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November 16, 2004

BehindTheMedspeak: Back pain - and the dirty little secret doctors would rather you not know

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The latest "breakthrough" in the treatment of back pain has just been unveiled: it's the Charité (memo to Johnson & Johnson: lose the accent mark - such fancy-pants product names don't go over real well with the American public) artificial spinal disc.

This implant is the first such product to be approved in the U.S.

Said Scott Hensley in the November 2 Wall Street Journal, "The ability to replace disks could open up a new era in back treatment."

Translation: it could mean your orthopedic surgeon or neurosurgeon can finally afford that Maybach he's been eying.

Continued Hensley, "With the approval of the Charité disk last week... many chronic back-pain sufferers who have been holding off on surgery are reconsidering."

Big mistake.

Because here's that dirty little secret I alluded to in the headline of this post: back pain has nothing to do with what shows up on x-rays, CT scans, or MRI's.

In other words: many people with terrible back pain have completely normal radiographic studies; many people with terrible studies have no back pain.

The New England Journal of Medicine published a landmark study years ago demonstrating the lack of correlation between pain and disk degeneration, along with an editorial pointing out the uselessness of surgery in most patients with chronic back pain.

Nevertheless, surgeons continue to run patients in and out of the OR for this tremendously complex and potentially dangerous surgery.

All you get for sure when you have back surgery is the likelihood of a repeat operation.

And then another, and another.

Here's the article.
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Artificial Spinal Disc May Open New Era In Treating Back Pain

But Worries Linger Regarding Implants' Long-Term Durability


There is a new solution for debilitating lower-back pain: replacing a spinal disc, just as worn-out hips and knees are swapped out for new ones.

Last week, the Food and Drug Administration approved the first artificial disc, an implant that surgeons can put in place of the spongy cushions between the bones of the lower spine, relieving pain and preserving flexibility.

The ability to replace discs could open up a new era in back treatment. When natural discs degenerate, they can cause excruciating pain in the back and legs.

The traditional treatment for recalcitrant back pain from degenerated discs is surgery that removes the damaged pad and fusion of the bones on either side of it.

That approach limits normal motion and flexibility, often transferring stress to other parts of the back, which can act up in later years.

With the U.S. approval of the Charité disc from Johnson & Johnson last week, after decades in development, many chronic back-pain sufferers who have been holding off on surgery are reconsidering.

Three more discs, with slightly different designs, are expected to become available in the next few years.

"It seems like it's time to have something done," says Mark Hall, a 38-year-old finance manager for Sprint in Kansas City.

Despite therapy and drugs, including frequent shots of cortisone into his spine, Mr. Hall says his back pain is so intense that it has kept him from sleeping and enjoying life.

A magnetic resonance imaging scan last year showed that a disc in the lumbar part of the spine appears to be the culprit.

After hearing about the Charité disc, Mr. Hall has been looking for a doctor qualified to take his case.

Many questions remain about the device, including concern about how long the implants will last.

"Just because you have back pain doesn't mean you should have disc replacement," says Geoffrey Blatt, a neurosurgeon with Midwest Neurosurgery Associates in Kansas City.

Disc disease, while painful, isn't fatal, he says, while disc replacement "is clearly dangerous surgery."

Nerve damage, infection and inadequate pain relief are possible.

For those who are considering whether to be the first on their block to get a new disc, there are some difficult questions to ponder.

First of all, the long-term durability of the Charité disc remains to be proven.

The same pressure that led the natural disc to fail could wear on the plastic in the replacement, though laboratory tests and the experience of patients in Europe who have had it implanted since the 1980s are reassuring to many doctors.

Also, the implantation is tricky and should be performed only by the "top echelon of spine surgeons," says Fred Geisler, a neurosurgeon at the Illinois Neuro-Spine Center, Rush-Copley Medical Center, Aurora, Illinois.

Dr. Geisler has implanted about 100 of the discs in a complex procedure that involves making an incision near the belly button and then moving the organs, blood vessels and nerves aside to reach the damaged disk.

He says it takes 20 to 30 cases for doctors to become comfortable with the procedure, which is far more difficult than a fusion.

"If you put this in crooked, it's like putting a knee in crooked," he says.

Just a few dozen surgeons in the U.S. are qualified to implant the Charité disc, though Johnson & Johnson has plans to train about 2,500 surgeons during the next year.

Many back specialists should be able to offer more information about the procedure.

At the moment, insurance coverage may be tough to come by, too.

The surgical procedure and the implant cost between $35,000 and $45,000.

