Glucosamine – Heart Disease and Osteoarthritis

Glucosamine associated with chondroitin Sulfate is a supplement taken for joint health and to relieve joint pain. Several studies have shown unclear results regarding its efficacy in arthritis, but it has been shown to be safe.

A study in the Annals of Rheumatologic Disease suggested it reduced the symptoms of knee pain from osteoarthritis by modifying the inflammatory response not suppressing the symptoms as non-steroidal anti-inflammatory drugs do.  In the MOVES trial, glucosamine was compared with Celebrex (celecoxib) for relief of knee pain in osteoarthritis. At six months the two were noted to be equivalent in reducing pain. Glucosamine did not produce the gastrointestinal side effects that Celebrex and other NSAIDs can while reducing pain.

In an editorial, written in the online journal Primary Care, Dr. David Rakel looked at 466,000 patients entered into the United Kingdom Biobank database who took glucosamine products for arthritis. They were followed for seven years.  Over that period, the glucosamine users had a 15% lower incidence of cardiac events than non-users. Smokers showed a higher reduction in cardiac events – almost 37%.  They attribute this to a reduction in systemic inflammation as evidenced by a decrease in the inflammatory marker levels of C Reactive Protein in glucosamine users.

In general, glucosamine is usually taken at a dose of 750 mg twice a day.  It is combined with chondroitin which increases the viscosity of the synovial (joint) fluid. Glucosamine helps retain fluid in the joint. It usually takes about six to eight weeks to see a positive effect.   For reasons that are not entirely clear, it works best in lean individuals rather than obese ones.

Glucosamine is made from Crustacean shells so those people with a shellfish allergy should avoid it.

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Tick-Borne Powassan Virus Infections Are Increasing

As we begin the summer months, and people spend more time outside, we experience more tick-borne illnesses. Mention tick-borne illnesses and you immediately think of Lyme Disease which is the most common tick-borne disease in the United States.

A new tick-borne illness is emerging in the same geographic area that Lyme Disease is seen.   Powassan Virus (POWV) has increased from two cases reported in 2008 to well over 30 reported in 2017.  Two cases have been reported recently in New Jersey, including one fatality.

In Lyme Disease the tick attaches to the human body for 36-48 hours prior to the bacterium being transmitted to humans. In Powassan Virus this occurs within the first 15 minutes that the tick latches on. The incubation period can range from one week to one month with patients experiencing fever, vomiting, headache, weakness, loss of coordination, confusion, difficulty speaking and or seizures. The virus affects the central nervous system and can cause encephalitis and meningitis. One in 10 cases is fatal.  Recovery with permanent neurological damage can occur.

There are no medications or vaccines available to prevent or treat POWV infections. Treatment is supportive. Scientists believe the increase in ticks and POWV is a direct result of climate change.

Prevention is the key especially if you are going to be in an area known to have ticks. Experts suggest:

  1. Wear long sleeves and pants with socks pulled up over the bottom of the leg pants.
  2. Wear light colored clothes so ticks can be spotted on your clothing
  3. Use insect repellant with at least 20% DEET. Spray it on the exterior of your clothing and apparel
  4. Upon returning inside perform a thorough tick check.

This is an infection and virus most practicing physicians know very little about. There are no telltale warning rashes as in Lyme Disease.  Until more is known, prevention is the best option.

Tidbits on Dementia and Alzheimer’s Disease

A few years back I attended a lecture given by the director of geriatrics and memory / wellness program at the Massachusetts General Hospital. She began the program by asking the audience for a show of hands as to how many doctors and health care providers were suggesting that their older patients try brain teasers and brain games and puzzles to keep their geriatric patients mentally sharp and stave off dementia.  Everyone’s hand shot up indicating that we all were trying this method to stave off memory loss. She responded with, “Your patient’s will all be great problem solvers when we diagnose their dementia.”   She delivered a message of the importance of older patients maintaining a social network of friends and family that provided the stimulation rather than relying on computer games and brain teasers.  Like everything else in medicine, time and research modify your approach as to what works.

