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Thursday, May 5, 2011

Does Soda Cause Gout?

Sugary sodas have recently been implicated in everything from obesity to high blood pressure. But if you’re worried about gout, it may be especially important to steer clear of the sweet stuff.

Ongoing research has examined the relationship between rising soft drink consumption and an increase in gout. Consider this: The number of people with gout back in the 1970s was 20 per 100,000. By the mid-1990s, that number had more than doubled to 45.9 per 100,000. Likewise, soda consumption among adults rose by 61 percent from 1977 to 1997.

This link between soda intake and gout makes sense since the "source of almost all of the sweetness in sugary drinks comes from fructose — and fructose elevates uric acid levels, [leading to] gout," explains Hyon Choi, MD, DrPH, clinical associate professor of medicine in the rheumatology section at Boston University School of Medicine. Dr. Choi also points out that fructose is used to make high-fructose corn syrup, a substance commonly used to sweeten many foods and beverages besides soda.

Soda and Gout: The Link

Uric acid is usually filtered by the kidneys and excreted from your body in your urine. Gout occurs when uric acid builds up in the blood, causing uric acid crystals to form in one or more joints and leading to intense pain and swelling. There are a number of factors that can cause elevated uric acid levels, including heavy fructose consumption.

Choi's research has shown that study participants who consumed two or more servings of sugar- or fructose-sweetened soda each day had an 85 percent increased risk of developing gout, compared with participants who consumed less than one serving of sugary soda per month. Even sugary fruit juice, such as orange juice, raises the risk.

If diet soda is your vice, you may not have to worry as much about developing gout. "With diet soda, we did not find the association," Choi says.

Choi and his colleagues did find a slight increase in gout risk with consuming high-fructose fruits, such as apples and oranges. However, Choi emphasizes, artificially added fructose found in soda is linked to a higher risk of gout than naturally occurring sources of fructose like fruit.

Soda and Gout: What This Means for You

Traditionally, gout prevention strategies have focused on limiting protein-rich foods and alcohol, which can encourage uric acid accumulation in the body. This new research, however, suggests that cutting back on soda consumption may be just as important in preventing future gout attacks.

Also keep in mind that in the United States, the biggest single source of calories is soda sweetened with sugar or fructose. This means that beyond reducing your risk of developing gout, avoiding the empty calories in soda may also help you shed excess weight and keep your blood sugar levels in check. So instead of reaching for another soda or sugar-sweetened drink at your next meal, opt for water instead — your joints will thank you.
Sugary sodas have recently been implicated in everything from obesity to high blood pressure. But if you’re worried about gout, it may be especially important to steer clear of the sweet stuff.

Ongoing research has examined the relationship between rising soft drink consumption and an increase in gout. Consider this: The number of people with gout back in the 1970s was 20 per 100,000. By the mid-1990s, that number had more than doubled to 45.9 per 100,000. Likewise, soda consumption among adults rose by 61 percent from 1977 to 1997.

This link between soda intake and gout makes sense since the "source of almost all of the sweetness in sugary drinks comes from fructose — and fructose elevates uric acid levels, [leading to] gout," explains Hyon Choi, MD, DrPH, clinical associate professor of medicine in the rheumatology section at Boston University School of Medicine. Dr. Choi also points out that fructose is used to make high-fructose corn syrup, a substance commonly used to sweeten many foods and beverages besides soda.

Soda and Gout: The Link

Uric acid is usually filtered by the kidneys and excreted from your body in your urine. Gout occurs when uric acid builds up in the blood, causing uric acid crystals to form in one or more joints and leading to intense pain and swelling. There are a number of factors that can cause elevated uric acid levels, including heavy fructose consumption.

Choi's research has shown that study participants who consumed two or more servings of sugar- or fructose-sweetened soda each day had an 85 percent increased risk of developing gout, compared with participants who consumed less than one serving of sugary soda per month. Even sugary fruit juice, such as orange juice, raises the risk.

If diet soda is your vice, you may not have to worry as much about developing gout. "With diet soda, we did not find the association," Choi says.

Choi and his colleagues did find a slight increase in gout risk with consuming high-fructose fruits, such as apples and oranges. However, Choi emphasizes, artificially added fructose found in soda is linked to a higher risk of gout than naturally occurring sources of fructose like fruit.

