3 Lifestyle Choices Lower Breast Cancer Risk

Women who make healthy lifestyle choices lower their risk of developing invasive breast cancer, regardless of whether they have a family history of the disease, according to a new study.

"We have more awareness of our familial risks, and we may be led to believe there's nothing we can do — that it's fate," said study researcher Dr. Robert Gramling, a professor at the University of Rochester in New York. But his study showed "whether or not you have a family history of the disease, engaging in healthy behaviors is beneficial."

Women with a family history of breast cancer had a higher risk than those without, he said, but both groups lowered their risk by a similar proportion by maintaining a healthy lifestyle.

Specifically, the researchers found women who had a family history of breast cancer lowered their risk by about one-fourth by getting regular exercise, limiting their alcohol intake and maintaining a healthy body weight.

Similarly, women without a family history of the disease who followed a healthy lifestyle lowered their risk by about the same amount, Gramling said.

The researchers based their analysis on data from 85,644 postmenopausal women who participated in the Women's Health Initiative, a long-term study launched in 1991 and conducted by the National Institutes of Health. They considered a woman to have a family history of breast cancer if her mother or sister developed the disease after age 45.

Gramling was surprised, he said, that the findings in the two groups were nearly the same.

"It would have been expected that women without a family history of the disease would have lowered their risk," with a healthy lifestyle, he said. That women with a family history of breast cancer lowered their risk by a nearly-identical amount was more unexpected, he said.

In his medical practice, Gramling told MyHealthNewsDaily, he's encountered women who seem to have come to believe there's nothing they can do to lower their risk, but these results show otherwise.

The researchers defined regular exercise as 20 minutes of moderate or vigorous activity at least five times a week, moderate drinking as fewer than seven drinks per week and a healthy body weight as having a body mass index or BMI (a measure of a person's weight in proportion to her height) between 18.5 and 24.9.

The researchers chose to include exercise, BMI and alcohol intake in their definition of a healthy lifestyle, Gramling said, as opposed to other factors such as eating lots of fruits and vegetables, because these criteria have shown the strongest evidence, based on previous studies, of having an impact on one's breast cancer risk.

"Many of us have some family history of a scary disease," Gramling said, "this shouldn't be a barrier to making healthy choices."

The analysis excluded women who had previously had breast cancer, as well as those with a mother or sister who had developed early-onset breast cancer (before age 45), because it was more likely such women have genetic factors that may put them at an even higher risk.

Women who make healthy lifestyle choices lower their risk of developing invasive breast cancer, regardless of whether they have a family history of the disease, according to a new study.

"We have more awareness of our familial risks, and we may be led to believe there's nothing we can do — that it's fate," said study researcher Dr. Robert Gramling, a professor at the University of Rochester in New York. But his study showed "whether or not you have a family history of the disease, engaging in healthy behaviors is beneficial."

Women with a family history of breast cancer had a higher risk than those without, he said, but both groups lowered their risk by a similar proportion by maintaining a healthy lifestyle.

Specifically, the researchers found women who had a family history of breast cancer lowered their risk by about one-fourth by getting regular exercise, limiting their alcohol intake and maintaining a healthy body weight.

Similarly, women without a family history of the disease who followed a healthy lifestyle lowered their risk by about the same amount, Gramling said.

The researchers based their analysis on data from 85,644 postmenopausal women who participated in the Women's Health Initiative, a long-term study launched in 1991 and conducted by the National Institutes of Health. They considered a woman to have a family history of breast cancer if her mother or sister developed the disease after age 45.

Gramling was surprised, he said, that the findings in the two groups were nearly the same.

"It would have been expected that women without a family history of the disease would have lowered their risk," with a healthy lifestyle, he said. That women with a family history of breast cancer lowered their risk by a nearly-identical amount was more unexpected, he said.

In his medical practice, Gramling told MyHealthNewsDaily, he's encountered women who seem to have come to believe there's nothing they can do to lower their risk, but these results show otherwise.

The researchers defined regular exercise as 20 minutes of moderate or vigorous activity at least five times a week, moderate drinking as fewer than seven drinks per week and a healthy body weight as having a body mass index or BMI (a measure of a person's weight in proportion to her height) between 18.5 and 24.9.

