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Avoiding the painkiller-overuse rut in migraines

December 23, 2008 on 1:21 pm | In Uncategorized | Comments Off WASHINGTON (AP) -- Those pain pills you think help your migraines? Take too many and you could make them worse. Overusing painkillers can spin migraine patients into a rut, spurring more headaches that in turn require more pain medication. A very unlucky fraction even get what's called chronic migraine, where they're in pain more days than not, and new research suggests certain prescription painkillers, including narcotics, increase that risk.

Don't misunderstand: Treating migraines, properly, is important. The bigger message is to try migraine-preventing medicines if the tenacious headaches strike regularly - so that you don't fall into the painkiller rut like Rena Cerbone did.

"It was a double-edged sword," Cerbone, 41, of Montclair, N.J., says of a period when only one pain reliever dulled her migraines and then invariably triggered rebound headaches a day or so later. "I was taking Fiorinal on a daily basis just to function."

The caution is timely, as the estimated 30 million Americans who suffer migraines - migraineurs, they're called - often find the holiday season a time of increased pain. Lack of sleep, tempting treats and the stress of travel are common triggers.

The head throbs, usually on one side, anywhere from a few hours to three days. Nausea and sensitivity to light and sound are common. Moving makes it worse. Some people can sense them coming with visual disturbances like seeing pinpoints of light, although lacking that classic "aura" doesn't mean you don't have a migraine.

Fortunately for most patients, migraines are every-so-often miseries. Studies suggest that about a third of migraine sufferers have them often enough to be candidates for prevention medications that can cut the frequency in half. Yet only about 10 percent use them.

And depending on acute painkillers more than a few days a week can signal overuse.

"Most people outside the specialty community are not aware of the concept," said Dr. Stephen Silberstein of Thomas Jefferson University, a spokesman for the American Academy of Neurology. "I think there's an epidemic in the U.S. of patients having frequent headaches, taking their pain pills over and over again," and winding up in more pain.

Overusing any pain medication, over-the-counter or prescription, can cause a rebound headache once it's stopped.

But occasionally in frequent migraine sufferers, the brain gradually becomes more sensitive to pain so they worsen even more. When they're having pain a stunning 15 or more days a month, it's called chronic migraine or "transformed migraine." No one knows exactly how many people get that bad, although migraine specialist Dr. Richard Lipton of the Albert Einstein College of Medicine says some estimates suggest there could be as many as 5 million.

"Chronic migraine is a condition we should be trying to prevent," says Lipton, who also heads New York's Montefiore Headache Center and studied whether particular medicines are linked to this worst-case pain.

The study tracked 8,200 episodic migraine sufferers for a year, and found 2.5 percent worsened to a state of chronic migraine. Those who took two classes of prescription medications - drugs containing narcotics, such as Percocet, or drugs containing barbiturates, such as Fiorinal - were most likely to worsen, Lipton and colleagues reported in the journal Headache. Risk increased with higher doses.

Over-the-counter standbys, from plain acetaminophen to the anti-inflammatories called NSAIDS - ibuprofen, naproxen and their cousins - weren't linked to chronic migraine. The NSAIDS even showed a hint of protection. Migraine-specific painkillers called triptans likewise showed no risk at low to moderate use, becoming a risk factor only after 10 pain days a month.

Some patients will need the stronger narcotics or barbiturates, especially for severe attacks, Lipton acknowledges. But, "the reality is they're overused" in migraines, he says, advising that patients who truly need them limit weekly doses.

Chronic migraine aside, getting out of the medication-overuse rut is hard. In New Jersey, it took Cerbone several tries before she found a migraine specialist who cut her prescription painkiller cold turkey and found a daily prevention medication that has worked since August.

Headache specialists advise:

-Ask about migraine-prevention drugs. Choices range from blood pressure-lowering drugs called beta-blockers to epilepsy drugs and certain antidepressants, all of which have side effects to be considered. Some patients even try Botox injections, to quiet overactive nerve endings.