Suzanne Roy, a project manager at Allmerica Financial in Worcester, Massachusetts, had the disc implanted during an extension of the clinical trial only after her human-resources department took up the battle for her.

The recuperation time from the disc implant is about half as long as that from spinal fusion, doctors say.

Many patients aren't candidates for the replacement.

Osteoporosis can weaken the spine, making a tight fit of the implant impossible.

Patients whose spinal joints are severely damaged also may be ineligible.

Also, the implant works only for people whose pain is caused by a single degenerated disc.

Besides MRI and CT scans, doctors poke the suspicious disc with a needle to see if it hurts.

Another poke with the needle in a good disc serves to make sure the pain isn't psychological.

For those who do qualify, the promise of lasting pain relief and the restoration of normal function is obvious.

About seven years ago, Kyle Spooner, a computer specialist in Weatherford, Texas, hurt his back lifting a concrete fountain. He tried physical therapy, acupuncture and massage treatments without finding relief.

"I was on a pretty steady diet of muscle relaxers and pain pills," says Mr. Spooner, 35 years old.

After three years of chronic pain in his back and legs transformed him from an active golfer and outdoorsman to an antisocial shut-in, he concluded reluctantly he would need spinal fusion.

Mr. Spooner received the disc in a clinical test in early 2000.

The surgery was painful, he recalls, but the constant ache he had felt in his legs was gone.

He was on his feet later that day and back to work in three weeks.

"Within a month and a half, I was swinging a sand wedge," he says.

Other doctors are optimistic about the treatment's potential.

"Everything we've been able to do up to now is get the pressure off the nerve or reduce inflammation by injections or oral medications," says Gerard Varlotta, director of Sports Rehabilitation at New York University Medical Center's Rusk Institute of Rehabilitation Medicine/Hospital for Joint Disease.

"We now have the means for changing the natural history of the diseases."

November 16, 2004 at 05:01 PM | Permalink | Comments (4) | TrackBack

Degas at Work

Eng4168

He's the subject of the new exhibition at London's National Gallery, one in a series called "Art in the Making," exploring how artists create.

Up through January 30, 2005, the free exhibit offers a detailed, in-depth examination of 12 works by Degas, complemented by x-rays, infra-red reflectograms (don't ask), and pigment analyses.

The complexity of his working methods becomes apparent, as his consistently innovative explorations in oil, pastel, and printmaking are deconstructed.

William Packer of The Financial Times brought this show to my attention.

He wrote, "We see him with thick paint and with thin, the ground showing through beneath the blue of Mlle. Rouart's dress (1886), always pushing on, not just his own work but Art itself." [tel: 4420 7747 2885]

November 16, 2004 at 04:01 PM | Permalink | Comments (0) | TrackBack

elgooG

Intles_allimageslogo

What's this?

I have no idea, but it's sure weird.

It says, at the bottom left of the home page, "Google Mirror brought to you by www.alltooflat.com

November 16, 2004 at 03:01 PM | Permalink | Comments (0) | TrackBack

BehindTheMedspeak: Night Eating Syndrome

Ones

Nanci Hellmich wrote an interesting article for yesterday's USA Today about this disorder, difficult to diagnose amidst a plethora of related problems.

It's very problematic, differentiating a normal behavior from one that tips into pathology when it comes to food.

Zoloft seems to help in night eating disorder, as it seems to help almost anything with a behavioral component.

"Listening to Zoloft" could well turn out to be Peter Kramer's next book, what with the drug's increasingly ubiquitous use.

Here's the story.
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The Loneliness of the Nighttime Snacker


When Carlo Porreca's three children were babies, he frequently got up at night to check on them.

Years later, when they were teenagers, he was still getting up at night, but by then he was going down to the kitchen and eating.

At first he nibbled on a few crackers, but then he began gobbling cookies and milk and sandwiches.

For more than 20 years, he ate three or four times between midnight and 4 a.m.

"It took on a life of its own, and my body started waking me up for the food," says Porreca, now 62, a computer manager in Philadelphia. One night he even cooked himself a steak.

He put on 50 pounds before he was diagnosed with a disorder called night eating syndrome.

Like Porreca, people who have this condition consume a third or more of their daily calories after dinner, either before going to bed or during the night, says psychologist Kelly Allison of the Weight and Eating Disorders Program at the University of Pennsylvania School of Medicine in Philadelphia.

They aren't sleepwalking; they're aware of what they're doing.

"But there is a feeling of compulsion and anxiety associated with it."

