, say, bitterroot from the local health food store; it required extensive (not to mention expensive) consultation.
Chiropractic? Forget that. I couldn't even get Shep to lie still for half a minute while I changed his diaper.
Acupuncture also seemed out of the question. I couldn't imagine sticking Shep with more needles than absolutely necessary.
Eliminating dairy sounded easy enough, so I put Shep on rice milk. But he took one taste, gave me a betrayed look and hurled the bottle across the room, shouting one of the few words he knows, "NOOOOOOO!"
By the time I took Shep to see Mark Dettelbach at the downtown Washington office of the Feldman ear, nose and throat group, I had done my homework and learned that otitis media -- which sounded to me like a vengeful Greek god -- is the medical term for inflammation of the middle ear.
The reason that infants are so often afflicted with otitis media, caused by bacteria or viruses that allow pus and mucus to accumulate behind the eardrum, is anatomical. The inner ear is not developed enough to allow drainage of fluid from the eustachian tube, which connects the ear to the back of the nose.
An immature eustachian tube inclines at about 10 degrees, as compared with the 45-degree angle of an adult's. That's why many parents try to have their otitis-prone infants drink bottles sitting up, to prevent milk entering the inner ear.
The condition of fluid in the middle ear, or otitis media with effusion (vengeful deity meets wicked stepmother), can last for months, impeding hearing. Left untreated, it can cause delays in speech and language development and even lead to hearing loss.
After Dettelbach took a look in Shep's ears -- one of which he diagnosed as infected -- a technician led us to a padded booth. While an assistant focused Shep's attention forward (with a variety of stuffed animals), the technician called his name through two different speakers, at various volumes. I beamed with pride every time Shep responded, and I held my breath every time that he seemed not to hear.
Shep was experiencing about a 25-decibel hearing loss, Dettelbach told me. "Basically, it sounds to him like everyone is talking under water," he explained. "If it were you, I'd recommend a hearing aid."
The diagnosis convinced me: We would get the tubes, despite my lingering worries over the one in 100,000 risk of "incident" that Dettelbach said anesthesia posed in children.
The actual surgery -- performed on Shep in a suburban outpatient surgical center in early February -- involves making a small hole in the eardrum to remove fluid with a suction device. A surgeon then inserts a tiny tube, which provides ventilation. Typically, children can return to school or day care the following day. The tubes remain in place for six to 12 months before falling out on their own. The only downside is the necessity of earplugs for swimming.
Shep's surgery took the longest 18 minutes of my life. By the time Dettelbach emerged from the operating room, the sound of Shep's wails filled me with relief. He'd had so much fluid in both ears that a larger suction had been required to get it all out. "But everything went fine," Dettelbach said.
By the time I got to him, in the arms of a nurse, Shep was sucking down a bottle and clutching his favorite stuffed animal. He wailed all the way home. By that afternoon, however, he was beyond chipper, taking in everything around him with a conspicuous new level of alertness.
My personal payoff came the next morning when I stepped into Shep's room. He stood up in his crib, looked at me, and, for the first time ever, shouted "Mommy!"
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March 18: Balance in Old Age Tied to Brain Changes, HealthDay News
TUESDAY, March 18 (HealthDay News) -- The severity of age-related changes to white matter in the brain affects how well older people are able to move around and keep their balance, a new study says.
White matter changes -- called leukoaraiosis -- are common in older people.
The study participants included 639 women and men, ages 65 to 84, who underwent walking and balance tests, along with brains scans. The scans revealed that 284 of the volunteers had mild age-related changes to their brain's white matter, 197 had moderate changes, and 158 had severe changes.
Compared to those with mild changes, people with severe changes were twice as likely to score poorly on the walking and balance tests and twice as likely to have a history of falls. Participants with moderate changes were 1.5 times more likely than those with mild changes to have a history of falls.
The findings of the three-year study were published in the March 18 issue of the journalNeurology.
