Gabrielle Giffords

By ALICIA CHANG , 01.10.11, 05:02 PM EST

GoogleNews.com, FORBES.com, TUCSON, Ariz. — Doctors treating Arizona Rep. Gabrielle Giffords’ brain wound said Monday the congresswoman was responding to verbal commands by raising two fingers of her left hand and even managed to give a thumbs-up.

Giffords, 40, is in critical condition in the intensive care unit of Tucson’s University Medical Center after she was shot through the head Saturday during a meet-and-greet with voters outside a supermarket. Two patients were discharged Sunday night. Eight others, including Giffords, remained hospitalized.

Recent CAT scans showed no further swelling in the brain, but doctors were guarded.

“We’re not out of the woods yet,” said her neurosurgeon Dr. Michael Lemole. “That swelling can sometimes take three days or five days to maximize. But every day that goes by and we don’t see an increase, we’re slightly more optimistic.”

After Saturday’s operation to temporarily remove half of her skull, doctors over the past two days had Giffords removed from her sedation and then asked basic commands such as: “Show me two fingers.”

“When she did that, we were having a party in there,” said Dr. Peter Rhee. “That’s a purposeful movement. That’s a great thing. She’s always grabbing for the tube.”

Giffords family is by her side and is receiving constant updates from doctors. On Monday, two well-known doctors with extensive experience in traumatic brain injury were en route to Tucson to help consult on Giffords’ case.

Doctors had said the bullet traveled the length of the left side of the congresswoman’s brain, entering the back of the skull and exiting the front. Her doctors have declined to speculate on what specific disabilities Giffords may face as her recovery progresses.

As for the other shooting victims who suffered injuries to the face, neck, stomach and other parts of the body, doctors said most will have a normal recovery. To ensure that they don’t suffer post-traumatic stress, depression or other problems, teams of experts will guide them through the next phase.

DRUG DELIVERY In an experimental treatment of glioblastoma,
the drug Avastin is sprayed directly into the affected part of the brain.
Fred R. Conrad/The New York Times

Fred R. Conrad/The New York Times

CHEMOTHERAPY Dr. John Boockvar, left, watched as Dr. Howard Riina and Dr. Jared Knopman infused drugs into Mr. Sugrue’s skull. The technique uses microcatheters

The New York Times, by Denise Grady  —  It was a desperate measure, for a desperate disease. Fourteen months ago, Dennis Sugrue let doctors thread a fine tube through his blood vessels and up into his head, so they could spray the drug Avastin directly into the part of his brain where a tumor had been cut out. It was an experiment, devised mainly to find out whether the procedure was safe, and to gauge how much Avastin the brain could tolerate. But Mr. Sugrue, then 50, was hoping the experiment would also free him of cancer.

John Hersey

He had glioblastoma, a brain tumor that fights off every known therapy. The same disease killed Senator Edward M. Kennedy in August of 2009. Mr. Sugrue’s cancer was diagnosed in April 2009 and bombarded with the usual weapons: surgery, radiation and chemotherapy. Within months, the tumor was growing back. That was when he signed up for the Avastin study.

About 10,000 Americans a year develop glioblastoma. Nearly all find that the standard treatments seem to work — for a while. And then the clock starts to run down. With treatment, the median survival is about 15 months. Only 25 percent of patients make it to two years.

The disease is the focus of much research, and will almost certainly be for years to come. Hundreds of studies are being conducted in glioblastoma and other brain cancers. Among other things, they involve vaccines, drug combinations and special drug-delivery techniques. Progress is measured in small steps — a few more months of survival, more patients managing to survive two years. On paper the gains may seem minute, but for patients the added time may translate into a graduation or wedding that might otherwise have been missed.

There are two enormous obstacles to treating glioblastomas. First, no drug is highly effective. Second, even if there were such a drug, getting it to the tumor would be difficult. Many drugs cannot squeeze through the blood-brain barrier, a system of tightly packed cells lining capillaries in the brain. The barrier makes all brain tumors hard to treat.

The study that Mr. Sugrue entered, for people with recurring glioblastomas, is being conducted by Dr. John Boockvar, a brain surgeon at NewYork-Presbyterian/Weill Cornell. Doctors first inject a substance called mannitol, which temporarily opens the blood-brain barrier, and then flood the tumor zone with Avastin.  Avastin blocks the growth of new blood vessels, which tumors need. The drug is approved for glioblastoma, but tumors can become resistant to it.

