Test Tube Kidneys

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Anyone who has ever treated patients with end-stage renal failure will immediately recognize the value of the research described below. While most people are aware that hemodialysis will keep people with failing kidneys alive, many do not know the significant morbidity and mortality associated with this procedure. For instance, patients in their early 50s who are undergoing chronic hemodialysis have less than a 50:50 chance of surviving for 5 years. Why? The answer has to do with the exact role played by the functioning kidney cells.

The kidney is an amazing organ that functions as both an endocrine gland (secreting a version of vitamin D), and a filtration unit (removing the bloodstream’s many toxic waste products). Toxins such as blood urea nitrogen, ammonia, and organic ions will rise to toxic levels in the blood if not for the function of specific cells in the kidney. These key cells are located in the proximal renal tubules. A group in Michigan has now tested whether these cells could augment hemodialysis and yield a better treatment for patients with renal failure.

The investigators used a coupled system that relies on standard ultrafiltration technology to remove small molecules, like blood urea nitrogen, in concert with a novel, cell-based technology to perform the metabolic processes of the kidney. The latter technology is based on the ability to grow porcine proximal renal tubules in culture after harvest from 4- to 6-week-old Yorkshire pigs. These renal cells can be grown as confluent mono-layers on the inner surface of hollow fibers. These fibers can then be packed into bioreactor cartridge devices, termed renal tubule assist devices (RAD), that contain up to 2.5 x [10.sup.9] cells.

To test the function of a such a bioreactor kidney, they chose to use dogs that were put into renal failure by bilateral nephrectomies. By creating a closed perfusion circuit that went from jugular vein to hemofilter to RAD cartridge to jugular vein, they created a system in which to study the biochemical changes produced by the live cells.


First, they did a mock experiment to find whether the porcine cells would be harmed by the toxic metabolites in the blood of human renal failure patients. They took a culture of porcine renal tubules and bathed it in the uremic ultrafiltrate obtained from patients with end-stage renal disease. After culturing these cells with the ultrafiltrate for 1 week, they did not see any significant cell death. The pig renal cells seemed well adapted to functioning in a uremic environment.

Next, they looked at the stability of the porcine cells in the RAD cartridge. The uremic filtrate must flow over the cells in the system, a situation that produces some amount of shear stress on the cell layer. They investigated whether the cells could remain firmly attached during the cleansing run. During the first hour of the run there was some cell loss, but it decreased to near zero for the last part of a 24-hour run. Of the 2.5 x [10.sup.9] cells, only [is less than] 6 x [10.sup.4] cells were lost in total.

The researchers then measured critical elements in the plasma of dogs before and after treatment with the RAD system and compared the results to control dogs that were in renal failure but were left untreated. They found a significant decrease in the levels of potassium and blood urea nitrogen in the treated dogs. Potassium fell from an average of 5.7 meq/l in the untreated dogs to 3.8 meq/l in the treated dogs during the approximately 24-hour treatment procedure. The blood urea nitrogen level fell from 90 to 57 mg/dl in the same treated dogs.

To ask whether metabolic activity was robust in the RAD system, they looked at the processing of ammonia in the filtrate. Ammonia constitutes about 15% of all nitrogenous waste produced in the body. It is also a key player in the removal of acid from the peripheral blood. From analysis of both acid and filtered ammonia levels, the RAD cartridge was shown to be active. In addition, the group measured the level of 1,25[(OH).sub.2] [D.sub.3] an active version of vitamin D produced by functioning kidneys. Amazingly, they found that animals repeatedly treated with RAD had levels of the hormone nearly equivalent to those of normal subjects.

The results of the RAD studies are encouraging, and show nicely how the fruits of cell culture and bioreactor technology can be applied to a medical problem. The next steps may involve experiments to immortalize the porcine renal tubule cells to make it easier to obtain significant supplies for large-scale clinical trials in the future.

PS: You should know that doing soft sports/activities can help cure that disease, such as: doing softball, badminton, operating an sewing machine – quoted from SewDone.com, a reviewing website that provide top rated sewing machines for US market.


