Health Headlines - August 23

Severe Allergies Bring Back-to-School Dangers

As kids head back to school, experts are urging that parents of children with allergies inform teachers and other school staff about anaphylaxis -- a potentially life-threatening allergic reaction triggered by allergens.

"All school staff must be made aware of the potentially severe nature of anaphylactic reaction. Parents need to work together with teachers, coaches and school nurses to avoid triggers and act quickly if a reaction occurs," Dr. S. Allan Bock, chairman of the anaphylaxis committee at the American Academy of Allergy, Asthma and Immunology (AAAAI), said in a prepared statement.

Symptoms of anaphylaxis include nausea and vomiting, severe headache, hives, sneezing and coughing, itching all over the body, swelling of the lips, tongue and throat, and anxiety. The most dangerous symptoms -- trouble breathing, a drop in blood pressure, and shock -- can all be fatal.

Experts at the AAAAI and the Food Allergy & Anaphylaxis Network (FAAN) outline steps parents with allergic children can take before the start of the school year:

Work with an allergist/immunologist to identify your child's allergy triggers and make sure he or she understands these triggers. Consider a medical bracelet or necklace that identifies your child's specific allergies.

Check out your child's school or child-care facility and ask about policies regarding foods and other potential triggers that might be present in the classroom.

Provide school staff with information and resources about your child's allergy. Have your allergist/immunologist provide written instructions on how to recognize a reaction early and how to administer medications. Inform the staff to call 911 immediately if your child has a reaction.

Children with a history of anaphylaxis should carry epinephrine with them at all times.

Insurers Focusing on Children's Health

Once a potato chip addict, 14-year-old Kate Brown won't touch the stuff these days. After enrolling in a nutritional program for kids, Brown learned things about her favorite snacks that horrified her -- like how much fat is loaded into a bag of chips. Gone are the days when she'd come home from school and park in front of the computer. She's joined a soccer team and gets out as often as she can.

The makeover comes courtesy of KidPower, a free program offered by Capital District Physicians Health Plan, a health insurer covering upstate New York and Vermont. The program is built around a kid-friendly fitness workbook, food charts and workshops covering everything from rock climbing to how to pack a healthy lunch.

One class, aimed at children ages 5 to 8, teaches the basics of how to read a food label.

The KidPower program is part of a growing national trend steering kids away from greasy fast foods and toward the fruit bowl.

Insurers have long encouraged adults to get in shape by offering discounts and rebates for gym memberships and weight loss programs, but now the spotlight is shifting as statistics about childhood obesity set off alarm bells nationwide.

Obesity-related illnesses represented just 2 percent of spending by health insurers in 1987; that figure rose to 11.6 percent by 2002, according to a study published in the policy journal Health Affairs.

Some 15 percent of U.S. schoolchildren are estimated to be obese, and 30 percent are believed to be overweight.

That could end up costing insurers big: Overweight adolescents have a 70 percent chance of becoming overweight or obese adults.

Concerned about her own weight, Schenectady mother Gina LeBlanc took advantage of a Weight Watchers discount offered by her insurer a few years ago. She got a 50 percent reimbursement for a 10-week, $130 program, and ended up feeling better about herself.

But when it came to getting her kids in shape, she struggled with how to approach the sensitive topic without using ego-bruising words like "diet."

As they continued eating junk food and packing on the pounds, she worried about the health problems obesity had caused in her family.

KidPower gave her a way to talk about health with her children in a positive way, LeBlanc said.

She highlighted sections of the workbook that explained how different nutrients pass through the body, and the impact they had on overall health.

The healthy foods magnet -- which listed "red light" foods like ice cream and "green light" foods like leafy vegetables -- went up on the microwave. Swimming started becoming a daily activity.

Her 10-year-old daughter, teased for being chubby since kindergarten, was especially excited to embrace the new lifestyle. When deciding where to go for dinner these days, LeBlanc said it's the kids who suggest restaurants with healthy choices, complaining that the fast food joints are too greasy.

"Now my daughter brings string beans to school for a snack," LeBlanc said.

The LeBlancs are among the hundreds of children strapping on pedometers and plunging into KidPower.