Normally, Avastin is dripped into a vein. But Dr. Boockvar and his colleagues wanted to try hitting the cancer with a much higher dose by guiding tiny tubes called microcatheters through blood vessels to the tumor site and then unleashing the drug.

Mr. Sugrue was the second patient to be treated, with a small dose. Since then, the study has shown that higher amounts — seven times the dose he received — can be safely used.

A report on the first 30 patients was published online two months ago,  in The Journal of Neurosurgery. Tumors shrank in some, particularly those who had not had Avastin before. But one patient suffered a stroke from the treatment, which caused weakness on one side. And it is still too soon to tell whether this approach can prolong survival.

“We started a year ago,” Dr. Boockvar said, adding that the early patients were quite ill and had only one dose of Avastin. “We’ve lost about 15, or half the patients. The rest are alive and kicking.”

His team has begun new experiments using mannitol and microcatheters to deliver other drugs directly into the brain. In the future, certain drugs may be combined with Avastin.

Dr. Keith Black, chairman of neurosurgery at Cedars-Sinai Medical Center in Los Angeles, and an expert on breaching the blood-brain barrier, said it was not clear that Avastin would work well enough to improve survival very much, even when infused right into the brain. Better drugs are needed.

“We can get drugs in, but there’s a belief in glioblastoma, for example, that even if you push the limit of the drugs you still won’t increase the survival all that much,” Dr. Black said. “It’s kind of like having the Trojan horse before we have the soldiers to put in it.”

He said vaccines looked promising for some patients with glioblastoma. In addition, research with animals suggests that Viagra or Levitra — the drugs for erectile dysfunction — can open the blood-brain barrier, particularly around tumors, and let chemotherapy in. In theory, the drugs could be taken in pill form, unlike mannitol. Dr. Black said he was planning to study the idea in people with various types of brain tumors, including those that had spread from other sites, like the breast or lung. Cancer from other organs invades the brain in about 100,000 Americans a year.

The study that Mr. Sugrue entered is still going on. And so is Mr. Sugrue. He lives in Stamford, Conn., with his wife, Donna, and their teenage children, Molly and Tim. Molly, a high school senior, is about to apply to nursing schools. Mr. Sugrue is still receiving intravenous Avastin regularly. (He had only one dose infused into his brain.) There is no sign of tumor recurrence.

But it has not been an easy year. An infection in his incision required many operations. He has lost some peripheral vision and no longer drives. He needs physical and occupational therapy. Though he does some work, he has not been able to return full time to his job at a hedge fund. But he never lost his quick wit or sense of humor, his wife said, adding, “What he went through would have killed a lesser man.”

If he had it to do again, would he enter the study?

“Absolutely,” Mr. Sugrue said in a telephone interview last week. “In fact, I’m going to ask Dr. Boockvar if there are any more trials out there.”

By ANAHAD O’CONNOR

Tony Cenicola/The New York Times What alternative remedies belong in your home medicine cabinet?

The New York Times, January 7, 2011 —  More than a third of American adults use some form of complementary or alternative medicine, according to a government report. Natural remedies have an obvious appeal, but how do you know which ones to choose and whether the claims are backed by science? In this occasional series, Anahad O’Connor, the New York Times “Really?” columnist, explores the claims and the science behind alternative remedies that you may want to consider for your family medicine cabinet.

The Remedy: Garlic.

The Claim: It can treat athlete’s foot.

The Science: You don’t have to be much of an athlete to contract athlete’s foot. All it takes is a step on a moist floor or a moment in a gym locker room to end up with the pesky and widespread fungus, which causes flaking and tiny cracks between the toes that sting as much as paper cuts.

Treating tinea pedis, as it is known scientifically, can be just as irritating. Those who have it often experiment with all sorts of creams, sprays, gels and prescription drugs that have varying success rates. And the condition has a notorious habit of returning, in part because the fungus often lingers even after symptoms subside, causing many people to end their treatments before the fungus has been completely extinguished.

But one alternative remedy that a small number of studies support is garlic, widely used throughout history for its antimicrobial properties. In particular, studies have looked at a compound in garlic known as “ajoene,” which gets its name from “ajo,” the word for garlic in Spanish. The compound seems to be especially effective against the fungus that causes athlete’s foot.

