Massachusetts cannot ban FDA-approved painkiller, judge rules

By Brady Dennis, Published: April 15 E-mail the writer

A federal judge on Tuesday blocked an effort by Massachusetts Gov. Deval L. Patrick to ban sales of a controversial new painkiller in the state, saying the governor’s move was preempted by federal law and could harm people who need the drug for pain relief.

In a five-page order, U.S. District Judge Rya W. Zobel sided with the drug’s California-based manufacturer, Zogenix, which had argued that Patrick had no right to bar a medication that the Food and Drug Administration has deemed safe and effective.

More: http://www.washingtonpost.com/national/health-science/massachusetts-cannot-ban-fda-approved-painkiller-judge-rules/2014/04/15/91436946-c4db-11e3-b574-f8748871856a_story.html

New pain killer Zohydro making headlines

Zohydro to be Manufactured by Same Company That Makes Addiction Medicine

By Join Together Staff | November 18, 2013 | 2 Comments | Filed in Addiction,Government, Healthcare & Prescription Drugs

The newly approved pure hydrocodone product, Zohydro ER (extended release), will be made by the same company that manufactures Vivitrol, a drug used to treat patients addicted to opioids or alcohol, The New York Times reports.

https://www.drugfree.org/join-together/addiction/zohydro-to-be-manufactured-by-same-company-that-makes-addiction-medicine

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Judge hits state on painkiller ban

Boston Globe ‎- 6 hours ago

A federal judge said Tuesday that she will probably strike 

down Governor Deval Patrick's emergency ban on the sale of Zohydro, 

http://www.bostonglobe.com/metro/2014/04/08/federal-judge-expresses-skepticism-about-mass-zohydro-ban/GLZp14pW8lAWmAniElJYhL/story.html

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Super-Strong 'Zohydro' About To Hit The Street - HuffPost Live

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FDA-Approved Painkiller Zohydro Concerns Critics - WebMD

www.webmd.com/pain.../new-painkiller-zohydro-criticized‎

WebMD

Feb 27, 2014 - A new narcotic painkiller is due to come on the market in March, and critics want the FDA to reverse its approval of the drug, Zohydro ER.

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From the manufacturer

1. Zohydro ER (hydrocodone bitartrate) Extended-Release Capsules

   www.zogenix.com/content/products/zohydro.htm‎

   Zohydro™ ER is an opioid agonist, extended-release, oral formulation of hydrocodone bitartrate indicated for the management of pain severe enough to require ...

   ‎SUMAVEL DosePro - ‎Pipeline - ‎Investor Relations

Chronic Pain Patient, first visit with Pain Management Doctor ~ SIGNING UNFAIR PAIN CONTRACT

Dammed if you do and dammed if you don't!
SIGNING A DRUG CONTRACT ~ FROM PATIENT PERSPECTIVE ~ GIVING UP YOUR RIGHTS

  Chronic pain patients are required to sign contracts with their pain management physician. Many of the stipulations in these contracts remove the patient's rights to privacy of their medical information as well as removing the constitutional rights that require law enforcement to obtain a warrant (meaning need to show probable cause to get such a warrant) in order to get the medical record. These contracts also often contain false information regarding what is drug seeking behavior, physical dependence, and tolerance to pain medication. Also they rely upon presumptive testing that is widely known to be inaccurate in order to deny treatment. Basically these contracts are set up in such a way that every chronic pain patient will eventually violate some part of the contract and lose treatment. Depression is NOT drug seeking behavior, it is a common occurrence with ANY chronic illness, not just chronic pain.

To learn more, including information about the so-called studies that the DEA rely upon to call prescription drug abuse an "epidemic" when the numbrs don't support it. To learn more about chronic pain, contracts, and more:
http://www.dailykos.com/story/2011/04...
http://pain-topics.org/ for updates on studies http://updates.pain-topics.org/

To learn more about Richard Paey, an example of the unfair investigation procedures and prosecution on chronic pain patients see here:
http://www.november.org/thewall/cases...

Marijuana, Narcotics Help Patients Reduce Chronic Pain, Study Finds

WASHINGTON -- A new study out of UC San Francisco has found that medical marijuana, combined with certain opiates, appears to be a safe and effective treatment for patients with chronic pain.

The study, published this month in Clinical Pharmacology and Therapeutics, found that patients who use cannabinoids inhaled through a vaporizer, combined with long-acting morphine or long-acting oxycodone, experienced a greater reduction of pain than those who used opiates alone.

The 21 chronic pain patients involved in the study were split into two groups. Those who combined four consecutive days of exposure to vaporized cannabis with morphine experienced a 33 percent reduction in pain, while those who combined it with oxycodone saw a drop in pain of 20 percent. The study is the first to examine the combined effect of these drugs on humans.

"Pain is a big problem in America and chronic pain is a reason many people utilize the health care system," said lead author Donald Abrams, a professor of clinical medicine at UCSF and chief of the Hematology-Oncology Division at San Francisco General Hospital and Trauma Center. "And chronic pain is, unfortunately, one of the problems we're least capable of managing effectively."
Continue article here: http://www.huffingtonpost.com/2011/12/08/marijuana-narcotics-help-patients-reduce-pain_n_1137416.html

Deaths from painkiller overdose triple in decade

By STEPHANIE NANO - Associated Press

AP – 13 hrs ago..

NEW YORK (AP) — The number of overdose deaths from powerful painkillers more than tripled over a decade, the government reported Tuesday — a trend that a U.S. health official called an epidemic, but one that can be stopped.

Prescription painkillers such as OxyContin, Vicodin and methadone led to the deaths of almost 15,000 people in 2008, including actor Heath Ledger. That's more than three times the 4,000 deaths from narcotics in 1999.

Such painkillers "are meant to help people who have severe pain," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention in Atlanta, which issued the report. "They are, however, highly addictive."

The report shows nearly 5 percent of Americans ages 12 and older said they've abused painkillers in the past year — using them without a prescription or just for the high. In 2008-09 surveys, Oklahomans reported the highest rate of abuse; the lowest was in Nebraska and Iowa.

The overdose deaths reflect the spike in the number of narcotic painkillers prescribed every year — enough to give every American a one-month supply, Frieden said.

Prescriptions rose as doctors aimed to better treat pain and as new painkillers hit the market.

Frieden and White House drug czar Gil Kerlikowske, who joined him at CDC headquarters in Atlanta, said states need to take sharp actions to reverse the long-running trend.

