Human Stem Cell Research: Promises and Perils, Part 2
Posted by drbob2 on Jul 25, 2008
In my last blog entry, I reported some of the basic information about stem cells in general and just a bit about why they are increasingly important and in the news. Now I’d like to start presenting some information about the (now) three different types of stem cells currently being studied in research and those that are being used clinically. I make no bones about my perspective which is, I hope, that of a physician who holds dear the ethical rule attributed to Hippocrates: “First, do no harm.” Except where otherwise noted, I will be writing of stem cells of human origin.
Adult stem cells, primarily those found in bone marrow, have been used for over three decades in treating human patients. First, they were used to treat leukemia, which can be thought of as a cancer of the bone marrow. The concept was to first destroy the leukemia patient’s bone marrow with a high dose of chemotherapy and radiation, and then restore the patient’s ability to make blood (red and white blood cells and platelets) by transplanting into their veins, immunologically matched cells taken from someone else’s the bone marrow. That “someone else” could be an identical twin, a family member, or an unrelated donor—as long as they were a compatible match. Bone marrow transplantation became increasingly effective in treating leukemias and certain other malignant diseases like lymphoma and multiple myeloma as well as some non-malignant conditions like sickle cell anemia. In current clinical trials, transplanting these kinds of adult stem cells is being tested in the treatment of rheumatoid arthritis and multiple sclerosis, as well as other conditions.
A lot has been learned over the years about how to identify the different types of adult stem cells, based on certain molecules that serve as markers on the surface of the cells. For example, hematopoietic (blood forming) stem cells found in bone marrow carry on their surfaces a molecular receptor site named CD 34. Not all CD 34 cells are blood forming stem cells but all blood forming cells—to my knowledge— are found within the CD 34 cluster. CD stands for “cluster of differentiation” (some researchers use the term “cellular differentiation”) and there are many different numbered clusters—like the CD 4 cells which are used to monitor patients with HIV infections.
Using new equipment which can recognize, and sort out, CD 34 cells from a blood sample, donating adult CD34 stem cells to treat blood diseases has gotten easier for the donor. Instead of taking marrow from a donor by aspirating it from their hip bone by a needle, the donor now receives a drug to stimulate increased production of their CD 34 cells, which are then “harvested” from their peripheral venous blood and injected into the patient’s vein. Another thing that was discovered within the last decade or so was that some adult CD 34 cells transplanted into a leukemia patient could, without any guidance from the doctors, form other kinds of cells, liver cells for example, in the patient who received them! It demonstrated that some of the stem cells within the CD 34 cluster had the inherent capacity to form more than “just” blood cells.
Among other things, discoveries like that stimulated a search for other sources of adult stem cells and ways to coax them to form specific types of tissue needed for repair and regeneration. These days, according to www.stemcellresearch.com, a website I heartily recommend, adult stem cells can be taken from bone marrow, peripheral blood, umbilical cord blood, amniotic fluid, placenta, brain tissue, and fat, including the fat removed by liposuction, as well as other organs and tissues. These adult stem cells are then grown and multiplied in the lab and used in the treatment of about 73 human conditions currently.
Not only can adult stem cells be found in many tissues and organs, a great deal has been learned about how to use substances called growth factors and other means to guide them to become just the cell type needed. As just one example, University of Florida researchers at the McKnight Brain Institute have developed a method to change non-nerve cell tissue taken from human brain biopsies into nerve cells!
Next time we’ll look at embryonic stem cells and the newest—and perhaps most promising—development called Induced Pluripotent Stem Cells, or iPSC.
Remember, if you have a topic you’d like me to address, just send me an email at drbob@superhealthms.com.
Human Stem Cell Research: Promises and Perils
Posted by drbob2 on Jul 7, 2008
Stem cell research is such an important, timely, and evolving topic that I plan to make several blog entries about it. It’s really a fascinating subject and is full of promises and perils. I remember years ago that my (undergrad) Senior Seminar in Biology was a study of “Cytodifferentiation and Macromolecular Synthesis” which was a compilation by author Michael Locke of (then) cutting edge reports by noted scientists who were investigating not only the way that animals, including we humans, develop from a single fertilized cell, but how that happens. That’s exactly what’s going on in science today, but with new capabilities in research tools which have answered a lot of the questions asked in the old days and which have generated many more questions.