The researchers chose to include exercise, BMI and alcohol intake in their definition of a healthy lifestyle, Gramling said, as opposed to other factors such as eating lots of fruits and vegetables, because these criteria have shown the strongest evidence, based on previous studies, of having an impact on one's breast cancer risk.

"Many of us have some family history of a scary disease," Gramling said, "this shouldn't be a barrier to making healthy choices."

The analysis excluded women who had previously had breast cancer, as well as those with a mother or sister who had developed early-onset breast cancer (before age 45), because it was more likely such women have genetic factors that may put them at an even higher risk.

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Vitamin D Deficiency Puts Inflammatory Bowel Disease Patients at Greater Risk of Osteoporosis, Study Finds

ScienceDaily (Oct. 18, 2010) — Vitamin D deficiency puts patients with Inflammatory Bowel Disease (IBD) at greater risk of osteoporosis, osteopenia and an overall higher rate of abnormal bone density, according to the results of a new study unveiled at the American College of Gastroenterology's (ACG) 75th Annual Scientific meeting in San Antonio, Texas.

The study, "Vitamin D Deficiency and Abnormal DEXA Scans in Inflammatory Bowel Disease Patients," found that of the 161 IBD patients in the cohort, reduction in bone density with a diagnosis of osteoporosis or osteopenia was found in 22 percent of these patients, 50 percent of whom were under age 50.

IBD is a fairly common condition affecting more than one million people in the United States. The number of IBD patients is split equally between those with Crohn's disease and those with ulcerative colitis. Children and adults with IBD between the ages of 10 and 70 participated in the prospective study between 2008 and 2010. Vitamin D deficiency was defined as Vitamin D 25‐hydroxy levels less than 30ng/mL. DEXA scan results were considered abnormal if osteopenia and osteoporosis were found.

"IBD patients with an abnormal bone density exam had a significantly higher rate of Vitamin D deficiency than those who had normal DEXA scans," said Dr. Bincy P. Abraham, Assistant Professor of Medicine, Baylor College of Medicine and Director, Baylor Clinic Inflammatory Bowel Disease Program.

Dr. Abraham, who presented the findings, said that previous research has suggested a high prevalence of osteoporosis and overall abnormal bone density in IBD patients that is likely caused by corticosteroid use and excess of inflammatory cytokines, as well as from calcium and Vitamin D malabsorption.

"We aimed to determine the association between Vitamin D deficiency and abnormal bone density in IBD patients," said Dr. Abraham.

According the study, Crohn's disease patients with Vitamin D deficiency were four times more likely to have a higher rate of abnormal bone density exams compared to patients with ulcerative colitis.

"This finding is not surprising since Crohn's disease usually affects the small intestine, which is the part of the gut that absorbs the most nutrients," said Dr. Abraham. "The widespread malabsorption in Crohn's disease does not occur in ulcerative colitis, which involves only the colon."

However, both Crohn's disease and ulcerative colitis patients diagnosed with osteoporosis had a significantly higher rate of Vitamin D deficiency irrespective of prednisone intake, according to the study.

"Abnormal bone density was relatively high among our IBD patients with Vitamin D deficiency irrespective to age, gender or corticosteroid use that would place them at a significantly higher risk of having an abnormal DEXA result," said Dr. Abraham. "It remains important for those caring for IBD patients to evaluate for Vitamin D nutritional deficiency and for its potential consequence of osteopenia or osteoporosis."

ScienceDaily (Oct. 18, 2010) — Vitamin D deficiency puts patients with Inflammatory Bowel Disease (IBD) at greater risk of osteoporosis, osteopenia and an overall higher rate of abnormal bone density, according to the results of a new study unveiled at the American College of Gastroenterology's (ACG) 75th Annual Scientific meeting in San Antonio, Texas.

The study, "Vitamin D Deficiency and Abnormal DEXA Scans in Inflammatory Bowel Disease Patients," found that of the 161 IBD patients in the cohort, reduction in bone density with a diagnosis of osteoporosis or osteopenia was found in 22 percent of these patients, 50 percent of whom were under age 50.