-Quit the overused medication, but brace for painful withdrawal. A doctor may advise different short-term medications to help.

-Use a headache diary to pinpoint migraine triggers and learn to minimize them.

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EDITOR's NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

© 2008 The Associated Press.

Sex no longer a taboo subject at nursing homes

December 23, 2008 on 1:21 pm | In Uncategorized | Comments Off KANSAS CITY, Mo. (AP) -- When Kansas State University sent researchers into nursing homes to find out how the topic of sex was being addressed, they initially found silence.

"Nobody was talking about it; it was a really hush-hush subject," said Gayle Doll, director of the university's Center on Aging. "I guess it's hard enough for people to think about their parents having sex, let alone their grandparents."

In response, the researchers have produced seminars and training aids to encourage nursing home caregivers to discuss and accommodate sexual desires.

The effort brings Kansas into a national discussion that advocates say will only grow as baby boomers age and take their beliefs about sexual freedom and civil rights into the nation's nursing homes.

One of the first Kansas seminars was held at Schowalter Villa in Hesston, where many staff first reacted with, "We're going to talk about WHAT?" said Lillian Claassen, vice president of health services at the villa.

Claassen said residents' sexuality had always been a difficult subject for nursing homes and the Kansas State training affirmed her earlier efforts to address the topic.

"It wasn't like we hadn't cared for these needs in the past, but it was liberating to some folks to have an open discussion with university researchers," Claassen said. "It empowered people to think about how they could help folks."

Doll said the training focuses on explaining what sexuality means for older adults, identifying barriers to fulfilling the sexual needs, finding strategies to help residents and how to discern appropriate from inappropriate sexual behaviors.

Solutions can be as simple as providing "do not disturb" signs or making sure staffers don't barge into residents' rooms without knocking. Claassen said her nursing home provides a discreet room for residents and has staff work through possible scenarios they may encounter.

Sometimes, it's as simple as arranging a bed for someone who needs physical therapy in a way that also allows that patient to be with his or her companion, she said.

"My greatest interest is to promote dignity in a situation that can be very challenging," Claassen said. "We all need touch, kindness and companionship. We try to enable that in this setting, which can be very public but where there is still a need for privacy."

Sexuality doesn't always mean intercourse. Many lonely or depressed residents are simply looking for ways to relieve loneliness and depression, Doll said.

For example, she told of one resident who had asked for pornography but dropped the request when the staff started spending more time with him.

"The staff can help with the loneliness and need for connection that residents often have," Doll said. "Some sexual expressions that might be seen as inappropriate will go away when they simply get the attention they deserve."

When the need does include sexual activity, the issue becomes more difficult if one of the residents is suffering from dementia, advocates say. That can manifest itself in a resident making passes at a staff member.

Claassen said her staff is trained to respond politely and to understand that the impaired resident may be mistaking the staff member for a spouse or reacting as he or she has in the past, which is often more vivid than the present for those suffering from dementia.

If a resident with dementia becomes involved with another resident, the issue becomes determining if the sexual activity is consensual, said Robin Dessel, a national expert on dementia who is the director of memory care at Hebrew Home in Riverdale, N.Y.

Dessel said people with dementia, even those who can no longer speak, have wants and desires and the ability to express them. It takes a trained and educated staff to recognize if a sexual overture or relationship involves abuse or is borne of real need, she said.

Dessel said she has seen a growing awareness that the aging do not forfeit their rights as they become infirm, and that includes the right to express sexuality. She expects that trend to increase as baby boomers, with more liberal attitudes toward sex than their parents, continue to age.

"No matter what we see, even if someone needs total care or is incontinent, they still feel," Dessel said. "If there's a bonding with someone else, I think it's a time of celebration at that point that there's something left, something good and pleasurable for that person."

To meet that challenge, clinicians and providers need some standardized parameters to use to assess patients' consent, Dessel said.

The Kansas State researchers say federal guidelines should be developed to help nursing homes deal with sexuality in a positive way.

