Monthly Archives: April 2011

Rule 319a: Don’t handle, eat an armadillo

Armadillos have never been among the cuddly creatures routinely included in petting zoos, but on Wednesday federal researchers offered a compelling reason to avoid contact with the armored animals altogether: They are a source of leprosy infections in humans, according to a story in the New York Times.

Using genetic sequencing machines, researchers were able to confirm that about a third of the leprosy cases that arise each year in the United States almost certainly result from contact with infected armadillos.

The cases are concentrated in Louisiana and Texas, where some people hunt, skin and eat armadillos.

Leprosy, also known as Hansen’s disease, is an ancient scourge that has largely disappeared, but each year about 150 to 250 people in the United States and 250,000 in the world contract the illness.

As long as the disease is identified relatively quickly, treatment with antibiotics — a one- to two-year regimen with three different drugs — offers an effective cure.

But every year dozens of people in the United States do not recognize their skin lesions for what they are early enough and suffer lifelong nerve damage as a result.

Part of the problem is that doctors sometimes fail to consider leprosy in patients who have not traveled to parts of the world where the disease is endemic, like India, Brazil, Africa, the Philippines and other islands in the Western Pacific. Two-thirds of leprosy patients in the United States are people who have either lived or worked in such places before coming down with the illness.

Now researchers are hoping that their study leads doctors to ask one more question of patients who have skin lesions that are numb in the center: Any armadillos in your life?

Some studies have shown that as many as 20 percent of armadillos in some areas are infected with leprosy. The important thing is, don’t consume armadillo flesh or handle it.

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Sea salt not a low-sodium option

Sea salt is not a low-sodium version of table salt, but 61 percent of Americans believe it is.

Further, while most Americans believe (perhaps accurately, in this regard) that drinking wine is good for the heart, they don’t know the recommended limits. Such are the results from an American Heart Assn. poll meant to assess how much adults know about the risk factors for high blood pressure.

The survey of 1,000 results had at least one encouraging finding — 59 percent of Americans know their blood pressure numbers.

Now to work on what might affect those numbers…

About 76 percent of Americans said wine is good for the heart — and medical evidence does tend to point in that direction, though it’s far from conclusive.

But whether moderate wine drinking is heart-protective or just neutral (excessive drinking is widely regarded as a bad idea), only about 30 percent of adults know the heart association has recommended daily limits on wine. The association’s position on drinking to your health:

“If you drink any alcohol, including wine, beer and spirits, the American Heart Association recommends that you do so in moderation. Limit consumption to no more than two drinks per day for men and one drink per day for women.”

When it comes to wine, the association says that amounts to eight ounces of wine for men, four ounces for women. The American Dietary Guidelines defines it as five ounces of wine.

But back to the salts. We’re not sure how the American people started believing that sea salt was a diet version of table salt, but we suspect their tendency to equate “natural” with “better for you” has something to do with it. To that way of thinking, anything with the word “sea” must be more natural.

Both table salt and sea salt are mostly sodium chloride, a naturally occurring chemical combination of sodium (Na) and chlorine (Cl), familiar elements on the periodic table.

Table salt is dug from underground mines, while sea salt is evaporated from — you guessed it — sea water. Sea salt may have a slightly different flavor and color because of trace amounts of other minerals found in seawater, including sulfate, magnesium and calcium, but its main ingredient is still sodium chloride. Further, table salt often has some iodine added to prevent iodine deficiency, as well as anti-caking agents.

Still, salt is salt. If you want to sprinkle something low in sodium on your food, go for one of those herb blends.

In the same survey, 46 percent thought table salt is the primary source of sodium in American diets. Actually, most sodium that Americans consume — about 75 percent –comes from processed foods, soups and canned foods.

About one-quarter of adults know the daily recommended sodium limit for most people is 1,500 milligrams — a fraction that doesn’t impress the American Heart Assn.

