Lance Armstrong Shares His Struggle to Survive Cancer… and Thrive!

Trusted Health Information from the National Institutes of Health

MedlinePlus Summer 2006 NIH the magazine Winning the Race medlineplus.gov Lance Armstrong Shares His Struggle To Survive Cancer… and Thrive!

Beware America’s Silent Killer Detecting and Managing High Blood Pressure Achoooooo! This Is the “Season of the Itch”—What You Can Do About It

Dream Robber The Challenges of Living with Parkinson’s Disease

A publication of the National Institutes of Health and the Friends of the National Library of Medicine Friends of the National Library of Medicine

s chairman of the Friends of the National Library of Medicine (FNLM), I am delighted to welcome you to NIH MedlinePlus magazine and the MedlinePlus AWeb site. We want you, your family and friends to know that you can have confidence that the information you read here and on the Web site comes directly from our nation’s best scientists and the world’s leading medical and health research organization, the National Institutes of Health. Our mission is to support the Library’s vital role to collect, organize and disseminate biomedical information. Because we believe strongly that the Library is a national treasure, we also want you to be aware that we are building a coalition of members to help inform The Hon. Paul G. Rogers the public, as well as the health and corporate communities, about the Library’s continuing Chairman, Friends of the National Library of Medicine contributions to society. and former member of the If you are interested in becoming a Friend of the National Library of Medicine, you will U.S. Congress from Florida (1955-1979) find a membership envelope inside this exciting inaugural issue of the NIH MedlinePlus magazine. You may also use the envelope to sign up for a free subscription to the magazine. On behalf of the Friends of the National Library of Medicine, we hope that you find the information presented in these pages over the coming months and years to be helpful. Thank you for your interest.

Sincerely, Paul G. Rogers Chairman Friends of the National Library of Medicine

Helping the Library Extend Medical Knowledge In 1986, the Friends of the National Library of Medi- The mission of the Friends of the National Library of cine (FNLM) was formed as a nonprofit organization to Medicine is to improve health by increasing the use of promote, publicize and support the Library. FNLM is a the latest, most effective medical and scientific infor- coalition of individuals, medical associations and societ- mation by health care professionals, scientists and the ies, hospitals, health science libraries, corporations and general public. The major objective of the Friends is to other nonprofit organizations dedicated to increasing educate the health, corporate and public communities public awareness and public use of the National Library about the National Library of Medicine and to do this by of Medicine. building a coalition of financial and other supporters. NIH MedlinePlus ® the magazine Summer 2006 NATIONAL LIBRARY OF MEDICINE at the NATIONAL INSTITUTES OF HEALTH Table of Contents 8600 Rockville Pike, Bethesda, MD 20894 www.nlm.nih.gov www.medlineplus.gov

Donald A.B. Lindberg, M.D. Director, NLM Betsy L. Humphreys, M.L.S., A.H.I.P. Deputy Director, NLM Donald West King, M.D. Deputy Director for Research and Education, NLM Robert B. Mehnert, Director Office of Communications and Public Liaison, NLM Kathleen Cravedi, Deputy Director Office of Communications and Public Liaison, NLM 6 Christopher Klose Magazine Coordinator Inside Peter Reinecke, Front Cover Letter from the Friends Chairman Strategic Advisor, NLM 1 Table of Contents 2 Introductions Paul G. Rogers Chairman, Friends of the National Library of Medicine 4 Clinical Trials Friends of the NLM P.O. Box 31130 6 Winning the Race: Bethesda, MD 20814 Lance Armstrong shares his struggle to survive cancer ... and thrive! 11 Pressure Points Detecting and managing high blood pressure Selby Bateman, Managing Editor Jan McLean, Creative Director Shay Sprinkles, Art Director 14 dream Robber Traci Marsh, Production Director The challenges of living with Parkinson’s Disease.

NIH MedlinePlus, the Magazine is published by Vitality Communications 20 Achoooooo! 407 Norwalk St. This is the “season of the itch”— Greensboro, NC 27407 (336) 547-8970 what you can do about it

William G. Moore, President Pat Blake, Controller 26 NIH Research News Pat Schrader, Administrative Assistant 28 Advisors & Sponsors Articles in this publication are written by professional journalists. All scientific and Inside medical information is reviewed for accuracy by representatives of the National Back Institutes of Health. However, personal decisions regarding health, finance, exercise CIBCover NIH MedlinePlus Editorial Board and other matters should be made only after consultation with the reader’s physician or professional advisor. Opinions expressed herein are not necessarily those of the National Library of Medicine. NIH MedlinePlus Summer 2006 1 MedlinePlus and NIH’s National Library of Medicine

Welcome to NIH MedlinePlus, the magazine

t is a pleasure to support the how to stay healthy for a lifetime and will National Library of Medicine and also profile some of the most fascinating the Friends of the National Library people—from laboratory scientists and of Medicine in launching the first public figures to patients just like you— issue of NIH MedlinePlus. This who are making a difference in the search quarterlyI guide for patients and their for medical advances. families brings to you the latest and most The American people have made authoritative medical and healthcare a long-term investment in the crucial information from the National Institutes medical research being carried on by The Nation’s Medical of Health (NIH) as featured online at the the NIH. NIH MedlinePlus magazine is Research Agency MedlinePlus Web site. Your physician has an important way to make this research made this magazine available to you as and healthcare information even With roots in the 19th century, a free health resource; please take a copy more accessible and useful to health the National Institutes of Health with you today. professionals and patients alike. (NIH) is the world’s leader in medi- The MedlinePlus Web site is a free cal research. Comprised of 27 and comprehensive public health separate Institutes and Centers, information resource from the world’s NIH is the primary federal agency largest medical library, NIH’s National for conducting and supporting Library of Medicine. MedlinePlus has medical research, providing lead- extensive information from the NIH ership and financial support to and other trusted sources on more than top scientists in every state in the 700 diseases and conditions. There are nation and throughout the world. also lists of hospitals and physicians, a Supported by the American medical encyclopedia and a medical taxpayer, NIH research has led dictionary, health information in Spanish, to tremendous breakthroughs extensive information on prescription and in what we know about diseases nonprescription drugs, health information and how to prevent, detect, diag- from the media and links to thousands nose and treat them. More than of medical clinical trials. NIH Director Elias A. Zerhouni, M.D., 80 percent of NIH’s funding is This magazine will provide you with leads the nation’s medical research agency awarded through almost 50,000 a gold standard of reliable, up-to-date and oversees the NIH’s 27 Institutes and competitive grants to more than health information in a very user-friendly Centers and more than 17,000 employees. 212,000 researchers at over 2,800 format that can act as a springboard to universities, medical schools and the Web site. Each issue will highlight four other research institutions in ev- major health conditions, offering the latest The National Institutes of Health ery state in the U.S. and around advice on prevention, diagnosis, treatment is an agency of the U.S. Department the world. and research findings. Regular features of Health and Human Services. will include the latest information on

2 Summer 2006 NIH MedlinePlus Dear Reader, It is a pleasure to welcome you A National Treasure- to NIH MedlinePlus magazine, your House of Knowledge guide to the vast resources that you will find at MedlinePlus.gov, The National Library of the free Web site of authoritative Medicine (NLM), on the campus health information from the of the National Institutes of National Institutes of Health (NIH) Health in Bethesda, Maryland, and other trusted sources. is the world’s largest medical MedlinePlus.gov was created library. The Library, which has by the National Library of Medi- long served health professionals, cine, a part of the NIH and the U.S. educators and scientists, now Department of Health and Human Dr. Donald Lindberg and grandson also provides free information Services. Founded in 1836, primar- explore www.medlineplus.gov. for the general public at ily for doctors, the Library has www.medlineplus.gov. expanded its mission and now serves the general public as well as health professionals. Each month, the public, physicians and health professionals view some 75 million pages of timely health information on the MedlinePlus Web site. There is no advertising, no registration and the site is completely free. In addition to a remarkable array of consumer-friendly information, there are con- venient links to the scientific medical literature (PubMed), a registry of 27,000 clinical trials, extensive information about genetic diseases and much more. The Web site is updated daily, so it always carries the latest information. NLM collects materials in all I hope that you, your family and friends will find this magazine useful. areas of biomedicine and health- If you would like to receive NIH MedlinePlus regularly, please fill out the care, as well as works on bio- subscription envelope attached inside this issue. And take a look at the Web medical aspects of technology, site. I think you will find a wealth of information that will help keep you and the humanities and the physical, your loved ones healthy. life and social sciences. The col- Sincerely, lections stand at more than Donald A.B. Lindberg, M.D. 8 million items—books, journals, Director, National Library of Medicine technical reports, manuscripts, microfilms, photographs and images. Housed within the Li- brary is one of the world’s finest medical history collections of old and rare medical works. NLM is a national resource for all U.S. health science libraries through the National Network of Libraries of Medicine.

