Keytruda, Lung Cancer, and Mesothelioma

Keytruda - Clinical Trials

Keytruda (also known as pembrolizumab) is a new cancer-fighting drug that is making a big splash. Introduced by the pharmaceutical company Merck, Keytruda belongs to a class of drugs known as monoclonal antibodies. Unlike traditional chemotherapy drugs Monoclonal antibodies are specialized proteins that are part of the body’s own immune system.

So how does it work? Researchers have known for awhile that some cancers contain a specific protein called PD-L1 that helps to protect them from attack. Keytruda blocks this protein, allowing the immune system to attack and destroy the cancer cells.

Keytruda Shows Promise in Clinical Studies

In the summer of 2014, Merck launched a new study called KEYNOTE-024 whose goal was to see if Keytruda could do a better job of fighting cancer cells than some of the more traditional medications that are currently used. The study followed 305 patients with metastatic non-small cell lung cancer (NSCLC) who were previously untreated and whose tumors expressed high levels of the PD-L1 protein. Some of the patients received the standard chemotherapy treatment, which was usually a combination of carboplatin, cisplatin, pacilatexel and pemetrexed, while the rest were given Keytruda.

About 11 months later, researchers followed up with all the patients and discovered the following results:

  • Keytruda reduced the risk of cancer progression or death by 50% compared to the standard chemotherapy treatment.
  • The median (progression-free) survival for Keytruda was 10.3 months compared to 6 months with standard chemotherapy.
  • Even at six months into the trial, 62.1% of patients treated with Keytruda were alive and had no disease progression compared to 50.3% of those receiving standard chemotherapy.

By all measures, the results of this study were extremely impressive. Stefan Zimmermann of Lausanne’s University Hospital told reporters at a conference where the results were presented, “Remember this day. It’s a new day for lung cancer treatment.”

What Keytruda Means for Mesothelioma Research

Lung cancer is the biggest cause of cancer deaths globally, so it’s a logical starting point for many researchers to begin with when trying new drugs for cancer treatment. But the work doesn’t stop there. With the success of Keytruda in this trial, it is expected that research will expand to include its use in other types of cancer like mesothelioma.

In fact, clinical trials involving the use of Keytruda in patients with Mesothelioma are already underway. One trial in particular, called KEYNOTE-028, is looking at patients with malignant pleural mesothelioma – a cancer of the lining of the lungs that is caused by exposure to asbestos – to see if these patients have better outcomes with Keytruda than with standard treatments alone.

Keytruda is especially important because it is a drug that mesothelioma patients who have exhausted all other treatment could potentially turn to as a last resort. Although the trial is still in its beginning phase, early results are promising.

Dr. Roger M. Perlmutter, the president of Merck Research Laboratories said of the initial Keytruda trial, “These studies may represent a turning point in worldwide efforts to control lung cancer.” Only time will tell if these words prove to be prophetic, and it is hoped that with the Food and Drug Administration’s recent approval of Keytruda for the treatment of metastatic NSCLC that the same may soon happen for mesothelioma.

Is Your Brain Fog From Menopause, Dementia, or ADHD?

Attention deficit/hyperactivity disorder, or ADHD, has long been studied, mainly in children, but experts have come to realize it occurs in women more often than previously thought. If you begin having trouble focusing during menopause, you may be wondering whether it’s a result of hormones, dementia, or something else. That something else could be ADHD.

Cognitive issues like brain fog are very common among women going through menopause, says Mary Rosser, MD, PhD, an ob-gyn at the Montefiore Women’s Center in Scarsdale, New York.

“This is something that is wide-ranging, but people are worried that they’re developing dementia,” Dr. Rosser says. “They rush to tell us their memory is declining, they can’t concentrate, they’re not as organized, and that they have a lower attention span.”

The good news is that in most cases, it’s not early-stage dementia. The symptoms are more often a normal part of menopause, or a result of undiagnosed ADHD, Rosser says.

ADHD Before and After Menopause

Women struggle the most with memory problems during the first year after their last menstrual period, according to a study published in the journal Menopause in 2013.