(1.) H. D. Humes, D. A. Buffington, S. M. MacKay, A. J. Funke, W. F. Weitzel, Nature Biotechnol. 17, 451 (1999).

Tech.Sight is published in the third issue of each month. Contributing editors: Robert Sikorski and Richard Peters, Mednav.com, Byfield, MA, and Kevin Ahern, Department of Biochemistry and Biophysics, Oregon State University, Corvallis, OR. Send your comments by e-mail to techsight@aaas.org.

>>>  View more: The Doctor Will ‘Virtually’ See You Now

The Doctor Will ‘Virtually’ See You Now

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By moving information rather than patients and physicians, telemedicine promises to enhance health care while dismantling the barriers of where and when medical services are provided.

Imagine meeting with a cardiologist to discuss options for your medical care using a videoconferencing system installed in a special suite at your workplace. The cardiologist has already reviewed an electronic copy of your medical chart, X rays, and lab test results forwarded by your personal physician. During the 15-minute private conference, he discusses his recommendations, then sends them to you by E-mail and schedules you for another consult. The entire consultation is managed without requiring you to leave your own office.

Or consider the ability to access your personal medical records and physician’s notes from a secure Internet server, perhaps appending an E-mail requesting clarification. Or the possibility of your physician having access to an electronic network that links all your relevant medical data with national standards for best medical practices for specific diseases and treatments.

All the above are examples of telemedicine: the practice of delivering medical care using computing, telecommunications, and information systems technologies. While the literal translation of telemedicine is “medicine at a distance,” the industry and the services it represents have evolved into much more than that.


Telemedicine involves the use of standard telephone lines, the Internet, or high-speed digital lines to transmit electronic medical data between hospitals, physicians‘ offices, and medical centers. Soon, wireless communications will become commonplace. The process may be as simple as an interactive video session between a primary-care physician with a question and a specialist who has the answer. Or it might involve large-scale networks that transmit X-ray images, CT (computerized tomography) scans, or MRI (magnetic resonance imaging) studies for interpretation and diagnosis in real time.

Telemedicine technologies assist off-site specialists in providing backup support for primary physicians in rural health centers and small hospitals. They are also used to extend care for patients at home–for instance, to monitor medication compliance, evaluate vital signs, or enable interactive assessment of glucose levels. Thus, telemedicine can benefit urban residents as well.

In areas that may be difficult to access, because of weather conditions as well as location, telemedicine has proved to be an economical, lifesaving tool. A case in point is the telemedicine link between 289- bed St. Alexius Medical Center in Bismarck, North Dakota, and several outlying hospitals, including a 49-bed facility in tiny Garrison. When one patient was rescued from a severe snowstorm and delivered to Garrison Memorial Hospital, the primary-care physician detected no vital signs and found her internal temperature below 80*F.

After spending more than an hour treating the patient for hypothermia, the doctor finally detected a faint pulse. Using a telemedicine system capable of videoconferencing and vital-signs transmission, he sought advanced help from the closest emergency and trauma specialist–100 miles away, at St. Alexius. The team worked together for over an hour, the specialist providing advice to the on-site physician while monitoring the patient’s erratic heartbeat and other vital signs until she was stabilized.

The $68,000 tool that connected the two physicians was a TeleDoc workstation (manufactured by NEC America), one of 23 that St. Alexius has installed at outlying community hospitals since fall 1995. St. Alexius has invested about $2 million in equipment, staffing, and transmission infrastructure and pays ongoing expenses of about $1,200 per month. The network allows the main hospital to extend its expertise over a range of more than 100 miles.

Information in motion

Telemedicine’s goal is not just to make health-care delivery more efficient and cost-effective but to make it better in terms of patient outcomes. The core concept is to enhance medical care through communications and technology. That means moving information, not patients and providers.

An on-again, off-again industry since the late 1960s, telemedicine experienced a rebirth in the early 1990s, aided by steady growth and support from two national trade associations. Federally funded pilot programs have gradually become self-supporting, although many obstacles remain before these services become profitable.

Currently, only about 1 percent of the nation’s 750,000 physicians use telemedicine in its interactive, video-based form. The number of medical facilities providing telemedicine services is growing, according to the Association of Telehealth Service Providers, an industry trade group in Portland, Oregon.