NIH MedlinePlus Summer 2006 3 Clinical Trials A Crucial Key to Human Health Research At the forefront of human health research today are clinical trials— studies that use human volunteers to help medical professionals observe and test new treatments for a wide array of health products and practices

clinical trial is a research study by contributing to medical research. n Diagnostic trials to find better designed to answer specific There are several different kinds tests or procedures for diagnosing a health questions by using of clinical trials, including: particular disease or condition. human volunteers to help n Screening trials that test the best way Atest those answers. Carefully conducted n Treatment trials to test experimental to detect certain diseases or health clinical trials are the fastest and safest way treatments, new combinations of conditions. to find treatments that work in people, drugs or new approaches to surgery n Quality of Life trials (or Supportive and there are clinical trials going on all or radiation therapy. Care trials) that explore ways to the time in virtually every area of medical n Prevention trials that look for better improve comfort and the quality research. People who volunteer to take part ways to prevent disease in people of life for individuals with chronic in clinical trials do so for several reasons, who have never had the disease, or to illnesses. including the chance to play a more active prevent a disease from returning. These role in their own health care, gain access approaches may include medicines, The latest and most complete to new research treatments before they vitamins, vaccines, minerals information about clinical trials today are widely available and help others or lifestyle changes. is available at the ClinicalTrials.gov

4 Summer 2006 NIH MedlinePlus institution. The results will show you (www.pubmed.gov) and links to the what studies are under way, whether a National Cancer Institute (www.nci. trial is actively recruiting, the purpose nih.gov), the lead NIH institute on this of the study, where and when it will take particular topic. place and whom to contact for more “It’s really one-stop shopping, information. allowing the user to dig deeper for “From the very beginning, information on the disease or condition ClinicalTrials.gov has been designed after viewing the list of clinical trials,” for use by patients,” observes Donald says Dr. Lindberg. “ClinicalTrials.gov Lindberg, M.D., director of the National is a powerful tool for the individual Library of Medicine (NLM), the health care consumer, and it has untold coordinating agency for NIH. “With benefits for the public health, too, as new patients taking an increasingly active role drugs and therapies evolve from these in their own healthcare, they now have important studies.” n a chance to learn more about clinical studies on everything from Alzheimer’s disease to zinc supplementation. Without question, it has helped investigators with their research How to Participate recruiting efforts, too.” Clinical trials are sponsored or Launched in February 2000, funded by a variety of organizations ClinicalTrials.gov currently contains or individuals, such as physicians, information on more than 27,000 trials. medical institutions, foundations, The site has proven very popular with voluntary groups and pharma- the public, logging approximately ceutical companies, in addition to 8 million page views monthly and federal agencies such as the NIH, the hosting over 20,000 visitors daily. The Department of Defense (DOD) and site is updated regularly, with new the Department of Veterans Affairs information added every day. (VA). Trials can take place in different Web site (http://clinicaltrials.gov). This ClinicalTrials.gov has many helpful locations, such as hospitals, is a free, confidential online resource features for the consumer. If you are universities, doctors’ offices from the National Institutes of Health checking out trials on breast cancer, and community clinics. (NIH), which anyone with a computer for example, the site also links you If you would like to participate and Web browser can tap into for to the NLM’s MedlinePlus (www. in a clinical trial, you can find oppor- a comprehensive listing of clinical medlineplus.gov), with in-depth tunities and more information studies—in the U.S. and abroad— information on the topic, including at government Web sites such as: sponsored by the NIH and other federal recent news articles and an interactive n http://www.clinicaltrials.gov agencies, pharmaceutical companies, tutorial. ClinicalTrials.gov also points n http://www.cancer.gov/search/ universities and nonprofit organizations. you to NLM’s Genetics Home Reference clinicaltrials (Cancer studies) Here’s how it works. After you enter site (www.ghr.nlm.nih.gov), helping you n http://www.aidsinfo.nih.gov/ the ClinicalTrials.gov Web site, you can understand possible genetic factors that clinical_trials (HIV and search for a trial by the name of the can increase the incidence of the disease. AIDS studies) disease, the location of the study, the It allows you to search medical journal type of treatment or the sponsoring references via NLM’s PubMed

NIH MedlinePlus Summer 2006 5 Winning the Race Lance Armstrong Shares His Struggle To Survive Cancer ... and Thrive!

The world knows and celebrates Lance Armstrong for his remarkable defeat of life-threatening cancer and for his unparalleled seven consecutive victories in the Tour de France bicycle race. But, as Armstrong reveals in this exclusive interview, he is prouder of his cancer victory than all of his racing wins. Armstrong, whose non-profit Lance have clipped into a pedal and started a bike Dr. von Eschenbach finds Lance Armstrong Foundation (LAF) is now a race ever again.” Armstrong’s story so compelling: “Lance leader in the fight against cancer, knows Success stories such as Armstrong’s is a cancer survivor who represents so all too well the impact that cancer of any are part of an evolving strategy in the many, many others across this country and kind can have on an individual. In 1996, fight against cancer, notes Andrew von the world who have faced the challenge his own aggressive form of testicular Eschenbach, M.D., NCI director and of cancer,” he says. “He is an example to cancer metastasized into his lymph acting commissioner, U.S. Food and Drug us of what is possible, what is within our nodes, lungs and brain. Armstrong Administration. grasp—a world in which no one suffers underwent two surgeries, one to remove “Over the course of the 20th century, and no one dies as a result of cancer.” his cancerous testicle and another to the primary strategy for treating cancer remove two cancerous lesions on his brain. was ‘seek and destroy’,” he says. “Now, in an How did you learn of your cancer, Over a three-month period, he received effort to preserve healthy cells and improve and how did you feel about it? four rounds of chemotherapy. For these outcomes, we are increasing efforts to I was diagnosed with advanced Treasons, he understands that defeating ‘target and control’ cancer by modulating testicular cancer on October 2, 1996. cancer cannot be done alone. and altering the behavior of the disease. I had ignored the symptoms for As he told doctors, researchers and Someday we will eliminate cancer, but for months; pain comes with professional clinical trial participants on one of his visits today, our immediate goal is to eliminate cycling, so it was easy to dismiss the to the NIH’s National Cancer Institute the suffering and death due to cancer.” soreness in my groin, headaches and (NCI), without their cancer research and (Read more comments from Dr. von difficulty breathing. I reluctantly went that of others, “...quite frankly, I wouldn’t Eschenbach on page 8.) to the doctor after my testicle had be here today. And I certainly wouldn’t That is one of the many reasons that swollen to three times its normal size.

6 Summer 2006 NIH MedlinePlus I owe a lot to my neighbor—a friend more opinions and to not be afraid to Beyond supplying information, and doctor who insisted I get it checked question their doctors. the work of the NCI represents our out. By the time I was diagnosed, the I also think that a person with cancer government’s commitment to cancer. cancer had already spread to my lungs needs to seek out support from friends That is why the current $40 million in and brain, so it is fair to say I was in and family. I had a group of people budget cuts proposed for the NCI are bad shape. there for me—to listen to me, cheer wrong. There is a long budget battle How did I feel about it? Probably me on or remind me that I wasn’t really ahead, and I know the Senate has the same as anyone who has ever been alone. I was lucky to know that other proposed an amendment to restore diagnosed feels about cancer—I was in people were invested in my survival; funding. We cannot back away from our complete shock. Here I was, young and you can never overestimate the benefit healthy and riding better than ever and, of that kind of support and friendship. suddenly, I have cancer. I was worried MedlinePlus and about losing my career and, frankly, my In addition to talking with your life. I didn’t know how to tell my mom, doctors, did you seek information NCI Cancer Resources and I was scared and angry. from the National Cancer Institute, Main MedlinePlus Web page: I can now say that my life is better and how important was it to you? www.medlineplus.gov because of my cancer experience. At the time, I didn’t know anything Though I wouldn’t wish it for anyone, about the NCI and all the resources MedlinePlus cancer types: I believe I appreciate my life in a available to people with cancer. I http://www.nlm.nih.gov/ completely new and better way discovered the NCI while researching medlineplus/cancers.html because I faced cancer and was lucky information about my diagnosis, and I enough to survive. Having said that, believe it is a very important resource. Patient education tutorials: I also believe that cancer still affects I would encourage anyone facing http://www.nlm.nih.gov/ far too many people, and we must cancer to seek more questions and medlineplus/tutorial.html continue to work to change that fact. not be afraid. Especially now, with the increased use of the Web, it is amazing Drugs, supplements and herbal information: You say that “knowledge is power” how much information is available http://www.nlm.nih.gov/med in fighting cancer. From your to a new patient. lineplus/druginformation.html experience, what are the two or three most important things you believe Updated information about feder- cancer patients should keep in mind? ally and privately supported clinical My mom and a core group of research in human volunteers: friends helped me spend countless http://clinicaltrials.gov hours reading information and asking questions. It’s really important, and I Directories of health-care profes- can’t stress that enough. You must be sionals, services and facilities: your own best advocate to be sure the www.nlm.nih.gov/medlineplus/ treatment you are getting is best for you. directories.html I got a second opinion, which can National Cancer Institute (NCI): be tough to do. We are inclined to Armstrong and the Lance Armstrong Foundation www.cancer.gov/ trust our doctors implicitly and not hold LIVESTRONG Challenge cancer-research question them, but the second opinion fund-raisers in various cities across the country, Links to all types of cancer: I got was the right one for me. So, such as this 2005 Ride Portland event in Oregon. www.cancer.gov/cancertopics I would encourage people to seek For details, visit www.livestrongchallenge.org.