"Walking difficulties and falls are major symptoms of people with white matter changes and a significant cause of illness and death in the elderly," study author Dr. Hansjoerg Baezner, of the University of Heidelberg in Mannheim, Germany, said in a prepared statement.
"Exercise may have the potential to reduce the risk of these problems, since exercise is associated with improved walking and balance. We'll be testing whether exercise has such as protective effect in our long-term study of this group," said Baezner, who noted that mobility problems in older people often lead to hospitalization and nursing-home placement.
Monitoring white matter changes may assist early identification of walking problems, which have been linked to other health issues.
"Recently, gait abnormalities have been shown to predict non-Alzheimer's disease dementia, so recognition, early diagnosis and treatment of this disabling condition may be possible through early detection of walking and balance problems," Baezner said.
The causes of white matter changes and the reasons why it's worse in some people aren't fully understood. However, researchers have found evidence of a link to insufficiently treated high blood pressure.
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March 20: Do You Think I'm Sexy? Apnea Aid Raises Doubts, MSNBC
Hoses, masks and whirring noises make CPAP romance a little challenging
For people with severe obstructive sleep apnea, a Continuous Positive Airway Pressure device — known as CPAP machine — can be a lifesaving treatment.
by JoNel Aleccia
Health writer
Babbett Peterson thought there was nothing less sexy than her husband’s snoring — until he brought home the cure.
The 47-year-old Trabuco Canyon, Calif., woman took one look at the plastic face mask, the long tubing and the whirring motor that ran all night and decided there were worse things than a few snuffles and snorts.
As far as she was concerned, the Continuous Positive Airway Pressure machine — known as a CPAP — was a threat to her 22-year marriage.
“Things were great in the bedroom,” Peterson said. “Then there was this thing strapped to his head.”
Peterson and her husband, Chris, a 47-year-old engineer, are among growing numbers of couples whose romantic lives have been derailed by sleep problems — or their solutions.
Bedtime troubles send three in 10 couples to separate rooms, according to a poll by the National Sleep Foundation, a nonprofit agency. About a quarter of people with partners and 10 percent of singles said sleep problems left them too tired for sex.
Snoring is the most obvious interference, sleep experts say, but some users contend that the most commonly prescribed cure — the CPAP machine — can put an even bigger damper on libido.
“It’s a huge emotional loss,” said Peterson, who works as an executive assistant. “I am a cuddler. I felt like I couldn’t touch him.”
Peterson’s opinion isn’t the most popular view in the online support group at www.sleepapnea.org, the Web site aimed at people who suffer from the serious sleep disorder that advocates say involves so much more than snoring.
People with obstructive sleep apnea have a problem that causes their airways to collapse during sleep, cutting off breathing sometimes dozens — or even hundreds — of time a night. Because they awake over and over, they’re never fully rested and often wind up with the chronic, life-threatening consequences of extended sleep deprivation.
Compared to the possibility of high blood pressure, heart disease and stroke, looking less sexy at bedtime is a minor concern, said Barbara Ruggiero, who coordinates the southern Nevada chapter of the AWAKE support group run by the American Sleep Apnea Association.
“I couldn’t have cared less,” said Ruggiero, 49, a married mother of two from Las Vegas who started using a CPAP nearly three years ago. “It’s not just the snoring; people do die from sleep apnea.”
But while CPAP users are grateful for the treatment, dozens of posts on the popular apea Web sites reveal some also are worried about the social consequences of the cure.
“I am having a hard time seeing an educated, attractive man looking for an over-weight single mother (2 year old girl) who also has the joy of wearing a full face mask to bed,” one 27-year-old woman wrote.
“It’s a very big thing,” acknowledges Edward Grandi, executive director of the sleep apnea association that counts 10,000 registered members in its ranks. “We hear that a big challenge is having somebody that’s coming to bed with all these accoutrements as opposed to just their jammies.”
Like sleeping with Darth Vader
And the challenge is growing with the number of sleep apnea sufferers. An estimated 4 percent of men and 2 percent of women between the ages of 30 and 60 in the United States suffer from severe sleep apnea, Grandi said.