IBD is a fairly common condition affecting more than one million people in the United States. The number of IBD patients is split equally between those with Crohn's disease and those with ulcerative colitis. Children and adults with IBD between the ages of 10 and 70 participated in the prospective study between 2008 and 2010. Vitamin D deficiency was defined as Vitamin D 25‐hydroxy levels less than 30ng/mL. DEXA scan results were considered abnormal if osteopenia and osteoporosis were found.

"IBD patients with an abnormal bone density exam had a significantly higher rate of Vitamin D deficiency than those who had normal DEXA scans," said Dr. Bincy P. Abraham, Assistant Professor of Medicine, Baylor College of Medicine and Director, Baylor Clinic Inflammatory Bowel Disease Program.

Dr. Abraham, who presented the findings, said that previous research has suggested a high prevalence of osteoporosis and overall abnormal bone density in IBD patients that is likely caused by corticosteroid use and excess of inflammatory cytokines, as well as from calcium and Vitamin D malabsorption.

"We aimed to determine the association between Vitamin D deficiency and abnormal bone density in IBD patients," said Dr. Abraham.

According the study, Crohn's disease patients with Vitamin D deficiency were four times more likely to have a higher rate of abnormal bone density exams compared to patients with ulcerative colitis.

"This finding is not surprising since Crohn's disease usually affects the small intestine, which is the part of the gut that absorbs the most nutrients," said Dr. Abraham. "The widespread malabsorption in Crohn's disease does not occur in ulcerative colitis, which involves only the colon."

However, both Crohn's disease and ulcerative colitis patients diagnosed with osteoporosis had a significantly higher rate of Vitamin D deficiency irrespective of prednisone intake, according to the study.

"Abnormal bone density was relatively high among our IBD patients with Vitamin D deficiency irrespective to age, gender or corticosteroid use that would place them at a significantly higher risk of having an abnormal DEXA result," said Dr. Abraham. "It remains important for those caring for IBD patients to evaluate for Vitamin D nutritional deficiency and for its potential consequence of osteopenia or osteoporosis."

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Study makes the case for vegetable juice

A study published in Nutrition Journal has suggested that promotion of vegetable juice could be an effective way of increasing vegetable intake among healthy adults.

A diet rich in vegetables has been associated with lower risk of various health disorders including heart disease and yet the authors of the paper said vegetable consumption in the US has fallen over the past decade.

Working from the nutritional science lab at the University of California, Davis, the scientists therefore sought to determine whether drinking vegetable juice is a practical way of closing the gap between dietary recommendations and vegetable intake. The second research aim was to see how vegetable juice affected cardiovascular health.

To fulfill these objectives, a randomised, controlled study was constructed with 90 volunteers who received 0, 8 or 16 fluid ounces of vegetable juice daily for 12 weeks and were asked to follow the Dietary Approaches to Stop Hypertension (DASH) diet.

Daily vegetable servings with and without the vegetable juice were measured along with heart health parameters including blood pressure

Study results

Without the addition of the juice, the results showed that consumption of vegetable juice was below both dietary guidelines and DASH diet recommendations. This was in spite of the education that the participants received about the DASH diet.

Compared to public health recommendations of 4 servings per day, average vegetable intake for all groups, without counting vegetable juice, was 2.6 servings per day after 6 weeks and 2.3 servings per day after 12 weeks.

But once the vegetable juice was counted, the participants were able to reach the daily recommendations.

The authors concluded from these results that vegetable intake, even in an educated, healthy population, remains lower than recommendations and that adding vegetable juice daily was “an effective and acceptable way for healthy adults to close the dietary vegetable gap.”

Heart health impact

Regarding the secondary aim of the study, the authors said that generally parameters associated with heart health did not change over time. However, participants who were pre-hypertensive at the start of the study showed a significant decrease in blood pressure during the intervention period.

The authors called for more research to be done to explore the health impact of drinking vegetable juice among other at risk subgroups.