States oversee prescription practices and can rigorously monitor prescriptions and crack down on "pill mills" and "doctor shopping" by patients, Frieden said.
Click here to read the rest: http://news.yahoo.com/deaths-painkiller-overdose-triple-decade-160401910.html

New medical FICO score sparks controversy, questions

Jeremy M. Simon, On Thursday July 28, 2011, 8:00 am EDT

Within the next 12 months, whether you like it or not, about 10 million Americans are expected to be scored -- much like a credit score -- on how likely they are to fill a prescription and take all the pills the doctor ordered, on schedule.

FICO , creator of the widely used credit score that predicts whether you'll borrow responsibly, is now rolling out its new Medication Adherence Score.

FICO based its score on a formula that predicts whether you will take your prescription drugs. FICO says that since correct use of medication is important for patients, medical providers, insurers and pharmaceutical companies, the Medication Adherence Score will help achieve that goal. They predict it will improve therapy effectiveness and reduce health care costs.

The company says those who score low can be targeted for extra reminders and educational efforts, with the goal of making patients more likely to complete their prescribed regimens.

"It's very important to identify those people who may need that additional education and that additional help," says Dave Shellenberger, senior principal consultant in FICO's health care division.

Critics aren't so sure. Since the score uses information on patients' employment, homeownership and living situations, they say that in the current economic environment, the Medication Adherence Score may unfairly target people who have found themselves in challenging financial situations. It could also, they say, open the door for a new way for insurance companies to charge different prices for different scores. This happened in recent years to consumers buying auto insurance: The cost of those policies are now likely based on an auto insurance credit score .

What's in the score?
FICO launched the Medication Adherence Score on June 23, 2011. To create the scoring algorithm, FICO looked at data from a random sample of several million anonymous patients provided by a large pharmacy benefits manager. FICO observed patients who filled (or refilled) their prescriptions and patients who failed to, with the company then identifying those variables that best predicted medication adherence. For the Medication Adherence Score, those variables include age, gender, family size and asset information -- such as the likelihood of car ownership -- data also used by direct marketing companies. FICO says that with only a patient's name and address, it can pull the remainder of the necessary information from publicly available sources.

The scores range from 1 to 500. "The higher the score, the higher the likelihood a patient will be adherent to a drug regimen," FICO's Shellenberger says. FICO says patients who score 400 or higher are likely to take medication as prescribed, while those who score below 200 are at high risk of not taking medication. According to FICO, patients who earn a low score may receive a medication reminder in the form of an email, letter or phone call from their doctor -- tactics that would be too costly to apply across the board.

FICO says those who wouldn't want to receive notices should contact their health care providers and ask about their opt-out policies. High scorers who appear likely to take all their meds probably won't be contacted.

Click here to read the rest!

FDA Acts to Reduce Harm from Opioid Drugs

FDA Acts to Reduce Harm from Opioid Drugs


On This Page:

•FDA Opioid Strategy

•Widespread Problem

The White House on Tuesday unveiled a multi-agency plan aimed at reducing the “epidemic” of prescription drug abuse in the U.S.—including an FDA-backed education program that zeros-in on reducing the misuse and misprescribing of opioids.



Gil Kerlikowske, director of the White House Office of National Drug Control Policy, says the plan—a collaborative effort involving agencies of the departments of Justice, Health and Human Services, Veterans Affairs, Defense, and others—provides a national framework for reducing prescription drug abuse and the diversion of prescription drugs for recreational use.



“The toll our nation’s prescription drug abuse epidemic has taken in communities nationwide is devastating,” says Kerlikowske. “We share a responsibility to protect our communities from the damage done by prescription drug abuse.”



Key elements of the plan—called Epidemic: Responding to America’s Prescription Drug Abuse Crisis—include:



•expansion of state-based prescription drug monitoring programs

•recommending convenient and environmentally responsible ways to remove unused medications from homes

•supporting education for patients and health care providers

•reducing the number of “pill mills” and doctor-shopping through law enforcement

back to top



FDA Opioid Strategy

In concert with the White House plan, the Food and Drug Administration (FDA) is announcing a new risk reduction program—called a Risk Evaluation and Mitigation Strategy—for all extended-release and long-acting opioid medications.



Opioids are synthetic versions of opium that are used to treat moderate and severe pain.



FDA experts say extended-release and long-acting opioids—including OxyContin, Avinza, Dolophine, Duragesic, and eight other brand names—are extensively misprescribed, misused, and abused, leading to overdoses, addiction, and even deaths across the United States. FDA says a 2007 survey revealed that more than half of opioid abusers got the drug from a friend or relative.



Opioids—such as morphine and oxycodone—are used to treat moderate and severe pain. Over the past few decades, drug makers have developed extended-release opioid formulas to treat people in pain over a long period.



The new REMS plan focuses primarily on: educating doctors about proper pain management, patient selection, and other requirements and improving patient awareness about how to use these drugs safely. As part of the plan, FDA wants companies to give patients education materials, including a medication guide that uses consumer friendly language to explain safe use and disposal.



FDA wants drug makers to work together to develop a single system for implementing the REMS strategies. Toward that goal, FDA is now notifying opioid makers that they must propose a REMS plan within 120 days.



Janet Woodcock, director of FDA’s Center for Drug Evaluation and Research, says this risk management strategy is designed to improve pain management, while preserving patient access to these needed medications.



“This will be an important step toward addressing what has become a critical public health problem,” she says.



Doctor training, patient counseling, and other risk reduction measures developed by opioid makers as part of the REMS are expected to become effective by early 2012. They will be required for various brand name products known under the generic names:



•hydromorphone

•oxycodone

•morphine

•oxymorphone

•methadone

•transdermal fentanyl

•transdermal buprenorphine

back to top



Widespread Problem

FDA estimates that more than 33 million Americans age 12 and older misused extended-release and long-acting opioids during 2007—up from 29 million just five years earlier. And in 2006, nearly 50,000 emergency room visits were related to opioids.



"Opioid drugs have benefit when used properly and are a necessary component of pain management for certain patients, but we know that they pose serious risks when used improperly—with serious negative consequences for individuals, families, and communities," says FDA Commissioner Margaret A. Hamburg, M.D. “The prescriber education component of this Opioid REMS balances the need for continued access to these medications with stronger measures to reduce their risks."