Soda and Gout: What This Means for You

Traditionally, gout prevention strategies have focused on limiting protein-rich foods and alcohol, which can encourage uric acid accumulation in the body. This new research, however, suggests that cutting back on soda consumption may be just as important in preventing future gout attacks.

Also keep in mind that in the United States, the biggest single source of calories is soda sweetened with sugar or fructose. This means that beyond reducing your risk of developing gout, avoiding the empty calories in soda may also help you shed excess weight and keep your blood sugar levels in check. So instead of reaching for another soda or sugar-sweetened drink at your next meal, opt for water instead — your joints will thank you.
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Tuesday, May 3, 2011

Pain Assessment in Cats


The importance of treating pain in cats has received more attention in recent years. There has been an inherent difficulty in identifying and quantifying the intensity of pain in cats due to the lack of available and validated pain assessment tools for this species. This could lead to veterinary practitioners providing less than adequate levels of pain relief. Reliability and validity of scoring systems are vital for use in recognizing pain, quantifying pain intensity, and evaluating treatment effectiveness. The purpose of this study was to refine and test construct validity and reliability of a composite pain scale used for assessing acute postoperative pain in 40 cats undergoing ovariohysterectomy. In a randomized, double-blind study cats received a placebo or an analgesic (tramadol, vedaprofen, or tramadol-vedaprofen combination). Respiratory rate and respiratory pattern were rejected after item analysis. Five dimensions were analyzed – F1 [psychomotor change], posture, comfort, activity, mental status, and miscellaneous behaviors; F2 [protection of wound area], reaction to palpation of the surgical wound and palpation of the abdomen and flank; F3 [physiologic variables], systolic arterial blood pressure and appetite; F4 [vocal expression of pain], vocalization; and F5 [heart rate]. Results indicated internal consistency was excellent for the overall scale and for F1, F2, and F3, very good for F4, and unacceptable for F5. Therefore, there is initial evidence of the construct validity and reliability of a multidimensional composite pain scale for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy. [VT]

Related articles:

More on cat health: Winn Feline Foundation Library

The importance of treating pain in cats has received more attention in recent years. There has been an inherent difficulty in identifying and quantifying the intensity of pain in cats due to the lack of available and validated pain assessment tools for this species. This could lead to veterinary practitioners providing less than adequate levels of pain relief. Reliability and validity of scoring systems are vital for use in recognizing pain, quantifying pain intensity, and evaluating treatment effectiveness. The purpose of this study was to refine and test construct validity and reliability of a composite pain scale used for assessing acute postoperative pain in 40 cats undergoing ovariohysterectomy. In a randomized, double-blind study cats received a placebo or an analgesic (tramadol, vedaprofen, or tramadol-vedaprofen combination). Respiratory rate and respiratory pattern were rejected after item analysis. Five dimensions were analyzed – F1 [psychomotor change], posture, comfort, activity, mental status, and miscellaneous behaviors; F2 [protection of wound area], reaction to palpation of the surgical wound and palpation of the abdomen and flank; F3 [physiologic variables], systolic arterial blood pressure and appetite; F4 [vocal expression of pain], vocalization; and F5 [heart rate]. Results indicated internal consistency was excellent for the overall scale and for F1, F2, and F3, very good for F4, and unacceptable for F5. Therefore, there is initial evidence of the construct validity and reliability of a multidimensional composite pain scale for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy. [VT]

Related articles:

More on cat health: Winn Feline Foundation Library
Read More


Monday, May 2, 2011

Chiropractic Management of Pain in a Young Scoliosis Patient

By Nancy Martin-Molina, DC, QME, MBA
Case History
The patient is a 14-year-old girl with a recent diagnosis of scoliosis received on medical referral.