"Nursing homes are the second most regulated industry in the country, behind nuclear power plants," Doll said. "But none of those regulations address sexuality. So, consequently, no one knows how to handle it."

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On the Net:

http://www.humec.k-state.edu/aging

© 2008 The Associated Press.

FDA warns against some diet pills sold on the Web

December 23, 2008 on 1:21 pm | In Uncategorized | Comments Off WASHINGTON (AP) -- If you're looking for a little help shedding extra pounds after the holidays, the government is warning you to stay away from nearly 30 weight-loss products that contain unlisted and possibly dangerous ingredients.

The pills are advertised as "natural" fat busters and have intriguing names like Imelda Perfect Slim and Zhen de Shou. Some are touted as new versions of "ancient remedies" from Asia.

They may promise an easy fix to weight problems, but the Food and Drug Administration on Monday said the concoctions contain unlisted ingredients, including high doses of a powerful anti-obesity drug, as well as a suspected carcinogen.

"When consumers are buying these products online, we're telling them that if it sounds too good to be true, it is likely to be too good to be true," said Michael Levy, an FDA lawyer who works on enforcement issues.

FDA lab testing found 28 dietary supplements that could land unsuspecting users in the emergency room. Most of the diet pills appear to be coming from China. They are mainly sold on the Internet.

Nearly all of the pills contain sibutramine, a powerful appetite suppressant that's a chemical cousin of amphetamines. It can cause heart attacks, strokes and heart palpitations, especially in people with a history of high blood pressure or heart problems.

Sibutramine is also the chemical ingredient in the prescription drug Meridia, which is used to treat obesity. But FDA testing found that some of the diet pills contain nearly three times the recommended daily dose.

Several of the pills contain phenolphthalein, a chemical long used as a laxative, but which is now being withdrawn from the market because of cancer risks.

None of the supplements lists the dangerous ingredients on the label. "Consumers have no way of knowing that these products contain powerful drugs that can cause serious health consequences," said Dr. Janet Woodcock, head of the FDA's drug evaluation center.

The FDA is considering criminal charges against some of the companies, because they have not responded to requests for recalls.

The products are:

Fatloss Slimming, 2 Day Diet, 3x Slimming Power, 5x Imelda Perfect Slimming, 3 Day Diet Japan Lingzhi, 24 Hours Diet, 7 Diet Day/Night Formula, 7 Day Herbal Slim, 8 Factor Diet, 999 Fitness Essence, Extrim Plus and GMP.

Also:

Imelda Perfect Slim, Lida DaiDaihua, Miaozi Slim Capsules, Perfect Slim, Perfect Slim 5x, Phyto Shape, ProSlim Plus, Royal Slimming Formula, Slim 3 in 1, Slim Express 360, Slimtech, Somotrin, Superslim, TripleSlim, Zhen de Shou, Venom Hyperdrive 3.0

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On the Net:

FDA warning: http://tinyurl.com/8oufor

© 2008 The Associated Press.

Medicaid applicants grow as recession widens

December 21, 2008 on 1:19 pm | In Uncategorized | Comments Off WASHINGTON (AP) -- That day in July was one that Tammy Morse won't soon forget. Five months earlier, her husband lost his job as a recruiter for the financial services industry. Once the family savings were gone, the mother of two from Stratford, Conn., saw no way to get health insurance coverage for her family other than to apply for Medicaid.

"It was humbling," she said of her visit to the state's Department of Social Services office. "For lack of a better way to put it, that was for other people. It wasn't for me."

Around the country, similar stories are playing out for thousands of families.

Since the recession began a year ago, many states have seen increases in the Medicaid rolls just as tax revenues are falling below projections. Governors have lobbied President-elect Barack Obama and Congress to help them weather the downturn by increasing the federal government's share of Medicaid spending for at least two years.

The governors said the extra $40 billion would ease the service cuts or tax increases that legislatures need to balance state budgets.