In one sense, when we were a single fertilized egg (known scientifically as a zygote or conceptus) we had more potential, in the words of Professor Jerome Lejeune, discoverer of the genetic basis for Down Syndrome, that at any other time in our lives. Our genetic code, contained in the DNA ½ of which we received from our mother and ½ from our father, had the potential to express all the genetic information it contained. That, however, might have been dangerous and is not the way things work. If all of our genes were put in play at once, we would not have developed in an orderly fashion at all.
Like an orchestra composed of many instruments, our DNA appears to be made to have its instruments (genes) played in an orderly fashion over time—and in response to signals. Just as the composer’s music gives signals to each musician about what notes each instrument is to play and when, the director also sends more signals: “more from the violins just now, less from the brass,” so now scientists are learning how cells signal each other and direct the fabrication (synthesis) of protein gene products, some of which signal back to the DNA “more (or less) of my protein (x) or more (or less) of another protein (y).” These messenger molecules, which can stimulate more gene activity (“up-regulation” or “expression” of a gene) or suppress gene activity (“down-regulation” or “repression” of a gene) can make for an incredibly complex but exciting scheme of things. It’s no wonder that stem cell research is so important and so active.
What is a “stem cell?” We know that living cells divide at varying intervals. When somatic cells, like skin, muscle, liver or kidney cells divide they produce two cells just like the one that divided. One skin cell divides into two skin cells, etc. When a stem cell divides, however, it can yield a cell that is different from itself, a differentiated cell, as well as another stem cell like itself. For example, when a “hematopoietic stem cell” (a Greek term that means “blood forming”) divides, it gives rise to one stem cell and a differentiated cell like a red blood cell, a white blood cell, or a platelet (a small cell essential to blood clotting).
That’s all for now. Next time we’ll delve into the types of stem cells, what they can do, are doing, and more about their “promises and perils.”
Remember, if you have a topic you’d like me to address, just send me an email at drbob@superhealthms.com.
Talking with Your Doctor - Part II
Posted by drbob2 on Jul 6, 2008
In Part 1 of this 2 part blog entry, I pointed out what’s obvious about talking with your doctor: the information you share is essential to your patient-physician relationship and can positively or negatively affect your health and your health care. The federal Agency for Healthcare Research and Quality (AHRQ) has published “Quick Tips—When Talking with Your Doctor” which is available at http://www.ahrq.gov/consumer/quicktips/doctalk.htm. You may want to print that paper from the website (it’s only two pages) and keep it with your medicines so you can review it before your next doctor’s visit.
“Quick Tips” emphasizes three related components of talking with your doctor. First, give information, don’t wait to be asked. Second, get information. Third, take the information home.
Give Information
If your visit is for a routine checkup or physical exam, take some time the day before your appointment to review everything that’s gone on with your health since your last visit. Be sure to tell your doctor if you have had any persisting pain, unexplained weight loss, breathing problems, decrease in exercise tolerance, lumps, or bumps, or anything else that you remember, write them down so you won’t forget them during the visit tomorrow. You may also want to mention aches and pains or even injuries that have gotten better by themselves or that you treated with home remedies.
If your visit is because you are ill, you will want to write down when it started, what you have done to help (and whether or not it did help), whether it’s getting better, staying the same, or getting worse. Again, write everything you can think of about what ails you down—if the doctor asks you, you have your answer ready. And, if the doctor does not ask you, you can ask him or her about any aspect of your illness that you want to know more about.
If it’s your first visit to this doctor, be prepared to answer, either on forms or in conversation, questions about allergies, bleeding tendencies, whether or not you are diabetic, and whether or not you have ever had blood clots in your legs or lungs.
In addition, you will also be asked about all the medicines you take as well as any vitamins or herbal preparations. Have you ever had a heart attack or stroke? Any operations or hospitalizations? If so, when, for what, and who was your doctor? Then, while you are reviewing all this the day before your visit, take a minute and ask yourself whether there’s anything else in your personal medical history—or your family’s history (like heart attacks, diabetes, strokes, or siblings or cousins dying in childhood) that can help your doctor get a complete picture of your individual health. Be as complete as possible and, if you remember something later, call the office to add it to your record.