Although experts don’t yet know why menopause brings on cognitive problems, it may be in part due to falling estrogen levels. Estrogen works with the areas of the brain that affect verbal memory and executive function, which helps with organizing information, according to the researchers.

In addition, other menopausal symptoms, such as depression, hot flashes, and trouble sleeping, can affect your ability to focus.

But having trouble focusing and paying attention are also the hallmarks of ADHD. It’s not just a condition of childhood: About 2.5 percent of adults have ADHD, according to the American Psychiatric Association.

Men have been diagnosed with ADHD twice as often as women, with the majority of the studies being done in men. Researchers now believe many women may have gone undiagnosed, according to an article in Frontiers in Human Neuroscience published in 2014.

Brain fog related to menopause and ADHD brain fog look similar, Rosser says. So how do you know whether what you’re experiencing is menopause or an attention disorder?

 

Ask yourself whether you had these symptoms before menopause. If the symptoms are new, they’re probably related to changing hormones, Rosser says. But if you’ve always been this way and it’s gotten worse with menopause, it could be a result of ADHD. “The only way to really know is to see a psychiatrist who is an expert in ADHD,” Rosser adds.

What to Do About Brain Fog

First, remember that menopause is a normal, healthy stage of life, says Nada Stotland, MD, MPH, a past president of the American Psychiatric Association and professor of psychiatry at Rush University in Chicago.

“We have symptoms and some of them can be hot flashes and night sweats that can be disruptive and tiring and draining, but I don’t think anything significant happens to our brains,” Dr. Stotland says. “I think it’s a normal, passing phenomenon.”

In fact, menopause symptoms of brain fog usually get better over time, Rosser says.

If the symptoms are bothersome enough that you want to get treatment and they’re related to menopause, hormone replacement therapy (HRT) can help, she says.

However, women are understandably nervous about HRT because of the potential increased risk of blood clots, stroke, heart attack, and breast cancer, according to the National Institutes of Health.

Other drug options include anti-anxiety drugs and antidepressants. When it comes to lifestyle factors, taking care of yourself by exercising, eating healthily, getting enough sleep, and limiting alcohol and caffeine can also help improve symptoms, Rosser says.

If your symptoms are related to ADHD, keep in mind that many women can benefit from treatment even if they’ve never previously been treated for the disorder.

“If you’ve gotten to menopausal age, unless you’re still having a lot of problems with attention, you can probably go along the same way, but you may feel better now that you recognize it,” Stotland says. Also, while people with ADHD have a hard time concentrating at times, they may also have the ability to focus very deeply at other times, she says.

If you want treatment for ADHD, you can see a psychiatrist, who may recommend a prescription medication. Also, much of the same lifestyle changes that help menopause can also help with ADHD.

10 Eating Tips to Help You Minimize Allergy Symptoms

Allergy and Asthma Symptom Relievers

1 / 11   Allergy and Asthma Symptom Relievers

If you endure the itchy eyes, runny nose, and congestion of allergies, or the shortness of breath and wheezing of asthma, your doctor may prescribe one of a variety of antihistamines, decongestants, corticosteroids, bronchodilators, and other drugs to tame your allergy symptoms. But making simple changes to your diet may also help you feel better. Here are 10 allergy-fighting foods and drinks you may want to try.

Sip a Cup of  Green Tea

2 / 11   Sip a Cup of Green Tea

“Tea, especially green tea, with or without caffeine, is very good for people with allergies,” says Murray Grossan, MD, an ear, nose, and throat doctor in Los Angeles. Tea contains natural antihistamines, he says, which makes it a great addition to your diet to reduce allergy symptoms. Histamine is a chemical that your body releases during allergic reactions. Grossan especially recommends a morning cup of hot tea just when you get up to help prevent morning sneezing.

Avoid Spicy Foods When Pollen Counts Are High

3 / 11   Avoid Spicy Foods When Pollen Counts Are High

Some people with seasonal allergies can enjoy a diet of spicy Thai and scorching Mexican foods during part of the year, but not when high pollen counts are triggering their allergy symptoms, Grossan says. That’s because spicy foods create an “outpouring of histamine” that only bothers you when it’s added to the histamine produced by your seasonal allergies. When your allergy symptoms are acting up, skip the spicy stuff.

