Medical Information


I realize it has been quite a while since my last post. However, this was some info that I really thought needed sharing. A patient of mine is having some difficulty sleeping. The counselor he is seeing recommended taking melatonin as a sleep aid, but asked that he clear it with his physician first as the patient has celiac disease. Truly, I thought that as long as the product was gluten-free, there should be no problem. However, being who I am, I decided to research the product just a bit. What I found  was news to me.
Melatonin , albeit natural, is a potent immunostimulator. In other words, it awakens the immune system causing it to become somewhat hyperactive. In doing so, melatonin increases Interleukin-1 and Interleukin-2, both strong inflammatory markers, thereby increasing the number of T-cells in the system. Together, these reactions stimulate the immune response and worsen already existing autoimmune diseases. In fact, the article that I read stated that Melatonin is absolutely contraindicated in conditions such as Rheumatoid Arthritis and Lupus.
Now, the question still remains “How about Celiac Diseae?” In those of us with celiac disease, while on a strict gluten-free diet, we manifest no inflammatory response as we have removed the offending agent from the equation. So, theoretically, it should be safe to take melatonin. However, there is no research specific to melatonin and celiac disease, so I cannot recommend the use of this product presently.
As an aside, I also researched L-tryptophan as alternative sleep aid. According to the research I did, L-trytophan causes an autoimmune condition called eosinophillic myalgia syndrome, which can be severe if not treated in time. If one already has an underlying autoimmune condition, it is safe to say that we do not want to introduce a risk factor for developing another one.
If you would like to research these products on your own, you can go to http://en.wikipedia.org/wiki/Melatonin.

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May is Celiac Awareness Month. What better time for some FREE informational lectures on celiac-related topics?

We have some old topics that we have updated and some new topics that have never been discussed. On the agenda are the following lectures:

1) Anatomy of Celiac Disease
2) You Might Be A Celiac If …
3) Gluten Intolerance vs Celiac Disease vs Gluten Allergy
4) Myths About Celiac Disease
5) Gluten Free & Symptomatic
6) Type 1 Diabetes and Celiac Disease
7) Medicolegal Aspects Celiac Disease

The lecture series will take place next Sunday May 15, 2011.

Registration starts at 12:30 PM
Lectures go from 1PM to around 4:30PM
We will leave plenty of time at the end for questions
After questions are finished, the CSA-GC will have a short meeting for members.

In addition to the lectures, there will be several vendors of gluten-free products present with product samples, so not only will you learn about celiac disease, but you will also get some great gluten-free food.

In order to get an idea of the number of attendees, the Celiac Sprue Association of Greater Chicagoland is asking that attendees preregister. Doing so is quick and painless. There are three ways to register:
1. Go to the CSA-GC’s Facebook page and click on the link for our lecture, then click on the “will be attending” link.
2. Send an e-mail to CSACGNewsletter@yahoo.com and let them know if you’ll be attending
3. Respond directly to the CSA-GC president Tony Deany at 630-640-0128

The lectures will be held at:
Pipefitters Training Center
Local Union 597
10850 W 187th Street
Mokena, IL 60448

You can find a map to the Training Center here. If you type in your address on the page, you can get door-to-door directions. The easiest way to get to the center is to exit Interstate 80 at LaGrange Road South, turn right (West) at the first light (191st Street), follow 191st Street about 2 miles until it ends at Wolf Road, turn right (North) on Wolf Road, then turn right (East) on 187th Street.
When you are driving down Interstate 80, the Training Center is the large complex on the South side of Interstate 80 at Wolf Road.

We also want to express our sincere gratidute to the Chicago Pipefitters Local Union 597. They are allowing us to use their Training Center free of charge on Sunday as a service to the public. Please keep them in mind if you have a piping job or if you are interested in becoming a pipefitter!

Microscopic colitis is a term used for two types of bowel inflammation, collagenous colitis and lymphocytic colitis. Both entities can cause chronic, non-bloody watery diarrhea and abdominal cramping. This array of symptoms can either be continuous or have symptom-free periods. In a study, An association between microscopic colitis and celiac disease by Green PH, Yang J, Cheng J, Lee AR, Harper JW, Bhagat G, the authors state that there is a 70-fold increase in the development of microscopic colitis in a celiac patient. With the large array of celiac patients that I am seeing in my office, I am seeing my fair share of microscopic colitis as well.

  Six months ago, I had one such patient visit my office. She was recently diagnosed with celiac disease and had biopsies done that revealed microscopic colitis. Because of the increased propensity for this condition in celiac patients, I wanted to be well versed on the treatments that are available. One such treatment  is a poorly absorbed steroid called Entocort (Budesonide). Entocort is absorbed mainly in the gastrointestinal tract and to a lesser degree, systemically, so it is more appealing due the lesser array of side effects. I began this patient on Entocort and within one month her diarrhea had completely resolved and she started to gain weight and feel significantly improved. We have already begun the weaning process and she continues to do well.

 On a recent visit with her husband to his colorectal surgeon, she mentioned to him that she was on Entocort for microscopic colitis. He stated to her that this was inappropriate treatment for her condition as it is absorbed strictly in the terminal ileum (the end of the small intestine) and not in the colon. My patient called me distressed over my poor choice of treatments.

 The National Institutes of Health list Entocort as one of the main treatments for microscopic colitis (http://digestive.niddk.nih.gov/ddiseases/pubs/collagenouscolitis/ ), as does Mayo Clinic and MedicineNet.com. It is absorbed both in the small intestine as well as parts of the large intestine.  So, if you are suffering with microscopic colitis and your physician has prescribed Entocort for you, rest assured that you are on the appropriate treatment, no matter what the local surgeon states!