Although doctor training is not mandatory under the REMS plan, other federal agencies are working to get Congress to link mandatory physician training to the already required Drug Enforcement Administration registration number that doctors must have to prescribe controlled substances.



FDA will also require the risk management plan to include a way to determine if the education programs are helping to reduce problems associated with long-acting and extended-release opioids, as well as allowing patients who need opioids to get them.



FDA has had the power to request companies to develop REMS since 2007. The plans may also include medication guides and patient package inserts.



This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.



April 19, 2011
http://www.drugs.com/fda-consumer/fda-acts-to-reduce-harm-from-opioid-drugs-178.html

Asherman syndrome
Uterine synechiae
Last reviewed: September 12, 2010.

Asherman syndrome is the formation of intrauterine adhesions (scar tissue), which typically develop after uterine surgery.

Causes, incidence, and risk factors
Asherman syndrome is a rare condition. In most cases, it occurs in women who have had several dilatation and curettage (D&C) procedures.

A severe pelvic infection unrelated to surgery may also lead to Asherman syndrome.

Intrauterine adhesions can also form after infection with tuberculosis or schistosomiasis. These infections are rare in the United States, and uterine complications such as Asherman syndrome related to these infections are even less common.

Symptoms
The adhesions may cause amenorrhea (lack of menstrual periods), repeated miscarriages, and infertility.

However, such symptoms could be related to several conditions. They are more likely to indicate Asherman syndrome if they occur suddenly after a D&C or other uterine surgery.

Signs and tests
A pelvic exam is usually normal.

Tests may include:

•Blood tests to detect tuberculosis or schistosomiasis

•Hysteroscopy

•Hysterosonogram

•Infertility evaluation

•Transvaginal ultrasound examination

Treatment
Treatment involves surgery to cut and remove the adhesions or scar tissue. This can usually be done with hysteroscopy, which uses small instruments and a camera placed into the uterus through the cervix.

After scar tissue is removed, the uterine cavity must be kept open while it heals to prevent adhesions from returning. Your health care provider may place a small balloon inside the uterus for several days and prescribe estrogen therapy while the uterine lining heals.

Antibiotic treatment may be necessary if there is an infection.

Support Groups
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See www.ashermans.org for information about an online Asherman syndrome support group.

Expectations (prognosis)
Asherman syndrome can be cured in most women with surgery, although sometimes more than one procedure will be necessary.

Women who are infertile because of Asherman syndrome may have a successful pregnancy after treatment Successful pregnancy depends on the severity of Asherman syndrome and the difficulty of the treatment, as well as other factors that affect fertility and pregnancy.

Complications
Complications of hysteroscopic surgery are uncommon and include bleeding, perforation of the uterus, and pelvic infection.

In some cases, treatment of Asherman syndrome will not cure infertility.

Calling your health care provider
Call your health care provider if your menstrual periods do not resume after a gynecologic or obstetrical procedure. An evaluation for infertility is also warranted if you are unable to achieve a pregnancy after 6 to 12 months of trying.

Prevention
Most cases of Asherman syndrome cannot be predicted or prevented.

References
1.Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 38.
2.Simpson JL, Jauniaux ERM. Pregnancy loss. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 24.
Review Date: 9/12/2010.

Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Drug Used For Neuropathic Pain Relieves Discomfort From Abdominal Adhesions: Henry Ford Study

Pregabalin, FDA-approved for neuropathic pain (pain caused by shingles and peripheral neuropathy), effectively reduced abdominal pain and improved sleep in women with adhesions, according to a Henry Ford study.


Adhesion pain, a common complication after abdominal or pelvic surgery, currently lacks effective therapy. Adhesions can also form after infections in the bowel such as diverticulitis.

"Many patients in the study went from debilitating pain to complete resolution of pain on pregabalin," says Ann Silverman, M.D., senior staff gastroenterologist at Henry Ford Hospital and lead author of the study.


Study results were presented at the American College of Gastroenterology's Annual Scientific Meeting in San Diego.


"Aside from the use of analgesics, additional surgery is the only treatment option for abdominal pain from adhesions but repeat surgery can lead to more adhesions," says Dr. Silverman.


The estimates of abdominal adhesion formation following surgery have been found to be as high as 100 percent in certain studies. Surgery is only recommended for bowel obstruction.


The randomized Henry Ford study looked at 18 women who received the drug or a look-alike placebo. All patients had previous abdominal surgery and were similar in age. The first eight weeks was a randomized placebo controlled trial of pregabalin followed by a four-week open label study in which all patients received the active study drug.


Click the link to read the rest.
http://www.medicalnewstoday.com/articles/168888.php

Pregabalin Side Effects


Brand Names: Lyrica



Please note - some side effects for Pregabalin may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).



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Side Effects of Pregabalin - for the Consumer

Pregabalin

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Pregabalin:



Blurred vision; changes in sexual function; constipation; dizziness; drowsiness; dry mouth; gas; headache; increased appetite; lightheadedness; stomach pain; trouble concentrating; weight gain.



Seek medical attention right away if any of these SEVERE side effects occur when using Pregabalin:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue, unusual hoarseness); burning, numbness, or tingling of the hands, feet, or skin; chest pain; confusion; fast or irregular heartbeat; fever, chills, or persistent sore throat; inability to control urination; loss of coordination; memory loss; muscle aches, pain, tenderness, or weakness (especially if this occurs with a fever or general feeling or discomfort); new or unusual skin sores; new or worsening mental or mood changes (eg, anxiety, depression, restlessness, irritability, panic attacks, feeling "high," behavior changes, suicidal thoughts or attempts); new or worsening seizures; reddened, blistered, swollen, or peeling skin; shortness of breath or wheezing; speaking problems; sudden, unexplained weight gain; swelling of the hands, feet, or ankles; tremor; trouble sleeping; trouble walking; unusual bruising or bleeding; unusual tiredness or weakness; vision changes.



This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.