A year after it was launched, 546 children are now enrolled in the program; 136 of them are between the ages of 5 and 8, and 355 are between 8 and 14 years old.

At America's Health Insurance Plans, an association of health insurers, 89 percent of members offer free nutritional counseling for members. The association does not track how many offer nutrition programs specifically for children, but the issue has become a focus for members with data emerging on childhood obesity, said Mohit Ghose, spokesman for AHIP.

In the past couple years, insurers have started fostering programs to curb childhood obesity, whether sponsoring fitness programs at schools or devising plans like KidPower, he said.

For Kate Brown, the plan is working.

The food chart magnet that helped keep her on track when she first started the program is gone from her refrigerator.

It's of no use to her these days; she's got it memorized.

New treatment works against SARS in monkeys

An experimental treatment approach called RNA interference reduced the severity of SARS infections in monkeys, U.S. researchers reported on Sunday.

A tiny Maryland-based biotech company less than a year old said monkeys infected with SARS either before or after treatment became less ill than untreated monkeys.

They believe their approach helps prevent the virus from infecting cells and perhaps also from spreading from cell to cell, they report in the September issue of the journal Nature Medicine.

Severe Acute Respiratory Syndrome, caused by a never-before-seen virus now named the SARS coronavirus, swept China's Guangdong province and then spread globally in 2003. It infected more than 8,000 people and killed around 800 by causing pneumonia and lung failure.

It was contained using quarantine and isolation. But experts fear another outbreak could come at any time and companies are working on vaccines to prevent it and drugs to treat it.

Intradigm, a small spinoff from Swiss drugs giant Novartis, set up business a year ago to develop experimental treatments using small interfering RNAs.

These are short stretches of RNA -- the genetic counterpart of DNA that actually functions in cells -- specifically designed to interfere with certain genes.

They developed two siRNAs, as they are called, to counteract two key genes in the SARS virus known as Spike and ORF1b23.

Working with colleagues in China, they tested their siRNAs in 20 monkeys infected with SARS. Macaque monkeys can be infected with the virus and develop fever and lung damage, but their disease is not as severe as it is in humans.

Patrick Lu of Intradigm and colleagues delivered the siRNA into the noses of half of the monkeys, some before infection with SARS and some afterwards. One group of monkeys was treated with an siRNA that had no activity against SARS.

Those treated developed lower temperatures than untreated or placebo-treated monkeys, although all became sick. "The prophylactic treatment group had the lowest temperature (38.7 C), close to the normal body temperature of Rhesus monkey (38.5 C)," the researchers wrote.

"All animals displayed a loss of appetite and some became agitated and aggressive."

Only 25 percent of the treated monkeys had detectable virus in their throats compared to all the untreated monkeys.

And when the monkeys were killed and their lungs examined, the treated monkeys had fewer infected lung cells, the researchers said.

They said their experiment showed the treatment was safe and could be tested in humans.

Joint Replacement: Less Is Sometimes More

Every year in the United States, more than 325,000 aching knees and more than 172,000 painful hips must be replaced as age, arthritis and injuries take their toll.

Advances in orthopedics, however, also mean there's less hospitalization and a quicker recovery time for joint-replacement patients because more surgeons are performing what are known as "minimally invasive" or "less invasive" procedures.

While the newer techniques won't work for everyone, they can be a godsend, especially for busy people who can't take a lot of time off from work to recover from surgery.

Today, joint-replacement surgery is classified as "conventional," "less invasive" or "minimally invasive," according to Dr. Jay Mabrey, chief of orthopedic surgery at Baylor University Medical Center at Dallas. The minimally invasive procedures involve the smallest surgical incisions; the conventional, the largest.

Minimally invasive surgeries are performed with specially designed, smaller surgical instruments, and the instruments can also be used for the less invasive surgeries.

Doctors typically insert two small tubes into the incision site. One tube contains a fiber optic camera and a light source; the other usually contains miniaturized surgical instruments. The surgeons watch a TV monitor to guide them during the operation.

Total hip replacement involves removing the head of the thighbone. The ball-and-socket mechanism of the hip is then replaced with the artificial implants. Knee replacement involves resurfacing the worn-out surfaces of the knee and replacing the cartilage with metal and plastic, Mabrey said.

