MCW HealthLink -- vol. 4 no. 10

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MCW HealthLink

Medical College of Wisconsin

Milwaukee, Wisconsin

http://healthlink.mcw.edu/

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15 November 2000

Vol. 4 No. 10

In this issue:

(1) Public Health Advisory and Recalls of Products Containing

Phenylpropanolamine (PPA)

(2) Cranberries: A Functional Food

(3) Simple Reading Test Could Identify Patients Who Need Extra

Attention

(4) Glaucoma Basics

(5) Diagnosis and Treatment of Glaucoma

(6) What's New on MCW HealthLink

(7) Subscriber Information

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(1) Public Health Advisory and Recalls of Products Containing

Phenylpropanolamine (PPA)

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You'll notice some empty shelves at the local drugstore as

manufacturers of several non-prescription cold remedies and diet

drugs recall products containing the chemical phenylpropanolamine

hydrochloride (PPA). The Food and Drug Administration (FDA) issued

a public health advisory recommending that consumers not take

products containing PPA. The FDA is taking steps to remove PPA

from all drug products and has requested that drug companies

discontinue marketing products containing PPA.

A recent study reported that taking PPA increases the risk of

hemorrhagic stroke (bleeding into the brain or into tissue

surrounding the brain) in women. The study showed that the number

of people having strokes when taking phenylpropanolamine was

greater than the number of people having strokes who were not

taking phenylpropanolamine. The risk of hemorrhagic stroke is very

low, but there is concern because of the seriousness of the

adverse event (the irreversible outcome) and the inability to

predict exactly who is at risk.

The increased risk of hemorrhagic stroke was detected among women

using the drug for weight control and for nasal decongestion in

the 3 days after starting use of the medication, but men may also

be at risk. FDA does not consider the conditions for which PPA is

used as justifying the risk of something as serious as hemorrhagic

stroke. Alternate nasal decongestants which do not contain

phenylpropanolamine are available both with and without

prescription. Many manufacturers will likely reformulate their

products so that they do not contain PPA.

A list of popular brand name products that contain PPA is included

in the HealthLink web site article on PPA. But the list does not

include house brands from drug store chains, so check for

phenylpropanolamine on the list of active ingredients in all your

prescription and non-prescription cold remedies and diet aids.

>> http://healthlink.mcw.edu/content/article/29499/973892533.html

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(2) Cranberries: A Functional Food

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Doctors have always given the advice to drink cranberry juice to

help prevent urinary tract infections, despite the fact that this

was long considered an old wives tale. Quantitative research

conducted by the Harvard Medical School and Rutgers University in

1994 and 1998 revealed that the cranberry actually does help by

preventing the E. coli bacteria from adhering to the lining of the

bladder.

Cranberries also contain many phytochemicals and antioxidants that

may help to prevent diseases including cancer and heart disease,

along with slowing the aging process. So don't save cranberries

just for Thanksgiving! Drink cranberry juice: stick with 100%

juice not the " juice cocktails " for the most benefit.

>> http://healthlink.mcw.edu/content/article/29499/947779646.html

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(3) Simple Reading Test Could Identify Patients Who Need Extra

Attention

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A study by Medical College of Wisconsin researchers shows that a

10-minute reading test could help health care providers determine

which patients are at risk of not understanding basic treatment

directions. The study of 102 adolescent females at a central city

clinic was conducted in association with Children's Hospital of

Wisconsin by C. Matson, MD, Associate Professor of

Pediatrics, and A. Haglund, RN, CS, MSN, Nurse

Practitioner, both of the Medical College's Milwaukee Adolescent

Health Program.

Other studies have suggested that illiteracy may influence health.

Some studies reveal that nearly one half of adult patients were

unable to understand the instructions on a medication bottle.

High-risk adolescents who need information the most may be unable

to read and understand basic information, such as educational

materials about contraceptive use, sexually transmitted diseases,

or administering medication to their children.

Participants in the Medical College study were ages 12-20. Each

subject completed the Accuracy Level Test (ALT), a 10-minute timed

reading test. The subject's reading test grade level was

subtracted from her appropriate grade in school(based on her

age)to provide a reading delay level.

The average reading grade level based on the test was 6.7 and the

average reading delay level was 4.5 grades (plus or minus 2.5).

This means that on average subjects in the study read at a level

of 2 to 7 grades lower than their age would indicate. Not

surprisingly, students who did not attend school often or who

repeated grades had more significant reading delays. Previously

pregnant students had an even greater delay in reading level.

The study concludes that the ALT may serve as a tool to identify

high-risk patients who need more intensive clinical intervention

to alleviate a communication deficit that leads to poorly informed

patients and decreased success in prevention, health education and

treatment regimens. Brief but effective, the test could become a

standard part of a new patient visit.

>> http://healthlink.mcw.edu/content/article/29499/974144487.html

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(4) Glaucoma Basics

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Glaucoma is a serious disease of the eye whose effective treatment

depends on early detection. Glaucoma is a condition in which

intraocular(inside the eye)pressure is elevated and may damage the

optic nerve, which connects the retina to the brain. This may lead

to loss of peripheral vision and, if untreated, total blindness.

