Archive for April, 2013

Weekend Warriors Most Likely to Tear an Achilles Tendon

If you’re a man who exercises mostly on the weekend, a so-called “Weekend Warrior,” you have a higher risk of rupturing your Achilles tendon while playing sports than other Americans.

Kobe Bryant, the Los Angeles Lakers star basketball player who ruptured his Achilles tendon earlier this month, is in good company, according to a new study of Achilles tendon injuries in the US.Kobe Bryant Achilles injury

Basketball leads to about 1/3 of all Achilles ruptures in the US, followed by tennis (9%) and football (8%), report researchers in the April issue of Foot & Ankle International.

They reviewed 406 records from patients diagnosed with Achilles tendon injuries from August 2000 to December 2010.

On average, the patients who ruptured their Achilles tendon were 46 years old, mostly men (83%), and were injured playing sports (more than 2/3rds).

Older patients (over age 55) and those whose body mass index (BMI) was greater than 30 (considered obese) were more likely to have non-sports related causes and were more likely to not have been diagnosed correctly until more than one month after the injury.

More than 1/3 of the tendon ruptures not caused by sports occurred at work.

When the diagnosis was missed, it was usually because the initial diagnosis was an ankle sprain.

“Delayed diagnosis and treatment have been shown to result in poorer outcomes,” says lead author Steven Raikin, MD, of the Rothman Institute in Philadelphia, PA.

“Older individuals, and those with a higher BMI, should be evaluated carefully if they have lower leg pain or swelling in the Achilles tendon region.”

Re-rupture of the same tendon occurred in 5% of the group, and 6% of the study’s population had previously ruptured the other leg’s tendon.

The study supports previous findings that an Achilles tendon rupture on one leg increases the likelihood of a rupture on the other leg.

When the same tendon was re-ruptured, 85% of those injuries had not been treated surgically earlier.

Signs of an Achilles Rupture

One sign of an Achilles rupture is the inability to stand on your toes.

However, this test is not completely reliable.

Also, when you walk, your foot may turn out to the side.

A ruptured Achilles tendon can be confused with a partial rupture because it may cause little pain at first.

In fact, an Achilles rupture is quite often misdiagnosed.

The only foolproof way to know if you have ruptured this tendon is to lie on your stomach with your foot off the end of a bed, toes pointing down, and have someone squeeze your calf.

The front of the foot normally will move down.

If there is no flex in the foot, then the tendon is torn.

You can also compare the two legs.

Squeeze the uninjured leg first to observe the flexing movement, and then squeeze the injured leg to see whether it moves.

As this new study shows, if you injure your Achilles tendon, getting to a doctor sooner than later will speed your recovery.

Double Winner: Patrick Shaw Beat Cancer, Then Heart Disease

When my sister-in-law Carol Peerce died suddenly at age 49 exactly three years ago, it was discovered that radiation-induced heart disease likely led to her heart attack and eventual death.

It turns out the radiation therapy to treat her Hodgkin’s lymphoma 30 years previously had damaged Carol’s heart.

At my wife Margie’s suggestion, I looked into this condition and sure enough found medical evidence that radiation, and chemotherapy, given to Hodgkin’s lymphoma patients put them at risk for later heart problems.

Then I found out that my friend Patrick Shaw, a contractor I knew in East Hampton, was one of these patients as well.

Pat had been diagnosed with Hodgkin’s lymphoma at age 29 and received multiple sessions of radiation therapy and chemotherapy that included heart-toxic anthracyclines.

Little did he know that the radiation therapy and chemotherapy he received to cure his cancer would scar his heart and lead him to have several silent, near-deadly heart attacks and a stroke 20 years later.

Pat’s story, and the heart risks of cancer therapies, are the basis of the cover story for the just released May 2013 issue of Heart Insight magazine.

Heart Risks from Radiation Therapy

Many people survive their cancers, but end up dying of cardiovascular disease.

Among Hodgkin’s lymphoma patients who have received radiation, cardiovascular disease is one of the most common causes of death.

Studies have shown that these patients have an increased risk for coronary artery disease, heart valve disease, congestive heart failure, pericardial disease (disease of the heart lining), and sudden death.

The basic mechanism appears to be radiation-induced damage to the lining of blood vessels.

Compared to the general population, Hodgkin’s lymphoma patients have higher heart risks if they were treated before age 21 or had radiation to the central part of the chest, which increases the risk of death from a fatal heart attack by 1.5 to 3 times.

In addition, a woman who received chest radiation therapy for breast cancer has a 63% increased risk of cardiac death.

With improvements in radiation techniques, including smaller amounts of radiation aimed at specific body areas, the risk of cardiovascular complications has declined.

But patients treated through the mid-1980s have a higher risk of congestive heart failure and heart valve problems.

Pat’s cardiologist, Ronald Drusin, MD, Professor of Clinical Medicine at New York-Presbyterian Hospital, says: “If you had chest radiation for lymphoma in the central part of the chest and have chest pains or tightness and shortness of breath, you should be evaluated by a cardiologist.”

Road to Recovery

For Pat, Dr. Drusin decided that stents to reopen the blocked coronary arteries in his heart were a better choice than bypass surgery because of radiation-induced scarring in Pat’s heart.

Pat felt better after the procedure, although his recovery was complicated by a stroke.

Today, Pat’s prognosis is fine, says Dr. Drusin “as long as he takes good care of himself, which he does.”

Pat is back to work and now pays close attention to his exercise and diet.

As the family chef, he cooks heart-healthy meals containing more whole grains and vegetables, no salt and fewer processed foods.

He checks his blood pressure regularly and takes daily medications, a beta-blocker and baby aspirin, to keep his heart healthy.