Health experts urge cutting back on sodium to lower blood pressure. The National Institutes of Health has a few tips for reducing salt in your diet:

— Buy fresh vegetables, or check for no-salt-added frozen or canned vegetables

— Rinsed canned foods to remove some sodium

— Cook with seasoning blends that have no salt added

— Use fresh poultry and meat, not canned or processed

And of course, watch the amount of salt you shake on your food. But feel free to use whichever salt tastes better.

Green cleaning losing its shine with consumers

When Clorox introduced Green Works, its environment-friendly cleaning line, in 2008, it secured an endorsement from the Sierra Club, a nationwide introduction at Walmart, and it vowed that it would move “natural cleaning into the mainstream,” according to a story in the New York Times.

Sales that year topped $100 million, and several other major consumer products companies came out with their own “green” cleaning supplies.

But America’s eco-consciousness, it turns out, is fickle. As recession gripped the country, the consumer’s love affair with green products, from recycled toilet paper to organic foods to hybrid cars, faded like a bad infatuation. While farmers’ markets and Prius sales are humming along now, household product makers like Clorox just can’t seem to persuade mainstream customers to buy green again.

Sales of Green Works have fallen to about $60 million a year, and those of other similar products from major brands like Arm & Hammer, Windex, Palmolive, Hefty and Scrubbing Bubbles are sputtering.

“Every consumer says, ‘I want to help the environment, I’m looking for eco-friendly products,’ ” said David Donnan, a partner in the consumer products practice at the consulting firm A. T. Kearney. “But if it’s one or two pennies higher in price, they’re not going to buy it. There is a discrepancy between what people say and what they do.”

For instance, a 32-oz bottle of Clorox Green Works All-Purpose cleaner is $3.29 at Stop & Shop. A 32-ounce bottle of Fantastik cleaner, by contrast, costs $2.89.

Indeed, outside a Whole Foords Market in the Chicago suburb of Evanston, June Shellene, 60, said she did not buy green products as often as she did a few years ago.

“People are so freaked out by what is happening in the world,” she said, before loading her groceries into a Toyota Prius. Of green products, she said, “That’s something you buy and think about when things are going swimmingly.”

Sales in most consumer-products categories dropped off during the recession. But according to an analysis by Sanford C. Bernstein & Company, certain green products have fared worse.

“You see disproportionately negative impact from products like Green Works, out of the big blue-chip companies that have tried to layer a green offering on top of their conventional offering, and a relatively better performance from the niche players who remain independent,” said Stephen Powers, an analyst at Bernstein.

Using data from the Nielsen company, Bernstein looked at sales for nearly 4,300 items in 22 categories, like cleaning spray, liquid soap, bathroom cleaners and detergents. It studied monthly sales from March 2006 to March 2011, the most recent data available. (Nielsen’s data includes mass market, grocery stores and drugstores but excludes Walmart.)

Bernstein found that the market shares of green products generally were down from their peak — especially those offered by the big consumer-products companies. But the market share of the independent brands, like Method and Seventh Generation, is starting to increase relative to the shares of traditional brands’ green products in categories where they compete.

“In terms of the big players like Clorox, there’s no doubt that they’ve de-emphasized the brands relative to their early aspirations, and that’s reflective of what they are seeing from the consumer,” Mr. Powers said.

Green products are more expensive because the ingredients tend to cost more than their more conventional counterparts, and transportation costs are higher too because they are sold in smaller volumes than the big brands.

Ohio town overdosing on prescription drugs

Portsmouth, Ohio was once known for its shoes and its steel. But after decades of decline it has made a name for itself for a different reason: it is home to some of the highest rates of prescription drug overdoses in the state, and growing numbers of younger victims, according to a story in the New York Times.

Their pictures hang in the front window of an empty department store, a makeshift memorial to more than two dozen lives. The youngest was still in high school.