The cause of glaucoma is not known, but is related to the

production and removal of the fluid in the eye known as the

aqueous humor. It is a transparent fluid that provides nutrition

to the lens and cornea, and transmits light rays to the retina at

the back of the eye. Aqueous humor leaves the eye through a sieve-

like tissue called the trabecular meshwork, and glaucoma is

believed to be caused by changes in the meshwork that prevent

aqueous humor from leaving the eye. The result is increased

pressure within the eye. There is no cure and there may be no

initial symptoms.

Family history of glaucoma is a risk factor, notes C.

, MD, Assistant Professor of Ophthalmology at the Medical

College of Wisconsin and Froedtert & Medical College Eye

Institute. African-Americans, diabetics and people with high blood

pressure are also at increased risk. At-risk individuals may wish

to have an annual eye exam after the age of 40.

There are many types of glaucoma. Open-angle glaucoma is the most

common form of the disease, affecting 3 million Americans.

Normal(or low)tension glaucoma is characterized by progressive

optic nerve damage and visual field loss even though intraocular

pressure is normal. Angle-closure glaucoma is most common in

people of Asian descent and people who are farsighted. Acute

angle-closure glaucoma occurs when pressure inside the eye

increases suddenly, sometimes within hours, and may be very

painful. Pigmentary glaucoma is largely inherited, is more

frequent in men, usually begins in the 20s or 30s and is more

common among nearsighted individuals. Exfoliation syndrome is most

common among people of European heritage and occurs when

material is deposited on the lens and iris and clogs the

trabecular meshwork. Finally, trauma-related glaucoma may occur

from a chemical burn, blow to the eye or penetrating injury that

causes a change in the eye's drainage system.

>> http://healthlink.mcw.edu/content/article/29499/974141783.html

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(5) Diagnosis and Treatment of Glaucoma

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According to C. , MD, Assistant Professor of

Ophthalmology at the Medical College of Wisconsin and the

Froedtert & Medical College Eye Institute, four criteria are used

to diagnose glaucoma: pressure within the eye, the appearance of

the meshwork, the appearance of the optic nerve, and the

individual's visual field, particularly peripheral vision. Most

cases of glaucoma are detected during a routine eye exam.

Research into glaucoma causes and treatments is ongoing.

Currently, three types of treatments are available: medication

(eye drops and pills), laser procedures and incisional surgery. A

laser may be used to alter cells in the meshwork to let aqueous

fluid leave the eye more efficiently. (See the above article for

an explanation of the aqueous humor). A laser is also sometimes

used to make a small hole in the colored part of the eye (the

iris) to allow the aqueous fluid to flow more freely within in the

eye.

Open, incisional surgery may be performed if medication and

initial laser treatments are unsuccessful in reducing pressure

within the eye. One type of surgery, a trabeculectomy, creates an

opening in the wall of the eye so that aqueous humor can drain. If

the trabeculectomy fails, another type of surgery places a

drainage tube into the eye. A final -- and infrequently used --

surgical procedure uses a laser or freezing treatment to destroy

tissue in the eye that makes aqueous humor.

Surgery may save remaining vision, but it does not improve sight.

With early detection, the disease can be more easily managed

without invasive procedures.

>> http://healthlink.mcw.edu/content/article/29499/974141591.html

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(6) What's New on MCW HealthLink

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* Herb Blurb: Peppermint

Peppermint is helpful in relieving cold symptoms, nausea,

and heartburn, and appears to be helpful in treating

irritable bowel syndrome.

http://healthlink.mcw.edu/content/article/29499/974146434.html

* Turkey Topics

A fresh or a frozen turkey? What do they mean by free-range?

How long does it take to thaw a turkey? What's that phone

number I can call with questions at the last minute?

http://healthlink.mcw.edu/content/article/29499/973893213.html

* Small Changes to Recipes Maintain Your Health and Your

Thanksgiving Traditions

Recipes for pumpkin pie, sweet potatoes, stuffing and gravy

that are lower in fat, higher in antioxidants.

http://healthlink.mcw.edu/content/article/29499/973894401.html

* Depression After Surgery

Any form of surgery can adversely affect one's notion of

health and invincibility.

http://healthlink.mcw.edu/content/article/29499/973894971.html

* Creatinine Tests Before CT Scans

Some patients are required to have a creatinine blood test

to asses their kidney function before having a CT scan.

http://healthlink.mcw.edu/content/article/29499/973896344.html

* Cholesterol Ratios

When evaluating cardiac risk, you need to know total

cholesterol, LDL, HDL, and the ratio of total to HDL.

http://healthlink.mcw.edu/content/article/29499/973896477.html

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(7) Subscriber Information

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MCW HealthLink is published by the Medical College of Wisconsin,

Milwaukee, Wisconsin, as a service to our patients and the

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information is not intended as a substitute for medical care, or

for the advice of a physician. Please consult your doctor to

determine how the information here pertains to you.

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Medical College Physicians

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HealthLink home page: http://healthlink.mcw.edu/

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Appointments & information: (414) 805-3666 or

1-800-272-3666 toll-free

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ALL RIGHTS RESERVED.

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