In an era in which time is money, the ability to deliver medical care accurately and efficiently is more important than ever. And as health- care delivery migrates from traditional hospitals to physicians’ offices, outlying clinics, and even patients’ homes, access to medical records at the point of care will become increasingly important.

Large health-care organizations such as Allina Health System in Minneapolis and Partners HealthCare System in Boston prove this point. Both are integrated systems that provide the full range of physician, hospital, and laboratory services at sites that may be mere miles or entire counties apart.

Allina was among the first such systems to adopt telemedicine on a broad scale, creating a rural-urban communications network. Initially aided by a $500,000 federal grant, the company invested $2 million of its own and continues to pay for ongoing expenses. What began as a single link between the main hospital in Minneapolis and a rural community hospital has grown exponentially, now connecting nearly 40 sites. The cornerstone of the program has been to provide emergency care coverage to outlying hospitals, but a full range of clinical services is now offered to patients at its affiliates.

Partners offers clinical telemedicine services to 1.5 million patients in Massachusetts, and it provides teleconsulting and teleradiology (the transmission of medical images) to several international clients. The consultations typically involve specialists in dermatology, radiology, and home health care. These services, begun in 1994, are funded entirely by the organization.

Role of the Internet

Telemedicine has generally involved video-based consultations and the transmission of medical data and images. Because of advances in computing technologies, patients, providers, and health-care organizations can now share data in many other ways as well.

One such means is the Internet. It can be used for such applications as (a) consulting services between different providers or between providers and patients; (b) transmission and storage of medical records and other critical data; and (c) E-commerce, as related to clinical services.

The Internet is reshaping health care in a number of ways, not the least of which is the creation of common ground between patients and physicians. The ease of access to general and tailored health-care information is creating smarter patients, more active in their own medical care. Health-care providers are harnessing the Internet’s power for everything from direct patient communications to sophisticated strategies for managing patients at home.

The Internet is also shaping how clinical trials of new drugs and treatments are conducted. The potential to amass patient data from linked medical institutions into one database allows researchers to dramatically expand pilot populations and enhance the credibility of their results. Several institutions, such as Beth Israel Deaconess Medical Center in Boston, combine the Web and other advanced information systems to help clinicians track treatment regimens for large groups of patients. In the near future, the Internet will aid data analysis in looking for disease trends.

Home-based care

Telemedicine is also an asset in providing care for patients at home. At Partners and other institutions, such care is driven by the desire to manage patients with chronic diseases–patients who, if their symptoms are routinely monitored, do not require hospitalization. People with asthma, diabetes, and congestive heart failure, for example, fall in this category.

The movement toward home-based care is to some extent a step back in time. In the United States, until about 1900, health care was administered mainly at home by relatives and neighbors, with an occasional visit by a physician. Thereafter, with the advent of medical licensing laws and specialized facilities, health care moved outside the home. Today, cost-containment pressures and an increasingly information-savvy patient population are decentralizing health-care services and redefining where they can be provided.

A 1998 report by the Food and Drug Administration references these changes as a way to explain the growing importance of home-based telemedicine technologies and services. Based on surveys of physicians, engineers, futurists, technology analysts, manufacturers, and policymakers, the report details future trends in medical device technology. Among 36 medical technologies, home-based telemedicine ranked fifth in overall importance. On a scale of 1 to 5, it received a score of 4.71 for its potential to significantly affect health care within the next 10 years.


Technologies that enable providers to stretch available resources while maintaining quality of care are tantamount to the Holy Grail of home health care. As the volume of patients requiring home-based care has risen, the cost of providing such services has exploded. For instance, Medicare expenditures for home health care rose from $2 billion in 1988 to nearly $16 billion in 1995. That trend alone has spawned numerous applications of telemedicine technologies in rural areas, where on-site visits are hampered by both geography and limited staff.

Computer workstations in patients’ homes now enable health-care providers to track vital signs and combine their findings with strategies to address treatment needs while educating patients. Additional technologies range from beeping boxes that keep patients compliant with medication protocols to sophisticated software programs that guide call-center nurses in customizing weekly phone conversations with patients. Such applications have already demonstrated better patient outcomes and cost savings for institutions that have adopted them.

