Below are featured articles on the following topics by AIM providers:

• Understanding Hair Loss / Alopecia

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Understanding Hair Loss / Alopecia

More than half of men and women in the United States experience hair loss. About 30% of people have hair loss by age 30 years, and about 50% have hair loss by age 50 years. Hair loss is so common that most of the time it is considered a normal variation and not a disease. In general, most hair loss is not associated with systemic or internal disease. Under normal conditions, scalp hairs live for about three years; then they enter the resting phase. It is therefore normal to lose about 100 hairs every day. Common causes of hair loss are male pattern baldness, thyroid disease, iron deficiency, high fever, medications, stress, sudden weight loss, surgery, chemotherapy, childbirth. Some conditions produce small areas of hair loss, while others affect large areas of the scalp.
Alopecia areata: A common condition, alopecia areata usually starts as a single, quarter-sized circle of perfectly smooth baldness. Alopecia patches usually regrow in three to six months without treatment. Sometimes, hair grows back in white. Alopecia areata is considered an autoimmune condition, in which the body attacks itself (in this case its own hair follicles). Most alopecia patients, however, do not have systemic problems and need no medical tests. Treatments for alopecia areata include injecting steroids into affected patches to stimulate hair growth.
Traction alopecia: Tight braids and ponytails can pull hard enough on hairs to make them fall out. If this happens, it's best to choose hairstyles that put less pressure on hair roots.
Trichotillomania: This is a habit of pulling at hairs or twisting them, sometimes without realizing it.
Tinea capitis (fungal infection): Fungal infection of the scalp for the most part affects school-age children. Bald spots usually show broken-off hairs.
Androgenetic alopecia (male-pattern baldness): Doctors refer to common baldness as "androegentic alopecia," which implies that a combination of hormones and heredity (genetics) is needed to develop the condition.
What treatments are there for hair loss in men?
Many conditioners, shampoos, vitamins, and other products claim to help hair grow in some unspecified way. These are harmless but useless. To slow down hair loss, there are two basic options:
Minoxidil (brand name: Rogaine): This topical application is over-the-counter, no prescription is required. It works best on the crown, less on the frontal region. Available as a 2% solution, Rogaine may grow a little hair, but is better at holding onto what's still there. There are few side effects with Rogaine. The main problem with this treatment is the need to keep applying it twice a day, and most men get tired of it after a while. In addition, Minoxidil works less well on the front of the head, which is where baldness bothers most men. This drug also comes in a higher strength, 5%, which may be a bit more effective.
Finasteride (brand name: Propecia): This is a lower-dose version of a drug that shrinks prostates in middle-aged men. Propecia is by prescription and is taken once a day. Propecia does grow and thicken hair to some extent, but its main use is to keep hair that's still there. It's therefore best for men who still have enough hair to retain. One side effect is impotence, but this is no more common than it is in the general population, and is reversible when the drug is stopped. There's also the cost, about $60/month, not reimbursed by most health insurers.
What treatments are there for hair loss in women?
Ask your doctor about minoxidil (the generic name for Rogaine). This is over-the-counter and available in 2% and 5% concentrations. It's something of a nuisance to apply, but it helps conserve hair and may even grow some. Propecia is a drug that helps men retain their hair. It is unsafe for women of childbearing age to take this drug, or even handle tablets. Propecia is safe for older women but not very effective; newer studies suggest that it might be somewhat helpful and may be worth considering. Surgical procedures like hair transplants can be useful for some women.
What are other options for hair loss?
Hairpieces, etc.: Among the time-honored ways to add hair temporarily are hairpieces or hair weaving, in which a mesh is attached to your remaining hair and artificial or human hair of similar color and texture is woven with existing hair.
Surgery: Surgical approaches include various versions of hair transplantation (taking hair from the back and putting it near the front) or scalp reduction (cutting away bald areas and stitching the rest together). Transplant procedures have improved greatly in recent years. They can produce much more attractive and natural-looking results. When considering a hair transplant, check the surgeon's credentials and experience carefully.

- Diliana Panova, MD

If your group

needs a speaker

to address health topics

contact

MaryJaneHolt@aol.com

or

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Frequently Overlooked Vitamin Deficiency

The elegant 76 year old had spent the last 10 years totally disabled in a wheelchair. Yet, at every encounter, she made you feel like a dear friend and the joy of our Lord was always on her lips, in spite of, or perhaps because of..., the challenges she faced. We always ended our visits in prayer. Though I suspect she is now dancing on both legs with Jesus... I will miss her!