Top

Side Effects by Body System - for Healthcare Professionals

Nervous system

Nervous system side effects including dizziness (up to 38%), somnolence (up to 28%), ataxia (up to 20%), tremor (up to 11%), neuropathy (up to 9%), abnormal thinking (up to 9%), abnormal gait (up to 5%), confusion (up to 7%), speech disorder (up to 7%), amnesia (up to 6%), incoordination (up to 6%), twitching (up to 5%), vertigo (up to 4%), myoclonus (up to 4%), euphoria (up to 3%), and nervousness (up to 1%) have been reported. Anxiety, depersonalization, hypertonia, hypesthesia, decreased libido, nystagmus, paresthesia, stupor, and twitching have been reported frequently. Abnormal dreams, agitation, apathy, aphasia, circumoral paresthesia, dysarthria, hallucinations, hostility, hyperalgesia, hyperesthesia, hyperkinesia, hypokinesia, hypotonia, increased libido, myoclonus, and neuralgia have been reported infrequently. Addiction, cerebellar syndrome, cogwheel rigidity, coma, delirium, delusions, dysautonomia, dyskinesia, dystonia, encephalopathy, extrapyramidal syndrome, Guillain-Barre syndrome, hypoalgesia, intracranial hypertension, manic reaction, paranoid reaction, peripheral neuritis, psychotic depression, schizophrenic reaction, torticollis, and trismus have been reported rarely.



Metabolic

Metabolic side effects including peripheral edema (up to 16%), weight gain (up to 16%), edema (up to 6%), and hypoglycemia (up to 3%) have been reported. Decreased glucose tolerance and urate crystalluria have been reported rarely.



Gastrointestinal

Gastrointestinal side effects including dry mouth (up to 15%), constipation (up to 7%), increased appetite (up to 6%), vomiting (up to 3%), flatulence (up to 3%), nausea and diarrhea have been reported. Gastroenteritis has been reported frequently. Cholecystitis, cholelithiasis, colitis, dysphagia, esophagitis, gastritis, gastrointestinal hemorrhage, melena, mouth ulceration, pancreatitis, rectal hemorrhage, and tongue edema have been reported infrequently. Aphthous stomatitis and esophageal ulcer have been reported rarely.



General

General side effects including infection (up to 14%), accidental injury (up to 11%), headache (up to 9%), asthenia (up to 7%), pain (up to 5%), chest pain (up to 4%), facial edema (up to 3%), flu syndrome (up to 2%), and back pain (up to 2%) have been reported. Abdominal pain and fever have been reported frequently. Abscess, cellulitis, chills, malaise, neck rigidity, overdose, pelvic pain, photosensitivity reaction, and suicide attempt have been reported infrequently. Ascites, granuloma, hangover effect, intentional injury, retroperitoneal fibrosis, shock, and suicide have been reported rarely.



Ocular

Ocular side effects including visual field changes (13%), reduced visual acuity (7%), and blurred vision (6%) have been reported. Conjunctivitis and diplopia have been reported frequently. Abnormality of accommodation, blepharitis, dry eyes, eye hemorrhage, hyperacusis, photophobia, retinal vascular disorder, and retinal edema have been reported infrequently. Anisocoria, blindness, corneal ulcer, exophthalmos, extraocular palsy, iritis, keratitis, keratoconjunctivitis, miosis, mydriasis, night blindness, ophthalmoplegia, optic atrophy, papilledema, parosmia, ptosis, and uveitis have been reported rarely.



Blurred vision resolved in the majority of cases with continued dosing. Less than 1% of patients discontinued pregabalin treatment due to vision related events (primarily blurred vision).



Patients should be informed that they should notify their physician if changes in vision occur. If visual disturbance persists, further assessment should be considered. Furthermore, more frequent assessment should be considered for patients who are already routinely monitored for ocular conditions.



Other

In a cohort study of 333 diabetic patients who received pregabalin for at least 2 years, the average weight gain was 5.2 kg. Pregabalin associated weight gain was related to dose and duration or exposure.



Other side effects including weight gain have been reported. In controlled clinical trials of up to 13 weeks, weight gain of 7% or more over baseline has been reported in 8% of pregabalin-treated patients. Otitis media and tinnitus have been reported frequently. Taste loss, and taste perversion have been reported infrequently.



Cardiovascular

Cardiovascular side effects including edema, primarily peripheral edema (6%) have been reported. Deep thrombophlebitis, heart failure, hypotension, syncope, and postural hypotension have been reported infrequently. Depressed ST and ventricular fibrillation have been reported rarely. There have been postmarketing reports of angioedema.



Specific symptoms of angioedema have included swelling of the face, mouth (tongue, lips, and gums), and neck (throat and larynx). There have also been reports of life-threatening angioedema with respiratory compromise requiring emergency treatment. Pregabalin should be discontinued immediately in patients with these symptoms. Caution is recommended if prescribing pregabalin to patients who have had a previous episode of angioedema. In addition, patients who are taking other drugs associated with angioedema (e.g., angiotensin converting enzyme inhibitors [ACE-inhibitors]) may be at increased risk of developing angioedema.



Respiratory

Respiratory side effects including dyspnea (up to 3%) and bronchitis (up to 3%) have been reported. Apnea, atelectasis, bronchiolitis, hiccup, laryngismus, lung edema, lung fibrosis, and yawn have been reported rarely.



Genitourinary

Genitourinary side effects including urinary incontinence (up to 2%) have been reported. Anorgasmia, impotence, and urinary frequency have been reported frequently. Abnormal ejaculation, albuminuria, amenorrhea, dysmenorrhea, dysuria, hematuria, kidney calculus, leukorrhea, menorrhagia, metrorrhagia, nephritis, oliguria, and urinary retention have been reported infrequently. Acute kidney failure, balanitis, bladder neoplasm, cervicitis, dyspareunia, epididymitis, female lactation, and glomerulitis have been reported rarely. Two cases of unilateral painful gynecomastia have also been reported.



Musculoskeletal

Musculoskeletal side effects including myasthenia (1%) have been reported. Arthralgia, leg cramps, myalgia, and myasthenia have been reported frequently. Arthrosis has been reported infrequently. Generalized spasm has been reported rarely.



Oncologic

Oncologic side effects including an unexpectedly high incidence of hemangiosarcoma have been reported in animal studies after pregabalin was given their diet for two years. In clinical studies comprised of 6,396 patient-years of exposure, new or worsening-preexisting tumors were reported in 57 patients. It is not known if the incidence seen in these clinical studies is or is not affected by treatment.



Hypersensitivity

Hypersensitivity side effects including allergic reactions have been reported frequently. Allergic reactions have included skin redness, blisters, hives, rash, dyspnea, and wheezing. Pregabalin should be discontinued immediately in patients with these symptoms. Anaphylactoid reactions have been reported rarely.