Nearly 1 in 10 babies born last year in this Appalachian county tested positive for drugs. In January, police caught several junior high school students, including a seventh grader, with painkillers. Stepping Stone House, a residential rehabilitation clinic for women, takes patients as young as 18.

In Ohio, fatal overdoses more than quadrupled in the last decade, and by 2007 had surpassed car crashes as the leading cause of accidental death, according to the Department of Health.

The problem is so severe that Gov. John R. Kasich announced $36 million in new spending on it this month, an unusual step in this era of budget austerity. And on Tuesday, the Obama administration announced plans to fight prescription drug addiction nationally, noting that it was now killing more people than crack cocaine in the 1980s and heroin in the 1970s combined.

The pattern playing out there bears an eerie resemblance to some blighted cities of the 1980s: a generation of young people who were raised by their grandparents because their parents were addicts, and now they are addicts themselves.

“We’re raising third and fourth generations of prescription drug abusers now,” said Chief Charles Horner of the Portsmouth police, who often notes that more people died from overdoses in Ohio in 2008 and 2009 than in the World Trade Center attack in 2001.

“We should all be outraged,” Chief Horner said. “It should be a No. 1 priority.”

Scioto County, of which Portsmouth is the seat, has made it one, bringing what had been a very private problem out into the public.

A coroner and a pharmacist are among its state lawmakers, and a bill in the state legislature would more strictly regulate pain clinics where drugs are dispensed. The most popular drug among addicts here is the painkiller OxyContin.

The county’s efforts got the attention of political leaders in the state, including Governor Kasich, who declared the county a pilot project for combating addiction.

The problem is so bad that a storage company with business in the county recently complained to Chief Horner that it was having trouble finding enough job candidates who could pass drug tests.

“Around here, everyone has a kid who’s addicted,” said Lisa Roberts, a nurse who works for the Portsmouth Health Department. “It doesn’t matter if you’re a police chief, a judge or a Baptist preacher. It’s kind of like a rite of passage.”

About 10 years ago, when OxyContin first hurtled through the pretty hollow just north of town where the Mannering family lives, the two youngest children were still in high school. Their parents tried to protect them, pleading with neighbors who were selling the drug to stop. By mid-decade, they counted 11 houses on their country road that were dealing the drug (including a woman in her 70s called Granny), and their two youngest children, Nina and Chad, were addicted.

A vast majority of young people, officials said, get the drugs indirectly from dealers and other users who have access to prescriptions. Nina and Chad’s father, Ed Mannering, said he caught a 74-year-old friend selling the pills from his front door. The sales were a supplement, the man said sheepishly, to his Social Security check.

“You drive down the road here, and you think, ‘All these nice houses, no one’s doing any of that stuff,’ ” said Judy Mannering, Nina and Chad’s mother. “But they are. Oh, they are.”

Nina Mannering tried to quit, her mother said. She had a small daughter to care for. She was in a counseling program for a few months, but was told to leave when her boyfriend brought her pills. At one point, Ms. Mannering counted the number of schoolmates in four graduating classes who had died from overdoses, her mother recalled. The total was 16.

“It’s like being in the middle of a tornado,” said Ed Hughes, director of the Counseling Center, a network of rehabilitation and drug counseling clinics in the county. “It was moving so fast that families were caught totally off guard. They had no idea what they were dealing with.”

Former NYC marathon champ Waitz passes away

Grete Waitz, the splendid Norwegian runner who set a world mark in her first marathon, in New York City in 1978, died of cancer on Tuesday in Oslo. She was 57.

Her death was confirmed by her husband.

Waitz was just 18 when she competed in the women’s 1,500-meter race at the 1972 Munich Olympic Games. She was eliminated in the first round in Munich but her career as a competitive runner and pioneering athlete was just getting started.

Waitz set the world record at 3,000 meters in the summer of 1975, but did not make the finals of the 1,500 at the 1976 Olympics in Montreal. Her chance at a third straight Olympics was foiled when Norway joined the American-led boycott of the 1980 Moscow Games over the Soviet invasion of Afghanistan.