She reports her actual pain onset started at menarche around 11-12 years of age, worsening in the past 6-9 months, during which time she underwent a growth spurt.  Written parental consent is obtained and an initial evaluation is provided with radiographic spinal record review performed. She hand-carried her medical radiograph report, dated six months prior.
The patient's complaint on pain drawing is neck / mid-back / low back / midline; the pain level was rated as a 6-7/10; severe on a scale of 1-10 with 10 being severe pain with moderate interference in activities of daily living. The quality of the pain is as follows: aches at suboccipital to upper dorsal, stabbing intrascapular, aches low back. Provocative: daily ADL. Palliative: nothing; mother has tried administering Tylenol. Source: oral history and pain.
Evaluation & Findings
Clinical evaluation showed a tall, thin female with significant right convex kyphoscoliosis, left convex lumbar with hyperlordosis, and generalized weakness, especially around the pelvic and shoulder girdles. Spinal listings detected at vertebral levels C2/3, T4/T5, L3 and PSI. Allis testing was negative for femoral shortening. Measurements: Umbilicus to medial knee: L 23," R 23." Sensation is normal on light touch and to vibration and light prick. Negative Romberg. Tandem gait intact. Coordination is normal on heel-shin, finger-nose and rapid alternating.
Radiological views submitted from outside imaging included posterior and lateral projected views of thoracolumbar; revealed 12-degree dextroscoliosis with apex at T10-11, Levoscoliosis of lumbar spine with apex at L3-L4.
Treatment Plan
I discussed my findings in detail with the patient and parent utilizing charts and diagrams. I recommended that the mother purchase a gym ball; they are available in most retail outlets for home use and assist in maintaining normal flexibility in a scoliotic spine.
The frequency of radiographic monitoring is also important for achieving maximal correction. We are now recommending routine radiographs every six months to monitor for any curvature progression beyond its current degrees. Should a rapid increase in curvature or decrease in flexibility occur, a neurological referral may be indicated. (Most often, curvatures of this type do not involve the viscera, but may in the event of any growth spurts; it may progress before full skeletal maturation occurs.)
I also discussed the importance of good posture and continuity of exercises designed for curve flexibility. As the patient is a typical young female teenager overtly concerned with body image, I warned against performing any abdominal exercises whereby both the psoas muscle and the back arching come into play. I also instructed on a particular order of abdominal muscle sequencing: lower abdominal work before upper abdominal work, and oblique abdominal work before straight abdominal work.
Medical IPA authorization from the medical director approved chiropractic manipulation at a frequency of 2-3 times/week for 4-6 weeks since spinal manipulation was not felt to be contraindicated. The patient reported a subjective pain reduction of 75 percent. This is a recognized and common response to chiropractic in that like any other joint, the motor segment may become locked. This is usually associated with pain. The patient was discharged after 18 sessions with good response and scheduled for follow-up in six months.
By Nancy Martin-Molina, DC, QME, MBA
Case History
The patient is a 14-year-old girl with a recent diagnosis of scoliosis received on medical referral.

She reports her actual pain onset started at menarche around 11-12 years of age, worsening in the past 6-9 months, during which time she underwent a growth spurt.  Written parental consent is obtained and an initial evaluation is provided with radiographic spinal record review performed. She hand-carried her medical radiograph report, dated six months prior.
The patient's complaint on pain drawing is neck / mid-back / low back / midline; the pain level was rated as a 6-7/10; severe on a scale of 1-10 with 10 being severe pain with moderate interference in activities of daily living. The quality of the pain is as follows: aches at suboccipital to upper dorsal, stabbing intrascapular, aches low back. Provocative: daily ADL. Palliative: nothing; mother has tried administering Tylenol. Source: oral history and pain.
Evaluation & Findings
Clinical evaluation showed a tall, thin female with significant right convex kyphoscoliosis, left convex lumbar with hyperlordosis, and generalized weakness, especially around the pelvic and shoulder girdles. Spinal listings detected at vertebral levels C2/3, T4/T5, L3 and PSI. Allis testing was negative for femoral shortening. Measurements: Umbilicus to medial knee: L 23," R 23." Sensation is normal on light touch and to vibration and light prick. Negative Romberg. Tandem gait intact. Coordination is normal on heel-shin, finger-nose and rapid alternating.
Radiological views submitted from outside imaging included posterior and lateral projected views of thoracolumbar; revealed 12-degree dextroscoliosis with apex at T10-11, Levoscoliosis of lumbar spine with apex at L3-L4.
Treatment Plan
I discussed my findings in detail with the patient and parent utilizing charts and diagrams. I recommended that the mother purchase a gym ball; they are available in most retail outlets for home use and assist in maintaining normal flexibility in a scoliotic spine.
The frequency of radiographic monitoring is also important for achieving maximal correction. We are now recommending routine radiographs every six months to monitor for any curvature progression beyond its current degrees. Should a rapid increase in curvature or decrease in flexibility occur, a neurological referral may be indicated. (Most often, curvatures of this type do not involve the viscera, but may in the event of any growth spurts; it may progress before full skeletal maturation occurs.)
I also discussed the importance of good posture and continuity of exercises designed for curve flexibility. As the patient is a typical young female teenager overtly concerned with body image, I warned against performing any abdominal exercises whereby both the psoas muscle and the back arching come into play. I also instructed on a particular order of abdominal muscle sequencing: lower abdominal work before upper abdominal work, and oblique abdominal work before straight abdominal work.
Medical IPA authorization from the medical director approved chiropractic manipulation at a frequency of 2-3 times/week for 4-6 weeks since spinal manipulation was not felt to be contraindicated. The patient reported a subjective pain reduction of 75 percent. This is a recognized and common response to chiropractic in that like any other joint, the motor segment may become locked. This is usually associated with pain. The patient was discharged after 18 sessions with good response and scheduled for follow-up in six months.
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Scoliosis Prevalence Increases With Age