Hematologic

Hematologic side effects including ecchymosis have been reported frequently. Anemia, eosinophilia, hyperchromic anemia, leukocytosis, leukopenia, lymphadenopathy, and thrombocytopenia have been reported infrequently. Myelofibrosis, polycythemia, decreased prothrombin, purpura, and thrombocytopenia have been reported rarely.



Dermatologic

Dermatologic side effects including pruritus have been reported frequently. Alopecia, dry skin, eczema, hirsutism, skin ulcer, urticaria, and vesiculobullous rash have been reported infrequently. Angioedema, exfoliative dermatitis, lichenoid dermatitis, melanosis, petechial rash, purpuric rash, pustular rash, skin atrophy, skin necrosis, skin nodule, Stevens-Johnson syndrome, and subcutaneous nodule have been reported rarely.

From Drugs.com

No health insurance? Get help here

From CNN
Click below for full story.
http://www.cnn.com/2009/HEALTH/02/12/ep.health.insurance.help/index.html

Negotiating with doctors and hospitals is just one thing you have to learn how to do when your insurance disappears, says Steve Luptak, executive director of an assistance group called Healthcare Advocacy. "I've had so many people who've just been laid off coming to me for help because they've lost their insurance. They're so stressed, they're so depressed, they feel like it's the end of the world," he says. "But there are things you can do. It's not a futile situation," he says. Watch for more tips for the uninsured »
If you want to try to get new, affordable insurance, or find programs that offer you financial help for doctor's visits, prescription drugs and more, follow these steps:
Step 1: Get good advice
When you get laid off and lose your health insurance, you may need someone in your corner. Several places specialize in helping people find new, affordable insurance and free care:
Healthcare Advocacy
Patient Advocate Foundation
Patient Services Incorporated
Step 2: Search for affordable insurance
With advice from experts at the groups above, begin your search for affordable insurance. Start with COBRA, which means you continue with your employer's insurance, except now you're paying the entire premium on your own. You can learn about COBRA at the Department of Labor's Web site.
If you can't afford to go on COBRA, you're in good company; a recent study by the Commonwealth Fund found that only nine percent of people who are offered COBRA actually use it. Sometimes it's less expensive to buy your own insurance policy rather than going on COBRA. You can compare prices at ehealthinsurance.com.
Step 3: Get your child on SCHIP
Even if you have too much money to qualify for Medicaid, your children may qualify for SCHIP, the State Children's Health Insurance Program. Here's a state-by-state directory of SCHIP programs.
There are other government programs, too. Your entire family may qualify for insurance from a state high-risk pool if you live in a state that has one.
If you think you might quality for Medicaid, see this state-by-state Medicaid directory.
Step 4: Get help with prescription drugs
If you can't afford health insurance -- or if your insurance doesn't include good prescription drug benefits -- look for $4 generic drugs at many major supermarkets and drug stores. Also, your state may offer a discount drug program (after you click, scroll down to see Table 2). You can also check these private groups that offer prescription assistance.
HealthWell Foundation
FamilyWize discount drug card
Needy Meds
Rx Assist
Rx Hope
Chronic Disease Fund
Partnership for Prescription Assistance
The Access Project
Step 5: Find financial assistance for your particular disease
Many diseases have specific foundations that offer financial assistance.
Heart Disease: Heart Support of America
Kidney Disease: American Kidney Fund
HIV/AIDS: The Access Project
Hepatitis: The Access Project
Cancer: see this Empowered Patient for a list of services
Alpha-1 Antitrypsin Deficiency, Chronic Granulomatous Disorder, Huntington's Disease, Idiopathic Pulmonary Fibrosis, and Pulmonary Arterial Hypertension: Caring Voice Coalition
Other rare diseases: National Organization for Rare Diseases
Vision Care: EyeCare America and Vision USA
Step 6: Find free clinics
Federally funded health centers offer free care in both urban and rural areas. Put in your address here and find one near you.

Symptoms of post-traumatic stress disorder (PTSD)

Following a traumatic event, almost everyone experiences at least some of the symptoms of PTSD. It’s very common to have bad dreams, feel fearful or numb, and find it difficult to stop thinking about what happened. But for most people, these symptoms are short-lived. They may last for several days or even weeks, but they gradually lift.
If you have post-traumatic stress disorder (PTSD), however, the symptoms don’t decrease. You don’t feel a little better each day. In fact, you may start to feel worse. But PTSD doesn’t always develop in the hours or days following a traumatic event, although this is most common. For some people, the symptoms of PTSD take weeks, months, or even years to develop.
The symptoms of post-traumatic stress disorder (PTSD) can arise suddenly, gradually, or come and go over time. Sometimes symptoms appear seemingly out of the blue. At other times, they are triggered by something that reminds you of the original traumatic event, such as a noise, an image, certain words, or a smell. While everyone experiences PTSD differently, there are three main types of symptoms, as listed below.
Re-experiencing the traumatic event
Intrusive, upsetting memories of the event
Flashbacks (acting or feeling like the event is happening again)
Nightmares (either of the event or of other frightening things)
Feelings of intense distress when reminded of the trauma
Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating)
PTSD symptoms of avoidance and emotional numbing
Avoiding activities, places, thoughts, or feelings that remind you of the trauma
Inability to remember important aspects of the trauma
Loss of interest in activities and life in general
Feeling detached from others and emotionally numb
Sense of a limited future (you don’t expect to live a normal life span, get married, have a career)
PTSD symptoms of increased arousal
Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hypervigilance (on constant “red alert”)
Feeling jumpy and easily startled
Other common symptoms of post-traumatic stress disorder
Anger and irritability
Guilt, shame, or self-blame
Substance abuse
Depression and hopelessness
Suicidal thoughts and feelings
Feeling alienated and alone
Feelings of mistrust and betrayal
Headaches, stomach problems, chest pain
Getting help for post-traumatic stress disorder (PTSD)
If you suspect that you or a loved one has post-traumatic stress disorder (PTSD), it’s important to seek help right away. The sooner PTSD is confronted, the easier it is to overcome. If you’re reluctant to seek help, keep in mind that PTSD is not a sign of weakness, and the only way to overcome it is to confront what happened to you and learn to accept it as a part of your past. This process is much easier with the guidance and support of an experienced therapist or doctor.
It’s only natural to want to avoid painful memories and feelings. But if you try to numb yourself and push your memories away, post-traumatic stress disorder (PTSD) will only get worse. You can’t escape your emotions completely – they emerge under stress or whenever you let down your guard – and trying to do so is exhausting. The avoidance will ultimately harm your relationships, your ability to function, and the quality of your life.
Why Should I Seek Help for PTSD?
Early treatment is better. Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes.
PTSD symptoms can change family life. PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life.
PTSD can be related to other health problems. PTSD symptoms can worsen physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD you could also improve your physical health.
Source: National Center for PTSD