On weekends he stays busy with his three sons’ lacrosse games and other activities, including his favorite hobby, building bird houses.

Pat has some simple advice to anyone with symptoms of heart disease:

“As soon as you are not feeling well, get to a doctor,” he says.

“You have to be proactive.

You are in charge of your own heart.”

That’s particularly true if you had radiation or chemotherapy to treat a cancer when you were younger.

The Harvard Medical School Guide to Tai Chi Released

It’s official! The Harvard Medical School Guide to Tai Chi:12 Weeks to a Healthy Body, Strong Heart & Sharp Mind is now available in book stores and online book sellers, including Amazon.com and Barnes&Noble.com.

Conventional medical science on the Chinese art of Tai Chi now shows what Tai Chi masters have known for centuries: regular practice leads to more vigor and flexibility, better balance and mobility, and a sense of well-being.

Cutting-edge research from Harvard Medical School also supports the long-standing claims that Tai Chi also has a beneficial impact on the health of the heart, bones, nerves and muscles, immune system, and the mind.

This research provides fascinating insight into the underlying physiological mechanisms that explain how Tai Chi actually works.

Dr. Peter M. Wayne, a longtime Tai Chi teacher and a researcher at Harvard Medical School, developed and tested protocols similar to the simplified program he includes in this book, which is suited to people of all ages, and can be done in just a few minutes a day.

This book includes:

• The basic program, illustrated by more than 50 photographs

• Practical tips for integrating Tai Chi into everyday activities

• An introduction to the traditional principles of Tai Chi

• Up-to-date summaries of the research literature on the health benefits of Tai Chi

• How Tai Chi can enhance work productivity, creativity, and sports performance

Peter M. Wayne, PhD, is Assistant Professor of Medicine at Harvard Medical School and the Director of Research for the Osher Center for Integrative Medicine, jointly based at Harvard Medical School and Brigham and Women’s Hospital.

Prior to this appointment, Dr. Wayne served as the Director of Tai Chi and Mind-Body Research Programs at the Osher Research Center and Founding Research Director at the New England School of Acupuncture.

He has more than thirty-five years of training experience in Tai Chi and Qigong and is an internationally recognized teacher of these practices.

It was an honor to work with such a renowned Tai Chi teacher and researcher to put together this new book.

I can honestly say my life is richer, and my mind and body certainly more relaxed, from having practiced Tai Chi over the past 3 1/2 years as I worked with Dr. Wayne on the book.

Simple Blood Test May Identify Concussion

A simple blood test may be able to identify football players who have suffered brain damage from hits to the head, even if they don’t have a concussion.

Much attention is being paid to concussions among football players and the big hits that cause them.

No single test can reliably diagnose a concussion, said Jeffrey Kutcher, MD, of the University of Michigan in Ann Arbor, at a recent press conference to announce the just-released, newly updated guidelines on sports concussions by the American Academy of Neurology.

Concussions can be difficult to diagnose, relying on player symptoms, cognitive tests, or very costly brain scans.

A $40 blood test for a protein, called S100B, normally found only in the brain may offer an objective measure of whether a player has endured head trauma.

Researchers at the Cleveland Clinic and University of Rochester have found that elevated blood levels of the S100B protein directly correlate to the number and severity of hits to the head during college football games.

Body contact or simply playing in a football game did not affect S100B levels in the players.

In an interview with the lead author, Damir Janigro, Ph.D., professor of molecular medicine and the director of cerebrovascular research group at Cleveland Clinic, he gave me
a scenario of how the blood test may be used.

“In a situation where a player is suspected of having a concussion, we could validate that by a blood test the following day,” says Janigro.

“If the test is positive for S100B, we can assume the player had some concussive event.

If the blood test is normal, we can assume the player did not have a concussion.”

In effect, the blood test could tell whether the player needs medical attention as a result of the in-game hits to the head.

In a study of 67 college football players, Janigro and colleagues found that the more hits to the head a player absorbed, the higher the levels of S100B leaked into the bloodstream after a head injury.

Typically, S100B is found only in the brain, says Janigro.

Finding it in the blood indicates damage to the layer of cells that prevent materials from the blood from entering the brain, the so-called blood-brain barrier.

Once in the bloodstream, S100B is seen by the immune system as a foreign invader, triggering an autoimmune response that releases auto-antibodies against it.

Those antibodies then seep back into the brain through the damaged blood-brain barrier, attacking brain tissue and leading to long-term brain damage.

Four of the football players tested showed signs of an autoimmune response to S100B.

Brain scans confirmed that the presence of S100B antibodies in the players’ blood correlated with brain tissue damage.

“To our surprise, even when players don’t have a concussion, the blood-brain barrier opens,” says Janigro, adding that many European countries do blood tests for S100B to diagnose mild traumatic brain injury.

Janigro and colleagues Nicola Marchi, Ph.D., of the Cleveland Clinic and Jeffrey Bazarian, M.D., M.P.H., of the Clinical and Translational Science Institute at the University of Rochester Medical Center, published their research on March 6, 2013, in the online journal PLOS ONE.

“And to our surprise a few of the non-concussed players had changes in brain scans and balance tests after the season,” says Janigro, noting that these players had the most openings in the blood-brain barrier.

With further tests, Janigro says he plans to figure out at what blood level of S100B players should stop playing to prevent further brain damage.

He also plans to look at former college football players and retired National Football League players to see whether they have S100B autoantibodies in the brain.

“It’s a matter of brain health,” says Janigro. “We don’t have a good experimental design to look at brain health, other than scans.”

He hopes to use the blood test to point out the risk factors associated with hits to the head as well as a pre-screening tool to narrow down those who may need to go for a brain scan to confirm a brain injury.