That’s at least 18 million Americans who shuffle through life in a sleep-deprived haze. Only about 10 percent of sufferers are diagnosed, but the most common prescription is a CPAP.
Still, less than half of those sent home with a CPAP wind up using it, experts said. It’s easy to see why. The machine works by blowing a stream of air down a plastic tube and through a plastic mask, using the pressure to keep airways open.
Even the most streamlined models can’t hide the Darth Vader-like effect of slipping on the device and flipping the switch, acknowledged Dr. William Orr, a sleep expert and president of the Lynn Health Science Institute at the Oklahoma University Health Sciences Center.
“It’s like sleeping with a vacuum cleaner strapped to your nose,” he said. “You wouldn’t go around dating somebody and put this thing on and say, ‘Hey, look what I’ve got.’”
While CPAP wearers complain about claustrophobia, inconvenience and the weird effect of being plugged into the wall all night, their partners have other issues.
The noise of the motor can be annoying, like leaving a blow-dryer on for hours, although some users insist the new models are no louder than a large fan or a refrigerator. The CPAP’s steady stream of exhaled air also can bother partners who suddenly feel like they’re sleeping in a wind tunnel.
After 46 years of marriage, Jim and Ann Hurd of Colorado Springs, Colo., had to stop cuddling because of her CPAP machine.
“My husband and I were snugglers all night long,” said Ann Hurd, 66. “But he doesn’t like the cold air blowing on him.”
And there’s no question it’s hard to feel seductive while wearing the thing. Vern Hulse, 66, of Ririe, Idaho, has worn a CPAP for seven years, so when his wife, Betty, 63, got one last fall, she didn’t mind.
“But if I wore one and he didn’t, I might have been a little vain,” said Betty Hulse. “If I were a young woman in my 20s and I was alone, I would wear it, but if I had an overnight visitor, there’s no way.”
Despite those obstacles, CPAP users and sleep experts said the benefits of the machine far outweigh the impositions on intimacy.
‘Most unromantic device ever’
Sleep-deprived people are not good partners, noted Rosalind Cartwright, chairman of the of the psychology department at Rush University and founder of the school’s sleep disorders center. She calls the CPAP "the most unromantic device ever," but says using the machine or an oral applicance can rescue a troubled marriage.
“You don't want somebody to go untreated," she said. "When people are sleepy, they can keep up their work role, but their husband role, their parenting role, their love role, they can’t keep it up."
That’s often true in a sexual sense as well. In addition to life-threatening health problems and psychological symptoms, people with untreated sleep apnea often suffer from impotence and other disorders.
Unexpected perks
For Reid Johnson, a 28-year-old salesman from Charleston, S.C., using the CPAP caused some funny moments with college girlfriends, but also some unexpected benefits.
“The relief of being able to sleep and have energy again was so great that I did not care what anyone thought,” Johnson said. “And, after the mask my libido unquestionably went up. I had energy again and was not always sick.”
Now married, Johnson said his CPAP doesn’t hamper his sex life. His wife, Christina, even nicknamed the device “Snuffalufagus,” he said.
Most CPAP users say they’re as matter-of-fact about the device as anyone who needs crutches, prosthetics or other aid for a serious medical condition — and that they expect romantic partners to be the same.
“I’ve never been self-conscious about it,” said Vicki Thon, a 50-year-old single mom who has balanced CPAP use and an active social life for 11 years. “I say, ‘This is what I need to be healthy.’”
For couples who can’t tolerate the device, there are a few options. Chris Peterson, for instance, lost 20 pounds, decreased his snoring — and ditched the machine, much to his wife’s delight.
“We got our life back,” Babbett Peterson said.
When that’s not possible, CPAP users have to cultivate a sense of humor — and a practical view, said Grandi, the apnea association director.
“No, it’s not sexy, but I don’t think snoring is sexy,” he said. “And, you know, you don’t have to do it with the mask on.”