News you can use ARDvark Blog

Gut Bacterium Linked To Colon Cancer
Written by Catharine Paddock, PhD
US scientists found that a common bacterium found in the gut could play a role in the development of colon cancer by producing a fermentation byproduct that damages DNA and affects signalling pathways used by colon cancer...[read article]Gut Bacterium Linked To Colon Cancer

Introducing NEW Voltarol Pain-eze® Tablets - A New And Effective Way Of Treating Body Pain Voltarol® Launches First Ever OTC Diclofenac Tablet

Pelvic Disorders Affect Large Number Of Women

Stateline.org Examines State Ballot Measures Related To Health Care

Introducing NEW Voltarol Pain-eze® Tablets - A New And Effective Way Of Treating Body Pain Voltarol® Launches First Ever OTC Diclofenac Tablet

Gordon Brown Praises NHS Staff On Reductions In C. Difficile And MRSA Infections, UK

Vaginal Brachytherapy Versus External Beam Pelvic Radiotherapy For High-Intermediate Risk Endometrial Cancer - Randomised PORTEC-2 Trial

Could An Absorption Enhancer Be More Convenient And Helpful For Colitis Patients?

Editorial: Where's The Data? Association Of Faculties Of Medicine Of Canada

In Crohn's Disease A Case Of False Positive Octreoscan

Canadian Scientists Report On Pain Research At NIDCR's 60th Anniversary Symposium

Montreal Water Treatment Plants Dumping As Much As 90 Times The Critical Amount Of Estrogen Products Into The River

Suppressing Hunger Hormone Could Be As Effective As Bariatric Surgery

What Impact Does "Fertility Tourism" Have On The NHS?

Discovery Of Master Switch In The Brain That Regulates Appetite And Reproduction

FDA:Potential Signals of Serious Risks/New Safety Information Identified by the Adverse Event Reporting System (AERS)

January - March 2008

The table below lists the names of products and potential signals of serious risks/new safety information that were identified for these products during the period January - March 2008 in the AERS database. The appearance of a drug on this list does not mean that FDA has concluded that the drug has the listed risk. It means that FDA has identified a potential safety issue, but does not mean that FDA has identified a causal relationship between the drug and the listed risk. If after further evaluation the FDA determines that the drug is associated with the risk, it may take a variety of actions including requiring changes to the labeling of the drug, requiring development of a Risk Evaluation and Mitigation Strategy (REMS), or gathering additional data to better characterize the risk.
FDA wants to emphasize that the listing of a drug and a potential safety issue on this Web site does not mean that FDA is suggesting prescribers should not prescribe the drug or that patients taking the drug should stop taking the medication. Patients who have questions about their use of the identified drug should contact their health care provider. FDA will complete its evaluation of each potential signal/new safety information and issue additional public communications as appropriate.

Potential Signals of Serious Risks/New Safety Information Identified by the Adverse Event Reporting System (AERS) January - March 2008

Product Name: Active Ingredient (Trade)or Product Class
Potential Signal of Serious Risk/New Safety Information

Arginine Hydrochloride Injection (R-Gene 10)
Pediatric overdose due to labeling / packaging confusion

Desflurane (Suprane)
Cardiac arrest

Duloxetine (Cymbalta)
Urinary retention

Etravirine (Intelence)
Hemarthrosis

Fluorouracil Cream (Carac) and Ketoconazole Cream (Kuric)
Adverse events due to name confusion

Heparin
Anaphylactic-type reactions

Icodextrin (Extraneal)
Hypoglycemia

Insulin U-500 (Humulin R)
Dosing confusion

Ivermectin (Stromectol) and Warfarin
Drug interaction

Lapatinib (Tykerb)
Hepatotoxicity

Lenalidomide (Revlimid)
Stevens Johnson Syndrome

Natalizumab (Tysabri)
Skin melanomas

Nitroglycerin (Nitrostat)
Overdose due to labeling confusion

Octreotide Acetate Depot (Sandostatin LAR)
Ileus

Oxycodone Hydrochloride Controlled-Release (Oxycontin)
Drug misuse, abuse and overdose

Perflutren Lipid Microsphere (Definity)
Cardiopulmonary reactions

Phenytoin Injection (Dilantin)
Purple Glove Syndrome

Quetiapine (Seroquel)
Overdose due to sample pack labeling confusion

Telbivudine (Tyzeka)
Peripheral neuropathy

Tumor Necrosis Factor (TNF) Blockers
Cancers in children and young adults

http://www.fda.gov/cder/aers/potential_signals/potential_signals_2008Q1.htm

Protect yourself from Medical Marketing

See this CNN podcast. It is critical that you consider the steps offered to protect yourself from Medical Marketing.

Who is wooing your doctor?

"Linda Lewis says that when she had back surgery two years ago, her surgeon didn't do what was best for her health; he did was best for his bank account."

Story Highlights

Expert: Research shows that financial ties to drug, device makers influence doctors

Last year, five companies were ordered to disclose payments to physicians

Drugs taken long term are heavily marketed to doctors; short-term drugs less so

Another consideration adhesion patients must face.

Air Charity Network™

Air Charity Network™ (ACN) is comprised of independent member organizations identified by specific geographical service area .
Airlift Hope, Angel Flight Central, Angel Flight Mid-Atlantic, Angel Flight Northeast, Angel Flight Southeast, Angel Flight West and Mercy Flight Southeast coordinate volunteer pilot missions in the continental United States as well as Alaska and Hawaii.
Mercy Medical Airlift, coordinates free airline tickets for missions over 1,000 miles and negotiates low cost air ambulance service for individuals and families, who are in need of this special service.
When requesting a flight, mission coordinators work diligently to successfully find a volunteer pilot or identify another appropriate transportation resource. Although many ACN member organizations have special volunteers who are "on-call" for last minute transplant, blood and special circumstance flights, our mission coordinators still appreciate as much time as possible to find the best transportation option for you.
To locate the Air Charity Network™ organization that serves your area, call 877-621-7177.