“Garlic has long been considered a powerful natural antifungal,” said Dr. Lawrence D. Rosen, chief of pediatric integrative medicine at Hackensack University Medical Center in New Jersey and a pediatrician at the Whole Child Center in nearby Oradell. Dr. Rosen pointed out that studies have found garlic effective against a number of fungal infections, including those caused by Candida and other common pathogens.

Tinea pedis seems to be just as vulnerable. In 2000, one team of researchers published a study in The Journal of the American Academy of Dermatology that compared a week of twice-daily applications of mild garlic solutions with topical applications of the popular drug Lamisil in about 50 people with diagnoses of athlete’s foot. Two months later, the scientists found that a garlic solution that contained about 1 percent ajoene had a 100 percent cure rate, compared with a 94 percent cure rate for 1 percent Lamisil. Other studies have found similar results.

Ajoene creams and solutions are not available commercially. But some experts recommend simply adding a few finely crushed cloves of garlic to a foot bath and soaking the affected foot for 30 minutes, or mincing a few garlic cloves, mixing the minced garlic with olive oil, and then using a cotton ball to rub some of the solution on the affected area.

The Risks: According to the American Academy of Family Physicians, side effects of garlic are generally mild and uncommon. But some people can develop allergic rashes or blisters with topical use.

Lasar Treatment for Toenail Fungus

Discussion on Lasar Treatment for Toenail Fungus

Laser treatment for toenail fungus

But back in 2009……….The NYTimes reported………

False Start on a Laser Remedy for Fungus

J.B. Reed for The New York Times

Dr. Stuart J. Mogul, a podiatrist in New York, using the PinPointe Footlaser. He said the maker of the device, PathoLase, told him it had received F.D.A. approval

The New York Times, March 20, 2009, by Natasha Singer  —  Laser eye surgery has enabled millions of people to throw away their eyeglasses. Now several medical technology companies are hoping that lasers aimed at the feet will allow millions to take their socks off, even in public.

The target is toenail fungus — an infection in an estimated 10 percent of American adults, or 23 million people — that causes toenails to become thick, yellow and fetid.

If these lasers, which recently completed small clinical trials, work, they will represent a new way to treat nail infection by selectively irradiating fungi while leaving the nail and surrounding tissue intact.

Right now, there is no sure cure. The fungi are so hardy that popular antifungal pills, which carry a small risk of liver damage, are completely successful less than half of the time. And a prescription lacquer, painted on the toenails daily for 48 weeks, has a complete cure rate of less than 10 percent.

Pharmaceutical giants like Schering-Plough and Novartis are developing new lacquers, pills and ointments to battle the fungi. But some podiatrists and patients are pinning their hopes on the experimental laser treatments.

Nomir Medical Technologies in Waltham, Mass., is developing a laser called Noveon for diseases like antibiotic-resistant staph infections as well as nail afflictions.

Noveon is a type of laser already commonly used by doctors for treatments like cataract surgery, dental work and even hair removal. Noveon beams two different wavelengths of near-infrared light at toenails to selectively take aim at and kill fungi.

After four treatments with Noveon, about half of the 39 toenails tested no longer had active nail infections, according to the results of a clinical trial that the company presented this month at a national dermatology meeting. Six months after the initial treatment, about 76 percent of the volunteers had clear nail growth, the study reported.

“We will be able to reach people who have heretofore stayed away from treatment because of the toxicity or the costs or other reasons,” said Richard F. Burtt, Nomir’s chief executive.

Mr. Burtt said the company was preparing to submit the data to the Food and Drug Administration, hoping to receive clearance to market Noveon by this fall. The agency has already cleared Noveon for use on the skin and in nasal passages. But the company is not taking orders for or distributing the laser for nails until it receives specific permission to do so, Mr. Burtt said.

Another company developing a laser, PathoLase, is so eager to get a piece of the billion-dollar-plus market for antifungal nail treatments that it has not waited for federal permission to begin marketing its device, the PinPointe Footlaser, for use on toenail fungus. Nearly 70 podiatrists in 21 states already offer PinPointe, according to PathoLase. The treatment, which is not covered by health insurance, costs $1,000 or more.

The F.D.A. requires manufacturers to wait for federal clearance before marketing a medical device for specific uses. But PathoLase appears to have jumped the gun in the war on spores.

Last week, a news broadcast by a Fox affiliate in Manhattan featured PinPointe as the latest thing for nail disorders. Dr. Stuart J. Mogul, a podiatrist in Manhattan who demonstrated the laser during the broadcast, said he had recently treated four patients with PinPointe at a cost of $1,200 each. He said it was too soon to tell whether the treatment had worked.