Get Information
Once you have answered all the questions asked and, if necessary, volunteered information that you think is important and relevant to your healthcare, it’s your turn to ask questions.
- What do you think my health status is?
- What are the results of all my tests and x-rays—may I have a copy of the results, please? If you need additional tests, be sure to ask why. And don’t be shy—in this era of transparency and accountability—to ask how much everything costs. If your doctor doesn’t know how much the charges are, how can he or she assess the cost/benefit of the test?
- What exactly am I supposed to do now?
- What are these medicines for?
- How will I know if they are effective?
- Should I expect any side effects from these medicines and, if so, should I call you about them?
Of course these are not all the questions you may want to ask but they should serve to get you started asking the right questions at the right time. It is also important to ask “How can I reach you if I have problems?”
Take Information Home
The third component of AHRQ’s “Tips…” is essential. It doesn’t matter if you ask all the questions you have and your doctor answers them all if you trust to your memory and then forget everything on the way home. Bring a pad and pen so you can make notes of what you asked and what your doctor answered. It’s always good , especially if you need more tests or have a chronic illness to ask for written instructions, brochures, care guidelines or audio tapes or even CD’s to keep handy at home—not just for you but for anyone else in your family that needs to know what to do to keep you on your plan of care. And, if you do not trust your memory or ability to take notes, bring someone from your family with you who can concentrate on writing down all the important information.
- If your doctor prescribed medicines, fill the prescription and take it according to instructions.
- If your symptoms get worse, call your physician
- If you have additional tests, you have a right to know the results. If your doctor does not call you within 3 days of most tests, you should call him or her.
Remember you can read and print the Agency for Healthcare Research and Quality’s “Quick Tips—When Talking with Your Doctor” http://www.ahrq.gov/consumer/quicktips/doctalk.htm
It’s all about your health care and building the doctor patient relationship.
If you have a topic you’d like me to address, just send me an email at drbob@superhealthms.com
Talking with Your Doctor
Posted by drbob2 on Jul 6, 2008
It just makes sense to have an ongoing relationship with one physician who is the first person you contact when you need medical checkup or have health questions. For purposes of discussion let’s call that relationship with your physician your Medical Home.
This is even more important if you have a chronic health condition like diabetes, high blood pressure, arthritis, chronic lung disease, or high cholesterol. It’s one thing to have a Medical Home that provides the context for your patient-doctor relationship, but what actually goes on between you and your doctor when you see him or her professionally? Are you afraid to see the doctor and only go when someone in your family makes you? If that is the case, then you may show up with an attitude like “OK, I’m here, doctor, , now you have to guess why. If you don’t ask just the right questions and find out what’s wrong with me, I’m going home and tell my family that I’m in the pink.” That’s a case of playing “guess what’s wrong with me” and it sets the stage for an unhealthy relationship. If you called a plumber to your home, I’ll bet you don’t expect them to spend their time, and your money, turning on every faucet, flushing the toilet and checking the water heater to find out why you called him in.
On the other hand, some of us want reassurance for every little sniffle, and to get it, we may present a long litany of not only what our symptoms are but so many details that the main message is buried and may not be dealt with during our appointment.
How much information, and how many details, are helpful? In general, fever, bleeding, pain, change in bladder or bowel habits, loss of appetite (especially if it is associated with unintentional weight loss), shortness of breath, swelling, bumps and lumps, inability to go to work or school, any change in our senses or level of consciousness are some of the things that good physicians pay special attention to. These symptoms (indications of an illness or disorder that you experience, as opposed to signs, those indicators that you don’t feel but are observed by your doctor) usually lead your doctor to ask a number of questions to further assess the problem.