Funding for the study was provided by the Campbell Soup Company, which makes V8 vegetable juice, and the UC Davis Center for Health and Nutrition Research.

Source: Nutrition Journal
The use of a commercial vegetable juice as a practical means to increase vegetable intake: a randomized controlled trial
Authors: Sonia F Shenoy, Alexandra G Kazaks, Roberta R Holt, Hsin Ju Chen1, Barbara L Winters, Chor San Khoo, Walker SC Poston, C Keith Haddock, Rebecca S Reeves, John P Foreyt, M Eric Gershwin and Carl L Keen

A study published in Nutrition Journal has suggested that promotion of vegetable juice could be an effective way of increasing vegetable intake among healthy adults.

A diet rich in vegetables has been associated with lower risk of various health disorders including heart disease and yet the authors of the paper said vegetable consumption in the US has fallen over the past decade.

Working from the nutritional science lab at the University of California, Davis, the scientists therefore sought to determine whether drinking vegetable juice is a practical way of closing the gap between dietary recommendations and vegetable intake. The second research aim was to see how vegetable juice affected cardiovascular health.

To fulfill these objectives, a randomised, controlled study was constructed with 90 volunteers who received 0, 8 or 16 fluid ounces of vegetable juice daily for 12 weeks and were asked to follow the Dietary Approaches to Stop Hypertension (DASH) diet.

Daily vegetable servings with and without the vegetable juice were measured along with heart health parameters including blood pressure

Study results

Without the addition of the juice, the results showed that consumption of vegetable juice was below both dietary guidelines and DASH diet recommendations. This was in spite of the education that the participants received about the DASH diet.

Compared to public health recommendations of 4 servings per day, average vegetable intake for all groups, without counting vegetable juice, was 2.6 servings per day after 6 weeks and 2.3 servings per day after 12 weeks.

But once the vegetable juice was counted, the participants were able to reach the daily recommendations.

The authors concluded from these results that vegetable intake, even in an educated, healthy population, remains lower than recommendations and that adding vegetable juice daily was “an effective and acceptable way for healthy adults to close the dietary vegetable gap.”

Heart health impact

Regarding the secondary aim of the study, the authors said that generally parameters associated with heart health did not change over time. However, participants who were pre-hypertensive at the start of the study showed a significant decrease in blood pressure during the intervention period.

The authors called for more research to be done to explore the health impact of drinking vegetable juice among other at risk subgroups.

Funding for the study was provided by the Campbell Soup Company, which makes V8 vegetable juice, and the UC Davis Center for Health and Nutrition Research.

Source: Nutrition Journal
The use of a commercial vegetable juice as a practical means to increase vegetable intake: a randomized controlled trial
Authors: Sonia F Shenoy, Alexandra G Kazaks, Roberta R Holt, Hsin Ju Chen1, Barbara L Winters, Chor San Khoo, Walker SC Poston, C Keith Haddock, Rebecca S Reeves, John P Foreyt, M Eric Gershwin and Carl L Keen

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Cyclosporine in Cats

Katayama M, Katayama R, Kamishina H: Effects of multiple oral dosing of itraconazole on the pharmacokinetics of cyclosporine in cats, Journal of Feline Medicine & Surgery 12:512, 2010.

Renal transplantation has been considered as one possible therapeutic option for cats with end stage kidney failure. Cyclosporine (CsA) has been used as a core immunosuppressive drug in preventing acute allograft rejection in cats. Three male cats were studied to see if the co-administration of itraconazole (Icz) with CsA resulted in significant increases of oral availability of CsA. It was found that the use of itraconazole reduces the dosage required as well as the administration frequency of cyclosporine (from twice daily to once daily). [VT]

Related articles:
Schmiedt CW, Grimes JA, Holzman G et al: Incidence and risk factors for development of malignant neoplasia after feline renal transplantation and cyclosporine-based immunosuppression, Vet Comp Oncol 7:45, 2009.

More on cat health: Winn Feline Foundation Library
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Katayama M, Katayama R, Kamishina H: Effects of multiple oral dosing of itraconazole on the pharmacokinetics of cyclosporine in cats, Journal of Feline Medicine & Surgery 12:512, 2010.