“I explain to patients that the only risk is financial,” Dr. Mogul said in an interview last week.

He added that representatives of PathoLase had told him that the F.D.A. had approved the laser as being safe.

Up until Tuesday, PinPointe’s Web site promoted the toenail laser as “F.D.A. cleared” and included an endorsement from a podiatrist in California saying he had used the device for six months on 225 patients.

Because the F.D.A. cleared the device in 2001 for use in dentistry, doctors are free to use it for other purposes, John Strisower, the chief executive of PathoLase, said in an interview on Monday.

Technically, the F.D.A. does not regulate the practice of medicine, so doctors are indeed able to use approved drugs and devices for unapproved purposes when they deem it appropriate.

But Timothy A. Ulatowski, director of compliance at the Center for Devices and Radiological Health at the F.D.A., said companies were legally allowed to market a medical device only for the specific use for which it had been granted clearance. Selling or promoting a device for unapproved indications is illegal, he said. He added that the company might face action from the agency, ranging from a warning letter to fines, injunctions or product seizures.

In response to a followup call and e-mail message to Mr. Strisower about the regulatory status of PinPointe, a spokeswoman replied in an e-mail message that he was unavailable for comment.

On Tuesday, PinPointe’s Web site went dark before briefly reappearing on Thursday, redesigned for European patients, and then went offline again.

Americans currently spend about $1.26 billion annually on oral and topical prescriptions for nail fungus, according to IMS Health, a health care information company. That is in addition to millions spent on unproved home remedies like tea tree oil, Vicks VapoRub, Listerine and Clorox. Industry analysts and executives estimate that more effective treatments could expand the market to as much as $3 billion annually.

In the meantime, people who have nail fungus — medically known as onychomycosis — can spread it by shedding invisible spores when they walk barefoot in locker rooms or across carpets, and even as they remove shoes and socks.

“The fungi get in under the overhanging edge of the nail and march from the edge of the nail like PacMan all the way to the cuticle,” said Dr. Boni E. Elewski, a dermatologist specializing in nail disorders.

Although for the majority of people, nail infection is primarily a cosmetic issue — one of the great unsolved American lifestyle problems, up there with balding and cellulite — it can lead to serious health problems among people with diabetes and immune disorders, said Dr. Elewski, who is also a professor of dermatology at the University of Alabama at Birmingham School of Medicine.

Alternative Medicine Cabinet: Thyme for Toenails

By ANAHAD O’CONNOR

Anahad O’Connor, who writes the Really feature in Science Times, explores the claims and the science behind various alternative remedies that you may want to consider for your family medicine cabinet.

Tony Cenicola/The New York Times What alternative remedies belong in your home medicine cabinet?

The Remedy: Thyme

The Claim: It cures toenail fungus.

The Science: It’s not exactly a life-threatening condition, but toenail fungus, known in the medical community as onychomycosis, can be cosmetically unattractive and painful. It is also somewhat prevalent, striking about 15 percent of Americans. And it can be a burden to treat. Conventional treatments are expensive, have a low success rate and can carry significant side-effects. The prescription drug Lamisil, for example, can cause liver damage. But those who want a natural alternative can try remedies that contain thymol, the primary oil found in thyme, a well-known herb and antiseptic. Thymol is commonly found in medicated chest rubs, including Vicks VapoRub.

In one study, scientists tested the antifungal effects of the ingredients in a generic medicated chest rub. Of the seven ingredients, thymol was among the most effective at inhibiting the growth of dermatophytes that cause nail fungus. Other studies in animals have also shown thymol oil to be effective against dermatophytes. And studies have also shown that thymol oil destroys another cause of nail fungus, Candida, by disrupting its cell membranes and metabolism. While the evidence is strong that thymol can attack the organisms that cause toenail fungus, no human studies have been conducted to test whether thymol is a lasting and effective treatment.

But for people vexed by the ugly fungus who don’t want to risk the side effects of a prescription drug, it’s worth a try. Adding the essential oil of thyme to regular foot baths is one option. Joe and Terry Graedon, authors of the popular People’s Pharmacy books on alternative remedies, suggested coating the affected toenail once or twice a day in Vicks VapoRub.