One triumph we shared was when Ella’s (not her real name) easy bruising cleared up after I increased her Vitamin C to 1000 mg twice a day. Unexpectedly she also became more alert and chipper. We had decided to check Vitamin C levels when it was learned that some of her routine medications blocked the absorption of Vitamin C. It thrilled me when she called me with the praise report to tell me she could not believe the difference she felt with the Vitamin C.  

Vitamin deficiency is frequently overlooked and discounted by many professionals; perhaps they are overwhelmed with the work loads practitioners endure since HMOs rule our world. Vitamin deficiency can wreak havoc on the way you feel, not only because of muscle aches, depression, and bruising, but also because of energy levels and endurance.  

Since Ella’s case, there have been nearly 30 other people who actually have had scurvy here in Fayette County. Seventy percent of our patients also have been found to be Vitamin D deficient. Vitamin D deficiency can cause leg pain, osteoporosis and hearing loss. We also know now that with Vitamin D levels greater than 50 ng/ml, there is decreased risk of breast cancer and diabetes. 

What makes matters worse: several of the medicines that are considered routine (for an internist) such as high blood pressure medications, cholesterol medications, diabetic medications, female hormones, antibiotics, and antacids can block the absorption of a variety of nutrients. For example, many cholesterol medications block co-enzyme Q10 which can cause leg pain, a weakened immune system and decreased energy. Decreased calcium can cause not only osteoporosis, but also seizures. Decreased zinc can cause loss of hair, dermatitis (dry itchy skin), as well as increased risk of infection.

Be sure you are exercising regularly and getting the correct amount of vitamins and minerals. If you are taking a medication that can cause decreased absorption of certain vitamins be aware of the symptoms you can develop. For instance, Vitamin K and Coumadin taken together without supervision can be life-threatening. Therefore it would be wise to consult your doctor before adding any vitamins to your daily health regimen.

Ella's quality of life was enhanced when we adjusted her Vitamin intake and I truly enjoyed my time with her! As you consider what vitamin and mineral supplements you might need, keep in mind that eating five or six fruits and vegetables a day is still the best way to get the proper amount of vitamins.

 - Coral Benge, PA-C

Always be willing

to ask questions

and discuss

any potential

health care options

with your physician.

Such open dialogue

continues to educate everybody.

Guidelines for Treating High Cholesterol

We use several variables to determine who needs to be treated with medication for high cholesterol. First is the fasting lipid panel which measure:

• total cholesterol, HDL-C (good cholesterol),

• LDL-C (bad cholesterol)

• triglyceride (TG)

• and non HDL cholesterol.

Next we assess for cardiovascular disease (CVD) equivalents. An equivalent means the risk is as high as if you had already had cardiac vascular disease (i.e. Heart Attack or M.I.).  Examples include:

• diabetes mellitus (DM)

• coronary artery disease (CAD)

• peripheral artery disease (PAD)

• abdominal aortic aneurysm (AAA)

Next we assess presence of other risk factors:

Now, we can determine who needs treatment as follows. A normal cholesterol is considered less than 200. Borderline cholesterol is 200-239. High cholesterol is over 240. Likewise, the HDL is low at less than 40 and high or favorable at over 65. However, our decision to use medications rests primarily on the LDL levels.

Generally, for those without risk factors and men under age 45 and women under age 55, an LDL level less than 160 is desirable. Patients under 45 men and 55 women may need treatment if two other risk factors apply. For those over age 45 men and 55 women with one risk factors for CVD (hypertension, low HDL, family member with heart disease under the age of 75 and smoker) LDL levels should be kept below 130 and preferably closer to 100. 
For those without risk factors for CVD except for age over 45 men and 55 women, LDL less than 130 is desirable. For those with so called CVD equivalents (history of coronary vascular disease, diabetes mellitus, peripheral artery disease, abdominal aortic aneursym), LDL should be kept below 100. In extraordinary cases, LDL goal should be 75.
There are newer assays to measure non HDL cholesterol (HDL-C) (lipoproteins, VLDL, etc.) The goals for non HDL-C are as follows:

• less than 130 for those with CVD equivalent

• less than 160 for those with 2 risk factors (i.e. age, high blood pressure, etc.

• less than 190 for everyone else over 45 men 55 women.

Triglycerides are another component of the fasting lipid panel (FLP). People who have known vascular disease, a strong family history of heart disease, or multiple risk factors for CVD should be treated to a goal of less than 150. Anyone with triglyceride over 500 needs treatment to prevent other non vascular complications.
Certainly, it makes sense to employ regular exercise and cutting back on saturated fats and total calories if one is overweight. Though newer medications have had a dramatic impact on changing one's destiny in so far as one's cardiovascular health, changing one's lifestyle is equally important for one’s overall general health.