Saw an interesting article on Medscape that involved a comparison between the medication group “statins” (i.e. Crestor, Lipitor) and their effectiveness in lowering cholesterol versus red yeast rice. The name of the study was Red Yeast Rice and Hyperlipidemia: How strong is the Evidence?  by author, Charles P. Vega, MD.  The author discusses both the benefits and drawbacks of statin therapy. Myopathy (muscle pain and breakdown) and rhabdomyolysis (the toxic product of muscle breakdown that will damage kidneys) are the most severe complications of statin therapy. However, these complications must be weighed against the benefits of reducing both cardiovascular events and arterial plaque.

 Red yeast rice was initially compared to placebo treatment in those patients who could not tolerate statin therapy. It was administered over a period of 24 weeks, with only 4 patients leaving the treatment group. After the treatment term ended, the researchers  found that the group taking the red yeast rice had a reduction in LDL cholesterol (bad cholesterol) by -27.3% versus the placebo group. In addition, a separate trial of 5000 patients with a history of heart attack demonstrated that red yeast rice reduced the risk of another heart attack by 62% and death due to cardiovascular disease by 31%. Although more research is needed, , red yeast rice certainly holds promise for the future without the toxic side effects.

 On the same front, also released today was a large study comparing Zetia/Vytorin versus Niaspan (Niacin is a B vitamin). The study revealed that niaspan was well more effective than Zetia in increasing HDL (good cholesterol) and modestly lowering the LDL.

 It is nice to see a more natural  line of effective treatments coming into vogue for the near future. I will anxiously await the outcome of further studies and report back.

SwineFluRecently, I have had several patients tell me that they do not want to receive the swine flu vaccine. They offer many reasons such as they “have never received the flu shot in the past and they have been just fine” and “the vaccination has not been out long enough to know the side effects”. I have even heard that some people believe this uproar over the H1N1 virus is all propaganda by the pharmaceutical companies (see comment section) created to increase vaccine profits.

I am here to tell you that the risk with this virus is very real!

H1N1 is proposed to kill between 90,000 and 100,000 patients in this country over the coming winter months. Although it is a new vaccine, it is safe. Tens of thousands of doses have already been dispensed to both adults and pediatric patients with no overwhelming side effects. In this case, the benefit strongly outweighs the risk. The unfortunate fact about this virus, in particular, is that the young healthy individuals are more likely to die from the disease. We have no immunity, as we have never lived through a pandemic such as this current swine flu.  We have been given the opportunity to protect ourselves and I suggest that we all take it. I believe so strongly in this coverage that my four children, my husband and I will be receiving the vaccination as early as possible.

Lastly, I do want to make the point that taking the seasonal influenza vaccine is still very important. Upward of 35,000 people die each year from seasonal flu. The H1N1 virus is entirely different from the viruses contained in the seasonal flu vaccine. Seasonal flu vaccine will NOT cover H1N1 and the H1N1 vaccine will NOT cover seasonal influenza. The CDC strongly recommends receiving both vaccines.

So, please take a proactive approach to your own health care and take both vaccines!

We’re already seeing some cases of influenza in the area and the swine flu is expected make a comeback in the next couple of months. Actually, the CDC has requested that we use the technical name of H1N1 virus to describe the swine flu since some people mistakenly believe that they can get the disease from being around pigs and eating bacon or other pork products.

Most of the time, H1N1 symptoms are relatively mild, including a low-grade fever, cough and sore throat. Sometimes H1N1 may just appear to be a cold, causing only nasal congestion or runny nose without a fever. Occasionally severe disease also has been reported where patients develop headaches, body aches, trouble breathing, vomiting or diarrhea.

Testing for H1N1 initially involves a nasal swab to determine whether or not influenza is present. If no influenza is present, then the patient does not have any type of influenza. If testing shows that a patient has Influenza B, H1N1 virus is unlikely. If the patient has Influenza A, the patient may have H1N1 influenza, but may also have many of the other strains of Influenza A – as are seen with seasonal influenza outbreaks. If the Influenza A is positive and H1N1 virus is suspected, a nasopharyngeal wash can be sent to the state department of health for testing, but currently Illinois is recommending testing only for hospitalized patients with severe respiratory symptoms and fever.

The good news is that a vaccine is coming. Even better news is that the vaccine will be provided by state and county health departments at NO COST. You can only be charged an “administration fee” that covers the doctor’s costs in storing the vaccine and giving you the vaccine – not a charge for the vaccine itself. I’m on the list of providers who will hopefully receive vaccine once it begins shipping.
The vaccine will be given to priority groups first, including pregnant women, household contacts of infants less than 6 months old, and health care workers.
An explanation of the distribution process for vaccines can be found here.

The best way to keep from getting sick is to practice what the IDPH calls the “Three Cs” –
Clean – properly wash your hands frequently – either with soap and water or alcohol-based cleansers
Cover – cover your cough and sneeze by coughing into your forearm
Contain – contain your germs by staying home if you are sick

For more information about the H1N1 virus, go to the Illinois Department of Public Health’s H1N1 Flu web site or the Centers for Disease Control H1N1 Flu web site.

Researching something online and found a very complete list of all gluten-free medications. The link is as follows:

http://gfmedications.com/

Note that manufacturers can change the formulations of their medications at any time, but in general this list is a great way to double check the medications you are taking to find out if they may have gluten in them.

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