The unemployment rate has jumped from about 4.7 percent last December, when the recession began, to 6.7 percent today. Economists estimated in a Kaiser Family Foundation report that each 1 percent gain in the unemployment rate adds 1 million people to the Medicaid and State Children's Health Insurance Program.

In Connecticut, a state faring better than many, enrollment in the Medicaid program has climbed from about 312,000 last December to about 329,500 in November - a 6 percent increase. Many who lost their jobs were eligible to continue group health insurance. But that is not an option in most cases because they no longer have an employer picking up a large share of their premiums.

Medicaid insures nearly one in six low-income people in the U.S. The program typically covers the very poor and about half of enrollees are children. Spending came to $333 billion in the budget year ending Sept. 30, 2007. Washington picks up about 57 percent of that; the states cover the remainder.

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On the Net:

Kaiser Family Foundation: http://www.kff.org

Centers for Medicare and Medicaid Services: http://www.cms.hhs.gov

Families USA: http://www.familiesusa.org

© 2008 The Associated Press.

Got the flu? CDC says Tamiflu may not be much help

December 20, 2008 on 1:18 pm | In Uncategorized | Comments Off ATLANTA (AP) -- The medical arsenal against the flu just got weaker. Government health officials said Friday that a leading flu medicine, Tamiflu, might not work against all cases of the flu this year. The most common flu bug right now is overwhelmingly resistant to Tamiflu, they said. The alert is "an early heads-up" for doctors. If current trends continue, they may need to change how they treat patients this flu season, said Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention.

Health officials say they aren't too worried, for several reasons. First, it's early in the flu season, and it's not clear this strain will dominate through the next several months. Second, not many people take antiviral medications for the flu.

Third, the flu vaccine - the primary weapon against flu - seems well matched against the circulating bugs.

But doctors need to take it seriously, said William Schaffner, a Vanderbilt University infectious diseases expert.

"Each influenza seasons provides a bit of a surprise and we got our (surprise) a little early this year," he added.

The flu causes 200,000 hospitalizations and 36,000 deaths annually, according to official estimates. The elderly, young children and people with chronic illnesses are considered at greatest risk.

For the public, the best course of action is vaccination, health officials said. Only about 30 percent of U.S. adults had gotten a flu vaccination this flu season, according to an online survey conducted by the RAND Corporation in November. A flu shot is recommended for those 50 and older, children from 6 months to 18 years, pregnant women, nursing home patients and those with certain medical conditions or who care for people with those conditions.

For people who get the flu, the two most commonly used antivirals are Tamiflu, a pill also known as oseltamivir, and Relenza, an inhaled drug also called zanamivir. The drugs are most effective if taken within two days of getting sick but most people don't see a doctor that quickly.

Early tests indicate that 49 of 50 samples of the main flu virus circulating this year - H1N1 - were resistant to Tamiflu. The samples came mainly from Hawaii, Texas and ten other states. Widespread flu has not yet been reported in most of the country.

"It could fizzle out," or H1N1 could become the dominant strain, Gerberding said.

A spokesman for Tamiflu's manufacturer - Roche, a Swiss company - said it's too early to draw strong conclusions about the drug's usefulness this flu season. The basis of the CDC's alert "is a small sample in a limited number of states, and Tamiflu is showing good activity against other circulating viruses," said spokesman Terry Hurley.

For those sick with the flu, doctors cannot simply choose Relenza instead of Tamiflu. That treatment is not approved for children younger than 7 or people who have asthma or certain other breathing problems. GlaxoSmithKline PLC, which makes Relenza, said Friday it has enough to meet the demands of the current flu season.

An option for some patients, Gerberding said, may be a combination of Tamiflu and rimantadine, another antiviral medication that works against H1N1 but lost effectiveness against another kind of flu virus.

However, it's not clear how well that combination will work, Schaffner said.

"This is a 'best advice with our back against the wall' kind of thing," he said.

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On the Net:

The CDC flu report: http://www.cdc.gov/flu/weekly/

© 2008 The Associated Press.