PLease note the price of fuel is having an impact on this charitable organization. Please start your planning early and contact them in plenty of time for your needs.
There is now no garuntee that a flight will be available.
Sorry

After Scar II

Self explanatory
The steps leading to the formation of adhesions and some of the factors that can influence the development of adhesions during surgery are illustrated.
How adhesions develop:
The tissue surface becomes damaged, either through surgery or injury, leading to disruption of the mesothelial lining
Bleeding and leakage of plasma proteins lead to fibrin deposits at injured sites, which is augmented by post-traumatic inflammation
The enlarging fibrin mesh might attach to an adjoining surface, a process that is counteracted by locally generated fibrinolytic factors
Depending on local peritoneal conditions, the fibrin mesh could either be degraded, resulting in scarless repair, or transformed into an adhesion consisting of connective tissue
If the fibrin is degraded within the first few days, the defect heals scarlessly
If remnants of fibrin remain for long enough, recruited reparative cells transform the initially reversible fibrinous adhesion to a fibrous, collagen-containing structure
Various factors can influence the development of adhesions during surgery - e.g. infection, heat, light, glove powder.
From the basic processes that result in the formation of adhesions, there are various steps that can be taken during surgery to minimise the risk of adhesions
These are:
increase vascular permeability
reduce infection risk
avoid GI contamination
minimise tissue handling by careful technique and microsurgery
reduce drying of tissues by using lubrication
limit use of cautery
limit use of sutures
avoid materials with fibres
use starch-free gloves
Although these measures will minimise the risks, they cannot eliminate the problem completely
Thus there is a clear need for improved adhesion-reduction strategies
Adhesion-reduction strategies involve:
Careful surgical technique
Minimisation of inflammatory response by use of
corticosteroids
NSAIDs
antibiotics
Augmentation of fibrinolysis
tissue plasminogen activator
Use of various adhesion-reduction agents
Risberg B. Eur J Surg 1997;577:32-39
Risberg reviewed a number of adhesion prevention strategies and techniques. The two major prevention strategies discussed are (1) adjusting surgical technique and (2) application of adjuvants.
NSAIDs (e.g. ibuprofen, tolmetin and oxyphenbutazone) can be applied systematically as well as intraperitoneally. Clinically efficacy remains questionable possibly because of drug delivery difficulties.
Corticosteroids (dexamethasone, hydrocortisone and prednisolone) can be administered intraperitoneally. Efficacy is doubtful due to associations with immunosuppression and delayed wound healing, e.g. infection, incisional hernia and wound dehiscence. Also, they do not remain in the peritoneal cavity for the duration of adhesion formation (4-5 days post surgery)
Fibrinolytics are designed to prevent or reverse fibrin deposition. Intraperitoneally or systematically administered plasminogen activator (tPA), streptokinase and elastase have undergone considerable laboratory evaluation with conflicting results, and in some cases, haemorrhagic complications. This lack of efficacy may be attributable to the problem of rapid peritoneal absorption and clearance.
To assess European opinion on post-operative adhesions two surveys were conducted, one at ESHRE 2002 (European Society of Human Reproduction and Embryology) and EACP (European Association of Coloproctology).
The respondents from ESHRE were all gynaecologists and results were as follows:
14.2% of respondents cited safety as an attribute associated with an ideal anti-adhesion agent
13.4% cited effectiveness
36.2% cited ease of use
15.7% cited low cost
Published in ANV 4
Note:
Preclude is referenced as ‘generally unavailable’ as clinical experience shows there are limitations in its use.
Hyskon is included in this slide as there is anecdotal evidence to suggest off-license use. However, cases of anaphylaxis have been recorded.
Mathias Korell – well recognised German gynae laparoscopy specialist has done studies with Spraygel and uses in endometriosis cases – where they do a lot of surgery (like colorectal in terms of extent of work in the abdomen – ie not neat and dainty stuff) and he is quoting need 5 kits to then coat the peritoneum to ensure adequate coverage – will be in Adhesions News & Vies Issue 5
Cost they quote around £150/sheet that would be a good size in abdominal surgery – but they won’t be more specific or detail how many sheets a colorectal surgeon might need to use
Adept® (icodextrin 4%) is a new potential solution to adhesions
Adept is approved throughout Europe for use in abdominal and pelvic surgery as an intraoperative wash and postoperative instillate for the reduction of adhesions
It is available as a 1 litre bag and most recently as a 1.5 litre bag to allow use of one bag for irrigating during surgery and to provide 1000ml to leave behind as a postoperative instillate
Work from a registry of routine use (ARIEL) which is now progressing in 150+ centres in Europe showed that a 1.5 litre presentation of Adept would be useful for most surgical cases allowing surgeons to irrigate with up to 500ml during surgery and then instil 1000ml to leave behind at the end of surgery
Icodextrin is a  1,4 linked glucose polymer
The structure is different from Dextran; the key difference lies in the linkage of carbon 1 and 4 (versus Dextran 1,6 which the human body cannot break down easily)
Icodextrin was developed from hydrolysis of corn starch (so it is a natural product)
Icodextrin is used for adhesion reduction as a 4% solution
This 4% solution is isosmolar and biocompatible with other drugs
Icodextrin is a large polymer and attracts a ‘water of hydration’ around it, increasing its size still further.
It is absorbed from the abdomino–pelvic cavity by the lymphatic system. In the blood it is broken down readily by amylase (acts on the 1,4 link) to maltose/isomaltose and then glucose, and is then excreted
Icodextrin has a well-established safety profile at the higher concentration of 7.5% where it is used in peritoneal dialysis - with > 36,000 patient years of safety data and use of Adept in >50,000 as at end January
Icodextrin was developed originally to overcome the issues associated with existing peritoneal dialysis fluids, specifically irritation to the peritoneum, etc
As a result of its structure, icodextrin with its ‘water of hydration’ stays in the abdomino–pelvic cavity over time (it is absorbed solely by the lymphatic system). It is this persisting presence in the abdomino–pelvic cavity that is thought to reduce adhesion formation/reformation as a result of ‘hydroflotation’
Hydroflotation is not a new concept, but the problem has been in finding a fluid that would stay in the abdomino–pelvic cavity long enough to keep tissues apart in the critical time after surgery when adhesions develop, but which does not have an irritant effect on the peritoneum, nor causes problems when absorbed (e.g. Dextran)
This slide looks at the persistence of 4% icodextrin over time compared to saline and glucose
It comes from a study in patients receiving peritoneal chemotherapy in whom 4% icodextrin was used as the carrier fluid1. In the periods between chemotherapy the icodextrin was used as a ‘dwell’ and aliquots drawn off through the Tenckhoff catheter
The results show that 50% of the icodextrin 4% solution was still retained after ~92+ hours, whereas within a day all the saline or glucose was absorbed by the lymphatics
This is the reason why crystalloid solutions such as saline are not very effective in the reduction of adhesions, as they do not stay in the abdomen for long enough to keep the organs and tissues ‘hydroflotated’
Reference
1. Hosie K, Gilbert JA, Kerr D et al. Fluid dynamics in man of an intraperitoneal drug delivery solution: 4% icodextrin. Drug Delivery 2001; 8: 9–12.
Video clips showing instillation at end of surgery
This slide shows the cost comparison of recent agents at current UK prices
Note the costs of agents is different in Finland but comparatively the relative price differentials will be the same
Two kits of Spraygel are often used to get adequate coverage of the surgical site and as per Prof Mathias Korell’s experience in major gynaecological surgery – 5 kits may be needed to ensure adequate coverage of the peritoneal cavity!
The US outcomes study with Seprafilm is using a mean 4.4 sheets/patients1
Intergel was withdrawn in April 2003
Reference
1. Beck DE, Cohen Z, Fleshman JW, Kaufman HS, vanGoor H, Wolff BG. Prospective, randomized, multicentre, controlled study of the safety of Seprafilm Adhesion Barrier in abdominopelvic surgery. Dis Colon Rectum 2003
This slide shows the cost comparison of recent agents at current UK prices illustrating costs of using 4.4 sheets Seprafilm (as per Beck) and 5 kits of Spraygel as (per Korell).
SurgiWrap not included as they don’t give a precise list price or how many sheets are used – when asked – and ?? Anyone using it yet??
Wilson MS et al. Colorectal Disease 2002;4:355-360
Wilson et al. modelled data from a lower abdominal surgery cohort from the SCAR data to assess cost effectiveness.
Results showed that:
Routine use of adhesion reduction products costing £50 per patient will payback the cost for such investment if they reduce adhesion-related readmissions by 16% after 3 years
A product costing £200 will need to offer a 64.1% reduction in readmissions after 3 years to recoup its direct costs
For the estimated 158,000 lower abdominal surgery operations conducted in the UK each year the cumulative costs of adhesion related readmissions over 10 years are estimated at £569 million
At year 3 – 64% reduction would be needed
And at 3 years
Wilson MS et al. Colorectal Disease 2002;4:355-360
Wilson et al. modelled data from a lower abdominal surgery cohort from the SCAR data to assess cost effectiveness.
Results showed that:
Routine use of adhesion reduction products costing £50 per patient will payback the cost for such investment if they reduce adhesion-related readmissions by 16% after 3 years
A product costing £200 will need to offer a 64.1% reduction in readmissions after 3 years to recoup its direct costs
For the estimated 158,000 lower abdominal surgery operations conducted in the UK each year the cumulative costs of adhesion related readmissions over 10 years are estimated at £569 million
This slide looks at cumulative costs of using an adhesion reduction agent over 9 years scaling up to the UK as a whole.
Using a £50 agent with a 25% efficacy would result in a saving of £71m
But using a £200 product with similar efficacy would result in a £142m loss – ie the health system would have to spend an extra £142m over the 9 years to reduce adhesion related readmissions by 25%.
In only 10.4% of cases were adhesions mentioned as part of the informed consent process
14.4% adhesions were discussed but not part of the consent
In those undergoing specific adhesiolysis operations 54% of patients reported being given some kind of information on adhesions before surgery
46% were given information on anti-adhesion agents
In procedures not involving adhesiolysis only 10% of patients reported receiving any adhesion information
Only 6% of cases were given information on anti-adhesion agents
Is this acceptable practice?
Most common adhesion-related claims
Failure to diagnose adhesion-related problems
Delay in diagnosis
Bowel damage at adhesiolysis
– laparoscopy > laparotomy
Infertility or risk of infertility
Starch granuloma – (use of starch-powdered gloves)
Failure to take precautions to prevent adhesions
1994 -1999 UK Medical Defence Union received 77 adhesion-related claims
Out of court settlements in 14 cases in 11 years ranged from £7960 - £124,261 (~€11,701 - €182,664)
– average £50,765 (€74,625)/case
And that was up until 1999
Since 1999
More evidence of burden of adhesions
SCAR study
Van Krabben enterotomy risk
SCAR-2
etc
Discuss high risk options then lead to prohylaxis