Renal transplantation has been considered as one possible therapeutic option for cats with end stage kidney failure. Cyclosporine (CsA) has been used as a core immunosuppressive drug in preventing acute allograft rejection in cats. Three male cats were studied to see if the co-administration of itraconazole (Icz) with CsA resulted in significant increases of oral availability of CsA. It was found that the use of itraconazole reduces the dosage required as well as the administration frequency of cyclosporine (from twice daily to once daily). [VT]

Related articles:
Schmiedt CW, Grimes JA, Holzman G et al: Incidence and risk factors for development of malignant neoplasia after feline renal transplantation and cyclosporine-based immunosuppression, Vet Comp Oncol 7:45, 2009.

More on cat health: Winn Feline Foundation Library
Join us on Facebook
Follow us on Twitter

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Health In Your Hands – Scoliosis Exercises for Prevention and Correction DVD

The Health In Your Hands DVD is a careful selection of exercises that you can do to reverse scoliosis in the comfort of your own home.

Broken down into three easy-to-digest sections, the DVD will take you through the various steps in order to start rebuilding and rebalancing your spine and its surrounding muscles and ligaments. The comprehensive sections cover everything from Body Balancing Stretches to Building Your Core and a number of different Body Alignment Exercises that have all been carefully designed and selected by Dr Kevin Lau.

Presented in a unique and accessible way, the DVD covers all areas of non-surgical intervention in the treatment of scoliosis in order to cure you permanently. The exercises in the DVD are tried and tested by qualified personal trainers, explained in the informative and insightful voice over of Dr Kevin Lau, who guides you to a straighter spine.

For anyone who suffers scoliosis, the main advantages of the DVD are:

•    It gives a 60-minute concise expansion of Dr Lau’s book by the same name, Health In Your Hands: Your Plan for Natural Scoliosis Prevention and Treatment.
•    The Body Balancing section in the DVD explains in detail the correct stretching techniques for scoliosis sufferers.
•    The Building Your Core section focuses on strengthening the muscles that give stability to your spine. Incorporating these core exercises in your daily routine will support and stabilise both your spine and your pelvis area
•    The last section, Body Alignment Exercises will ensure overall repositioning of your spine.
•    All the exercises that feature in the DVD are suitable for pre and post-operative rehabilitation for scoliosis conditions
•    All exercises covered in the Health In Your Hands DVD can be practiced at home, and with no special equipment required other than an exercise ball.

The Health In Your Hands DVD is a careful selection of exercises that you can do to reverse scoliosis in the comfort of your own home.

Broken down into three easy-to-digest sections, the DVD will take you through the various steps in order to start rebuilding and rebalancing your spine and its surrounding muscles and ligaments. The comprehensive sections cover everything from Body Balancing Stretches to Building Your Core and a number of different Body Alignment Exercises that have all been carefully designed and selected by Dr Kevin Lau.

Presented in a unique and accessible way, the DVD covers all areas of non-surgical intervention in the treatment of scoliosis in order to cure you permanently. The exercises in the DVD are tried and tested by qualified personal trainers, explained in the informative and insightful voice over of Dr Kevin Lau, who guides you to a straighter spine.

For anyone who suffers scoliosis, the main advantages of the DVD are:

•    It gives a 60-minute concise expansion of Dr Lau’s book by the same name, Health In Your Hands: Your Plan for Natural Scoliosis Prevention and Treatment.
•    The Body Balancing section in the DVD explains in detail the correct stretching techniques for scoliosis sufferers.
•    The Building Your Core section focuses on strengthening the muscles that give stability to your spine. Incorporating these core exercises in your daily routine will support and stabilise both your spine and your pelvis area
•    The last section, Body Alignment Exercises will ensure overall repositioning of your spine.
•    All the exercises that feature in the DVD are suitable for pre and post-operative rehabilitation for scoliosis conditions
•    All exercises covered in the Health In Your Hands DVD can be practiced at home, and with no special equipment required other than an exercise ball.