Two studies published in the Journal of Geriatric Psychiatry promoted the use of regular puzzle attempts by seniors. The first by Helen Brooker, Ph.D. from Exeter in the United Kingdom showing that older adults who regularly use word and number puzzles have higher cognitive functioning than those who do not.  She looked at 19,000 plus cognitively healthy individuals aged 50-93 years.  Participants self-reported their frequency of playing word puzzles.  Their frequency of performing word puzzles correlated positively with 14 measures of cognitive function.  They then compared individuals who used number puzzles against those who did not and found similar positive results for the puzzle participants.

Clearly being able to enjoy solving puzzles is correlated with beneficial cognitive performance. It is probably one piece of a larger puzzle including socialization, healthy lifestyle choices, genetics and human interaction that contributes to overall health.

Sunscreen Ingredients are Absorbed says FDA

For years public health officials, dermatologists and primary care physicians have been encouraging people to apply sunscreen before going out into the outdoors to reduce the risk of sunburn and skin cancers.  We are taught to apply it in advance of exposure by about 30 minutes and to reapply it every few hours especially if we are sweating and swimming.   Living in South Florida, sun exposure is a constant problem so we tend to wear long sleeve clothing with tight woven fabrics to reduce sun exposure.  My 15-month old grandson, visiting last weekend was smeared with sunscreen by his well-meaning parents before we went out to the children’s playground nearby.

These precautions seemed reasonable and sensible until an article appeared in JAMA Dermatology recently.  An article authored by M. Mata, PhD. evaluated the absorption of the chemical constituents of sunscreen after applying it as directed four times per day.  The article was accompanied by a supporting editorial from Robert M. Cliff M.D., a former commissioner in the FDA and now with Duke University School of Medicine and K. Shanika, M.D., PhD.

The study applied sunscreen four times a day to 24 subjects. Blood levels were drawn to assess absorption of the sunscreen products avobenzene, oxybenzone and octocrylene.  The results of the blood testing showed that the levels of these chemicals far exceeded the recommended dosages by multiples. The problem is that no one has evaluated these chemicals to see if at those doses it is safe or toxic causing illness?

The editorial accompanying the findings encourages the public to keep using sunscreen but cautions that the FDA and researchers must quickly find out if exposure to these levels is safe for us?  We do know that the chemical oxybenzone causes permanent bleaching and damage to coral reefs in the ocean from small amounts deposited by swimmers coated with sunscreen. The state of Hawaii has actually banned sunscreens containing oxybenzone to protect their coral reefs.

The fact that these chemicals have been approved and are strongly absorbed with no idea of the consequences is solely the result of elected officials wanting “small government” and reducing funding to the oversight organizations responsible for making sure what we use is not toxic.  It is a classic example of greed and profit over public safety.  The research on the safety of these chemicals must be funded and addressed soon. The American Academy of Pediatrics and Dermatology need to advise parents of youngsters whose minds and bodies are in the development and growth stages what is best to do for their children – sooner rather than later.

Fever Blisters or Herpes Simplex Labialis Treatment with Honey versus Acyclovir

Herpes Simplex lesions cause mouth and gum ulcers and fever blisters. In order for the virus to be activated it requires exposure to sunlight. As these ulcerations appear they are painful, unsightly and the virus can be transmitted person to person.  Modern day treatment has consisted of taking an antiviral medicine such as Acyclovir in topical form applied four to six times per day for seven days. The medication reduces the healing time and pain in this infection.

Researchers in New Zealand decided to test their home grown Kanuka Honey versus Acyclovir in the treatment of herpes labialis. They randomized 952 adults who presented to community pharmacies with herpes labialis over a two year period to two groups.  One group received a traditional acyclovir 5% cream, the other kanuka honey (90%), and glycerin cream (10%). They applied their medication five times daily.

They then observed how long it took for the infected and involved skin to return to normal and pain resolution.  It took 8-9 days for the acyclovir to work and 8-9 days for the kanuka honey to return skin to normal appearance. There were no differences in pain observations or time for the open wound to close.

A large jar of Kanuka honey costs $60 by ordering online. A 15-gram tube of 5% acyclovir topical ointment sells for $379.99 locally.

Consumer Reports Releases Sunscreen Ratings

Periodically, Consumer Reports aggressively reviews and tests sunscreens for effectiveness. Last month they posted their 2019 ratings.