Consider a Mediterranean Diet

4 / 11   Consider a Mediterranean Diet

There is some research to support the idea that adhering to a Mediterranean diet increases a person’s chance of controlling their asthma, according to a 2013 report in the Journal of Asthma. This diet includes lots of fruits, vegetables, beans, whole grains, fish, and olive oil, with a lesser amount of meat.

Don't Eat Raw Foods at the Height of Allergy Season

5 / 11   Don’t Eat Raw Foods at the Height of Allergy Season

Among other raw foods, raw apples or pesticides on lettuce may bother your allergies. During the height of allergy season, when symptoms are really bothering you, cut fresh foods out of your diet and stick with canned and cooked foods, Grossan suggests. Cooking foods lessens your risk of developing allergy symptoms. So switching from, say, fresh apples to applesauce may help.

Try Some Wasabi

6 / 11   Try Some Wasabi

Wasabi, the pungent green paste served with sushi in Japanese restaurants, might be helpful in opening up your nose and helping you breathe better when you have allergy symptoms, Grossan says. The next time your nose is plugged up, drop into a sushi restaurant for a bit of wasabi. It might do the trick if you can tolerate the heat. This method isn’t guaranteed, however, as wasabi also has the potential to unleash more allergy-related histamine in your system.

Eat Yogurt and Other Probiotics

7 / 11   Eat Yogurt and Other Probiotics

Grossan strongly recommends that people with allergy symptoms add yogurt and other sources of probiotics to their diet. Probiotics are known as “friendly bacteria,” according to the National Institutes of Health. Typically these are listed on labels as lactobacillus or bifidobacterium and are similar to bacteria found in your digestive tract. Probiotics, which you can get from yogurt, miso, fermented milk, and dietary supplements, can help regulate your immune system so you’ll have fewer allergy symptoms.

Go Low-Cal and Lose Weight

8 / 11   Go Low-Cal and Lose Weight

Researchers have found that being obese may actually worsen asthma. A recent study compiling 15 earlier studies on weight loss and asthma found that, in all of them, researchers observed some asthma improvement after subjects lost weight. So if you weigh too much and your allergy symptoms include asthma, changing your diet and controlling your weight may help.

Stick to a Low-Salt Diet

9 / 11   Stick to a Low-Salt Diet

Studies have found that eating a diet higher in salt may be associated with more severe asthma, and small studies have found that eating a low-salt diet can improve lung function, decrease symptoms, and reduce the need for medications in people with asthma. Good ways to reduce salt in your diet include eating plenty of fresh vegetables and cutting down on processed foods like frozen dinners and canned soups.

Up Your Omega-3 Intake

10 / 11   Up Your Omega-3 Intake

Some research indicates that eating a diet rich in omega-3 fatty acids may be helpful for reducing asthma symptoms. In one study, researchers had 23 adults with asthma take an omega-3 supplement or placebo for five weeks. Those taking the omega-3s had lower levels of a marker of airway inflammation. You can get more omega-3s in your diet by eating fatty fish such as salmon, herring, sardines, mackerel, and albacore tuna.

Skip the Fast Food

11 / 11   Skip the Fast Food

Looking for yet another reason to limit how many burgers and fries you eat? A New Zealand study of more than 1,300 kids found that those who ate hamburgers occasionally or at least once a week were more likely to have asthma symptoms than kids who never ate burgers. The good news: A diet designed to reduce asthma and allergy symptoms with foods like fruits and vegetables and fish might not leave a lot of room for fast food.

The Importance of Stretching With Multiple Sclerosis

Stretching is important when you have multiple sclerosis.

I’ve said in more than one blog that I consider myself to be a healthy person who happens to live with multiple sclerosis (Multiple Sclerosis). “Healthy,” perhaps, but lately I’ve found myself significantly out of shape.

With all that 2016 has brought upon me, I decided to ask my wife, Caryn, for help in getting onto a stretching program to help with the things that MS has thrown my way.

