Metal Joint Replacement – Should Allergy Testing Be Done First?

As our physically active baby boomers age, more and more of them are facing the need for joint replacement. We run, golf, bike and attend exercise class all in the name of fitness and cardiovascular health.  As a result, many of us have bodies that are becoming beat up and worn.

There have been numerous articles discussing the large increase in knee and hip replacements in active 50 year olds who wish to continue to be as active as they were prior to joint replacement surgery.  An article appeared in this week’s MedPage online journal about a small Italian study conducted regarding chronic pain in “successful “metal joint replacements in the lower extremity. Most of us know someone who had a perfectly unremarkable uncomplicated knee or hip replacement who is now suffering from unexplained pain at the surgically repaired joint site.  X Rays show perfect alignment. CT Scans and MRI scans show perfect surgical alignment. The patient remains in pain.

The study released by Italian researchers’ discusses allergic contact allergy being the cause of the continued pain. The individuals evaluated are allergic to the metals in the artificial joint. In the study subjects were patch tested in advance of joint replacement. Those showing allergic sensitivity to metals contained in the prosthesis received a hypoallergenic product instead. They did not develop the unexplained pain and discomfort and had a great outcome. While the study was small and the results preliminary, it raises the question of whether allergy patch testing prior to elective joint replacement should, and will, become the norm in the future.

Dr. Reznick – Appearance on Money Talk News

I recently appeared on Money Talk News in a story about concierge medicine.  The story was carried on 87 television stations throughout the U.S.

Click the link below to view the story.

http://www.youtube.com/watch?v=tvpoHaqc66Q&list=UUtu-auoQOw5x6Ji0RcH_W5A&index=17&feature=plcp

Soda – Does it Cause Asthma and COPD?

With the USA dealing with a youth epidemic of obesity we have been educated as to the large amount of sugar and calories we get from drinking a can of  carbonated soda pop or pouring a glass of soda.   Vending machines for soda as well as fountain service have been removed from schools and school cafeterias in an effort to stop the youth intake of cheap inefficient calories.  Nobody criticizes the occasional use of soda pop in moderation but the continued use at 250-500 calories per 8 ounce serving will cause anyone to gain weight easily.

We now have another disease entity to think about. Australian researchers, in a pulmonary journal named  Respirology, have published the results of a “cross sectional study” that seems to link drinking at least a half liter of soda per day with the development of asthma and chronic obstructive lung disease.   By design, cross sectional studies will not show that drinking a half liter of soda a day is a cause of asthma or COPD, but it certainly can establish a relationship.

US researchers looking at the preliminary data seem to feel that individuals who consume that much soda a day probably have a poor overall diet and pay poor attention to their overall health putting themselves at risk for many types of diseases.  Additional research is needed on the subject but the message is clear, keep your soda intake to occasional use at moderate levels until more is known.

Aspirin Use for Prevention of Cardiovascular Disease

A study by the Veterans Administration in the 1970’s on veterans over age 45 showed that if they were given aspirin they had fewer heart attacks and strokes.  This study didn’t divide the participants into men and women or patients who never had a heart attack or stroke versus patients who had known cardiac, Cerebrovascular and or Vascular Disease already.  The exact dosage of aspirin to take was never quite clarified either. For years physicians prescribed “baby aspirin” to patients over 45 to prevent heart attacks and strokes. While no definitive evidence existed to show the benefit was present in women as well as men, we tended to recommend the low dose aspirin in that group as well unless they were a high risk for bleeding.

Recent studies have questioned whether daily aspirin use for primary prevention of vascular disease is beneficial.  The current opinion is that a daily aspirin may cause more harm than good in women.  There is a feeling that the risk of bleeding may outweigh any benefit. The data is not quite as clear in men.  To add to the confusion, an article published in the journal Ophthalmology asserts that in a European study aspirin use was associated with an increased risk of developing wet, age related macular degeneration (AMD). Of the 4691 participants in the study, 36.4 % developed early AMD and 17% of that group took aspirin on a daily basis.  This is not the first study to raise this question with equivocal findings on several previous studies concerning the relationship between aspirin intake and AMD.  It is clear that further research is needed in this area.

The study is one of many that raise conflicts in approaching AMD and eye disease versus systemic health. This is especially a problem since these older AMD patients are the same ones who are more likely to already have cardiac, Cerebrovascular or Peripheral Vascular Disease and this is the very group that we know and agree that aspirin is beneficial in.

Clearly more studies are needed. I will continue to take my daily 81 mg of enteric coated aspirins unless I develop aspirin related gastritis, ulcers or GI Bleeding. My male patients over 45 years old with low or few risks of GI bleeding will continue to be advised to consider aspirin. With no studies showing a clear cut advantage for women taking aspirin for primary prevention of heart disease and stroke, I will present the pros and cons of therapy and advise it less frequently if the patient has a low risk of vascular disease or a high risk of bleeding.