One way to make the most of our visit to the doctor is to prepare for it, using the Golden Rule. The whole value of a visit to the doctor, whether it’s for a medical checkup or for something that ails you, is based upon information: who gives it; who receives and understands it; and what happens because of it. The Agency for Health Care Research and Quality (AHRQ) has developed “Quick Tips—When Talking with Your Doctor” available at http://www.ahrq.gov/consumer/quicktips/doctalk.htm. You may want to take a look at these “Quick Tips.” In my next entry, I’ll expand on some of AHRQ’s Tips and other factors that can enhance your communication with your doctor. It’s all part of having a good doctor patient relationship.
More About Stroke
Posted by drbob2 on Jul 6, 2008
Stroke is a mighty big problem in MS and the risk of stroke goes up with high blood pressure, diabetes, hypercholesterolemia, heart disease and arterial disease, all of which are, so far, rampant in our state. The two major types of stroke are ischemic (a plugged up artery to the brain) and hemorrhagic (a blood vessel which bleeds into the brain). About 4 out of 5 strokes are ischemic—and that’s the kind of stroke which can, with current interventions, be most successfully treated IF TREATMENT IS BEGUN WITHIN ABOUT 3 HOURS OF THE FIRST SIGNS OF A STROKE—including:
Sudden numbness or weakness of face, arm or leg - especially on one side of the body.
Sudden confusion, trouble speaking or understanding.
Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, loss of balance or coordination.
Sudden severe headache with no known cause.
What causes a plugged up artery (ischemia) to the brain, or one to the heart, for that matter? Well, high blood pressure, diabetes, and high cholesterol all stiffen and damage our arteries and can lead to the most common cause of stroke, atherosclerosis, (the accumulation, like scale in a pipe, of “atheromas” or fatty plaques, within our arteries). Once damaged, the arteries accumulate plaques which narrow the vessels. Sometimes the greasy plaques act like an irritant and the body calcifies them like little pieces of eggshell, which can flake off. Sometimes they stay cheesy and, like an aged cheddar cheese, can flake off little pieces under stress, like high blood pressure or a sudden spurt of exercise. If a piece of the plaque breaks off, it is called an embolus and the blood flow pushes it downstream until it plugs up a smaller vessel, causing a heart attack if the plugged vessel is in the heart, or a stroke if it is in the brain. If nothing flakes off, the plaque may just crack and leak some of its greasy contents. That causes a blood clot, called a thrombus, to form in the vessel—right where it’s already narrowed by the plaque. It can plug up the vessel right there and cause a heart attack or stroke.
So, an ischemic stroke (about 80% of all strokes) is caused by a plugged up an artery to the brain or within the brain, whether the plug came from somewhere upstream (an embolus) or was formed right where it plugged up the artery (a thrombus).
Back to why it’s important to recognize stroke symptoms as fast as possible. For a limited number of hours, a therapeutic window is open during which those plugs within the blood vessel to the brain can be treated by giving a clot busting medicine—usually an enzyme which activates the body’s own clot dissolver. After just a few hours, the window closes and giving the same clot buster, or thrombolytic agent, loses its effectiveness.
The other type of stroke, a hemorrhagic stroke, is caused by a broken or leaking blood vessel in the brain. It is also important to seek expert care rapidly for this kind of stroke, not because a thrombolytic drug can be used—it is contraindicated here because it might worsen the bleeding—but because bleeding into the brain causes increased pressure and that may need a different type of rapid treatment to keep more brain tissue from being lost.
You can check with www.giveme5forstroke.org/ for more good information about stroke that has been put together by the American Academy of Neurology, the American College of Emergency Physicians, and the American Heart Association/American Stroke Association. Another excellent source of information is available through the University of Mississippi Medical Center at http://www.umhc.com/Health/Content.asp?PageID=P00863 Both will help you recognize the first signs of a stroke and get help fast.
Remember, if you have signs or symptoms of a stroke or see someone who does, call 911!
Tune in to Super Health Mississippi each Tuesday from 9 to 10 AM on the Super Talk Network. You can reach me on air at 888-808-8637 or by email to drbob@superhealthms.com.
Let’s Talk About Stroke
Posted by drbob2 on Jul 6, 2008
In a recent Super Health Mississippi program, Dr. Hartmut Uschmann, a leader in stroke prevention and treatment at the University of Mississippi Medical Center, shared his passion about stroke with me and our audience. Dr. Uschmann is a Neurologist who is Vice Chair of Neurology at UMC and has been very active in spreading the word about stroke here in Mississippi where, deep in America’s Stroke Belt, about 5000 of us have strokes each year.