NIH MedlinePlus Summer 2006 7 commitment to beating cancer, and the tough questions, get a second opinion, NCI is critical in that fight. take care of yourself, surround yourself with family and friends, and do whatever What is the message you would you have to do to keep hope alive. most like to send to people recently diagnosed with cancer? The goal of this new magazine, Hope. There can and should be life NIH MedlinePlus, is to give people after cancer for more people, and I want access to trusted, easily understood people to know that. information about dealing with On Wednesday, May 17, you At a Lance Armstrong Foundation disease and staying healthy. Do you can help Lance and the LAF (LAF) event in Austin last fall, a lung often hear from people seeking such be a voice for change. Thou- cancer survivor told the audience that she reliable information? sands of people will take part changed doctors because the first one Constantly. A cancer diagnosis in LIVESTRONG Day events seemed to write her off. changes a person forever. It is an across the country to raise She said she fired the doctor because, overwhelming and confusing thing, awareness of and bring atten- as she put it, “I can’t have more hope than particularly since there are so many you do. I need someone to believe in me.” types of cancer and so many outcomes. tion to an issue that impacts Maybe that’s why she is still here and was More than anything else, people just all Americans—cancer. able to come to Austin to share her story. want information. They want to know For more information, visit Cancer is tough, and it still claims too about treatment, treatment centers, www.livestrong.org. many lives, but I think that hope is the side effects, fertility and depression greatest weapon a person has. Ask the and, of course, how they are going to

Working Together, We Can Defeat Cancer An interview with Andrew C. von Eschenbach

Cancer—in all its forms—continues to take a huge toll National Cancer Institute has committed itself to a goal, on people across the world. In your opinion, where do one based on our emerging understanding of cancer as a we stand in the fight today? disease process. Our plan is to eliminate the suffering and This year, more than 1.4 million Americans will hear death that result from this process that we understand as the words, “You have cancer.” One out of every two men cancer, and we are committed to a goal of doing so as early and one out of every three women during their lifetime as 2015. will hear the words, “You have cancer.” One American every minute is dying as a result of this disease. Now, we In what ways do you see the fight against cancer need fresh thinking about new goals—goals that remain changing so dramatically? focused not as a cure but as a long-term solution for We have the ability within our grasp, based on the controlling cancer. trajectory of progress, to expand our understanding of the In 1971—the same year that Lance Armstrong was fundamental mechanisms that give rise to our susceptibil- born—the National Cancer Act was passed, and the ity to cancers, the early events of malignant transformation, country committed its resources to conquer cancer. That the progression and the metastatic spread and the ultimate journey has led us to a truly transformational moment. The death that we see all around us in our friends and relatives.

8 Summer 2006 NIH MedlinePlus pay for their care. One of the goals of my own, but cancer in general. I knew research, advocacy and public health the LAF is to provide information to that I needed to use this experience to programs. It’s a big job; we are fully people about the physical, practical help others, which was how the idea for dedicated to it. and emotional consequences of cancer. the Foundation began. It’s a big job, and this information I’m lucky to meet so many people What does the future hold for is in demand, so we welcome more through the LAF that remind me how Lance Armstrong? resources for people with cancer. courageous the average cancer patient I hope to live up to the words of one is. And it’s a reminder that cancer of my doctors—Dr. Craig Nichols—and Could you share a brief anecdote or doesn’t discriminate. I have met people continue to fulfill the obligation of moment that occurred during your from all over the world with all types of the cured by leading a grassroots treatment that speaks to you about cancer and more brave kids than I can movement to reduce incidence, how the courageous struggle by count. A person could get discouraged increase survival and offer each person cancer patients can be a meaningful by that, but we use it to inspire us to with cancer the opportunity to live their boost to other cancer patients? work harder. life on their own terms. While I was being treated, my nurse, I am grateful for the tremendous and Latrice Haney, started introducing me What is your goal for the Lance unforgettable experiences my cycling to other patients. It was good for me. Armstrong Foundation? career has brought me, but I am most That was when I truly began to grasp We want to inspire and empower proud to be a cancer survivor and a the magnitude of cancer—more than people with cancer. We want to provide parent. It is these two roles that will 8 million people living with it at the people with the practical tools and guide my future. n time. I got really angry and became information they need to live strong. interested in fighting cancer, not just We are doing that through

We are now understanding the molecular mechanisms we can identify those patients who that control the process, and we are learning how to might benefit from that particular exploit those mechanisms to prevent, detect, eliminate intervention. or control the process. Also, we are moving from an era in which imagery is no longer Would you give us examples of how the NCI and its simply enabling us to see a lump on many researchers across the globe are proceeding a chest X-ray or a mass on a CT scan, Andrew C. von in their work? but enabling us to visualize—using Eschenbach, M.D. Genomics, proteomics and emerging technologies are molecular imaging—the biology of the Director, National Cancer enabling us to profile not only diseases but the persons disease in real time. For example, in Institute; Acting Com- who bear those diseases. We can, thus, understand the gastrointestinal cancer, using the new missioner, Food and genetic and molecular differences, so that we can begin drug Gleevec, you can use radioactive Drug Administration to personalize intervention strategies. imaging agents to see in 24 or 48 hours In our recent experience with lung cancer, we have seen whether you have changed the biochemistry of that tumor. the introduction of the drugs Iressa and Tarceva, which are What we thought was impossible back in 1971 is a targeted to affect an enzymatic pathway involved in the reality today. What we think is impossible today—a world proliferation and growth of cancer cells. By understanding in which no one would suffer or die from cancer—can the genetic mutations that lead to that abnormal pathway, become a reality if we make it happen together.

NIH MedlinePlus Summer 2006 9 HEART DISEASE

dCAREoesn’ WHAT�� YOU WEAR IT’S THE #1 KILLER OF WOMEN The Red Dress is a red alert to take heart disease seriously.

These women know The Heart Truth—no matter how great you Talk to your doctor and get answers that may save your life. The look on the outside, heart disease can strike on the inside. And Heart Truth is, it’s best to know your risks and take action now. being a woman won’t protect you. www.hearttruth.gov

Try these risk factors on for size: Do you have high blood pressure? High blood cholesterol? Diabetes? Are you inactive?

Are you a smoker? Overweight? If so, this could damage your heart and lead to disability, heart attack, or both.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Heart, Lung, and Blood Institute; National Institutes of Health • Office on Women’s Health

American Heart Association • WomenHeart: the National Coalition for Women with Heart Disease Pressure Points: Preventing and Controlling Hypertension

May is National High Blood Pressure Education Month, a good time for many Americans to make sure that they and their loved ones are protected against this silent killer.

Nearly one in three adults—almost 65 million Americans—suffers from hypertension, or high blood pressure. What’s more, high blood pressure leads to more than half of all heart attacks, strokes and heart failure cases HEART DISEASE in the United States. It also increases the risk of kidney failure, blindness and other serious health consequences. Faced with such alarming statistics physicians and communities across the numbers, the systolic (pressure during and based on a landmark 2002 study country will be taking part in the activities a heartbeat) over the diastolic (pressure called the Antihypertensive and Lipid- planned to inform the public how to between heartbeats). For example, a CARE WHAT YOU WEAR Lowering Treatment to Prevent Heart recognize and treat hypertension. measurement of 120/80 millimeters doesn’ Attack Trial (ALLHAT), the National of mercury (mmHg) is expressed as �� Institute of Health’s National Heart, Lung, Living by the Numbers “120 over 80.” Normal blood pressure is IT’S THE #1 KILLER OF WOMEN The Red Dress is a red alert to take heart disease seriously. and Blood Institute (NHLBI) has begun For patients and their families alike, it is less than 120/80. People with pressures a comprehensive, nationwide educational critical to understand the basics in order to between 120/80 and 139/89 are considered These women know The Heart Truth—no matter how great you Talk to your doctor and get answers that may save your life. The outreach program to better identify and be able to better control the disease. to have pre-hypertension and be likely treat high blood pressure. Simply put, blood pressure is the to develop high blood pressure without look on the outside, heart disease can strike on the inside. And Heart Truth is, it’s best to know your risks and take action now. “It often takes years for the results of force exerted by blood on the walls of the preventative measures. being a woman won’t protect you. www.hearttruth.gov Nmajor studies to become part of standard arteries and veins as it courses through the Today, clinical guidelines recommend healthcare,” says NHLBI Director body. Like the ocean tide, it is normal for that physicians work with patients to Try these risk factors on for size: Do you have high blood Elizabeth G. Nabel, M.D. “The results of blood pressure to rise and fall throughout keep their blood pressures below 140/90 ALLHAT and the clinical guidelines could the day. But when the pressure stays mmHg, and even lower for people with pressure? High blood cholesterol? Diabetes? Are you inactive? have an enormous impact on the health elevated over time, it causes the heart to diabetes or kidney ailments. In all cases, Are you a smoker? Overweight? If so, this could damage your of millions of Americans. By aggressively pump harder and work overtime, possibly patients are encouraged to lose excess heart and lead to disability, heart attack, or both. sharing this information, we will be able leading to various, serious health problems, weight, exercise regularly, not smoke, to put the results into action more quickly ranging from hardening of the arteries, limit intake of alcoholic beverages, and more effectively.” stroke and brain hemorrhage to kidney and follow heart-healthy eating plans, Throughout May, which is National malfunction and blindness. including cutting back on salt and other U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES High Blood Pressure Education Month, Blood pressure is recorded as two forms of sodium. National Heart, Lung, and Blood Institute; National Institutes of Health • Office on Women’s Health NIH MedlinePlus Summer 2006 11 American Heart Association • WomenHeart: the National Coalition for Women with Heart Disease ADDITIONAL INFORMATION ON HYPERTENSION