She and her colleagues at the university are presenting new research on the syndrome today in Las Vegas at the annual meeting of the North American Association for the Study of Obesity, a conference being held in partnership with the American Diabetes Association.

They've found that the antidepressant Zoloft is effective in controlling night eating, and Allison also has explored treating it with behavior modification strategies.

Allison has written a new book, "Overcoming Night Eating Syndrome," with Sara Thier and Albert Stunkard.

Stunkard is the University of Pennsylvania psychiatrist who discovered the syndrome in the early 1950s.

Estimates vary on how many people have this problem, but research suggests that it affects 6% to 8% of people treated in obesity clinics and about 1.5% of the general population, Stunkard says.

People of normal weight sometimes are affected, too, and it may be a pathway to the development of obesity, he says.

Penn researchers have studied more than 100 patients with the condition and also have gathered data from more than 2,000 others who've visited their Web site at www.uphs.upenn.edu/weight.

Night eaters are different from those who get up occasionally to snack or who consume a lot of food several times a week before bed.

Stunkard says night eaters often eat sparingly early in the day.

"The disorder represents a shift of the biological rhythm of eating to later in the day," he says.

People with the syndrome may, for example, eat 700 to 800 of their 2,200 daily calories at night.

They may eat peanut butter right out of a jar or chocolate cake or leftovers from dinner, Allison says.

The emotional and physical impact is circular.

"The eating helps soothe people and makes them feel better for a short time, but it also increases their weight, which makes them feel worse," she says.

Some are frustrated.

"They feel like even though they are eating well during the day, they can't lose weight because they feel so compelled to eat during the night."

Allison worked with one woman who got up and ate more often at night after her third child was born with a serious brain abnormality.

The increasing weight left her feeling depressed and hopeless.

Another patient woke nearly every hour on the hour and tried to do other activities but usually ended up giving in and eating.

"Then I sleep like a baby," he reported.

The syndrome often seems to be triggered by a stressful or emotional event.

About 75% of people can link its start to a specific event like a divorce, pregnancy or loss of job, Allison says.

"About 50% of our sample have had a major depressive episode in their lifetime."

Porreca didn't have a history of depression.

He believes he had a sleeping disorder that became an eating disorder.

"Between the two of them, it took hold and I couldn't control it," he says. When Penn doctors studied his eating patterns, they found he ate 34% of his calories between midnight and 4 a.m.

Key behaviors observed in people with night eating syndrome:

• Overeating in the evening. They may feel hungry and eat to relax before bedtime.

• Difficulty falling asleep. They may toss and turn for half an hour or longer. They may need to eat something just before going to bed.

• Waking at night and eating at least three times a week. After falling asleep, they often wake up at least once and need to eat before being able to fall asleep again.

• Not feeling hungry in the morning. They don't have any appetite and will often go without food until lunchtime or later in the afternoon. They may wake up "feeling kind of gross, nauseated, like they're really full," Allison says.

For some people, the syndrome becomes part of their daily lives for years, she says.

"We see people who are 60 and have had it since they were 30," she says.

David Neubauer, an associate director of the Sleep Disorders Center at Johns Hopkins Medical School in Baltimore, says doctors at sleep clinics treat a range of sleep-related eating issues.

In the 1980s, researchers wrote about a problem called nocturnal sleep-related eating disorder.

People suffering with this go to sleep, then get up and may not be fully aware that they are eating.

Some know what they've done only after being observed or by noticing missing food, crumbs and empty wrappers, he says.

They are different from people who actually wake up and get a snack, but they may share some of the characteristics of people with the night eating syndrome, he says.

For some with the syndrome the delayed pattern in eating disrupts sleep, Allison says.

"This can impact people's ability to concentrate and feel rested the next day."

Experts are researching treatments, including recommending basic behavioral changes in eating and exercise habits.

In three different studies, University of Pennsylvania researchers are prescribing the antidepressant Zoloft to patients with the disorder.

"We do get good results, but of course it's not a magic bullet for everyone," Allison says.

"Other drug treatments may work; they just haven't been studied yet."

After enrolling in a university study, Porreca started taking Zoloft.

"Within two weeks, I was sleeping through the night."

He also lost 25 pounds and his cholesterol dropped.

Then he started walking and doing other physical activities, eating healthier and quit smoking.

"I can't believe how well I feel. I didn't realize how wonderful it is to sleep through the night. I feel peppier. I feel tremendous."
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How the pounds add up

Here's a sample food diary of someone with night eating syndrome.

Note that just over 30% of the day's calories are consumed after dinner.