As with so many health problems, a stroke prevention program is the place to start. Most all of us will benefit from healthier diets (2000 or so calories, 60 grams or less of fats) and regular exercise (walk for 30 minutes 5 times each week). Those of us with high blood pressure need to take our meds and get our pressure to 140/85-90 or less and persons with diabetes are aiming to keep their HbA1c (long term blood glucose) at the target advised by their doctor. For most of us, especially if we are smokers, have high blood pressure, or have diabetes, if our total cholesterol remains over 200 mg/dl (milligrams of cholesterol per one tenth of a liter of blood—about 3 ½ fluid ounces) after we have been faithful to diet and exercise regiment, one of the statin drugs may help get our “bad” LDL-cholesterol down and our “good” HDL-cholesterol up—and lower our risk of ischemic stroke (caused by blockage of an artery to our brain) by about 20%. Since many strokes are at least partially disabling and about 1 stroke in three is fatal, every bit of risk reduction helps.
Now, suppose you suddenly feel or act strangely or someone near you does. Below is a helpful message taken from the website of the National Stroke Association: www.stroke.org –one of several fine organizations dedicated to improving the prevention and treatment of stroke
Stroke Symptoms
If you think someone may be having a stroke, act F.A.S.T. and do this simple test:
ACT F.A.S.T. (for FACE, ARMS, SPEECH, and TIME)
FACE: ASK THE PERSON TO SMILE.—-DOES ONE SIDE OF THE FACE DROOP?
ARMS: ASK THE PERSON TO RAISE BOTH ARMS.—-DOES ONE ARM DRIFT DOWNWARD?
SPEECH: ASK THE PERSON TO REPEAT A SIMPLE SENTENCE.—-ARE THE WORDS SLURRED? CAN HE/SHE REPEAT THE SENTENCE CORRECTLY?
TIME: IF THE PERSON SHOWS ANY OF THESE SYMPTOMS, TIME IS IMPORTANT. —-CALL 911 OR GET TO THE HOSPITAL FAST. BRAIN CELLS ARE DYING.
Stroke Symptoms include:
Sudden numbness or weakness of face, arm or leg - especially on one side of the body.
Sudden confusion, trouble speaking or understanding.
Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, loss of balance or coordination.
Sudden severe headache with no known cause.
If, at any time, even if you wake up with ANY of these symptoms, PLEASE DO NOT TRY TO EXPLAIN THEM AWAY. ACT FAST AND CALL 911. If you are having a stroke, there are interventions that, in some cases, can be done to treat stroke—but they must be done promptly in order to have their best chance of success.
Remember, stroke prevention is the key. If, however you or someone in your family, especially anyone with a diagnosis of high blood pressure, diabetes, coronary (heart) artery or carotid (neck) artery or peripheral (usually leg) arterial disease, or if your cholesterol is high, it why not make a plan with your doctor right now, during business hours, about what to do if you develop one of these symptoms, even if it seems mild to you at first, possibly in the middle of the night. Then you will be less likely to waste time on the phone—you will just call 911 and make every effort to go where your doctor told you that you can be treated promptly for stroke.
Tune in to Super Health Mississippi each Tuesday from 9 to 10 AM on the Super Talk Network. You can reach me on air at 888-808-8637 or by email to drbob@superhealthms.com.
Diabetes Foundation of Mississippi’s 29th Annual Super Conference, Part 2
Posted by drbob2 on Jul 6, 2008
Among the speakers at the Diabetes Foundation of Mississippi’s (www.msdiabetes.org) recent Super Conference, a sort of diabetes day, was Luis Bruno, Executive Chef for Mississippi’s Governor and Mrs. Haley Barbour. Chef Bruno presented an entertaining message before and during his preparation, on stage, of a tasty chicken dish and dessert, which he shared with several lucky members in the audience. He recounted how, while he was growing up and receiving formal education in the culinary arts, he relieved stress by eating. He enumerated the great personal and professional stresses he survived by eating. Overeating often causes diabetes or triggers it. In his case, he became huge, so morbidly obese that he became diabetic. He showed poster-sized photos of how big he had been—which brought a muffled gasp from the calorie-conscious audience. He then recounted how, with the help of God and his devoted wife, he stopped eating so much and lost well over 100 pounds. Since the photos he showed depicted a man bigger by far than anyone I saw at the Super Conference, Chef Bruno’s message was clear: If I can do it, you can do it—and still eat delicious food—just not too much and not for the wrong reasons.
