Hopkins News for You

This is a monthly service for our patients and friends around the world from Johns Hopkins International.  To receive monthly reports via e-mail, please send e-mail to patientnewsletter@jhmi.edu.

November/December 2002

HEALTH NEWS
1.  A Less-invasive Way to Reopen Sinuses
2.  Opioid Medications Better For Shingles-Related Pain
HEALTHY LIVING
1.  The Value of Self-Diagnosis
2.  Exercise Helps Diabetics Control Heart Problems
3.  Air Travel = Back Pain?

HEALTH NEWS
1.  A Less-Invasive Way to Reopen Sinuses
Many patients are told that they need major open surgery to unblock frontal sinuses, but Hopkins head and neck surgeon Andrew Lane has developed a less-invasive, endoscopic approach by threading a narrow tube through the nose to the sinus.  "What you do is essentially remove any blockages within the sinus," Lane explains.  "It's all through the nose so you do not leave any scars. 

What makes this approach possible is a high-tech mapping system that allows Dr. Lane to see sinus structures he would normally only be able to see in an open surgery.  "The frontal sinuses are considered high priced real estate," he says, "because you have the brain above you, the eyes to the side.  Knowing precisely where you are is very important so it adds to the safety of the operation and also allows you to be more aggressive in what you do." 

Using the image-guided endoscope, Lane is able to minimize scarring and reopen sinuses that, left untreated, would continue draining improperly, resulting in a painful buildup of bacteria and recurring infections.  The enlarged opening also allows antibiotics to reach her sinuses to attack underlying conditions such as sinusitis.

2.  Opioid Medications Better For Shingles-Related Pain 
Despite worries over side effects, morphine and other opiates appear to be effective in treating shingles-related nerve pain in older adults, a study at Johns Hopkins suggests.  Caused by the same herpes zoster virus that causes chicken pox, shingles and its bouts of painful rashes on the body, limbs and face yield severe nerve pain at the sites of the healed rash.  Doctors have been reluctant to prescribe painkillers for the treatment of this persistent pain, fearing that they create dependency or mental disturbances in elderly patients.  But a team of Hopkins pain researchers recently showed that in 76 elderly patients, opiates provided relief for the nerve pain, called postherpetic neuralgia (PHN), without any of the above side effects.

"By comparing opiates to antidepressants our study suggests that opiates effectively relieve pain and are preferred by a greater proportion of patients," says anesthesiologist Srinivasa N. Raja, M.D., lead author and director of pain research at Hopkins. "This adds further evidence that opiates are a good alternative for patients not responding to other types of pain medications."  The most common side effects were constipation, nausea, dizziness, drowsiness, loss of appetite and dry mouth. These were more common from opiates than the other medications.

HEALTHY LIVING
1.  The Value of Self-Diagnosis
When it comes to breast health, lately women have been receiving conflicting messages. Two recent studies have questioned whether regular mammograms and breast self-exams actually lessen breast cancer deaths. The latter study of 260,000 women in China has health advocates concerned that women will stop doing monthly self-exams. Johns Hopkins Breast Center educator Lillie Shockney notes that half the women referred to her clinic used a breast self-exam to both discover and initiate early treatment of their breast cancer.

"If women are the ones who the majority of the time are finding their own lumps, if I told them to stop doing breast self-exams, then I don't know when those women would have been diagnosed. It certainly would have been at a later stage; the later the stage the more treatment, the higher the risk that they're going to lose their life, definitely a higher risk that they're going to lose their breast."  Shockney says since annual breast exams by a doctor are still recommended, women who perform self-exams could catch problems months ahead of a scheduled office visit.

2.  Exercise Helps Diabetics Control Heart Problems
Many type 2 diabetes patients also have high blood pressure which increases their risk of heart problems and damages blood vessels all over the body.  Now a Hopkins exercise physiologist suggests that exercise may provide solutions to these heart problems.  Writing in the October 2 issue of the Journal of the American Medical Association , Kerry Stewart, Ed.D., director of clinical exercise physiology at Hopkins, says that regular aerobic and weight-lifting activities not only control blood sugar and lower blood pressure, but also provide cardiovascular benefits.  As an added bonus, exercise training reduces total and abdominal fat, both of which lead to improvements in insulin sensitivity, blood pressure and blood vessel function.

"There's a great focus on the search for genetic methods of treating diabetes and other chronic conditions," says Stewart, "but although gene therapy is not yet available for diabetics, 'gym therapy' is.  The benefits of exercise go far beyond controlling blood sugar and doctors should urge their patients to become more active." 

The American College of Sports Medicine and the American Diabetes Association have developed exercise guidelines for type 2 diabetics, suggesting that patients get aerobic exercise such as walking, cycling or swimming three days a week for up to 45 minutes per session.  In addition, resistance training using light weights and frequent repetitions should be performed at least twice a week.  Stewart cautions all diabetic patients to check with their doctor before engaging in a strenuous exercise program, but almost all patients can at least benefit from walking.

3.  Air Travel = Back Pain?
Many of us travel more during the holiday season and air travel can be mentally and physically demanding, especially to the back.  Hauling heavy bags, carrying young children, waiting for long periods in airport terminals, and sitting in cramped conditions all have the potential to aggravate an existing back problem or create a new one.  This month's issue of theJohns Hopkins Health After 50 Newsletter  suggests the following precautions and exercises to protect your back during air travel:

Precautions
1.  Avoid carrying heavy suitcases--Use wheeled luggage, pack lightly, or use baggage carts available in the terminal.  Check heavy carry on bags to avoid having to lift it into overhead baggage compartments and twisting or turning your head, neck or back.

2.  Place a pillow or rolled-up blanket behind your lower back and neck to maintain the natural S-shaped curve of the spine while sitting.
3.  If your seat is worn and hollowed, sit on a folded blanket.

4.  Carry resealable plastic bags with you on the plane.  If your back becomes sore during the trip, you can ask the flight attendant for ice.  Put the ice in the plastic bag and place it on your back.

5.  Ask for an aisle or bulkhead seat so that you will have more room.
6.  Take a muscle relaxant or anti-inflammatory medication before and during the flight.

Exercises
1. Warm up before and cool down after your plane trip by doing some stretching and brisk walking.

2.  To loosen your neck, rotate your head to the left and maintain this position for five seconds. Turn your head forward again and repeat to the right.  Repeat the sequence five times.

3.  To loosen your shoulders and neck, shrug your shoulders up while holding your arms at your sides.  Stay in this position for five seconds, then return to a resting position.  Repeat five times.

4.  To stretch your back, begin in a sitting position and gradually lower your torso toward your knees.  Let your arms drop down and then wrap them around your thighs.  Hold this position for 20 seconds while breathing deeply, then return to your normal seated position.

5.  To stretch your legs while sitting, keep the balls of your feet on the floor and raise your heels.  Lower your heels back down, and repeat 10 times.

6.  If you get the opportunity to stand, put your hands on your lower back and slowly stretch backward.

7.  Also while standing, place your hands on your hips and bend to the left. Maintain this position for five seconds. Return to the upright position and repeat to the right.