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Feline Orofacial Pain Syndrome

Rusbridge C, Heath S, Gunn-Moore DA et al: Feline orofacial pain syndrome (FOPS): a retrospective study of 113 cases, Journal of Feline Medicine & Surgery 12:498, 2010.

Feline orofacial pain syndrome (FOPS) is a pain disorder of cats with behavioral signs of oral discomfort and tongue mutilation. Affected cats commonly present with exaggerated licking and chewing movement, and pawing at the mouth that is episodic. Discomfort seems to be confined to one side of the mouth and lips. Diagnosis is by a process of elimination of other causes of oral pain. This study describes the syndrome in 113 cats including 100 Burmese in the United Kingdom. FOPS is suspected of being a neuropathic pain event. The predominance in the Burmese breed suggests an inherited disorder. The disorder is often recurrent and may with time become unremitting. Twelve percent of cases in this study were euthanized as a consequence of the problem. Sensitization of trigeminal nerve endings as the result of oral disease or tooth eruption appears to be an important trigger factor in the etiology. External situations causing anxiety also influenced the disease in 20% of cats. Identification of social incompatibility in a multi-cat household is a key step. FOPS appears not to respond well to traditional analgesics and some cases respond more successfully to anti-convulsants with an analgesic effect. Phenobarbital is considered a reasonable first choice for treatment.  [VT]

Related articles:
Heath S, Rusbridge C, Johnson N et al: Orofacial pain syndrome in cats, Vet Rec 149:660, 2001.

More on cat health: Winn Feline Foundation Library
Join us on Facebook
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Rusbridge C, Heath S, Gunn-Moore DA et al: Feline orofacial pain syndrome (FOPS): a retrospective study of 113 cases, Journal of Feline Medicine & Surgery 12:498, 2010.

Feline orofacial pain syndrome (FOPS) is a pain disorder of cats with behavioral signs of oral discomfort and tongue mutilation. Affected cats commonly present with exaggerated licking and chewing movement, and pawing at the mouth that is episodic. Discomfort seems to be confined to one side of the mouth and lips. Diagnosis is by a process of elimination of other causes of oral pain. This study describes the syndrome in 113 cats including 100 Burmese in the United Kingdom. FOPS is suspected of being a neuropathic pain event. The predominance in the Burmese breed suggests an inherited disorder. The disorder is often recurrent and may with time become unremitting. Twelve percent of cases in this study were euthanized as a consequence of the problem. Sensitization of trigeminal nerve endings as the result of oral disease or tooth eruption appears to be an important trigger factor in the etiology. External situations causing anxiety also influenced the disease in 20% of cats. Identification of social incompatibility in a multi-cat household is a key step. FOPS appears not to respond well to traditional analgesics and some cases respond more successfully to anti-convulsants with an analgesic effect. Phenobarbital is considered a reasonable first choice for treatment.  [VT]

Related articles:
Heath S, Rusbridge C, Johnson N et al: Orofacial pain syndrome in cats, Vet Rec 149:660, 2001.

More on cat health: Winn Feline Foundation Library
Join us on Facebook
Follow us on Twitter

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Your child and scoliosis

Scoliosis is a fixed lateral curvature of the spine. Frequently noted in adolescents, it is often picked up in "school screening" where a nurse evalautes a childs aligjnment on a forward bend test, and a note is sent home that the child needs evaluation for scoliosis. There are a number of causes of scoliosis and the natural history and treatment differ depending on the cause. Thus, it is important to understand the cause of your child's scoliosis before embarking on a treatment.

Scoliosis may be caused by severe muscle weakness (such as in muscular dystrophy), neurological abnormalities (such as cerebral palsy), spinal cord abnormalities (such as a syrinx which is an abnormal fluid filled cavity within the spinal cord), or congenital abnormalities in the way the bones of the spine are put together (referred to as "congenital scoliosis"). Finally, the most common cause of scoliosis is termed "idiopathic," meaning that the cause is "peculiar to the individual." Approximately 80% of scoliosis that comes into a physician's office is "idiopathic," and only about 30% of these idiopathic curves progress (get worse).