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March 24: Sleep deprived pay the price for shift work, Los Angeles Times
Trying to outsmart our circadian rhythms may have grim health results: obesity, cancer, mental illness and gastrointestinal problems.
By Shari Roan, Los Angeles Times Staff Writer
AT 6 a.m., the hospital's bright hallway lights flicker on, signaling the start of a new day. Doctors in crisp business clothes appear on their early-morning rounds, and the clang of breakfast carts will soon echo through the unit.
For registered nurse Liberty Bunag, however, it's finally time to go home and sleep. She began her shift 12 hours ago with an extra-large coffee and since has consumed a liter of caffeinated soda, more coffee and lots of rice, her personal energy food. Sometimes she and the other nurses on the orthopedic ward of White Memorial Medical Center in Los Angeles practice foreign languages to stay alert, squelching the yawns and drowsiness -- the body's way of protesting this nocturnal activity.
Bunag's head throbs as she walks to her car. "When I get home," says the 26-year-old from Torrance, "my body is tired and my mind is exhausted."
In a 24/7 world, such fatigue passes for normal. Twenty percent of American workers are night-shift workers, and the number is growing by about 3% per year, according to the Bureau of Labor Statistics. While the rest of society sleeps, police officers, security guards, truck drivers, office cleaning crews, hotel desk clerks, nurses, pilots and many others keep patients alive, streets safe and packages moving. But at a price.
These workers -- and people with more conventionally sleep-deprived lifestyles -- are known to be at higher risk for accidents, sleep disorders and psychological stress due to daytime demands, such as family and other obligations, that interfere with sleeping. Now scientific evidence suggests their disrupted circadian rhythms may also cause a kind of biological revolt, raising their likelihood of obesity, cancer, reproductive health problems, mental illness and gastrointestinal disorders.
The evidence for an increased cancer risk is so compelling that, in December, the International Agency for Research on Cancer, a unit of the World Health Organization, declared that shift work is "probably carcinogenic to humans."
Researchers are beginning to understand why. Among the most significant -- and startling -- reasons: As much as 15% of human genes function on a schedule, with highly regulated, oscillating patterns of activity.
These clocklike genes are common features of most cells and can be found in every major organ in the body. They, in turn, affect the schedule of scores of biological functions, from metabolism to cell division to cognitive processes.
"Less than 10 years ago, it was thought that sleep was for the brain and not for the rest of the body, so lack of sleep would make you tired, moody and more likely to have accidents," says sleep researcher Eve Van Cauter, a professor of medicine at the University of Chicago. "But sleep deprivation may be bad for the body too, representing a risk for a variety of abnormal conditions."
Evolution supports that theory. Life on Earth began with single-cell organisms that depended on sunlight for converting energy to food. "Life has been adapting to a light-dark cycle since the beginning of the planet," says Paolo Sassone-Corsi, chairman of the department of pharmacology at UC Irvine.
But modern humans wrongly think they can override their natural sleep patterns with impunity, says Dr. Charles Czeisler, director of the division of sleep medicine at Harvard Medical School. "It's a myth that we alone, among all animals, have the power to sleep when we want," he says.
Disrupted rhythms
Dennis Corrigan sometimes questions his decision to switch to a night shift 12 years ago.
By working nights, the UPS truck driver from West Covina, age 52, avoids the physical demands of the day shift, when lifting boxes is part of the job, plus the worst of L.A. traffic. The 10:45 p.m.-to-11 a.m. shift also allowed him to attend all of his son's high-school football games.
But Corrigan now sleeps only about six hours a day. He has put on weight and gets less exercise than before the switch and was diagnosed with diabetes five years ago.
"The rough part is, when I come home, I'm hungry," he says. "I eat a heavy meal before going off to bed. You're not supposed to do that. It's a worry."