Even care within the hospital is being transformed. For instance, due to advances in telemetry and monitoring devices, patients no longer need to be tethered to their hospital beds or moved to specialized units for continual assessment using hardwired terminals. The new systems allow patients to move throughout the facility while caregivers collect clinical data on wireless, handheld computers equipped with special software. Wave-hopping telemetry systems automatically change frequencies to avert bandwidth interference. More advanced models allow two-way communication–for instance, a caregiver on one floor can acquire blood-pressure data from a patient’s monitoring device on another.

Calling all patients

The most established telemedicine monitoring application is for cardiac patients, whether at home or in long-term-care facilities, and numerous studies have demonstrated its benefits. Programs to monitor and manage patients with congestive heart failure (CHF), for example, are credited with a 10 percent reduction in overall costs.

Using a telemonitoring system developed by Alere Medical of San Francisco, heart specialists at Columbia Presbyterian Medical Center in New York assessed daily symptoms and vital signs of 29 heart-failure patients. Of this group, 21 percent received medication adjustments resulting from data collected via the monitor. When compared with a group of 36 unmonitored patients, the monitored group had a lower rate of readmission (10 versus 17) and of visits to the emergency room (1 versus 10).

Other studies of cardiac patients have yielded similar results, leading to improved outcomes and reduced hospital lengths-of-stay. CHF, a common affliction among older patients, is characterized by a heart that’s no longer fully capable of pumping blood to vital organs. CHF patients have a high rate of rehospitalization, primarily for serious symptoms such as breathing difficulties and gastrointestinal tract pain. The consequent health-care costs are also high: about $10 billion annually. But the symptoms can be avoided with rigorous attention to diet, weight fluctuations, and medication compliance.

At the University of Michigan in Ann Arbor, telemedicine is playing a role in monitoring about 520 CHF patients, relying on trained, advance- practice nurses. The techniques include scheduled telephone calls to patients, to monitor symptoms and relay recommendations. An integrated, computer-based recording system is used to track and update patient status. To date, the telemanagement program has lowered the number of CHF patient hospitalizations. In addition, average hospital lengths-of- stay have been reduced by about three days per patient.

Such successes are also being seen when monitoring other conditions, such as asthma. As part of a pilot project at Columbia-Presbyterian, asthma patients monitor their condition at home by breathing into a device (spirometer) that measures pulmonary function. The spirometer is connected to a palmtop computer. Several times a day, patients transmit the data (via modem and phone line) to the hospital’s clinical information system, where it becomes available to physicians and nurses at a special Web site.

The results are checked by decision-support software that alerts a nurse if a potential problem is detected. The system is designed to pick up changes before they turn into a medical crisis.

Diabetes care is another condition that is benefiting from telemedicine applications that combine monitoring and disease management. As the seventh-leading cause of death, diabetes affects about 16 million Americans. That number is expected to double by 2010. About one-third of diabetic patients do not know they have the disease, experts say. Among those diagnosed with the condition, about half are noncompliant when it comes to management via blood glucose monitoring.

With appropriate lifestyle changes, many possible complications of the disease can be avoided. Education of diabetics is thus critical for reducing long-term problems. At the University of Iowa, the Diabetes Education Project uses set-top boxes with CD-ROMs and Internet access to supply patients with information, allowing them to become full participants in their own care. The multimedia approach makes it possible to reach patients with critical information in multiple ways, complementing written information with animated videos, anecdotes, and so on.

In addition to the above applications, a host of new technologies now under development will make it possible to collect, analyze, and use sophisticated medical data, regardless of where the patients and their physicians are located. They include noninvasive sensors; smart computerized devices; customized products with flexible configurations; data-analysis tools to assist in medical decisionmaking; electronic patient records; wearable products; and wireless, Internet-linked systems.