MedlinePlus: High blood pressure: he says, “so I’ve got to be more careful, pressure benefits of maintaining a healthy http://www.nlm.nih.gov/ especially at lunch when I usually grab diet. First is the Dietary Approaches medlineplus/ a burger and fries. Besides the fat, that to Stop Hypertension (DASH) clinical highbloodpressure.html meal has lots of salt.” study, which tested the effects of food n Carol Jackson, 42 and white, has thus nutrients on blood pressure. It emphasizes Tutorial on high blood pressure: far managed to avoid a diagnosis consumption of fruits, vegetables and low- http://www.nlm.nih.gov/ of high blood pressure although fat dairy foods, whole grains, poultry, fish medlineplus/tutorials/ her readings do fall within the pre- and nuts, and stresses reduction of fats, red hypertension/htm/index.htm hypertension range, putting her on meats, sweets and sugared beverages. notice. Further reasons to remain Second is the DASH-sodium study, DASH eating plan: http://www. on guard include a family history of which demonstrates the importance of nhlbi.nih.gov/health/public/ high blood pressure, lack of regular lowering sodium intake. Most Americans heart/hbp/dash/new_dash.pdf exercise and the fact that she smokes. consume far more than the current, daily “My mother and father both had high recommendation of 2,400 milligrams Links to clinical trials: http:// blood pressure, and my father passed (mg) of sodium—about a teaspoon of clinicaltrials.gov/ct/gui/ away from a stroke when he was only table salt—or less. This includes all salt action/FindCondition?ui= 59,” she says. and sodium consumed, not just at the D006973&recruiting=true By adopting healthier lifestyles, Tucker, table, but also in cooking. For those with Jackson and the millions more facing high blood pressure, consuming even less Types of blood pressure medica- hypertension can begin controlling their may be advisable, since the DASH-sodium tions: http://www.nhlbi.nih. conditions. “Don’t wait until your pressure study revealed that diets containing no gov/hbp/treat/bpd_type.htm spikes to make changes,” urges Lawrence more than 1,500 mg of sodium per day Appel, M.D., M.P.H., lead author of a had still greater pressure-lowering effects. Assessing Your Risk February 2006 report in Hypertension: Regular physical activity is another While many Americans develop high Journal of the American Heart Association, good step toward controlling or even blood pressure as they get older, it is not a which links healthier eating habits to preventing high blood pressure. Start with hallmark of healthy aging. This is especially lowered blood pressure. 30 minutes of moderate-level activity, such critical for African-Americans, in whom “While an individual’s blood pressure as brisk walking, bicycling or gardening the disease tends to begin at an earlier age may be normal now, 90 percent of on most—preferably all—days of the and be more severe. In addition to being at Americans over 50 years of age have a week. The activity even may be divided increased risk, they also experience higher lifetime risk of high blood pressure,” into three, 10-minute periods each. For rates of death from stroke and kidney says Appel, a professor at Johns Hopkins added benefit, these moderate half-hours disease than does the general population. University School of Medicine. “Americans may be increased or supplanted by regular, As the following examples illustrate, should take action before being diagnosed vigorous exercise. Of course, prior to the indicators for high blood pressure vary with high blood pressure.” upping the activity level, people should widely from individual to individual and check with their physicians, especially if bear very close, personal vigilance. An Ounce of Prevention they have had heart trouble or a previous n Ron Tucker, a 42-year-old For example, because blood pressure heart attack, a family history of heart African-American suffering from rises as body weight increases (and obesity disease at an early age or other serious hypertension, is always on the go. is a known risk factor for developing high health problems. His biggest challenge to lowering his cholesterol and diabetes, which in turn can Another healthy move is to limit blood pressure is to watch what he lead to heart disease), a loss of little as 10 alcohol intake. Excess alcohol can raise eats, especially fast food. “African- pounds can help to lower blood pressure. blood pressure as well as damage the liver, Americans are very sensitive to salt,” Two recent studies confirm the blood heart and brain. Drinks should be kept to a

12 Summer 2006 NIH MedlinePlus maximum of one per day for women, and Taking Control For much more information on high two for men. (One drink equals 12 ounces High blood pressure is a silent blood pressure, log onto the NIH Medline of beer or five ounces of wine.) killer, often with no obvious or visible Plus Web site (www.medlineplus.gov), Finally, quit smoking. Among other symptoms. The only way to find out if the free, consumer-friendly health and things, smoking damages blood vessel you have hypertension is through testing medical resource featuring thousands walls and speeds hardening of the arteries. by your physician, who will make the of definitions, encyclopedia articles, Ceasing smoking reduces the risk of heart diagnosis on the basis of two or more interactive tutorials and clinical trials. n attack in just one year. readings taken on different visits.

Hypertension—Listen to Your Heart An interview with Elizabeth G. Nabel Why should Americans be concerned Plan on the NHLBI Web site at about high blood pressure? www.nhlbi.nih.gov/health/ Hypertension—or high blood pressure—is a serious public/heart/hbp/dash/. public health problem affecting one in three Americans. Dr. Elizabeth G. Nabel Known as the “silent killer” because it usually has no Where do we stand Director, National symptoms, with high blood pressure, the heart works in the fight against Heart, Lung, and harder, your arteries take a beating and your chances of hypertension? Blood Institute (NHLBI) a stroke, heart attack and kidney problems are greater. High blood pressure causes Because it affects circulation, high blood pressure more visits to doctors than any other condition and, also creates a higher risk for mental deterioration and along with its complications, costs the U.S. economy Alzheimer’s. Once high blood pressure develops, it more than $100 billion annually. Just a 10 percent usually lasts a lifetime but the good news is that it can decline in the number of doctor visits would save $478 be treated and controlled by keeping a healthy weight, million each year. Data from clinical trials indicate that exercising regularly, following a healthy eating plan, controlling hypertension with medicines can produce reducing intake of salt and sodium, and consuming a 55 percent reduction in heart failure, a 37 percent alcohol in moderation if you drink. reduction in strokes and a 27 percent reduction in heart attacks. I have heard about the DASH Eating Plan to help control hypertension. What is it? What is the long-range prognosis DASH stands for Dietary Approaches to Stop for controlling high blood pressure? Hypertension. The DASH Eating Plan is a diet rich in fresh Controlling high blood pressure is doable, which is fruits, vegetables, low-fat dairy, fish and poultry, which especially important news for the nearly 60 million studies sponsored by the NHLBI have shown can achieve Americans who are over the age of 55 and face a 90 large reductions in blood pressure. For those who also percent likelihood of developing high blood pressure in reduce salt and sodium consumption, the decrease their lifetimes. They should have their blood pressures in blood pressure has been shown to be even more measured and follow their doctors’ advice and faithfully significant. The DASH Eating Plan promotes a diet that is do the things that can make a healthy difference: lose low in saturated fat, cholesterol and total fat, as well as weight; eat “heart healthy” diets low in fat, cholesterol, lowered intake of red meat, sweets and sugar-containing sodium and salt; and spend 30 minutes each day walking beverages. You can find and print out the DASH Eating or doing some other form of physical activity.

NIH MedlinePlus Summer 2006 13 Dream Robber: Living with Parkinson’s disease

14 Summer 2006 NIH MedlinePlus s a boy, John Kuhn dreamed of becoming a pilot. Mechanically minded and good with his hands, he earned Ahis first “wings” at 16. At 26, he became a commercial airline pilot, eventually rising to captain on the strength of his experience and finely honed motor skills.