His circadian rhythms may be to blame. Those rhythms determine when certain body processes take place. For example, melatonin, the hormone that aids sleep, is released at night; the hormone cortisol is low at night and pours out in the morning, jump-starting the body's daytime functions. But in night workers, melatonin continues to peak at night -- even though they're awake -- and cortisol levels continue to peak in the early morning hours, even when night-shift workers are eager to get some sleep.
Those disrupted circadian rhythms are why night-shift workers sleep less and with poorer quality, Van Cauter says: They try to sleep when their bodies want to be awake.
Chronic sleep deprivation may carry some of the same risks as disrupted circadian rhythms, she says. Today, Americans average about one hour less of sleep per night than they did 30 years ago.
Bunag feels the effect of night-shift work on her days off. If she tries to sleep at night, she often wakes around 3 a.m. and is alert until dawn, when she falls back to sleep, often for 10 hours. On work days, she sleeps about six hours during the day but still awakens tired.
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March 24: Elephant man transformed by transplant miracle tells his moving story, News of the World
By Nabila Ramdani & Peter Allen
Pascal tells his moving story to the News of the World through normal lips he once thought he would never have...
He talks about his escape from a nightmare of deformity—and his hope of finding LOVE for the first time at the age of 30.
Pascal says: "The operation has revolutionised my life. I can live as a normal human being for the first time. People in the street look at me very differently. They no longer stop and stare or shout cruel words.
"Instead I am accepted. I even dream of myself in my new face—and now I would love to find a wife, settle down and have children."
He spent 24 YEARS horrifically disfigured by Von Recklinghausen's disease, a rare genetic disorder suffered over 100 years ago by Elephant Man Joseph Merrick—famously played by John Hurt in the hit movie.
Pascal was left unrecognisable by hideous bulbous tumours that engulfed his eyes, nose, and mouth with boil-encrusted, ulcerated skin.
And it took 16 DRAMATIC HOURS in an operating theatre to give him back a life he had not known since childhood—with the help of another human being's face and the skill of leading French surgeon Laurent Lantieri.
Pascal was lined up for the revolutionary op after dog attack victim Isabelle Dinoire was given the world's first partial face transplant in 2005.
But he was told his procedure would be much more dangerous and that he could DIE because he needed the world's first FULL face transplant.
"It was not a question of using part of someone else's face to cover a wound, but of replacing one whole face with another," he says.
"Professor Lantieri told me there was a very real possibility I would die in the theatre or afterwards if my body rejected the new face.
Elated
"He used a line from the film Apollo 13, ‘Failure is not an option'."
On a cold January night Pascal was told a donor had been found. His cousin drove him to the Henri Mondor hospital on the outskirts of Paris.
Pascal recalls: "When the anaesthetist began to prepare me for surgery I was feeling elated. My chance had finally come. Even with the risk of dying, there was no question of me hesitating."
His old friend Prof Lanteiri picked up his scalpel and looked at the face which over the years had undergone THIRTY ops to remove tumours and carry out plastic surgery.
And then he began slicing it away. First he cut off all the growths before carefully filleting the rest of Pascal's face, cutting over the left eyebrow, across and under the right one, and then down and around in a complete oval.
Prof Lantieri then had to lift the skin off and cut away flesh—some of it right down to the bone. He and his fellow doctors gasped in horror at what was left. This was a step into the dark...and they prayed as they took the donor's face and placed it over the hole.
Now Prof Lantieri and his team painstakingly connected tissues, nerves, arteries and veins before sending him back to the ward.
Pascal says: "When I came too my new face was not in bandages, but it was heavily swollen. My first proper meal after the operation was
mashed potato and turkey. It felt very odd as my face was still numb. I had no problem eating it all, though."
The most moving moment for Pascal was when his mother Olga, 50, and younger sister Aurelie, 26, came to visit him.
"Both burst into tears of absolute happiness. It was one of the happiest days of their lives," he says, speaking in his native French.
"They are the rocks in my life—both absolute pillars of support. Whenever everything seemed impossible for me as I grew up, they made sure I kept going. Mum says I now look just like I did as a little boy." Until the age of six Pascal was just a normal child growing up in the Paris suburb of Argenteuil. "I was very ordinary and happy," he says.