The prevalence of scoliosis increases with advancing age, with a higher prevalence in whites, according to a study published in the April 20 issue of Spine.

THURSDAY, April 28 (HealthDay News) -- The prevalence of scoliosis increases with advancing age, with a higher prevalence in whites, according to a study published in the April 20 issue of Spine.
Khaled M. Kebaish, M.D., from Johns Hopkins University in Baltimore, and colleagues examined the prevalence of lumbar scoliosis in adults aged 40 years or older; the association between prevalence of lumbar scoliosis and age, race, and gender; and whether these factors affect curve severity. The presence of scoliosis, defined by a curvature greater than or equal to 11.0 degrees, was ascertained by digitally measuring Cobb angles using dual-energy X-ray absorptiometry lumbar spine images of 2,973 patients without a history of previous lumbar spinal surgery.

The investigators identified scoliosis in 263 individuals. A higher prevalence of scoliosis was related to age (40 to 50 years old, 3.14 percent; ≥90 years old, 50 percent), and varied among races (11.11 percent in whites, 6.49 percent in African-Americans). There was no association between the prevalence of scoliosis and gender. Curve severity was mild in most patients (80.6 percent), with no variation due to gender or age. African-Americans were more likely than other races to have mild curves (94.3 percent).

"The prevalence of scoliosis in our patients ≥40 years old was 8.85 percent and was associated with age and race, but not with gender. Most curves in our population were mild; curve severity was associated with race but not with age or gender," the authors write.
The prevalence of scoliosis increases with advancing age, with a higher prevalence in whites, according to a study published in the April 20 issue of Spine.

THURSDAY, April 28 (HealthDay News) -- The prevalence of scoliosis increases with advancing age, with a higher prevalence in whites, according to a study published in the April 20 issue of Spine.
Khaled M. Kebaish, M.D., from Johns Hopkins University in Baltimore, and colleagues examined the prevalence of lumbar scoliosis in adults aged 40 years or older; the association between prevalence of lumbar scoliosis and age, race, and gender; and whether these factors affect curve severity. The presence of scoliosis, defined by a curvature greater than or equal to 11.0 degrees, was ascertained by digitally measuring Cobb angles using dual-energy X-ray absorptiometry lumbar spine images of 2,973 patients without a history of previous lumbar spinal surgery.

The investigators identified scoliosis in 263 individuals. A higher prevalence of scoliosis was related to age (40 to 50 years old, 3.14 percent; ≥90 years old, 50 percent), and varied among races (11.11 percent in whites, 6.49 percent in African-Americans). There was no association between the prevalence of scoliosis and gender. Curve severity was mild in most patients (80.6 percent), with no variation due to gender or age. African-Americans were more likely than other races to have mild curves (94.3 percent).

"The prevalence of scoliosis in our patients ≥40 years old was 8.85 percent and was associated with age and race, but not with gender. Most curves in our population were mild; curve severity was associated with race but not with age or gender," the authors write.
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