How to Stretch With Multiple Sclerosis

The National Multiple Sclerosis Society (NMSS) has set out the following guidelines for people with MS as we get into a stretching routine:

  • Stretch on a daily basis, as much as is possible.
  • Include muscle groups that are tight or in spasm.
  • Do slow, gentle, prolonged stretches, and go just to the point where you feel a gentle pulling, but not pain.
  • Hold stretches for 20 to 60 seconds or 5 to 10 breaths.
  • Avoid bouncing movements.
  • Use assistance as needed: a partner, towel, or strap (talk to a yoga teacher or physical therapist about what you can use to help you stretch — and how to use it).

Most of the stretching I’ve been doing has included some form of assistance — be it a chair, the wall, or often, Caryn herself. My balance has become something of an issue, so having something or someone to hold onto while stretching has been helpful.

Also helpful for when balance is even more of an issue is an illustrated, online manual from the NMSS called Stretching for People With Multiple Sclerosis.

This manual has drawings of stretches that can be done seated or lying down. It has specific stretches for some areas of spasticity and other difficulties that commonly affect people with Multiple Sclerosis.

For my own routine, I’ve dug out my physical therapist’s notes from after my hip replacement to help ease some stiffness in that area of the old body, particularly.

How My Stretching Is Paying Off

How out of shape am I? Well, let’s just say that the day after those first stretches I felt like I’d gone a few rounds with an Olympic boxer. But I’m keeping it up. I’m feeling the benefits after just a week.

My balance isn’t any better, my stamina is the same, and my spasticity hasn’t eased in affected areas. But I do feel a bit more loose and flexible. I enjoy the routine of taking half an hour out of the day to look after myself, and I look forward to the other anticipated benefits as they come.

Even if they don’t, continued progress along the lines that I’ve already experienced would be enough to stay the course.

A physiatrist who specializes in multiple sclerosis once told me, “Everyone should stretch every day … Multiple Sclerosis or not.” It’s just taken me a little while to come around to heeding his words.

I’m probably late to the table on this one. Who else has some stories of stretching and their multiple sclerosis?

Wishing you and your family the best of health.

Cheers,

I Was a Heroin-Addicted Mom

“Looking back now, I can see 100 percent that [my son] was in pain and wanted me to stop.”

Of everything Crystal Oertle remembers from the darkest days of her heroin addiction, the memories that haunt her the most, she says, involve her children. Crystal was 24 years old and four months pregnant with her daughter before she put a halt to her daily drug routine of painkillers and meth. From the time that daughter was 2 and her son was 9, Crystal would leave her son at a skateboard park unattended for hours at a time while she made dope runs. On one of those occasions he was badly bitten by a dog and, bleeding, terrified, and alone, was rushed to the hospital by a concerned stranger. Often Crystal met with her dealers with her toddler daughter in tow. And she drove high with both kids. “I put them in danger many times,” Crystal, now 36, admits, her voice low. “I could’ve gotten into a wreck, been in a situation with drug dealers, gotten arrested. My kids could’ve witnessed that.”

Crystal has been clean for 10 months and is now an advocate for recovering addicts. She runs a website for people pursuing recovery called Erase the Shame, and hopes one day to become a substance abuse counselor. For almost a decade, though, she was one of the hundreds of thousands of Americans hooked on heroin and opioid painkillers, drugs that have plagued communities across the Midwest and Northeast, everywhere from rural Shelby, Ohio, where Crystal grew up, to the suburbs of Boston and New York City.

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According to the CDC’s most recent available statistics, more than 29,000 people died of opioid painkiller- or heroin-related overdoses in 2014, more than any year on record. Harder to quantify, however, is the devastation those drugs have wrought upon families and children. Over the last several months, painful accounts of opioids’ tiniest victims have gone viral. In September, law enforcement officials in Ohio posted a disturbing image of a grandmother slumped over after a heroin overdose in the front seat of her car, with her 4-year-old grandson in back. Authorities later placed the boy with relatives — but other kids don’t have that option. Experts attribute surging numbers of children in foster care in several states to the explosion of heroin abuse. In Ohio, Crystal’s home state, the number of kids in the system has spiked 13 percent since 2012, per state statistics. More babies are hospitalized in Ohio for symptoms of opiate dependence than in years past, too, from 14 for every 10,000 live births in 2004 to 134 per 10,000 in 2014. “Children really are the invisible victims,” Scott Britton, assistant director of the Public Children Services Association of Ohio, told the Columbus Dispatch in September.