But soon after his sixth birthday tumours began to grow on his face. "As things got worse I started to stay at home more and more," he says. "The tumours on my lips were so large and heavy it became very difficult to speak or eat.
"At school my classmates were made aware of my condition and never gave me any trouble at all. But the trouble happened with strangers when I went to places where I was not well known.
"There were awful times. People would not just stop and stare, some could not bear to be near me. I became a recluse.
"Once I was sitting quietly in a hospital waiting room when someone who looked at me fainted on the spot." Pascal had his first operations to remove tumours at the age of 12. "But in the early days they made very little difference," he says.
"In the meantime, I did the very best I could in all other aspects of my life. I played tennis and basketball, and had plenty of hobbies.
"I even travelled abroad when I was at school. There was a trip to Cardiff, which I loved. The Welsh people were very kind to me."
The brave teenager even won a place at university in Paris and did two years' vocational training in accountancy.
He says: "But despite all this, it was impossible for me to get a job afterwards. Nobody felt comfortable employing me. Despite my disability, I was only entitled to limited benefits. It was a struggle to survive."
But all those hard years were firmly put behind Pascal as he looked at his new face for the first time in a mirror six days after the transplant. "I whooped with joy. Seeing what the surgeons had done was quite incredible," he says. "I gave a V for Victory sign.
"I couldn't speak to begin with, but wrote my thoughts down. I wanted everyone to know how happy I was.
Cheering
"The crucial three weeks after the operation went very smoothly, with no rejection scares. Then I was slowly able to recuperate, exercising my new muscles and facial features."
When he got home from hospital, friends and neighbours were waiting to greet him.
"My operation was meant to have been a secret, but everybody in our neighbourhood had heard rumours about it.
"When I got out of the ambulance, there was a huge crowd waiting. They were all cheering and shouting, ‘Well done'. It was very touching indeed." It made him smile—something he hadn't been able to do for 24 years. "The flexibility and feeling gets better every day," he says.
"Ten months after the initial operation I underwent another op in which dental titanium implants were put in to give me new teeth."
Now, a year after the operation, tests have showed that Pascal is now completely free of the Elephant Man disease since the affected tissue was taken away.
He is about to start work as an accountant and is thinking about playing tennis and basketball again. He hopes to find a wife and have children.
"One of the main reasons I know the operation was a great success is because I now dream about myself in my new face, not the old one," he says. "Professor Lantieri says this is a sure sign that things are going well. This week I begin my first job with an accountancy firm. I'm also enjoying socialising with my friends. Life really is going pretty well for me at the moment."
Outside of the professor and his team and Pasacal's mother and sister, the person he will always be thankful to is the man whose face he now wears.
He will never know who his donor was—unless the family choose to come forward.
Pascal says: "All the details of the donor have been kept a secret, and I think this is the right thing.
"But there is not a day goes by when I do not pray for the person who gave me a new face—and a new life."
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March 25: Rx for Sinus Patients: Wait, The Washington Post
Antibiotics Don't Relieve Most Infections, Says Study
If you're one of the 20 million Americans who get a sinus infection each year, experts agree: You're being prescribed antibiotics too often. Now some are saying you shouldn't get them at all.
Antibiotics should never be prescribed for otherwise healthy adults with sinusitis, an analysis of a collection of studies concludes in The Lancet. Belgian and Swiss researchers who reviewed data from nine clinical trials involving more than 2,500 people with sinus infections found that the vast majority who received antibiotics didn't need them. That's because while 80 percent of patients diagnosed with an acute sinus infection are prescribed antibiotics, only 5 to 10 percent of such infections are bacterial and respond to the drugs. But doctors often have a hard time distinguishing between viral and bacterial strains.
Over-prescription of antibiotics for a host of medical conditions has led to widespread antibiotic resistance -- meaning doctors have fewer drugs effective against many bacterial infections.