To get from here to there, however, will require a coordinated effort. The foundation for widespread deployment of telemedicine, whether in the home or elsewhere, is the development of tools for processing large amounts of data. As technologies for the remote gathering and transmission of data are increasingly incorporated into the health-care system, the need for related systems that can interpret and evaluate the data will grow. More important will be systems that can help anticipate future medical problems, based on the database of information already gathered.n

Peter J. Leitner is president of Waterford Telemedicine Partners, a New York investment firm that founded TeleMedicineIndex.com, which publishes articles, reports, and statistics (in digital format) for the telemedicine industry. He is coauthor of The Telemedicine Industry Report 2000 and was a regular columnist for Telehealth Magazine (Miller Freeman). He may be contacted at Leitner

>>> View more: When the heart fails

When the heart fails

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Byline: Euden Valdez

April 08–American doctor introduces new heart biomarker in PH

According to the World Health Organization (WHO), out of 38 million people who died from non-communicable diseases in 2012, 17.5 million perished due to cardiovascular diseases (CVDs). With numbers this high, WHO officially declared CVDs as the No. 1 cause of death globally, noting that the range of heart conditions are most prevalent in low- to middle-income countries.

Alarmingly, such is also the case in the Philippines. Although no recent study has been conducted on CVD deaths in the country, an estimated 1.8 million Filipinos are suffering from heart failure (HF), which is classified as one of the most common types of CVDs.

To show just how dangerous a failing heart is, the Philippine Heart Association is now in the middle of a study that will form part of the National Nutrition and Health Survey.


Moreover, private institutions and individuals have also begun efforts to address the urgent health battle including American doctor Alan Maisel, who partnered with United Laboratories (Unilab) Inc. to introduce to the Philippines a new heart biomarker that has been saving lives in the United States.

In March, Dr. Maisel, who is a professor of medicine at the University of California and director of the Coronary Care Unit and Heart Failure Program of San Diego Veterans Hospital also in California, personally flew to Manila to attend a press briefing hosted by Unilab to talk more about this breakthrough called the ST2 cardiac biomarker.

Heart failure sounds like such a terrible name because the ‘heart fails.’ It fails because it is unable to supply the amount of blood you need to carry out your daily activities,” Dr. Maisel began. “And guess what. We are in an epidemic especially with all the obesity and diabetes that lead to heart failure . . . [There is] more mortality than just about all the cancers combined.”

Dr. Alan Maisel, a professor of medicine at the University of California and the director of the Coronary Care Unit and Heart Failure Program of the San Diego Veterans Hospital, talks about the new ST2 cardiac biomarker method.

Dr. Alan Maisel, a professor of medicine at the University of California and the director of the Coronary Care Unit and Heart Failure Program of the San Diego Veterans Hospital, talks about the new ST2 cardiac biomarker method.

Unfortunately, he also observed that in the US, hospitalization often results in poor outcomes: there is a 90day risk of death at 15 percent, and readmission is approximated at 30 percent, according to studies he considered.

Some doctors may be sending home patients not knowing they could be sicker,” Dr. Maisel noted. This is where the ST2 cardiac biomarker comes in.

A novel indicator of heart stress due to worsening heart failure, it is a form of body protein, which is a member of the interleukin family. And for the American heart expert, ST2 sets a robust biomarker for two reasons.

First, it gives the same value whether blood is taken from different body parts unlike other biomarkers, which has a “coefficient of variation.” In other words, whether ST2 is measured from blood extracted from the arms or from the foot, or whether it is taken today or the next day, the ST2 level will pretty much stay the same.

He continued, “The second reason why I really like the ST2 is that it has a number that we can remember: 35 nanogram per milligram

According to Maisel, this means that any patient with ST2 measurement above 35 has a much higher risk of death, compared to those below 35 with practically lesser risks.

The American doctor joined by Filipino physicians Dr. Dante Morales and Dr. Maria Rosario Sevilla hope to spread awareness about the availability of a new indicator of heart stress due to worsening heart failure in the Philippines.

The American doctor joined by Filipino physicians Dr. Dante Morales and Dr. Maria Rosario Sevilla hope to spread awareness about the availability of a new indicator of heart stress due to worsening heart failure in the Philippines.

Lastly, using this system further has the following advantages: It is not influenced by kidney and other body functions, age, and body mass index unlike other biomarkers.