"Most surgeons have gone to a smaller incision," Mabrey said, "and a smaller group of them have gone to minimally invasive techniques."

In traditional hip replacement surgery, for instance, the incision is about 12 to 14 inches in length, he said, and the operation involves a significant amount of blood loss. In less invasive techniques, the incision can be 4 to 8 inches, and in minimally invasive procedures, about 4 inches, he said.

It's not just the incision size that has changed in joint replacement surgery, Mabrey said. "Newer types of anesthesia techniques allow some patients to get out of the hospital within 24 to 36 hours [after surgery]," he said. Because the incision is smaller, the trauma to muscles and tissues is less, and thus recovery time is faster.

With minimally invasive surgeries, some patients go back to work in as little as 10 days to two weeks, said Dr. Mack Lancaster, an orthopedic surgeon at Baylor who does minimally invasive techniques in about 10 percent of his joint replacement patients. With less invasive techniques, the back-to-work timetable tends to be three to four weeks. With conventional surgery, it's six weeks or more, he said.

Both Lancaster and Mabrey, who does "less invasive" but not "minimally invasive" techniques, acknowledged that there are downsides to minimal incision surgery.

"There is a much smaller surgical field," Mabrey said. "So instead of being able to see everything, such as alignment of the implant, the actual surgery is not done under direct vision."

And a minimal incision operation, Mabrey said, "almost always increases the length of the surgery time."

Lancaster said he does not recommend minimal incision surgery unless it is crucial for the patient to get back to normal functioning, such as their job, quickly.

The best candidates for minimally invasive surgery, Lancaster said, are otherwise healthy people of average body weight. Overweight individuals are not good candidates for minimal incision surgery, Mabrey said, because "so much fat overlies the hip, it makes it difficult to see what you are doing."

Older patients who have more osteoporosis and are more likely to fracture are not good candidates for minimally invasive techniques either, Mabrey said.

If your surgeon says you are not a good candidate for minimal incision surgery, ask why, both doctors agreed. If you are a good candidate, ask your surgeon if he has trained in the technique.

Safety Tips When Taking Anticoagulants

Topic Overview

Anticoagulants, often called blood thinners, are medications that slow the clotting of blood. They do not actually thin the blood but increase the time it takes a blood clot to form. Anticoagulants help prevent existing blood clots from becoming larger and may be used to prevent deep vein blood clots or to treat certain blood vessel, heart, or lung conditions.

Safety tips for anticoagulants

Take the medication at the same time each day.

Check with your doctor before using nonprescription drugs, especially ones that contain aspirin.

Tell any new health professionals that you are taking medication that affects how your blood clots.

Be alert for signs of bleeding, and call the doctor immediately if any of the following symptoms occur:
Blood in urine or red or tarry stools
Bleeding from the nose or gums or spitting up blood
New, excessive, or prolonged vaginal bleeding
Frequent, severe bruising or tiny red or purple spots on the skin

Talk to your doctor about medications you are taking to find out how often you should have blood tests.

If you are taking ticlopidine, get frequent blood tests to check your white blood cell count during the first 3 months of treatment.

If you take warfarin (such as Coumadin):

Get regular blood tests to ensure that you are taking the right amount of medication.

Eat a balanced diet. Don't suddenly change your intake of vitamin K-rich foods, such as broccoli, brussels sprouts, cabbage, asparagus, lettuce, spinach, and some vegetable juices. It is most important to maintain a consistent level of vitamin K foods in your diet. Vitamin K can interfere with the action of warfarin, making it more likely that your blood will clot.

Avoid excessive use of alcohol. If you drink, do so only in moderation. Alcohol may increase the effect of of warfarin.

Don't use tobacco of any kind.

Avoid activities that have a high risk for injury, such as skiing, football, or other contact sports. If you are taking warfarin, an injury could result in excessive bleeding.

Wear a seat belt anytime you are traveling in a car.

Preventing minor bleeding while taking anticoagulants

You may find it helpful to use the following items to lower the risk of bleeding:

An electric razor
A soft-bristled toothbrush and waxed floss
Protective clothing, such as gloves and shoes
Nonslip mats in the tub and shower