Now 65, he has been permanently Subtle onset of classic symptoms grounded by Parkinson’s disease, Parkinson’s disease—the most Robber: unable, due to the loss of motor control common form of parkinsonism, in his right hand and leg, to qualify a group of disorders with similar for the special license he needs to fly features—produces a wide range of the sleek kit airplane he dreamed of problems that appear and progress at building and taking to the skies in different rates and to varying degrees retirement. from individual to individual. Early “Except for having to give up flying, symptoms are often subtle and may Parkinson’s hasn’t changed my life include mild shaking of the limbs much,” he says bravely, but a little (tremor), slowness of movement or wistfully. stiffness. Diagnosed with the disease in 1998, Often, family or close friends actor Michael J. Fox perhaps best may notice other changes in the captured the dramatic impact it can person with PD, including decreased have when he said, “Parkinson’s forced facial expression, increasingly soft me to make a fundamental life decision: voice or progressively more illegible adopt a siege mentality—or embark handwriting. As the disease advances, upon a life journey.” “It hasn’t changed four classic clinical signs typically Fox since has become one of the appear: nation’s foremost advocates for finding a cure for the disease, which was first my life much n Tremor—rhythmic, back-and- described in 1817 by English physician forth trembling of the hands, James Parkinson as “the shaking palsy.” except...” arms, legs, jaw or face In the early 1960s, researchers identified n Rigidity—stiffness of the limbs a fundamental brain defect that is and/or trunk the hallmark of PD: the loss of brain walks of life are diagnosed each year n Bradykinesia—the slowing down cells, or neurons, in an area known with Parkinson’s, and more than one- and loss of spontaneous and as the substantia nigra that produce half million people are affected at any automatic movement, particularly dopamine, a chemical that helps direct one time. Respecter of neither fame frustrating because it may be smooth, purposeful muscle activity. nor fortune, PD strikes all over the unpredictable, and what once was Like Kuhn, Fox, Muhammad Ali world, affecting men at a slightly higher routine, like washing or dressing, and former U.S. Attorney General Janet rate than women. may take significantly longer Reno, some 50,000 Americans from all

NIH MedlinePlus Summer 2006 15 n Instability—impaired balance and skin and scalp; excessive sweating and a to John Kuhn two months after his stooped posture variety of sleep difficulties. mandatory 60th birthday retirement as a commercial pilot. However, Other clinical features sometimes Difficult to diagnose research over the last several years present include depression; emotional Typically a disease of late middle age, has demonstrated that as many as 10 problems, such as anxiety; loss of Parkinson’s usually affects people over percent of Parkinson’s patients may motivation; difficulty swallowing; the age of 50, with 60 being the average experience onset before 40, like Michael urinary problems or constipation; oily age of onset—just what happened J. Fox when he was diagnosed. Even for experienced neurologists, accurately diagnosing Parkinson’s Unraveling Parkinson’s: in its early stages can be difficult in some cases. No blood or laboratory Three Clues tests are available, so physicians may have to observe patients for some time As yet, there is no way to predict the until it is apparent that clinical signs majority of cases of PD or prevent dis- and symptoms are consistent with a ease progression. Studies have shown diagnosis of PD. that Parkinson’s patients have lost 60 to 80 percent of the dopamine-producing Effective drug relief cells in their substantia nigra before Although there currently is symptoms begin. Researchers don’t no cure, various medications can know why or how the cells die, but provide dramatic relief from many they are beginning to find fascinating of Parkinson’s debilitating motor new clues. (movement-related) symptoms. Physicians tailor treatment to a patient’s Free radicals: One theory holds that particular condition since no two people free radicals—unstable and potentially react the same way to a given drug. damaging molecules generated by the body’s normal chemical reac- The primary therapy for PD is tions—may contribute to nerve cell death, thereby leading to Parkinson’s in replacement of dopamine via levodopa a process called oxidation. Evidence that oxidative mechanisms may cause (also called L-dopa, from the full name or contribute to the disease includes the findings that Parkinson’s patients L-3,4-dihydroxyphenylalanine), a exhibit increased brain levels of iron and decreased levels of ferritin, a pro- simple chemical found in plants and tein that stores, or binds, iron in the body. animals with which neurons can make dopamine to replenish the brain’s Environmental toxins: Some scientists have suggested that Parkinson’s dwindling supply; dopamine agonists, may occur from exposure to an environmental risk factor such as a pesti- which mimic the role of dopamine in cide or a toxin. This theory is based on the fact that a number of toxins are the brain; or a combination of both. known to induce Parkinsonian symptoms in humans. Introduced in the 1960s, levodopa relieves many troublesome symptoms Genetics: A relatively new theory explores the role of genetic factors, since of PD, extending the time in which 15 to 25 percent of Parkinson’s sufferers have a close relative who has expe- the majority of patients—who would rienced parkinsonian symptoms (such as a tremor). otherwise be very disabled—can lead relatively normal, productive lives. (Dopamine itself cannot be given

16 Summer 2006 NIH MedlinePlus Parkinson’s Disease: The Newest Advances An interview with Story C. Landis

What are the risk factors for developing Parkinson’s? already developed improved animal The clearest risk factor is age. In addition, researchers have models, so essential for our under- identified a number of genes that cause or contribute to standing of what causes the disease Parkinson’s disease (PD), as well as potential environmen- and for testing new treatments, and tal risk factors. A primary piece of evidence that environ- have made breakthroughs in cell biol- mental factors play a role is that the relative risk of PD is ogy that are helping to elucidate the higher in industrialized countries. Farmers and other agri- various neurodegenerative processes cultural workers also have an increased risk of developing and mechanisms in PD. In the future, Story C. Landis, Ph.D. PD, suggesting that exposure to toxic chemicals or other it may become possible to test for Director, National environmental factors present in industrial and agricultural individual gene differences in order to Institute of Neuro- areas might increase the risk of PD. In some studies, coffee customize treatment of individual PD logical Disorders and drinking has been inversely associated with PD, but the patients. Stroke evidence is uncertain, and combining coffee and hormone And these basic research successes therapy may actually increase women’s risk for developing are translating into the clinic: We now have a number of PD. Smokers have a lower rate of PD—about 50 percent new and exciting therapeutic strategies at or near the less—than nonsmokers, but the relationship between point of clinical testing. These include neuroprotection us- smoking and Parkinson’s disease is not clear. Contrary to ing various medications, other substances, or nerve growth popular belief, minor head injury does not cause Parkin- (neurotrophic) factors and gene therapy. Other potential son’s disease. A new study indicates that exercise may therapies still being tested in animals include a vaccine to lower PD risk. modify the immune system in a way that can protect dopamine-producing neurons, stem cell therapy and inhibition What is the most promising area of inflammatory enzymes, including COX-2. of current research? There are a lot of promising areas in PD research, but one How close are we to developing a cure? of the most exciting is genetics. Researchers have identi- It is not possible to predict a precise time line for major fied a number of genes and chromosomal regions believed breakthroughs or a cure for PD—even in this time of great to play a role in PD. Studying the gene mutations respon- scientific progress. But we are initiating clinical trials that sible for inherited cases can help researchers understand we believe will be critical to improving the treatment and both inherited and sporadic types of the disease. Identify- quality of life of individuals with PD, developing a frame- ing gene defects may be able to help researchers develop work so that basic research can be effectively translated animal models that accurately mimic the neuronal death into treatments, and continuing to invest in essential basic in human PD, identify new drug targets and improve research—the foundation for progress in medical science. diagnosis. Based on genetic findings, investigators have

because it doesn’t cross the blood-brain low blood pressure; and reduces the certain medications, either tolcapone barrier, the elaborate meshwork of fine amount of levodopa needed. or entacapone, can prolong the relief blood vessels and cells that filters blood Levodopa does not, however, replace gained from levodopa-carbidopa. reaching the brain.) lost nerve cells or stop Parkinson’s There are other medications for Levodopa is combined with the progression. Bradykinesia and rigidity particular symptoms or stages of drug carbidopa, which delays the respond best, while tremor may be less Parkinson’s, including: conversion of levodopa into dopamine responsive. Problems with balance until it reaches the brain; prevents or and other symptoms are often not n Apomorphine, bromocriptine, diminishes some of its common side responsive to dopaminergic therapy. pergolide, pramipexole, effects, such as nausea, vomiting and Recent studies show that adding ropinirole—which mimic