To give a clearer picture of the process and results, Dr. Maisel recalled a personal story of a patient from his hospital in the US. “We just started using ST2 around three months ago. I checked on everyone who has been measured his ST2 at the Coronary Care Unit. One was a man came in, about 65 years old, with clear heart failure.”

This man’s ST2 was measured at 80 but when his signs improved, he was sent home even without his ST2 dropping to the safe levels. And fellow doctors ignored Dr. Maisel’s suggestion for an angiogram.


He died over the weekend looking good and feeling good but with high ST2 level,” Dr, Maisel revealed. “Could I have saved his life if he wasn’t sent home just basing from his ST2 levels? I don’t know but I could’ve made a difference.”

With the help of ST2, doctors should be able to give better and more personalized medications to improve heart functions and prevent other complications.

Filipino doctors, Dr. Dante Morales and Dr. Maria Rosario Sevilla, joined Dr. Maisel at the presentation of the ST2 cardiac biomarker, which was held at The Peninsula Manila in Makati City. Together, they declared that their goal is to make physicians and nurses in the Philippines aware about the availability of the ST2 method in the country today, and ultimately save more lives from heart failure.

The ST2 method is now available as Pressage ST2 Assay, and exclusively distributed and marketed by Unilab. It is approved by the Food and Drug Administration and carries a Conformite Europeenne Mark.


(c)2015 The Manila Times (Manila, Philippines)

Visit The Manila Times (Manila, Philippines) at www.manilatimes.net

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Building a better you: it’s the difference between getting by and getting healthy

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The trouble with always trying to preserve the health of the body is that it is so difficult to do without destroying the health of the mind.” The quote is author G.K. Chesterton’s, but Torontonian Jim DeGasperis would be the first to admit that his many attempts at good health had him running in circles, so to speak.

The difficulty, he says, wasn’t just that he believed the latest thinking on diet and health, but he changed his lifestyle to follow suit. “I read about vitamins, so I took them for awhile,” says the father of four. “I tried vitamin C and multivitamins. They didn’t seem to help much–I still felt tired and lethargic.”

After his unsuccessful stint with vitamins, DeGasperis, 50, an independent contractor and developer, tried a number of health kicks to lose weight and gain energy. When low-fat diets became fashionable in the ’90s, he counted grams of fat. When Atkins took the spotlight, he cut down on carbs. At the end of it all, DeGasperis, like a number of us, was a little overweight and not particularly healthy, says Elaine Chin, his doctor and co-founder of Scienta Health, an executive health management clinic specializing in preventive genetic testing. At 224 lb. and five-foot-11, he had high insulin levels, high cholesterol, and a family history of heart disease.


Jim came to me because he wanted a health program that was tailored to his specific needs,” says Dr. Chin. “There is a gap between being at your optimum health and just getting by, and Jim was like a lot of people in that he wasn’t sure how to close that gap.”

DeGasperis’s confusion is fairly common, says Dr. Rejean Hebert, dean of the faculty of medicine and health sciences at Universite de Sherbrooke. “A lot of people want to improve their quality of life. They want a healthier lifestyle. They are afraid of going into their senior years sick or disabled. What I’ve found with my own patients is they are flooded with information, but they find it hard to select the right information to make an informed decision.”

One reason for the uncertainty is the multitude of conflicting claims about health, says Hebert. Take the received wisdom on fats. In the ’80s, fats were a no-no, as the emphasis was on reducing heart disease and lowering cholesterol. In the ’90s, a low-fat diet was thought to protect against breast cancer as well. Then last year, the Maryland-based Women’s Health Initiative announced that after putting thousands of post-menopausal women on a low-fat diet for eight years–the sample size was 49,000 women–there was no evidence that particular diet significantly reduced the incidence of either disease. The latest thinking is that we are to cut out trans fats, reduce saturated fats and embrace the monounsaturates–the good fats in olive oil and nuts that lower the type of cholesterol (LDL) that causes heart disease. There is also evidence that eating very little, known as Caloric Restriction, will increase lifespan, although critics would argue the strict diet and nutrition program sacrifices quality of life to gain longevity.