Fred Lebow, the director of the New York City marathon, invited Waitz to compete in the 1978 New York race. It would be her first-ever marathon, and it was understood that she would run as a rabbit, or early pacesetter, for the established and favored women marathoners.

She also planned to use the trip to New York to celebrate her retirement from competitive running, renew her focus on her job as a teacher, and perhaps start a family with her husband Jack Waitz, whom she had married in 1975.

“But, instead, I quit my job teaching and never had kids,” she said in a 2008 interview with the New York Road Runners club.

Waitz not only won the 1978 New York race, but also set a world best, finishing in 2 hours 32 minutes 30 seconds — 2 minutes faster than the previous mark.

Over the years, she would win the New York event eight more times.

End-stage kidney disease treatment may be at an end

Of all the terrible chronic diseases, only one —end-stage kidney disease — gets special treatment by the federal government. A law passed by Congress 39 years ago provides nearly free care to almost all patients whose kidneys have failed, regardless of their age or ability to pay.

But the law has had unintended consequences, kidney experts say in a New York Times story. It was meant to keep young and middle-aged people alive and productive. Instead, many of the patients who take advantage of the law are old and have other medical problems, often suffering through dialysis as a replacement for their failed kidneys but not living long because the other chronic diseases kill them.

Kidney specialists are pushing doctors to be more forthright with elderly people who have other serious medical conditions, to tell the patients that even though they are entitled to dialysis, they may want to decline such treatment and enter a hospice instead. In the end, it is always the patient’s choice.

One idea, promoted by leading specialists, is to change the way doctors refer to the decision to forgo dialysis. Instead of saying that a patient is withdrawing from dialysis or agreeing not to start it, these specialists say the patient has chosen “medical management without dialysis.”

“That is the preferred term,” said Nancy Armistead, executive director of the Mid-Atlantic Renal Coalition, a Medicare contractor who collects data and patient grievances.

The phrase, she says, “acknowledges that death is imminent,” but it also sends an important message: “We are not just sending people home to die. We are offering palliative care.”

A committee of the Renal Physicians Association recently formulated guidelines to use in deciding when dialysis is appropriate. It provides questions that doctors should ask themselves before suggesting the treatment. One is the “surprise” question: Would I be surprised if this patient is dead within a year?

But, said the committee’s chairman, Dr. Alvin H. Moss, a nephrologist and ethicist at West Virginia University, the task ahead is like turning around an ocean liner.

“Clearly, when the program was initiated in the 1970s, the hope and expectation was that this program would return otherwise healthy people back into society so they could work and be productive,” said Dr. Manjula Kurella Tamura, a kidney specialist at Stanford. But, she added, “dialysis at the end of life is a different sort of treatment.”

Dialysis is difficult, especially for the old and sick. Most of the nation’s 400,000 dialysis patients spend several hours, three days a week, hooked up to a machine, and additional time traveling back and forth to the clinic.

They have to restrict salt and fluids, and the procedure is so exhausting that some patients rest for the remainder of the day. Although dialysis may alleviate symptoms like fluid accumulation in the legs or lungs, it can lead to dizziness, weakness, leg cramps, nausea and other problems.

Complications like bloodstream infections or clogged blood vessels where the dialysis needles are placed are common, often requiring surgery or hospital stays. Ultimately, about one patient in five is unwilling to go on with it.

Yet it can be hard to say no.

An 84-year-old man being treated at a clinic in Elkins, W.Va., run by West Virginia University has been counseled against dialysis. He has high blood pressure and severe congestive heart failure, a condition as lethal as terminal cancer.

His heart problems make it hard for him to breathe, and he is often in the hospital. In a telephone interview, the man said he saw friends suffer on dialysis and always thought he would refuse it. But he is getting ready to start anyway. The man, whose name is being withheld to protect his privacy, says he changed his mind after he “sat and thought about how good life is.”