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Anchor lead: Why is the FDA sounding warnings about the herbal supplement kratom? Elizabeth Tracey reports

Kratom is an herbal supplement sold mostly over the internet that is much in the news lately, with the FDA insisting it’s an opioid. Eric Strain, a drug abuse expert at Johns Hopkins, says there really are grounds to this claim.

Strain: I think the FDA is saying there’s concerns with it is legitimate. Most of the concerns related to deaths is somebody has used kratom in combination with some other drugs. Risks increase when you start combining medications or drugs. I think we should be cautious about kratom and we really need more data about kratom. What are its effects in humans, both potential efficacy if it’s something that could be useful for people as well as the risks of side effects or of physical dependence.  :29

Most recently contaminated kratom has been implicated in Salmonella infections and hospitalizations, with some purveyors voluntarily ceasing kratom sales until more is known. Strain notes that for those using the supplement for chronic pain or opioid withdrawal there are options. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How can post-treatment Lyme disease syndrome be recognized? Elizabeth Tracey reports

Lyme disease sometimes fails to respond to treatment, and may result in a constellation of symptoms that, taken together with the presence of the characteristic rash at some point in the past, points to a diagnosis of post treatment Lyme disease syndrome. That’s according to research by John Aucott, a Lyme expert at Johns Hopkins, and colleagues.

Aucott: They continue to have symptoms that can be quite disabling including fatigue, cognitive complaints, musculoskeletal pain, sleep disruptions, and an onset after the treatment of their Lyme disease and when we see them their symptoms have often been going on for months or years. We showed in the study that they were quite disabling, they had an impact on their function and their healthcare related quality of life. Are these patients different? We showed they are different, their fatigue is much higher levels of severity, their pain is much higher levels of severity than people without Lyme disease, because we had a control group to compare them.   :33

Aucott says further research will hopefully identify ways to manage the syndrome. At Johns Hopkins, I’m Elizabeth Tracey.

 

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Anchor lead: A very specific group of people who’ve had Lyme disease may develop a chronic form, Elizabeth Tracey reports

If you’ve had Lyme disease or know someone who has, chances are good you also know that some people insist they’re still having problems even after treatment, while the medical community has largely disparaged such claims. Now John Aucott, a Lyme expert at Johns Hopkins, has published a study saying there is such a syndrome.

Aucott: Chronic Lyme disease is real in that there are subgroups now, specifically the subgroup called post treatment Lyme disease syndrome, that we have shown that you can identify, there’s two crucial characteristics: one is that we can demonstrate through a meticulous review of their medical records that they in fact had Lyme disease. It could have been six months ago, six years ago, and they had Lyme disease and they got treated but they remained ill. So the second part of the definition is they never recovered.  :30

Aucott notes that making such a diagnosis requires an experienced clinician and careful workup. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can the heart risk of some breast cancer treatments be avoided? Elizabeth Tracey reports

Radiation to the left side of the chest and some chemotherapy drugs used to treat breast cancer can result in increased risk for heart disease, the American Heart Association warns. But what are the options? Ben Park, a breast cancer expert at Johns Hopkins, comments.

Park: Understanding who’s at the greatest risk, trying to develop biomarkers for is this patient actually going to have an untoward side effect or toxicity or outcome, either in the heart world or in the breast world, the whole concept of precision medicine really rests on this. What is it about our DNA, our inherent biology that could hopefully predict that this a patient who should or should not get a given therapy because it’s going to have an untoward effect on her breast cancer versus her cardiovascular disease. But I do see that as the future so we can really try to individualize therapies for patients based on genetic and other factors.   :33

Park notes that new and more specific treatments are also under development that should also help reduce risk. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A major heart association is warning about the cardiovascular risks of some breast cancer treatments, Elizabeth Tracey reports

If you’ve been treated for breast cancer using certain therapies, the American Heart Association wants you to know you may be at increased risk for cardiovascular disease. Ben Park, a breast cancer expert at Johns Hopkins, says these risks have been known for some time.

Park: Knowing that there are certain therapies that cause increased risk to the heart, certain chemotherapies, anthrocycline class in particular, radiation, especially if it’s on the left side, these are all things that we’ve known about, are also very honest with our patients about the risks, but they’re relative risks. We really need to do what’s best for the patients, because at the end of the day if there’s an opportunity to cure breast cancer, we have to maximize that opportunity, and that involves giving these drugs and therapies that again, have risks.   :29

Park says that increased vigilance for heart problems is just one part of the constellation of care that should surround any women who’s been successfully treated for breast cancer. He says its good news that so many more women are living much longer after treatment. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Is a lot of sugar in your blood a risk factor for dementia? Elizabeth Tracey reports

Chronic high blood sugar, such as is seen in poorly controlled diabetes and even in those with prediabetes, may put someone at risk for an accelerated rate of cognitive decline, a recent study concludes. Rebecca Gottesman, a neurologist at Johns Hopkins who has done research in this area, describes what’s known.

Gottesman: Level of glycemic control was associated with rate of cognitive decline. In this particular study as well as other studies they showed that the worse your sugar control was, so both if you were prediabetic or diabetic and then amongst those people how bad your control of your glucose was, there was more decline in those patients. This is even after adjusting for other kinds of risk factors that are found in those patients. And this is important because it tells us a little bit about possibly preventable or controllable risk factors for cognitive decline, dementia, and maybe even Alzheimer’s disease.   :31

Gottesman says knowing your blood sugar level is the first step and should be a part of routine health screening for everyone. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Using surgery to remove blood clots in the brain can really help, Elizabeth Tracey reports

Thrombectomy is the medical term for removing a blood clot surgically, with two studies reported recently at the International Stroke Conference showing that now, such a strategy may be used for up to 24 hours following a stroke. Rebecca Gottesman, a stroke expert at Johns Hopkins, says very specific conditions must be met.

Gottesman: The actual amount of dead brain cells, the actual amount of damaged brain tissue that’s irreversibly damaged is relatively small, yet there’s evidence they’re at risk for having a larger area that’s not getting enough blood flow, if there’s a smaller core and a bigger area of at risk tissue, that we can determine from imaging, then those are patients that we can bring in and still do thrombectomy safely, DIFFUSE said up to 16 hours the DAWN trial said up to 24 hours, so this really dramatically changes the number of people with this type of stroke that we can actually do something for, to help their outcomes.  :32

Gottesman notes that both studies point to the utility of specialized stroke centers for best treatment. At Johns Hopkins, I’m Elizabeth Tracey.

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