Because there are different types of scoliosis, the behavior and problems that result differ dependent on the cause. For instance, the curvature that occurs in severe cerebral palsy occurs in the lower spine (thoraco-lumbar or lumbar curves) that cause difficulty sitting and may result in pain. However, they do not generally cause problems with the heart or lungs.

While the causes of idiopathic scoliosis remain elusive, there are a number of things that we do know about it. Idiopathic scoliosis can run in families and thus there is some genetic influence. While the gene (or more likely, genes) involved have yet to be defined, we are likely to have a much better understanding of the inheritance of scoliosis soon. There are some patients that have subtle neurological abnormalities, such as abnormal perception of horizontal or abnormal nystagmus (the little flicker that the eyes make when they move side to side). It is unclear if these are a cause of idiopathic scoliosis or a result of the curve. In the future, we may find that "idiopathic" scoliosis is actually a number of different diseases, each of which has its own natural history.

It is also important to recognize that idiopathic curves behave differently depending on their location, the patient's age, and the size of the curve. Curves in the thoracic (chest) region are the most common. They generally result

in a narrowing of the chest wall (a result of rotation of the vertebral body and resulting deformity of the ribs). If the curve is small (less then 40 degrees) by the time the child reaches skeletal maturity, it is not likely to worsen as an adult. Generally, once the thoracic curve gets over 50 degrees, it is like the Leaning Tower of Pisa, and will continue to worsen with time, potentially resulting in problems with the heart and lungs.Thus, if a thoracic curve reaches 50 degrees or more, most surgeons would recommend that the patient undergo surgery to prevent further worsening

Scoliosis is a fixed lateral curvature of the spine. Frequently noted in adolescents, it is often picked up in "school screening" where a nurse evalautes a childs aligjnment on a forward bend test, and a note is sent home that the child needs evaluation for scoliosis. There are a number of causes of scoliosis and the natural history and treatment differ depending on the cause. Thus, it is important to understand the cause of your child's scoliosis before embarking on a treatment.

Scoliosis may be caused by severe muscle weakness (such as in muscular dystrophy), neurological abnormalities (such as cerebral palsy), spinal cord abnormalities (such as a syrinx which is an abnormal fluid filled cavity within the spinal cord), or congenital abnormalities in the way the bones of the spine are put together (referred to as "congenital scoliosis"). Finally, the most common cause of scoliosis is termed "idiopathic," meaning that the cause is "peculiar to the individual." Approximately 80% of scoliosis that comes into a physician's office is "idiopathic," and only about 30% of these idiopathic curves progress (get worse).

Because there are different types of scoliosis, the behavior and problems that result differ dependent on the cause. For instance, the curvature that occurs in severe cerebral palsy occurs in the lower spine (thoraco-lumbar or lumbar curves) that cause difficulty sitting and may result in pain. However, they do not generally cause problems with the heart or lungs.

While the causes of idiopathic scoliosis remain elusive, there are a number of things that we do know about it. Idiopathic scoliosis can run in families and thus there is some genetic influence. While the gene (or more likely, genes) involved have yet to be defined, we are likely to have a much better understanding of the inheritance of scoliosis soon. There are some patients that have subtle neurological abnormalities, such as abnormal perception of horizontal or abnormal nystagmus (the little flicker that the eyes make when they move side to side). It is unclear if these are a cause of idiopathic scoliosis or a result of the curve. In the future, we may find that "idiopathic" scoliosis is actually a number of different diseases, each of which has its own natural history.

It is also important to recognize that idiopathic curves behave differently depending on their location, the patient's age, and the size of the curve. Curves in the thoracic (chest) region are the most common. They generally result

in a narrowing of the chest wall (a result of rotation of the vertebral body and resulting deformity of the ribs). If the curve is small (less then 40 degrees) by the time the child reaches skeletal maturity, it is not likely to worsen as an adult. Generally, once the thoracic curve gets over 50 degrees, it is like the Leaning Tower of Pisa, and will continue to worsen with time, potentially resulting in problems with the heart and lungs.Thus, if a thoracic curve reaches 50 degrees or more, most surgeons would recommend that the patient undergo surgery to prevent further worsening

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