NIH MedlinePlus Summer 2006 17 Additional Information on Parkinson’s Web Links dopamine and can be given alone adjusted by a physician in the office, MedlinePlus: http://www.nlm. or with levodopa, may be used in and to some extent by patients in nih.gov/medlineplus/ the disease’s early stages or started particular cases. parkinsonsdisease.html later. Although most patients still need n Selegiline—also known as to take medication after undergoing Information from NINDS: Par- deprenyl, selegiline provides some DBS, many experience considerably kinson ’s Disease: Hope through benefit for the symptoms of PD reduced symptoms and some are able Research: http://www.ninds. and may prolong the effect of to lower their doses. This helps reduce nih.gov/disorders/parkinsons_ levodopa side effects, such as involuntary disease/detail_parkinsons_ n Anticholinergics—initially movement, associated with the long- disease.html the principal treatment for term use of levodopa. Parkinson’s prior to levodopa, the Links to clinical trials: benefit of these drugs is limited Fighting for future health http://clinicaltrials.gov/ct/gui/ but they may help to control As a world leader in research on action/FindCondition?ui=D010 tremor and rigidity neurological disorders, the National 300&recruiting=true n Amantadine—an antiviral drug Institute of Neurological Disorders and often used alone in the early Stroke (NINDS) supports twelve Morris Genetic information: stages of the disease, or with K. Udall Parkinson’s Disease Research http://ghr.nlm.nih.gov/condi an anticholinergic or levodopa. Centers of Excellence throughout the tion=parkinsonsdisease Amantadine is sometimes also country. Much of the recent progress used to treat side effects of on Parkinson’s has been funded Interactive tutorial from Med- levodopa called dyskinesias. through the Centers and many other linePlus (slideshow): http:// NIH grants. www.nlm.nih.gov/medlineplus/ Surgery to relieve symptoms New studies have identified several tutorials/parkinsonsdisease/htm Prior to the development of genes that cause or contribute to PD Handy Publications* levodopa, treating Parkinson’s and some potential environmental risk n “Know Your Brain,” an 8-page with surgery was common but it is factors. These findings are improving fact sheet that explains how currently reserved primarily for those our understanding of the processes that the healthy brain works and patients with advanced PD. Today’s cause cell death in PD. In addition, a what happens when the brain preferred surgical approach is deep number of promising therapies are now is diseased or dysfunctional brain stimulation (DBS), which being tested. And continuing research n “Parkinson’s Disease: Challenges, uses a surgically implanted, battery- into the underlying biology of the Progress, and Promise” operated medical device called a disease is certain to lead to better ways n “Deep Brain Stimulation neurostimulator—similar to a heart of relieving Parkinson’s debilitating for Parkinson’s Disease” pacemaker and approximately the size symptoms and, ultimately, to halting or of a stopwatch—to deliver targeted preventing the disease itself. n * Available from: electrical stimulation to block the NIH NINDS abnormal nerve signals that generate P.O. Box 5801 Parkinson’s symptoms. Bethesda, MD 20824 Unlike previous surgeries, DBS does http://www.ninds.nih.gov/ not damage healthy brain tissue by 1-800-352-9424 destroying nerve cells. The advantage to DBS as compared with lesion surgery is that the stimulation settings can be

18 Summer 2006 NIH MedlinePlus Who can choose fruits & vegetables make it happen?

play active games

plan active outings share low-fat meals

ALL PARENTS CAN! For a free handbook with food, activity and screen time tips, visit http://wecan.nhlbi.nih.gov or call 1-866-35-WECAN.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Achoooooo! Nothing to Sneeze At

20 Summer 2006 NIH MedlinePlus s we enter the sneezing season, outdoor allergies are on the rise for many Nothing to Sneeze At Americans. The cost to our healthcare system from all allergies—indoor and Aoutdoor—is becoming truly breathtaking. If you are one of the 18.2 million of people in the United States and of inner-city children with moderate Americans who suffer from allergic around the world. One such NIAID- to severe asthma is quite effective in rhinitis, or “hay fever,” chances are you funded study has shown recently that an reducing allergen levels and asthma may be sneezing, reaching for a box of environmental intervention program to symptoms. Since continued exposure to tissues or rubbing your itchy, red, watery reduce indoor allergens, especially from allergens induces asthma’s symptoms, eyes as you read this. It’s May and the cockroach and dust mites, in the homes avoiding them is an attractive approach, start of yet another allergy season, when pollen seems to cover the universe and very little relief is in sight. While many of us endure mild to Finding Relief from Allergy’s Grip moderate symptoms, the larger truth n Antihistamines. These medications counter the effects of histamine, the is that the world of allergies is a complex substance that makes eyes water and noses itch during allergic reactions. and costly landscape. More than 50 While helpful in alleviating symptoms, older antihistamines often can cause million Americans suffer from all forms adverse side effects, such as drowsiness. Newer antihistamines are as effec- of allergies, which are the sixth-leading tive as older antihistamines, but do not cause drowsiness and have very few cause of chronic diseases in the United side effects. However, antihistamines do not effectively treat severe allergy States. In 1996, hay fever alone accounted symptoms or nasal swelling (congestion). for nearly 14 million doctor visits and cost the healthcare system approximately n Topical nasal steroids. These anti-inflammatory nasal sprays help by $1.9 billion. For unknown reasons, decreasing the number of inflammatory cells in the nose and reducing the incidence of hay fever has risen mucus production and nasal swelling. Nasal steroids work well in combina- substantially in the past 15 years. tion with antihistamines and are relatively free of side effects. These are just a few of the reasons n Cromolyn sodium. Also a nasal spray, cromolyn sodium can help stop why the NIH’s National Institute of hay fever, perhaps by blocking release of histamine and other symptom- Allergy and Infectious Diseases (NIAID) producing chemicals. This product has few side effects. is committed to funding ongoing n Decongestants. Decongestants constrict blood vessels and thereby may research for new ways to manage and, relieve nasal congestion. Available in oral and nasal preparations, decon- perhaps, even prevent allergic diseases. gestants thin nasal secretions and can reduce swelling and sinus discom- In 2005, NIAID awarded more than fort. They are usually used in combination with antihistamines. They $116 million in grants and contracts are intended for short-term use; long-term usage can actually make for investigation into the mechanisms, symptoms worse. diagnosis, treatment and prevention of allergic diseases, including asthma n Immunotherapy. Immunotherapy (allergy shots) might be a good and allergic rhinitis. course of action for patients who have had inadequate symptom relief For more than 50 years, NIAID with antihistamines and topical nasal steroids. Through injection under the research has led to new diagnostic tests, skin, immunotherapy alters the body’s immune response to allergens and vaccines, therapies and technologies that thereby helps prevent allergic reactions. have improved the health of millions

NIH MedlinePlus Summer 2006 21 allergens and other factors. Allergic asthma is responsible for almost 80 percent of all asthma diagnoses. It presents the same symptoms as nonallergic asthma, but differs in that it is set off primarily by an immune response to specific allergens. Both sinusitis and allergic asthma are manageable, but the research challenge always is to go beyond controlling the symptoms to address the root causes of disease.

Defending Against Invaders In a normal immune system, invading bacteria and viruses trigger antibodies, which are “programmed” to remember and defend against these germs in the future. During an allergic reaction, however, the immune system according to Anthony S. Fauci, M.D., inflammation or infection of the treats generally harmless allergens, NIAID Director. paranasal sinuses, which are four such as pollen, mold, animal dander “The NIAID-sponsored Inner City pairs of cavities located within the or dust mites, as pathogens and Asthma Study in children demonstrates skull. Congestion here can lead to begins producing large amounts of that environmental interventions reduce pressure and pain over the eyes, immunoglobulin E (IgE) antibodies. wheezing in proportion to the reduction around the nose or in the cheeks Allergic reactions are the biological in allergens,” he says. (Read more just above the teeth. Chronic equivalent of a fire drill: The body comments from Dr. Fauci on page 23.) sinusitis is associated with persistent defends itself against a potential Information on this and other NIH- inflammation and is often difficult pathogen although none is present. funded allergy studies, as well as a host of to treat. Extended bouts of hay The process is repeated as long as the other resources on allergies of all kinds, is fever, for instance, can increase immune system detects the allergen. available at www.medlineplus.gov. the likelihood of development of Some allergy sufferers are genetically chronic sinusitis.The annual cost disposed to have a sensitive immune Nuisance or Health Threat? of managing sinusitis has been system. In addition, the severity of For most people, hay fever is a estimated as high as $5.8 billion. allergy symptoms can become worse seasonal nuisance—something to n Asthma is a disease of the lungs due to illness or pregnancy. endure for a few weeks once or twice a in which the primary symptom That is what happened to Amy Kindt, year. But for others, such allergies can be is a narrowing or blockage of the a Mt. Clemens, Michigan, mother of two, life-altering conditions that lead to more airways, resulting in wheezing, who always suffered from hay fever when serious complications, including sinusitis shortness of breath, coughing and pollen counts rose during the spring and and asthma. other breathing difficulties. Asthma fall. However, since she became pregnant n Sinusitis, one of the most commonly attacks can be triggered by viral with her first child in 2000, the frequency reported chronic diseases, is the infection, cold air, exercise, anxiety, of her symptoms has gone way up.

22 Summer 2006 NIH MedlinePlus Fighting Allergies with Research and Information An interview with Anthony S. Fauci

Are seasonal allergies on the rise? If so, symptoms, and symptom relief why? There has been an increase in seasonal allergies, persisted for a year after the but this trend may be leveling off . The reasons for treatment was completed. If the increase are unclear, but one explanation may be future clinical trials are equally common lifestyle changes that include less physical successful, this could lead to Food exercise and more exposure to air pollutants and less and Drug Administration approval contact with microorganisms and childhood infections of the Dynavax product in two to Anthony S. Fauci, M.D. as a result of the broad public health advances of the three years, with major benefits NIAID Director past century. With regard to the latter, the “hygiene to ragweed allergy patients by hypothesis” suggests that microorganisms alter the way shortening the duration of treatment compared to our immune systems react to allergens, so our chances standard allergen immunotherapy. The feasibility of of developing allergies increase in the absence of developing comparable approaches against other exposure to infectious agents. seasonal allergies is still uncertain.