But the Lancet study's conclusions conflict with sinus infection guidelines published last fall by the American Academy of Otolaryngology -- Head and Neck Surgery. Those guidelines recommend antibiotics (usually amoxicillin) if symptoms last more than 10 days. And some experts are calling the study's advice too extreme.
"There's no question that antibiotic resistance is a huge issue when it comes to treating sinusitis," said Richard Rosenfeld, chairman of otolaryngology at Long Island College Hospital in New York and the head of the task force that issued the guidelines. "After all, about 20 percent of all antibiotics prescribed for adults are given to treat sinus infections, and at least some of that is unnecessary."
But Rosenfeld and others said the Lancet analysis was not a sufficient basis for changing clinical practice because it was a meta-analysis, not a randomized trial comparing patients treated with and without antibiotics. What's more, said Rosenfeld, the analysis did not include patients diagnosed on the basis of CT scans, nasal cultures or other sophisticated tests.
"That means that patients most likely to have a bacterial sinus infection would have been excluded from the study," said Rosenfeld.
A 2007 study in the Archives of Otolaryngology -- Head and Neck Surgery by researchers at the University of Nebraska Medical Center was also critical of what it called over-prescription of antibiotics for sinus infections.
Sinuses are hollow spaces behind the nose, cheeks, forehead and eyes that are lined with mucous membranes. These membranes can become infected when a virus in the nose travels to the sinuses. Nose secretions caused by allergies, colds, cigarette smoke and environmental irritants can also travel to the sinuses and become trapped, causing a bacterial infection. In either case, said Stanley Chia, a staff otolaryngologist at the Washington Hospital Center, symptoms may include low-grade fever, pain and pressure behind the nose, headaches and a runny nose, sometimes with a colored discharge.
An infection that lasts up to four weeks is defined as an acute infection; one that lasts more than 12 weeks is considered chronic.
According to a press release that accompanied the Academy guidelines, sinus infections are among the most common and costly ailments of U.S. adults. Rodney Taylor , an associate professor of otolaryngology at the University of Maryland Medical Center, says doctors often prescribe antibiotics under pressure from patients anxious to stop the pain that often accompanies infections. Plus, he said, prescribing the drugs often takes less time for rushed doctors than explaining to a patient why drugs won't help.
Better treatment choices, according to the Academy, are cleansing with a saline solution or using a nonprescription decongestant. Many physicians also recommend nonprescription painkillers, as needed, to relieve headaches and fever.
An antibiotic prescription is warranted for sinusitis patients with chronic health problems such as heart disease or diabetes, which could be exacerbated by a bacterial infection, said Taylor. Antibiotics can also curtail rare spreads of the infection to the eyes and even to the brain, said Chia.
According to the Centers for Disease Control and Prevention, the number of bacteria resistant to antibiotics has increased in the past decade, and many major bacterial infections -- including tuberculosis, some pneumonias and a growing number of hospital-acquired illnesses -- are becoming resistant to common antibiotics, such as amoxicillin, and even last-resort ones such as methicillin and vancomycin.
But a patient with a pounding headache from sinusitis typically is more focused on relief than the state of world microbials, say experts. The challenge, particularly for primary care doctors who treat the bulk of sinus infections, is to figure out when an infection is bacterial and when not.
While otolaryngologists can rely on sophisticated tools such as endoscopes -- lighted tubes that can see inside nasal passages and detect pus in sinuses, a sign that an antibiotic may be needed -- primary care doctors usually rely on nose secretions and a patient's report, said Taylor. And while yellow or green mucus was once regarded as a sure sign of bacterial infection, doctors now know that this is not necessarily the case, leaving generalists without a clear sign of when to prescribe drugs. ^ and when not.
The Academy guidelines suggest that doctors consider prescribing antibiotics (usually amoxicillin) if symptoms - including colored nasal discharge - persist beyond 10 days, or improve within a 10-day period and then worsen.