Crystal remembers taking a Vicodin for a hangover about 17 years ago. She slowly started taking more and became addicted. When she switched from opioid painkillers to heroin seven years later, Crystal vowed never to become a junkie. Injection was a boundary she would not cross. She only snorted, alternating between crushed Vicodin and Oxycontin and powdered heroin a few times a day. “It made me feel good,” she says.

‘Epilepsy Gene Network’ Identified in Brain

brain

Scientists say they have identified a gene network in the brain that’s associated with epilepsy.

Although the research is in the early stages, the investigators hope their discovery can revive interest in finding new epilepsy treatments.

“Identifying groups of genes that work together, and then targeting these networks of genes, may lead to more effective treatments,” said study senior author Michael Johnson. He’s a professor of medicine at Imperial College London in England.

“Our proof-of-concept study suggests this network biology approach could help us identify new medications for epilepsy, and the methods can also be applied to other diseases,” Johnson said in a college news release.

The newly discovered “epilepsy network” includes 320 genes believed to be involved in how brain cells communicate with one another. When the network malfunctions, it triggers epilepsy, the scientists said.

Epilepsy is one of the most common serious neurological disorders worldwide, affecting more than 50 million people, Johnson and his colleagues noted. People with the condition suffer seizures of varying severity.

“Despite almost 30 different drugs licensed for the condition, a third of people with epilepsy continue to suffer from uncontrolled epileptic seizures — despite taking medication,” Johnson said.

In the past 100 years, not much progress has been made in finding improved therapies, and many drug companies no longer try to develop new medicines for epilepsy, he added.

Medications that restore normal function in this gene network could provide a new type of treatment, according to Johnson.

“The discovery of this network of genes linked to epilepsy opens avenues for finding new treatments. This uses an approach that is entirely different to the past 100 years of anti-epilepsy drug development,” Johnson said.

“Until recently, we have been looking for individual genes associated with diseases, which drug companies then target with treatments,” he explained. “However, we are increasingly aware that genes don’t work in isolation.”

Treating Depression, Anxiety Saves Everyone Money

Treating mental illness is not only a good medical decision, but it also makes good economic sense.

depression anxiety treatment

Investing more in treatments for anxiety and depression could save countries around the world billions of dollars, according to a new study.

This is not meant to downplay the toll that mental illnesses take on people and their families. However some experts see this approach as a way to spur governments to open their eyes to a long-neglected health issue.

“This is an argument that we’re hoping governments who have limited dollars will actually respond to because mental health services have not been scaled up in most places,” Judith Bass, Ph.D., a global mental health researcher from Johns Hopkins Bloomberg School of Public Health, who was not affiliated with the new study, told Healthline.

 

Billions in Returns

The new study, published online this month in The Lancet Psychiatry, estimated the cost of treatment for anxiety and depression in 36 countries representing 80 percent of the world’s population.

Are Food Allergies On The Rise? Experts Say They Don’t Know

A new report from the National Academy of Sciences says it’s hard to know how many people in the U.S. actually have food allergies or whether they’re on the rise.

Part of the challenge is this: Food allergies are often self-diagnosed and symptoms can be misinterpreted. Sometimes people can’t distinguish a food allergy from other conditions such as lactose intolerance or gluten sensitivity, which don’t fit the medical definition of an allergy.

“There are a lot of misconceptions about what a food allergy is,” says Dr. Virginia Stallings, a board-certified nutrition pediatrician at the The Children’s Hospital of Philadelphia and the chair of the committee that wrote the new report.

One scenario is this: A parent of a young child introduces a new food — say, milk — into the diet, and then notices the child has an upset stomach or other symptoms of gastrointestinal distress.

The parent may suspect a food allergy. But, perhaps, these are signs of lactose intolerance — a completely different condition.

“The reason food allergy symptoms are often confused with other [conditions] such as lactose intolerance is because there’s an overlap in some of the symptoms,” Stallings explains.