What research has been done recently in Have there been changes in the the area of seasonal allergies? Specifically, effectiveness of over-the-counter or have there been any significant findings prescription medications? Over-the-counter or breakthroughs in allergy shots, e.g. are and prescription medications are generally very there new medications that “last longer” effective for the treatment of seasonal allergies, even between shots? Recent findings include the for patients with severe symptoms. In particular, discovery that allergen therapy delivered under the “newer” antihistamines effectively reduce nasal allergy tongue, called sublingual immunotherapy, is effective symptoms but have minimal sedative properties. in treating seasonal allergies, and substantially safer than the standard two- to three-year course of allergy Finally, can people hope for a cure? Or will shots, called subcutaneous immunotherapy. Another relief only come through proper prevention recent finding is that children who do not have asthma, and careful treatment of symptoms? Most but have seasonal allergies and receive subcutaneous patients can now obtain excellent symptom relief from immunotherapy, are far less likely to develop asthma allergic rhinitis, including complicating conditions, such over the ensuing years . as sinusitis and asthma. But further improvements will be possible with the development of new therapeutic I read that an immunotherapy for airborne- approaches and a better understanding of the immune allergy vaccine is nearing FDA approval, mechanisms that are responsible for allergic diseases. perhaps in time for the 2006 allergy season. Since continued allergen exposure is necessary to If so, what is the name of this product, what induce symptoms, allergen avoidance is an attractive allergies will it protect against and when approach, and the NIAID-sponsored Inner City Asthma can people expect to have access to it? Study of children demonstrated that environmental Recently, the NIAID-sponsored Immune Tolerance interventions reduced wheezing in proportion to the Network partnered with Dynavax on the clinical trial reduction in allergens. of a product called Tolamba. This trial showed that Tolamba was highly effective in reducing ragweed

For more information on allergies and other infectious diseases, visit the National Institute of Allergy and Infectious Diseases at www.niaid.nih.gov.

NIH MedlinePlus Summer 2006 23 MedlinePlus.gov Resources Want to know more about allergic rhinitis? Check out the resources at www.medlineplus.gov. Do a search on “allergy” or use one of the follow- n Allergy skin test—The most relief, but none is 100 percent effective. ing quick links: commonly used allergy skin Normally, allergy sufferers look to test, known as a “prick test,” this various over-the-counter medications National Institute of Allergy diagnostic procedure involves and physician-prescribed therapies. and Infectious Diseases: http:// pricking your skin with the (See sidebar story, “Finding Relief from www3.niaid.nih.gov extract of a specific allergen, then Allergy’s Grip,” page 21.) observing the skin’s reaction. Airborne Allergens: http://www. Another test, the intradermal Hoping for a Cure niaid.nih.gov/publications/ injection, introduces allergens just Relief may someday come in the form allergens/airborne_allergens.pdf below the skin’s outer layers, is of an allergy vaccine, several of which are more sensitive than the prick test in development and show great promise. Allergy Clinical Trials: http:// and is sometimes used when the In one clinical trial, for instance, a series clinicaltrials.gov/ct/gui/action/ prick test produces negative results. of six injections of a newly developed FindCondition?ui= Allergy skin testing is considered and specially formulated ragweed vaccine D006967&recruiting=true the most sensitive testing method lessened symptoms and reduced the and provides rapid results. need for antihistamines among study Asthma and Allergy Resources: However, skin tests cannot be used participants. Perhaps more exciting http://www.niaid.nih.gov/ when a patient suffers from certain is the fact that this particular vaccine factsheets/allergyr.htm skin conditions, such as eczema. seems to provide benefits for at least one n RadioAllergoSorbent Test additional year, without the need for Useful Publications (RAST) and enzyme-linked booster shots. Fact sheets, symptom checklists, immunosorbent blood tests— For vaccines to be most effective, prevention tips and more are at The RAST and enzyme-linked they must be specific. For someone http://www.niaid.nih.gov/ immunosorbent tests are two blood allergic to ragweed, the new vaccine in publications/allergies.htm tests that provide information development may be good news, but not similar to allergy skin testing, to one who reacts only to grass pollen. namely the levels of allergic (IgE) Clearly, more research, development “Ever since my first pregnancy, it antibodies to allergens. and testing are in order. While effective seems I’m allergic to something all day, allergy vaccines are still years away from every day,” she says. “I cough a lot from Searching for Relief general release, research funded by NIH the drainage, and it makes it hard to For allergy sufferers, the best shows long-term promise. n sleep. Over-the-counter medications treatment is to avoid the offending don’t seem to work any more.” allergens altogether. This may be possible if the irritant is a specific food, Testing for Allergies like peanuts, which can be cut out of When it comes to allergies, the diet, but not when the very air we knowledge is power. Knowing breathe is loaded with allergens. For exactly what you are allergic to example, a single ragweed plant can can help determine the best way to produce a million grains of pollen a day, lessen or prevent exposure and treat and ragweed pollen has been found 400 reactions when they occur. There are miles out at sea and two miles high in several tests that physicians use to the atmosphere. pinpoint what you are allergic to. Air purifiers, filters, humidifiers and For example: conditioners provide varying degrees of

24 Summer 2006 NIH MedlinePlus Wait too long to talk about kidney disease and you could be waiting for a kidney.

If you have diabetes, high blood pressure or a family history of kidney failure, you're at high risk for developing kidney disease. There may be no early symptoms, so talk to your family about their medical history and to your doctor about getting tested. It could save your life. For a free brochure, call toll-free 1-866-4-KIDNEY (1-866-454-3639), or visit www.nkdep.nih.gov today. You Have The Power To Prevent Kidney Disease

U.S. Department of National Institutes National Institute of Diabetes National Kidney Disease Health & Human Services of Health & Digestive & Kidney Diseases Education Program

The National Kidney Disease Education Program is an initiative of the National Institutes of Health, U.S. Department of Health and Human Services. Research News from the National Institutes of Health

Low Calorie Diet LactMed: New NLM Affects Aging- Database on Drugs Related Factors and Lactation LactMed, a free online database with Results from a controlled clinical information on drugs and lactation, trial indicate that overweight people is one of the newest additions to the National Library of Medicine’s TOXNET who cut their calories by 25 percent system, a Web-based collection of resources covering toxicology, chemical for six months have reduced fasting safety and environmental health. LactMed may be searched at http://toxnet. insulin levels and core body tempera- nlm.nih.gov/cgi-bin/sis/htmlgen?LACT. ture—two markers associated with Geared to the healthcare practitioner and nursing mother, LactMed contains increased longevity in humans. The over 450 drug records. It includes information such as maternal levels in breast study is part of a project sponsored by milk, infant levels in blood, potential effects in breast-feeding infants and on the NIH’s National Institute on Aging lactation itself. The American Academy of Pediatrics’ LactMed category indicates (NIA) to learn more about the effects the level of compatibility of the drug with breast-feeding and alternate drugs to of sustained low-calorie diets in consider. As a work in progress, LactMed will continue to expand, with additional humans on factors affecting aging. drugs and with other substances, such as industrial chemicals and radiation. This type of intervention—maintaining a substantial percent reduc- Behavioral Therapy, Genetics Experts tion in caloric intake—has been shown to substantially extend the Incentives Enhance Unite to I.D. Unknown longevity of laboratory rodents if sus- Addiction Treatment Katrina Victims tained over much of the animal’s life span. Effects of such an intervention New research supported by the NIH’s A multi-institution team of experts, co- on human aging are not yet known. National Institute on Drug Abuse (NIDA) ordinated by geneticists from the NIH’s The study, part of the NIA-supported indicates that people who are trying to National Human Genome Research Comprehensive Assessment end their addiction to marijuana can Institute (NHGRI), is supporting efforts of Long-Term Effects of Reducing benefit from a treatment program that to identify more than 70 bodies in the Intake of Energy (CALERIE), was con- combines motivational incentives with aftermath of Hurricane Katrina. ducted by Leonie K. Heilbronn, Ph.D., cognitive-behavioral therapy. “What we are discovering in the Eric Ravussin, Ph.D., and colleagues at “Marijuana remains one of the most recent advances in molecular biology the Pennington Biomedical Research widely used drugs of abuse,” says NIDA and genetics,” says team member Center of Louisiana State University Director Nora D. Volkow, M.D. “Heavy Stephen Sherry, Ph.D., of NLM’s in Baton Rouge. use of the drug impairs a person’s National Center for Biotechnology The low-calorie diet also resulted ability to form memories, recall events Information, “is that we have an un- in changes in some, but not all, of the and shift attention from one thing to precedented opportunity to identify metabolic factors that have been re- another.” There also are significant lung people with precision and to affiliate lated to longevity or aging. That study and respiratory risks for regular smokers. them correctly with their families. is a pilot project for a longer CALERIE “The study results are largely positive, This is a new aspect of science, and its trial expected to start in the autumn but there should be continued efforts impact is on everyone.” of 2006 at three U.S. locations to test to develop and evaluate effective treat- Katrina claimed more than 1,200 effects of lowering caloric intake ments for marijuana addiction,” lives in Louisiana and Mississippi. More for two years. Dr. Volkow adds. than 70 bodies remained unidentified.