The Risks: Allergic reactions to thyme, when applied to the skin, are rare but can include itching and rash. Vicks VapoRub can also cause temporary reddening of the skin in some people.

Alternative Medicine Cabinet: Back Pain

By ANAHAD O’CONNOR

Anahad O’Connor, who writes the Really? column for The New York Times, explores the claims and the science behind various alternative remedies that you may want to consider for your family medicine cabinet.

Tony Cenicola/The New York Times What alternative remedies belong in your home medicine cabinet?

The Remedy: Devil’s claw

The Claim: It cures back pain.

The Science: Devil’s claw (Harpagophytum procumbens), also known as wood spider and grapple, is a plant from South Africa named for the small hooks on its fruit. Known for its anti-inflammatory effects, it has been shown in recent years to work particularly well for chronic lower back pain. In several randomized, double-blind studies, scientists found that it worked better than placebo and was just as effective as roughly 12.5 milligrams of Vioxx when taken daily. Most studies suggest that doses of devil’s claw from 50 milligrams to 100 milligrams are effective. There is also growing evidence that it is safe for short term treatment — about 8 to 12 weeks — of arthritis pain.

The Risks: Devil’s claw is not to be viewed lightly. While it is generally safe, its side effects can include stomach upset, low blood pressure and increased heartbeat. Doctors also recommend that patients with stomach ulcers or those using blood thinners like warfarin avoid it.

Mehmet Oz MD and Michael Roizen MD

If you dream of eating pasta without the belly-padding, carbo-loading guilt, then check out shirataki noodles and spaghetti.

Because of the plant from which they are made, shirataki noodles are particularly high in fiber and low in carbohydrates. And new research suggests these Asian noodles may even help with weight, cholesterol, and blood sugar control.

Multiple Metabolic Benefits
Shirataki noodles are made from an Asian root vegetable called konjac, which is rich in glucomannan — a type of soluble fiber. And although glucomannan is not a magic bullet for weight loss or cholesterol and blood sugar control, a recent review of the research suggests it might help. Results from 14 different studies — some funded by producers of glucomannan products, some not — revealed key benefits of a glucomannan-enhanced diet, like slower digestion, increased feelings of fullness, and less absorption of cholesterol- and glucose-spiking foods.)

How to Serve Shirataki
Shirataki noodles are pretty mild in terms of flavor, so it’s all about how they’re seasoned. Try substituting them in any of your favorite savory, spicy, tangy Asian dishes,

Read the research below………..

Am J Clin Nutr. 2008 Oct;88(4):1167-75.
Effect of glucomannan on plasma lipid and glucose concentrations, body weight, and blood pressure: systematic review and meta-analysis.
Sood N, Baker WL, Coleman CI.

University of Connecticut Schools of Medicine and Drug Information, Hartford Hospital, Hartford, CT 06102-5037, USA.

Abstract

BACKGROUND: Several clinical trials have investigated the impact of glucomannan on plasma lipids, body weight, fasting blood glucose (FBG), and blood pressure (BP), but have yielded conflicting results and had only modest sample sizes.

OBJECTIVE: The objective was to perform a meta-analysis of randomized controlled trials of glucomannan to better characterize its impact on plasma lipids, FBG, body weight, and BP.

DESIGN: A systematic literature search of MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Library, and the Natural Medicines Comprehensive Database was conducted from the earliest possible date through November 2007. A random-effects model was used to calculate the weighted mean difference (WMD) and 95% CIs as the difference between the mean for the glucomannan and control groups. Standard methods for assessing statistical heterogeneity and publication bias were used.

RESULTS: Fourteen studies (n = 531) met the inclusion criteria. The use of glucomannan significantly lowered total cholesterol [weighted mean difference (WMD): -19.28 mg/dL; 95% CI: -24.30, -14.26], LDL cholesterol (WMD: -15.99 mg/dL; 95% CI: -21.31, -10.67), triglycerides (WMD: -11.08 mg/dL; 95% CI: -22.07, -0.09), body weight (WMD: -0.79 kg; 95% CI: -1.53, -0.05), and FBG (WMD: -7.44 mg/dL; 95% CI: -14.16, -0.72). The use of glucomannan did not appear to significantly alter any other study endpoints. Pediatric patients, patients receiving dietary modification, and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree.

CONCLUSIONS: Glucomannan appears to beneficially affect total cholesterol, LDL cholesterol, triglycerides, body weight, and FBG, but not HDL cholesterol or BP.