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Anchor lead:  Should you manage your own blood pressure medicines? Elizabeth Tracey reports

Many people with high blood pressure are capable of managing not just monitoring but also increasing or decreasing their medicines to keep blood pressure under control, a new study concludes.  Howard Levy, an internal medicine expert at Johns Hopkins, says there is precedent for such a strategy.

Levy: I don’t yet have any clinical experience with self-titration of medications.  I have some potential fears.  I love the idea of self-monitoring and participating in one’s own healthcare. I’m also open to self-titration of medications, I do engage my patients with other types of self-titration.  We have a long track record of training diabetics to titrate their insulin based on certain parameters.  It comes down to making sure we have the resources to educate patients on how to do it properly and safely, and taking steps to minimize harm.  :31

Levy says too much or too little medicine for blood pressure can result in falls or other bad outcomes, so care is needed.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  One day soon you may be called upon to manage your own blood pressure, Elizabeth Tracey reports

Blood pressure is a tricky thing, going up temporarily in stressful situations like a doctor’s office.  So rather than rely on such a reading, many people measure their own blood pressure at home with an eye toward greater accuracy.  Now a new study puts forward the notion that people can also manage their own blood pressure medications.  Howard Levy, an internal medicine expert at Johns Hopkins, comments.

Levy:I simply ask my patients to go get a blood pressure monitor, bring it into the office, so we can check and make sure it’s accurate, and then I turn them loose. Check your blood pressure, check it a few different times a day, and one of the cool things we’re able to do with our electronic health record is set up flow sheets that enable patients, at home, to not only record their blood pressure but enter it into this electronic flow sheet.  This way they’re actually participating in writing into their medical record, we do it with blood sugar, nutrition, we have a weight flow sheet.  We can really build it on anything we want to just based on the parameters we ask a patient to monitor at home.   :30

Levy is open to investigating whether medications can also be managed by patients themselves.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How might epigenetics be involved in cancer development? Elizabeth Tracey reports

Epigenetics, or changes to genetic material that don’t involve DNA, have been shown to be present in a variety of types of cancer, work by Andrew Feinberg and colleagues at Johns Hopkins and Harvard has shown. But how might such changes promote cancer growth? Feinberg explains.

Feinberg: The most important thing that we think is going on is that there is a randomization of gene expression.  Genes are being allowed to kind of randomly get turned on and turned off, and if you think about how cancer develops if you have a cell or a group of cells where the genes within them are able to become activated or silenced kind of randomly, maybe they have a change in gene expression that isn’t very good for their growth around other cells, so that cell will die, but other cells might have an advantage in that environment and they’ll grow at the expense of cells around them.  :31

Feinberg sees potential clinical utility in assessing someone’s cancer for epigenetic as well as genetic changes.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Epigenetic changes are confirmed in several types of cancer, Elizabeth Tracey reports

What do lung, breast, colon and several other cancers have in common?  Research by Andrew Feinberg and colleagues at Johns Hopkins and Harvard has shown a pattern of so-called epigenetic changes is common to all, which could have profound implications for how genes operate in cancer cells.

Feinberg: Things get turned on and turned off somewhat erratically, and that might give cells an advantage in growing as tumors within a person’s body.  We had originally studied colon cancer.  Here we’ve extended that to look at lung cancer, breast cancer, thyroid cancer and pancreatic cancer, and we found the same things are going on in those tumors.  Also that these changes, these large scale changes in the genome that are affecting these big blocks we call it, they occur at the earliest stages of cancer.   :30

Early changes may be useful for early detection sometime down the road, Feinberg says.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a new material restore pain-free joint movement? Elizabeth Tracey reports

Hyaluronic acid is the name of a molecule that helps your joints move smoothly. In people with osteoarthritis levels of this molecule are low, so attempts have been made to inject more into joints to alleviate pain.  But observations by Jennifer Elisseeff and colleagues at Johns Hopkins show that there’s also a problem on the joint surface, so they’ve developed a new material to help.

Elisseeff: What’s going on clinically now is injections of hyaluronic acid. The problem is once you inject it it goes away really fast. The surface of cartilage is designed to interact with hyaluronic acid. Unfortunately in disease you don’t have that interaction anymore, so what we’ve done is replicate that so the surface of the tissue can then interact.  We’ve taken a synthetic polymer but then also added to that a peptide that specifically binds hyaluronic acid.  :28

Elisseeff says research is underway to see if this material can improve joint function in osteoarthritis.  At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include Ebola face to face, the best way to diagnose kidney stones in the ED, spinal manipulation for sciatica, and generic versus trade name statins.

Program notes:

0:31 Ebola Face to Face
1:31 Takes about five minutes to put on the gear
2:33 To see what it is to be on the ground there
3:32 Lots of community stigma
4:30 Need to ramp up efforts
4:50 Diagnosing kidney stones in the ED
5:50 Sonograms is lower cost and radiation
6:32 Generic versus brand name statins
7:32 Average out of pocket cost
7:52 Spinal manipulation for sciatica
8:50 More relief with spinal manipulation
10:04 End

Related blog: http://podblog.blogs.hopkinsmedicine.org/2014/09/19/ebola-face-to-face/

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This week’s topics include new hip and knee prostheses, cannabis use in adolescents, questionable use of medicines in people with dementia, and aspirin to prevent preeclampsia.

Program notes:

0:35 Cannabis use in teenagers
1:35 Frequency of use before age 17 and outcomes
2:35 Do metabolites compromise neurons?
3:36 Need to have efforts to reform legislation
3:58 Continuing medications in advanced dementia
4:58 Over half received medications of questionable benefit
5:58 Opportunity to decrease adverse events
6:22 Aspirin for preeclampsia
7:23 Risk reduction by about 10-20%
8:01 New hip and knee prostheses
9:01 Over 15,000 implants
10:05 Approval of devices needs registry
10:51 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2014/09/12/marijuana-and-the-teenage-brain/

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