- Betsy Horton-Pawlowski, MD

To schedule

a consultation with

AIM's Registered Dietitian,

Lisa Stillman,

call 770-719-5490

Negative Effects of Diabetes on Overall Health

Over seven (7) percent of the adults in the United States have diabetes, therefore it is common knowledge that diabetes results in high blood sugars.  However, many people do not know the effects that the disease has on your body.  Small vessel and large vessel arterial disease resulting from high blood sugars accounts for large amount of morbidity in the US such as heart attacks, strokes, end-stage kidney disease, vision loss and foot ulcers. To prevent these complications routine care is recommended.

Small vessel or microvascular disease accounts for:

Microvascular disease is caused by direct damage of high blood sugars on the small microscopic arteries in the organs of the body resulting in dysfunction and disease.  Routine eye examinations by an optometrist or ophthalmologist are recommend to detect any early signs of vision loss.  Also, a urinalysis to check for urine protein and a microfilament foot exam to evaluate for any sensory loss is recommended yearly.  In addition, use of an ACE inhibitor (lisinopril, benazepril, etc) or an ARB (losartan, candesartan, etc) is recommended to slow the progression of microvascular disease. Large vessel disease or atherosclerosis is the major cause of heart disease and peripheral artery disease that will lead to heart attacks, foot ulcers and limb loss.  The major factors in reducing the risk of atherosclerosis include:

Of course, the major risk reduction is improvement of blood glucose levels.  The goal should be an average blood glucose less than 120 or an HbA1c less than 6.5.  Regular exercise, dietary fat modification, weight reduction and daily intake of vitamin C, vitamin D and folate are also helpful in reducing risk. 

The negative effects of diabetes has on major organs directly impact the health of a diabetic, therefore good control of blood sugars and excellent medical care is very important to maintain a good quality of life.

- Erinn Harris, MD

If your group

needs a speaker

to address health topics

contact

Mary Jane Holt@aol.com

or

call 770-719-5490

Pneumonia Vaccine

Pneumonia is caused by infection of the lower respiratory tract and lungtissue. This condition can cause missed days of work/school, respiratoryfailure requiring hospitalization and even death. Each year, 1.2 million people are hospitalized for pneumonia. The majority of thesehospitalizations are for people age 65 and up.Although many bacteria and viruses can cause pneumonia, Streptococcus pneumoniae (S. pneumonia) is the most common cause of bacterial pneumonia in adults. Fortunately, a vaccine for this infection is available. S. pneumoniae was first isolated by Louis Pasteur in 1881.

Since then,vaccines targeted against this bacteria have been developed and refined. S. pneumoniae not only causes pneumonia but also sinusitis, infectionsof the inner ear, and meningitis. Currently, there are two vaccines available (23 valent pneumococcal vaccine), each directed at the samebacterial target to stimulate the immune system against future exposuresto this organism. There also exists a slightly different vaccine for children.

The current recommendations for use of this vaccine are as follows:

Generally, antibodies should be present for 5-7 years after initial vaccination. This being the case, some recommend revaccination in10 year intervals. Though antibiotics are available to treat this infection,resistance to antibiotics has surged in recent years. This underscores theimportance of appropriate vaccination against this bacteria.In summary, though the causes of pneumonia are many, a common causeof pneumonia and other serious infections in adults is S. pneumoniae. Infection with the organism can be prevented in some individuals with the administration of the current 23 valent pneumococcal vaccine.

- Betsy Horton-Pawlowski, MD

Melanoma

Melanoma is a form of skin cancer that starts in the pigment-producing skin cells called melanocytes. These cells become abnormal, grow uncontrollably, and aggressively invade surrounding tissues. Melanoma accounts for only 4% of all skin cancers; however, it causes the greatest number of skin cancer–related deaths worldwide.

There are several risk factors that increase your risk of developing melanoma including fair complexion, excessive childhood sun exposure and blistering childhood sunburns, an increased number of moles, a family history of melanoma.

The most important sign of melanoma is a change in a mole or other skin growth, such as a birthmark. Any change in the shape, size or color of a mole may indicate melanoma. Melanoma usually looks like a flat, brown or black mole that has irregular, uneven borders, and is not symmetrical.

Your health professional will examine your skin to look for melanoma. If he or she suspects melanoma, a biopsy of the affected skin is needed to make a diagnosis. Melanomas detected at an early stage have the best chance for cure. Surgical removal, or excision, of the melanoma is the most effective treatment.  