26 Summer 2006 NIH MedlinePlus Breast Cancer and Estrogen-Alone Update

Estrogen-alone hormone therapy does not increase the “Longer follow-up is needed to fully explain the reduced risk of breast cancer in postmenopausal women, according number of breast cancers in women taking estrogen. How- to an updated analysis of the breast cancer findings of the ever, this new analysis does not alter the overall conclusion Women’s Health Initiative (WHI) Estrogen-Alone Trial. from the WHI that hormones, including estrogen-alone The results contrast with the previously reported WHI and estrogen plus progestin, should not be used for the Estrogen plus Progestin Trial, which found an increase in prevention of chronic disease,” said NHLBI and WHI Director breast cancer over about 5 years among those taking com- Elizabeth G. Nabel, M.D. “The findings still support current bined hormone therapy. Over an average of about 7 years recommendations that hormone therapy should only be of follow-up, study participants taking estrogen had fewer used to treat menopausal symptoms and should be used at breast cancer tumors than those in the placebo group. the smallest effective dose for the shortest possible time.” NIH Researchers Identify Cortex Matures Faster OCD Risk Gene in Youths With Highest IQ Scientists at the NIH’s National Institute on Alcohol Youths with superior IQ are distinguished by how fast the Abuse and Alcoholism (NIAAA) have identified a thinking part of their brains thickens and thins as they grow previously unknown gene variant that doubles an up, researchers at the NIH’s National Institute of Mental Health individual’s risk for obsessive-compulsive disor- (NIMH) have discovered. Magnetic resonance imaging (MRI) der (OCD). The new functional variant, or allele, is scans showed that their brains’ outer mantle, or cortex, thickens a component of the serotonin transporter gene more rapidly during childhood, reaching its peak later than (SERT), site of action for the selective serotonin in their peers—perhaps reuptake inhibitors (SSRIs) that are today’s mainstay reflecting a longer de- medications for OCD, other anxiety disorders velopmental window for and depression. high-level thinking cir- “Improved knowledge of SERT’s role in OCD cuitry. It also thins faster raises the possibility of improved screening, treat- during the late teens, ment and medications development for that disor- likely due to the der,” said Ting-Kai Li, M.D., NIAAA Director. “It also withering of unused provides an important clue to the neurobiologic neural connections basis of OCD and the compulsive behaviors often as the brain stream- seen in other psychiatric diseases, including lines its operations. alcohol dependence.” “Studies of brains Approximately 2 percent of U.S. adults (3.3 mil- have taught us that lion people) have OCD, the fourth most prevalent people with higher IQs mental health disorder in the United States. Individ- do not have larger brains,” uals with OCD have intrusive, disturbing thoughts says NIH Director Elias A. Zer- or images (obsessions) and perform rituals (compul- houni, M.D. “Thanks to brain sions) to prevent or banish those thoughts. Many imaging technology, we can other individuals demonstrate obsessive-compulsive now see that the behaviors that do not meet OCD diagnostic criteria difference may be in the but alter the individuals’ lives. way the brain develops.”

NIH MedlinePlus Summer 2006 27 National Institutes NIH of Health MedlinePlus Quickfinder Advisory Group

Marin Allen, Ph.D., Office of Com- For more information or to contact any of the following NIH institutes, centers munications and Public Liaison, NIH and offices directly, please call or go online as noted below: Christine Bruske, National Institute Institutes of Environmental Health Sciences Vicky Cahan, National Institute n National Cancer Institute (NCI) www.cancer.gov n National Institute on Drug Abuse (NIDA) on Aging 1-800-4-CANCER (1-800-422-6237) www.nida.nih.gov (301) 443-1124 Kym Collins-Lee, National Eye n National Eye Institute (NEI) www.nei.nih.gov n National Institute of Environmental Health Institute (301) 496-5248 Sciences (NIEHS) www.niehs.nih.gov Kate Egan, National Institute n National Heart, Lung, and Blood Institute (NHLBI) (919) 541-3345 of Mental Health www.nhlbi.nih.gov (301) 592-8573 n National Institute of General Medical Sciences Marian Emr, National Institute n National Human Genome Research Institute (NIGMS) www.nigms.nih.gov of Neurological Disorders (NHGRI) www.genome.gov (301) 496-7301 and Stroke n National Institute on Aging (NIA) n National Institute of Mental Health (NIMH) Sue Feldman, National Cancer www.nia.nih.gov www.nimh.nih.gov [email protected] Institute Aging information 1-800-222-2225 1-866-615-6464 Ray Fleming, National Institute Alzheimer’s information 1-800-438-4380 n National Institute of Neurological Disorders of Arthritis & Musculoskeletal n National Institute on Alcohol Abuse and and Stroke (NINDS) www.ninds.nih.gov & Skin Diseases Alcoholism (NIAAA) www.niaaa.nih.gov [email protected] 1-800-352-9424 Susan Johnson, National Institute (301) 443-3860 n National Institute of Nursing Research (NINR) of Dental & Craniofacial Research n National Institute of Allergy and Infectious www.nih.gov/ninr/ (301) 496-0207 Kathy Kranzfelder, National Insti- Diseases (NIAID) www.niaid.nih.gov tute of Diabetes and Digestive (301)496-5717 Centers & Offices and Kidney Diseases n National Institute of Arthritis and Musculoskeletal n National Library of Medicine (NLM) Lonnie Lisle, National Institute on and Skin Diseases www.niams.nih.gov www.nlm.nih.gov 1-888 FIND NLM Deafness and Other Communica- 1-877-22NIAMS (1-877-226-4267) n Center for Information Technology (CIT) tion Disorders n National Institute of Biological Imaging www.cit.nih.gov (301) 594-6248 Terry Long, National Heart, Lung, and Bioengineering (NIBIB) n Center for Scientific Review (CSR) and Blood Institute http://www.nibib.nih.gov (301) 451-6772 www.csr.nih.gov (301) 435-1115 Claire McCullough, National n National Institute of Child Health and Human n Fogarty International Center (FIC) Institute of Allergy and Development (NICHD) www.nichd.nih.gov www.fic.nih.gov Infectious Diseases 1-800-370-2943 n National Center for Complementary John McGrath, Ph.D., National n National Institute on Deafness and Other and Alternative Medicine (NCCAM) Institute of Child Health and Communication Disorders (NIDCD) www.nccam.nih.gov 1-888-644-6226 Human Development www.nidcd.nih.gov n National Center on Minority Health and Health Gregory Roa, National Institute 1-800-241-1044 (voice) Disparities (NCMHD) www.ncmhd.nih.gov on Alcohol Abuse and Alcoholism 1-800-241-1055 (TTY) (301)402-1366 Dennis Rodrigues, Office of Com- n National Institute of Dental and Craniofacial n National Center for Research Resources (NCRR) munications and Public Liaison, NIH Research (NIDCR) www.nidcr.nih.gov www.ncrr.nih.gov (301) 435-0888 Chris Thomsen, National Center n National Institute of Diabetes and Digestive and n Warren G. Magnuson Clinical Center (CC) for Complementary & Alternative Kidney Diseases (NIDDK) www.niddk.nih.gov www.cc.nih.gov Medicine Diabetes 1-800-860-8747 n Office of Research on Women’s Health (ORWH) Larry Thompson, National Human Digestive disorders 1-800-891-5389 http://orwh.od.nih.gov (301) 402-1770 Genome Research Institute Overweight and obesity 1-877-946-4627 Anne Thurn, Ph.D., Office of Kidney and urologic diseases 1-800-891-5390 Dietary Supplements 28 Summer 2006 NIH MedlinePlus Institutes Joinand theAdvisors Friends of the National Library of Medicine

NIH MedlinePlus Magazine Editorial Board

Don Detmer, M.D. Roger Bulger, M.D. President, American Medical Informatics Association Senior Consultant, National Center on Minority Health Professor of Medical Education, University of Virginia and Health Disparities, NIH 4915 St. Elmo Avenue, Suite 401 Past President and CEO, Association of Academic Bethesda, Maryland 20814 Health Centers (301) 657-1291 6707 Democracy Boulevard, Suite 800 E-mail: [email protected] Bethesda, Maryland 20892-5465 (301) 402-1366 Jordan Cohen, M.D. E-mail: [email protected] President, Association of American Medical Colleges 2450 N Street, NW Kenneth Forde, M.D. Washington, DC 20037 José M. Ferrer Professor Emeritus of Clinical Surgery (202) 828-0460 and Special Lecturer in Surgery, E-mail: [email protected] Columbia University College of Physicians and Surgeons, Department of Surgery, MHB 7SK The Hon. Paul G. Rogers 177 Fort Washington Avenue Partner, Hogan & Hartson New York, NY 10032-3784 555 13th Street, NW, Suite 12W Telephone: (212) 305-2735 Columbia Square Email: [email protected] Washington, DC 20004-1109 (202) 637-5753 Leslie Kuhn, M.D. [email protected] Clinical Professor of Medicine Mount Sinai School of Medicine, Division of Cardiology Jay Sanders, M.D. Mt. Sinai Medical Center, Box 1030 President, The Global Telemedicine Group 5th Avenue and 98th Street Adjunct Professor of Medicine, Johns Hopkins University New York, NY 10028-0110 School of Medicine (212) 876-9009 President Emeritus, American Telemedicine Association 1317 Vincent Place McLean, VA 22101 (703) 448-9640 E-mail: [email protected]

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