The report was divided into creams and lotions versus sprays.   To test each sunscreen, they applied it to human skin then soaked the skin in water to duplicate the effects of swimming and sweat. They then exposed the volunteers to sunlight.  To cover the skin adequately they used about a shot glass worth of sunscreen on bodies wearing a bathing suit. They said this approximated using one teaspoon per body part area such as one teaspoon for your face, one teaspoon for your head and neck, one teaspoon for each arm and leg etc.

Their top-rated lotion was La Roche-Posay Anthelios 60 Melt In Sunscreen giving it a rating of 100.  A tube costs $36.  The next highest rated was BullFrog Land Sort Quik Gel SPF 50.  It was given a rating of 95 and only costs $13 for a bottle.

Consumer Reports also rated spray sunscreens. To properly apply the spray they suggested holding the nozzle close to the skin and then spraying until the skin glistens. At that point they advise rubbing it in even if the product is advertised as a “no rub“ product.  Once this is done, they suggest repeating the process. They emphasize to never spray directly into the face or eyes. They suggest trying to refrain from inhaling the spray which is why spray sunscreen is not recommended for children.  Their favorite spray choice is Trader Joe’s Spray SPF 50+.  It gets a rating of 100 and sells for $6.  They describe it as having a beach aroma in a combination of floral and citrus scents.   Banana Boat SunComfort Clear UltraMIst Spray SPF 50+ received a score of 96 and is priced at $13.

This past year research has shown that several sunscreen ingredients including oxybenzone are absorbed and achieve blood serum levels at much higher numbers than anticipated.  Oxybenzone is now forbidden in sunscreens used in the state of Hawaii because small amounts of bleach which can kill their coral reefs. There are now sunscreens without Oxybenzone.  Walgreens Hydrating Lotion SPF 50 achieved a score of 74 and has none of the offending ingredient.  It sells for $3. Hawaiian Tropic Sheer Touch Ultra Radiance Lotion SPF 50 achieved a score of 70 and cost only $8.

Mineral or barrier sunscreens composed of titanium dioxide and zinc oxide are known to be safe in major studies.  Consumer Reports believes these products do not provide as much protection as the products containing oxybenzone and similar active absorbable chemical.  “Some provide adequate SPF protection but not enough UVA protection and vice versa.”  The mineral sunscreens that performed admirably in their tests include California Kids # Supersensitive Lotion SPF 30+ for $20 and BadgerActive Natural Mineral Cream SPF 30 for $16.

Lung Cancer Screening is Underutilized

Dr. Jinai Huo of the University of Florida (Go Gators!) presented data to Reuters Health that primary care physicians are under-utilizing the technology available to screen for lung cancer. This is a particularly sore topic to me because my associate and I always screened smokers and heavy past smokers for lung cancer with an annual chest x-ray until the United States Preventive Task Force issued guidelines that it didn’t save lives and was not cost effective.  They said, it cost $200,000 in normal x-rays to find one cancer early and it was deemed not worth it.

We actually sold our chest x-ray unit, let go our certified radiology technician and cancelled a contract with radiologists to read our films because insurers stopped paying for chest x-rays after the USPTF ruling.  Twenty years later that same group said “woops” an error was made. The statistical analysis on that study was done incorrectly and actually screening does save lives and is cost effective.

Today we have the fast low dose CT scanner to screen for lung cancer and screening does save lives according to the data.  Who should be screened?

Current smokers or those who have quit smoking within the last 15 years who are 55 to 77 years old and have a smoking history of 30 packs or more per year (one pack per day for 30 years or 2 packs a day for fifteen years).  Screening should be done on individuals in good health so if a lesion is found they are considered well enough to undergo diagnostic tests and treatment.

Screening is also recommended in those individuals over 50 years old with a twenty (20) pack year smoking history and a family history of lung cancer or lung disease or occupational exposure to items associated with causing cancer such as radon.

I inquire about smoking at each visit and have been fortunate in that few of our patients still smoke so we spend less time on counseling for smoking cessation.  If you fall into one of the screening groups mentioned in this article, and have not been screened, please notify us so we can arrange for the testing which will be a low dose chest CT scan.