Vitamins have gone through an about-face too. Until very recently, it was thought that high doses of antioxidants, or compounds like beta carotene, lycopene or vitamin E, helped prevent cancer by neutralizing cancer-causing free radicals. It turns out that not only do antioxidants fail to vanquish free radicals, but beta carotene supplements actually increase the risk of certain cancers.

A lot of people want a quick miracle pill that can prevent disease or stop aging,” Hebert says. “They are willing to try multivitamins, vitamin C, Ginkgo Biloba or DHEA [an antiaging hormone replacement]. The problem is that there is a lot of false information out there. And there is little scientific evidence that these products actually work.”

The good news is that the 20 per cent of Canadians who take alternate health products are still healthier than those who don’t. Unfortunately, a body of research shows this has absolutely nothing to do with the vitamins they take. On average, supplement takers are better educated, and more affluent than those who abstain from these products; they likely take a greater interest in personal health, and have more money to spend on things like gym memberships and flesh fruit and vegetables.

The rise of vitamins and other supplements are both aspects of our shifting attitudes toward health and disease, says Sheldon Elman, the chief executive officer of Medleys, a national executive health provider. A growing number of Canadians would like to take steps to prevent them from getting sick, he says. They are more educated about their own symptoms and illnesses. Unlike previous generations, they don’t take their physician’s word as sacrosanct. They are well versed in the medical information available, but don’t always know how best to navigate through the deluge of scientific claims.

DeGasperis says all of the conflicting information led to poor decisions on his part. His combination of symptoms–unfit, overweight, high cholesterol–aren’t unusual. They are a major cause of chronic illnesses in Canada, says Dr. Ian Bowmer, vice-chair of the Health Council of Canada. One in three Canadians has a chronic condition, such as heart disease, diabetes and high blood pressure, chronic obstructive pulmonary disease, arthritis or mood disorders. Diabetes alone has increased from three to five per cent in the past decade. Chronic illnesses cost the health system $80 billion per year, but many are preventable with lifestyle changes, says Bowmer.

Individuals need to take control of their own health, but the health care system needs to change too,” he advises. “We need to focus on prevention and providing at-risk individuals with the help they need, such as access to a coordinated team of health professionale including nutritionists and dieticians. It would mean more money at the outset, but it has proven cost-effective in the long run.”


As medicine has advanced, we have raised our expectations to follow suit, says Hebert. Canadians, especially boomers, want to be free from disability as they age. “We’ve shifted our priorities away from life expectancy toward quality of life,” says Hebert. “People care about how many disability-free years they can enjoy, not just how many years they have left.”

Dr. Brian Day, president-elect of the Canadian Medical Association, believes this attitudinal change forces us to redefine what it means to be truly healthy. “Canadians in their 50s, 60s and 70s expect much more from their senior years than previous generations. They want their senior years to be extremely active. And because they have these higher expectations, there is a lot of uncertainty about the best way to do that.”

After consulting with Dr. Chin and a team of health professionals, Jim DeGasperis was able to lower his cholesterol and reduce his weight. Part of the problem, he says, was a lack of knowledge. Understanding the relationship between his fatigue, weight, high cholesterol and elevated insulin levels played a key role in changing his priorities. “There is a gap between really caring for your health and getting by, but it took some professional help for me to see what that was. I think I always cared about my health; I just wasn’t sure how to be at my best.”

Some love for the heart

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Byline: Abram Katz

Nov. 19–AN ADULT HEART BEATS about 100,000 times a day, sending five quarts of blood a minute through 60,000 miles of arteries, veins and capillaries.

With luck, the 8- to 10-ounce pump will reach about 2.5 billion cycles before it stops. That’s if you exercise, don’t smoke, watch your cholesterol, avoid diabetes, tend to your blood pressure and keep your coronary arteries unencumbered and clean.

But, many Americans don’t pay attention to what they eat, sit in a chair all day, put on weight, and line their vessels with a waxy sludge.

The latter, a plaque between the inner and outer walls of the vessel, eventually hardens and ruptures the inner lining of an artery. Blood platelets gather at the site and clot, closing off the already narrowed passage.