Mr. Joe Solowiejczyk, a Registered Nurse, Certified Diabetes Educator, and Master of Social Work, presented an engaging session “Family Parenting, Kids Living with Diabetes,” which addressed, from a practical, common-sense perspective, many of the special challenges that families of children with diabetes face all day, every day. A talented speaker with a New York City accent, he opened with a preemptive apology, pointing out that, while he recognized that “sarcasm is considered rude in the South, it is required in New York.” He endeared himself to his audience, which included many parents and some young people, by announcing that he was a person with diabetes. He calculated, through his diabetes management, he had given himself 77,623 insulin injections. Then he drank a glass of water, stepped away from the podium, raised his arms for about a minute and said “See, no leaks.”
Mr. Solowiejczyk then turned on his Social Worker persona and pointed out that, although “diabetes is a drag” and a feeling of powerlessness is common, especially in parents of children with early diabetes, and there are many chores associated with diabetes, nevertheless there is no reason to bestow special privileges on those with Type 1 or childhood diabetes. He presented rules that help children control their diabetes but not their families. 1. No negotiating about diabetes care, insulin doses, glucose testing and diet. 2. “You don’t have to like it—just do it”. 3. Non-compliance (by a child with his or her treatment plan) and mismanagement of diabetes is like any other misbehavior. 4. Dietary indiscretions must be reported and addressed. Children are to check their blood glucose at least 4 times each day and, if their blood glucose it too low, “they should eat a Twix, Butterfinger or 3Musketeer—choose which one and do it now, or you’ll fall over.” 5. “Your insulin dose is not your own thing—yet!”
All-in-all, this diabetes day was a success. It not only informed…it inspired those who have the disease to continue life. And for those who do not have it, to stay healthy, through proper nutrition and exercise. Great ideas to move Mississippi forward.
Diabetes Foundation of Mississippi’s 29th Annual Super Conference, Part 1
Posted by drbob2 on Jul 6, 2008
The Diabetes Foundation of Mississippi (www.msdiabetes.org) hosted its 29th Annual Super Conference at the Jackson Hilton on January 12, 2008. It was so well attended that it sold out. As the keynote Speaker, Rear Adm. (Ret.) Kenneth Moritsugu, MD, the former US Surgeon General noted, the energy of the audience was remarkable. Many of those attending were persons with diabetes or family members. A lot were children, including those with childhood diabetes, and young people but there were also a lot of seasoned citizens and a number of folks who just wanted to learn more about Mississippi’s biggest health problem: diabetes.
Among the exhibitors present were service groups who offered on the spot diabetes screening to attendees and pharmaceutical companies who make new types of insulin or oral drugs to treat diabetes. Companies who make devices to monitor blood glucose were also represented and one of the main sponsors of the event was a company that makes insulin pumps.
It was a very informative day and, since several presentations were presented at the same time for those following different “tracks,” I had to miss some sessions. Nevertheless, I’d like to report in this (and upcoming) blog entries, several highlights of the day, from my perspective.
Dr. Moritsugu noted that he has an unusual form of diabetes, a specific kind of adult onset Type 1 diabetes. Type One diabetes is caused by islet cells in the pancreas not producing enough insulin and is usually, but obviously not always, seen in young people. As a person with diabetes, Dr. Moritsugu was “speaking to the choir” when he noted that he, like at least some in the audience, was “terrified” when he learned of his condition. He told how he came to grips with it-and how it did not then, and does not now, matter that he is a physician and has had great experience in public health matters relating to diabetes-he still has to remember to ask his doctor about those things that bother him and has to make an effort to remember, and follow the advice his doctor gives him. (More about the DFM Super Conference next time).