An allergy is an immune response to a food or other substance that is normally harmless. Common symptoms include hives and swelling or GI distress. Food allergies can be life threatening. Lactose intolerance, on the other hand, means a person can’t easily digest the natural sugar found in milk. And, as the American Academy of Pediatrics points out in this FAQ on the topic, “while lactose intolerance can cause a great deal of discomfort, it will not produce a life-threatening reaction such as anaphylaxis.”

10 Habits of Successful Bariatric Patients

Image result for 10 Habits of Successful Bariatric Patients

I’ve had the priveldge of working with weight-loss surgery patients for the past six years seven years (at the time of this post). During this time, I’ve learned what habits my most successful patients change in their life, and stick to long-term. I try not to “get on my soap box” too often when I’m counseling pre-op patients, but at the same time…I want them to succeed so I love sharing with them what habits they should focus on to get the most out of their surgery.

 

1. They make changes before they have surgery. 

Without a doubt my most successful patients DON’T put off their changes until surgery makes them change. They start the second they walk out the door of their first visit to clean out the house, quit the soda and sweet tea, and cook more at home instead of eating out. They know these things will be tough, so they jump on it right away. Learn more about an effective Pre-Surgery diet plan. 

2. They have a strong support system.

In all my visits I ask my patients “who is your biggest cheerleader going through this journey?” When they say “myself” I don’t disagree, but I strongly encourage them to think of who they could reach out to for cheerleading and accountability. We weren’t meant to do this alone. Whether it’s a friend, neighbor, family member or someone at support group I am a firm believe that having a great support system can make all the difference.  When your family is not on board, make sure you have someone outside of the family cheering you on.

3. They get to support groups.

Seriously. Not just because the doctor said “you have to go to at least one” but instead they make it a priority to take the time to get to a group. It’s like “church” for your “post-op soul” (just go with it). You walk away feeling refreshed, encouraged, motivated and (see above) like you aren’t doing this alone. If getting to an in person support group just isn’t feasible, consider finding a closed Facebook group by searching the month and year you had surgery on Facebook. These specific groups can be a better fit than the REALLY large groups. If not the same date, try the same area you’re in. Another great online resource for support – Obesity Help! 

7 Bad Habits to Drop With Rheumatoid Arthritis

Adjusting to Life With RA

1 / 8   Adjusting to Life With RA

It’s easy to fall prey to bad health habits, especially when you’re busy with work and family demands. And you feel so tired at the end of most days that all you want to do is grab a fast-food meal, sit on the couch, and veg out. Beyond being generally unhealthy, that battle plan can increase your risk for developing rheumatoid arthritis (RA) or can make managing RA more difficult, if you already have it.

Whether you’re newly diagnosed with RA or have been dealing with the joint pain from RA for a while, here are seven bad health habits to kick to the curb once and for all. And because RA is a progressive disease, there’s no time like the present to make these changes.

Smoking

2 / 8   Smoking

Quitting smoking can go a long way toward rheumatoid arthritis prevention. If you’re at risk for developing RA, you don’t want to light up, and if you’re already smoking, you want to quit. This goes double if you already have RA.

A study done in Sweden and published in the Annals of Rheumatic Diseases shows that more than a third of cases of the most common form of RA can be attributed at least in part to smoking. For people who have a genetic risk, the link is 50 percent. Smoking also can reduce the effectiveness of methotrexate, one of the most commonly prescribed and effective drugs for treating rheumatoid arthritis and its joint pain, says Houston rheumatologist Alan Friedman, MD.

Drinking Too Much Alcohol

3 / 8   Drinking Too Much Alcohol

Drinking too much is not good for anyone’s health, Dr. Friedman says. That’s especially true for people who are on medications to reduce the joint pain and swelling of rheumatoid arthritis and to slow its progression. The problem is that alcohol taxes your liver, and so can RA medications, including methotrexate, “so heavy drinking can be a double whammy,” Friedman says.

Drinking also can reduce your bone density, and a lower bone density puts you at greater risk for complications from arthritis, including fractures. Love your merlot? Drink in moderation, and ask your doctor if the general health rule of one drink a day for women, two for men, is the right one to follow.