If this happens in one of the three arteries that carries oxygen to the heart, you’ve entered the ranks of the 650,000 men and women in the United States who have heart attacks every year.

About 158,000 heart attack victims die, according to the American Heart Association. The rest suffer varying degrees of damage. Those who promptly receive an angioplasty experience the fewest damaged cardiac cells.

In the procedure, a balloon is threaded up a large artery in the leg into the heart and to the blockage. The balloon is then inflated, pushing the clot and plaque to the sides, allowing blood to flow again.

Before angioplasty, physicians could only treat heart attacks with “clot-busting” drugs such as tissue plasminogen activator, or tPA.

The survivors of myocardial infarction join those with other kinds of heart problems resulting from hypertension, arrhythmias, viruses and many other causes. All share at least one diagnosis: congestive heart failure.

Although congestive heart failure can be treated with drugs and pacemakers, Yale-New Haven Hospital cardiologist Brian C. Swirsky said stem cells would be ideal to repair damaged hearts.

Stem cells from bone marrow, umbilical cord blood, fetuses and cell lines all carry the potential to develop into different kinds of tissue, from neurons to somatic cells.

Swirsky reviewed recent stem cell studies conducted in Norway and Germany and published in the New England Journal of Medicine. He also reviewed additional examinations involving stem cells and repair of heart muscle.

These stem cells are taken from bone marrow, yet are pluripotent, meaning they maintain their freedom to grow into any kind of cell, he said. The cells are likely attracted to damaged tissue issuing growth factor proteins.

In patients with congestive heart failure, the stem cells were infused directly into the heart. The studies are difficult to interpret, Swirsky said, because infusions in the studies varied by time and amount infused, the amount of heart damage, and the number of participants.

Some studies suggested that stem cells did the most good in the most heavily damaged hearts, he said.

It is significant that the stem cells did not worsen outcomes in any study, Swirsky said. This suggests that stem cell therapy for heart damage is safe, he said.

So, it is promising. The studies need to be repeated in larger, multicenter trials with standardized techniques,” he said.

Meanwhile, the prevalence of congestive heart failure is increasing because more people survive initial heart attacks and other illnesses, Swirsky said. Americans are also becoming fatter sooner, and many seem headed for heart disease.

During congestive heart failure, the heart cannot pump enough blood. The result is fatigue, shortness of breath and swelling of the ankles.

With the left ventricle not working efficiently, the right ventricle becomes overloaded, and blood pressure increases, forcing fluid out of vessels. Gravity pulls the fluid into the lower extremities, Swirsky said.

People with congestive heart failure often die suddenly of ventricular fibrillation. Instead of pumping blood, the left ventricle quivers ineffectually. Quick action with a defibrillator can reset the chaotic ventricle.

However, blood flow remains reduced, causing the kidneys to lose function. The lungs are saturated with backed-up fluid and heavy. They cannot sweep out bacteria effectively, so pneumonia claims more lives.

About 25 years ago, angiotensin converting enzyme, or ACE, inhibitors, were developed. The drugs constrict vessels, increasing blood pressure, easing strain on the heart. Then, 10 to 15 years ago, beta blockers entered the fray.

These drugs inhibit adrenal glands, which react to the sluggish blood flow by emitting large amounts of adrenaline. Constant stimulation from this would wear down the already over-stressed heart, Swirsky said.

Diuretics squeeze water from the system, leading the kidneys to produce more angiotensin. A newer class of drugs, angiotensin receptor blockers, counteract this unwanted effect.


Others drugs are necessary to block the effects of another hormone, aldosterone, which detains salt and water.

Most heart failure therapy is a cocktail of drugs,” Swirsky said.

Now, surgeons are exploring the use of ventricular remodeling, which involves removing scar tissue and making the heart smaller and more efficient.

Preventing congestive heart failure is far better than treating the disease, Swirsky said. The secrets of prevention are well known: Reduce obesity, stop smoking, control hypertension and reduce cholesterol.

Then there would be less heart disease to start with. The solution is lifestyle change,” Swirsky said. Abram Katz can be reached at akatz@nhregister.com or 789-5719.

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Copyright (c) 2007, New Haven Register, Conn.

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