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March 31: Complications from Heartburn on the Rise, AP
By LAURAN NEERGAARD
AP Medical Writer
WASHINGTON (AP) -- Chronic heartburn is a daily acid bath for the esophagus, and complications from it are on the rise. New government figures show a worrisome increase in esophagus disorders from severe acid reflux. The worst one, esophageal cancer, is continuing its march as the nation's fastest-growing malignancy.
What to do if you're one of the estimated 3 million Americans whose eroded esophagus means high risk for this especially deadly cancer? More doctors are trying to zap away the worst damage, beaming radiofrequency energy down the throat to burn off precancerous cells.
While it's not yet certain that will block cancer from ever forming, the studies are promising enough that specialists have begun debating how to better find at-risk patients, people who suffer a condition called Barrett's esophagus. Ironically, a damaged esophagus may no longer feel the burn of acid reflux, keeping sufferers in the dark.
"You become desensitized. You can go a long time without knowing you have Barrett's," warns Dr. John I. Allen of the American Gastroenterological Association.
Heartburn sometimes is a temporary problem, but it also can signal gastrointestinal reflux disease, or GERD, where a loose valve allows stomach acid to regularly back up into the delicate esophagus. Millions have GERD, which is on the rise along with expanding waistlines. For most people, acid-suppressing medications are the answer.
But severe reflux over many years can cause serious problems for a fraction of people. The lining of the esophagus erodes until it bleeds, narrows to make swallowing difficult or, worse, starts to repair itself with more acid-resistant intestinal cells that happen to be more cancer-prone. That last condition is called Barrett's esophagus, and sufferers are 30 times more likely than the average person to go on to develop esophageal cancer.
Hospitalizations for all reflux-caused esophageal disorders doubled between 1998 and 2005, says a sobering new count by the U.S. Agency for Healthcare Research and Quality.
And over the past two decades, esophageal cancer has risen six-fold. About 16,470 Americans will be diagnosed with it this year, according to the American Cancer Society. Fewer than one in five survives five years, and 14,280 are predicted to die this year.
Hence a renewed focus on Barrett's patients, to try to prevent their damage from progressing to cancer.
The good news is that esophageal cancer is slow to develop, so Barrett's patients are given regular down-the-throat exams to spot precancerous changes in cells. Those termed "high-grade dysplasia" are the most dangerous - one in five of those patients will get full-blown cancer within five years.
Cutting out the esophagus has long been standard treatment to stop high-grade dysplasia from turning into cancer. Don't go straight to that extreme step, say guidelines issued last week by the American College of Gastroenterology.
Instead, the new guidelines urge a two-step process: Send a device down the throat to carefully slice off the precancerous layer and make sure it hasn't already turned into invasive cancer. Then burn away the remaining Barrett's tissue with other endoscopic techniques in hopes of getting healthy cells to grow back in its place - as long as patients stay on long-term, acid-controlling drugs, too.
There are various ways to burn away the problem areas, but specialists increasingly are turning to a device named Barrx that lets them nestle a balloon directly onto the esophagus lining and beam RF energy straight into it.
Small studies suggest Barrx can successfully treat precancerous spots in about 90 percent of patients with no return in two years and counting. Specialists are anxiously awaiting a more in-depth study, to be released later this spring, that compared 120 patients who got either Barrx or a sham procedure.
"It'll have very impressive results," promises Dr. Richard Sampliner of the University of Arizona Health Sciences Center, one of the 19 participating medical centers.
A big question, though, is whether precancerous cells still lurk under the new healthy cells that form, ready to grow again. So patients getting Barrx or other ablation treatments today can't yet abandon regular endoscopic exams.
"Common sense suggests if we eliminate the Barrett's segment, we're going to eliminate the cancer in people. That really will take decades to know for certain," cautions Dr. John Carroll of Georgetown University Hospital.
But Carroll is optimistic enough that this spring, Georgetown begins a study to see if it's worth doing Barrx treatment even earlier - in patients whose Barrett's esophagus hasn't yet developed precancerous spots.
Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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