You can prevent all forms of skin cancer, including melanoma, by avoiding overexposure to ultraviolet rays.  Stay out of the sun during the midday hours. Wear protective clothing outdoors. Use daily a sunscreen with an SPF of least 15. Avoid sunbathing and tanning salons. Perform a skin self-exam monthly to identify suspicious growths that may be cancer or growths that may develop into skin cancer.  Look for any abnormal skin growth or any change in the color, shape, size and notify health professional. 

- Diliana Panova, MD

The 100 Day-Old Cough...Pertussis

The Chinese for centuries have referred to Pertussis (Whooping cough) as the “100 day old cough” as they observed it was the cough that just wouldn’t stop. Descriptions of whooping cough date back to 1500 and the illness was named in 1670 by Thomas Sydenham.

Whooping cough is considered a serious childhood illness; however,

it manifests in adults with rather alarming complications as well.

Thirty five percent of adults with Pertussis had three or more clinical visits and missed a mean of 9.8 days from work. Twelve percent of those over 65 years of age suffering with Pertussis end up hospitalized.

Five to eleven percent ended up with pneumonia. Four percent ended up fracturing a rib from coughing. Three to six percent ended up passing out (syncope) from coughing so violently. The CDC reported 11,647 cases in the US in 2003 the highest since 1964.

Prolonged cough is the common feature of Pertussis, with the majority of people coughing for more than three weeks and sometimes for many months.

It has 3 classic phases:

1.) Catarrhal: 1 -2 weeks of runny nose, sneezing, and watery eyes

2.) Paroxysmal: 4 to 6 weeks with spasmodic cough, post-tussive

vomiting, and inspiratory whoop

3.) Convalescent: 2 to 6 weeks to months with slow improvement

in symptoms.

The diagnosis can potentially be made clinically, however the CDC Laboratory Criteria for Diagnosis is isolation of Bordetella pertussis by culture or positive PCR assay for B. pertussis DNA. Pertussis has an incubation period of 7 to 10 days (range 4-21). Anyone symptomatic should remain home for 5 days on antibiotic therapy before returning to work or school.

Fortunately, certain antibiotics are effective against Pertussis. Steroids and cough suppressants have shown not to be very effective. Children are routinely immunized and a booster immunization is available, the Tdap. 1 dose is recommended for those 11 to 64 years of age whenever their next Tetnaus is due. Antibiotic prophylaxis is recommended for all household contacts and child care workers with the same antibiotics used to treat Pertussis, as 80% of household contacts acquire infection regardless of immunization status.

- Coral Benge, PA-C

Regardless of your age,

personal immunization,

or health history,

never let a persistent cough

go unchecked.

Bioidentical Hormone Replacement Therapy

Bioidentical hormone replacement therapy (BHRT) is use of supplemental doses of steroid hormones with a chemical structure identical to endogenous human hormones (hormones naturally produced in the human body). Traditionally BHRT is prescribed to relieve the symptoms of menopause, though more recent therapies have extended to preventive aging, sexual dysfunction, and menstrual irregularities, among others. BHRT differs from conventional hormone therapy, which by definition uses animal or synthetic hormones whose structure differ from those produced in the body.

Many studies primarily done in Europe have indicated that BHRT appears to be safer than non-identical hormone therapy. For instance, progestins (hormones that are synthetic analogue of the human hormone progesterone) have recently been linked with an increase in breast cancer, while bioidentical progesterone has been linked with a downregulation (decrease) in cancer cells. The FDA has also permitted the marketing and approval for some of the bioidentical hormones in standardized formulas. There are also compounded formulations that come from raw ingredients, however these are not standardized from one pharmacy to the next.

Although this is very promising data, more large studies are needed (and some are undergoing) to have confidence. So why the difference? A change in molecular structure, even slight, can send signals to the body that differ from the original molecule. Thus, more “side effects” can occur. However, no drug/therapy is without risk (even BHRT) and the risk/benefit ratio should always be considered. Also, each individual’s situation should be assessed and blood levels should be obtained and monitored for optimum health. Levels that can be measured include estradiol, progesterone, testosterone, DHEA, and thyroid.

The key is to replenish deficient hormones to optimum and balanced but not excessive levels in the body.

- Carrie Madej, DO

Always be willing

to ask questions

and discuss

any potential

health care options

with your physician.

Such open dialogue

continues to educate everybody.

To schedule

a consultation with

AIM's Registered Dietitian,

Lisa Stillman,

call 770-719-5490.

To inquire about

Yoga Classes

email Flo at Fluffwinship@bellsouth.net

or call 770-719-5490

To schedule an appointment

for a massage at AIM

call 770-235-5684.