Food and beverage consumed; Quantity; Calories

• 10 a.m. - (Breakfast); Average; 176

• 1 p.m. - (Lunch); Average; 808

• 6 p.m. - Pepperoni pizza; 3 slices; 930; Iced tea, sweetened; 12 oz.; 150

• 8 p.m. - Vanilla ice cream; 1 cup; 300

• 11 p.m. - Chocolate chip cookies; 3;180

1 a.m. - Potato chips; 1 oz.; 150

3 a.m - Peanut butter; 3 tbs.; 315

Total calories: 3,009
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Eight ways to break the cycle

Keep a journal of thoughts and emotions.

Keep a detailed food journal, recording each meal and snack immediately after eating it and the time it was eaten.

Try to shift some caloric intake to earlier in the day.

Exercise at least three times a week. It helps physically and physiologically by activating certain chemicals in the body.

Consult a mental health professional or physician if suffering from depression, anxiety, obsessions or compulsions.

Examine sleep habits and possibly cut back on caffeine, alcohol or smoking, especially in the afternoon and evening.

Keep only healthful foods in the house to limit cravings for high-calorie foods.

If you eat food to help you fall back to sleep, reduce the amount.

November 16, 2004 at 02:01 PM | Permalink | Comments (0) | TrackBack

ItinerantGastronomy.com

Logo1

"Living well is its own reward" are the first six words of the catchphrase of this New York City company.

I prefer the rest of the sentence: "Any relationship with a person or a root vegetable should have time to develop properly."

Donna Wingate and Mary Ellen Carroll are responsible for both this phrase and the company,

But what, asketh thou, is this company, and what does it do?

It's a road show that prepares gourmet meals anywhere you like.

Using portable hot plates, they've prepared crab cakes with aioli for a gathering of city planners atop the abandoned elevated railroad tracks in the meatpacking district.

They've made osso buco for villagers in Italy.

Recently, they served a six-course meal to engineers perched on the Goethals Bridge.

Give 'em a holler, and hey - don't forget to invite me... I mean, who brung ya?

November 16, 2004 at 01:01 PM | Permalink | Comments (0) | TrackBack

Isophone

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"It's a cross between a flotation tank and a telephone," said James Auger, who together with Jimmy Loizeau invented the device.

More from the BBC story:
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The helmet is basically the telephone.

It fit's over the user's head and is then attached to three floats that can be adjusted to provide the perfect floating position.

It's a project of Media Lab Europe, a Dublin-based outpost of MIT's famed Media Lab.

Auger said, "Whilst it's not necessarily very efficient, in many ways it's very pragmatic, in that the user will be totally focused on who they're talking to."

He added, "It cuts out all other sensory inputs for the wearer."

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"You can't hear anything else, you can't see anything else, you can't smell anything else, all you have coming in is the telephone call."

"You can't feel anything because you're basically floating around in water that's heated to body temperature, which removes the distraction of gravity, and allows the user's body to blur into the environment."

"In a way it's a luxury item that allows for a really in-depth conversation."

"So you can imagine your businessman who's abroad in Japan might be able to make a telephone call from the swimming pool to a loved one, or indeed to someone else involved in business, and have a really in-depth telephone call."

But there are some obvious practical problems. If you are making a business call, you will probably want to refer to your notes.

This is not an easy task if you are wearing a darkened helmet in a swimming pool.

And whenever you want to make a call, you will need to have your Isophone with you, plus a heated swimming pool.
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I like it, especially the reference to the really "in-depth" telephone call.

Do not let William Hurt use this phone,

630513313101lzzzzzzz

no matter how much he insists his car broke down and he just wants to call a tow truck.

[via the BBC]

November 16, 2004 at 11:01 AM | Permalink | Comments (0) | TrackBack

Studio Monitor Action Figures

Sn3btc1

Are these the world's

Sonikmatterdotcom

coolest speakers, or what?

Designed by Jason Siu

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and available at KidRobot,

Sn3b1

Soundspeakers are a series of action figures standing between 12 and 18 inches high, featuring real working speakers.

Sn3b2

[via sonikmatter.com]

November 16, 2004 at 10:01 AM | Permalink | Comments (0) | TrackBack

Paint your iBook

0265162283883585

PaintedBytes.com will do it for you.

A tattoo shop for computers.

$139 and up, depending on what you want.

Waycool.

Suddenly, ColorWare's monochrome choices seem just plain dowdy.

[via engadget]

November 16, 2004 at 09:01 AM | Permalink | Comments (2) | TrackBack

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