Before SCAR
Before we knew the real extent of the problem
Before we had newer anti-adhesion agents
Adhesions continue to be a significant burden
For the patient:
pain, SBO, infertility, re-operative complications
For the surgeon
increased workload, lengthy and complex procedures, medicolegal consequences
For the healthcare system
increased workloads, costs, bed stay

Where are we now?
Any advances in surgery have had little impact
Action on adhesions has received low priority
even in high risk procedures
New developments in anti-adhesion agents

not all are difficult or costly to use
emerging evidence of efficacy
Adopt use of anti-adhesion agents in ‘High Risk’ surgery
Adhesiolysis
Small bowel resection
Formation of stoma
Hartmann’s procedure
Anterior resection
Abdomino-perineal excision
Colectomy
Surgical treatment of peritonitis & fistulae

Thank you
Fellow SCAR Panel Members
Prof Harold Ellis, UMDS, London
Malcolm Wilson, Christie Hospital, Manchester
Don Menzies, Colchester Hospital, Colchester
Jeremy Thompson, Chelsea & Westminster Hospital, London
Brendan Moran, North Hampshire Hospital, Hampshire
Adrian Lower, St Bartholomew's Hospital, London
Rob Hawthorn, Southern General Hospital, Glasgow
Prof Alastair McGuire, City University, London
Graham Sunderland, Southern General Hospital, Glasgow
David Clark, James Boyd, Alan Finlayson, ISD, NHS Scotland, Edinburgh
Prof Ian Ford, Robertson Centre Biostatistics, Glasgow
Alastair Knight & Alison Crowe, Corvus
Shire Pharmaceuticals Group plc
Powerpoint template

Please read more
http://www.euuzlet.hu/koloproktologus/2004/parker.ppt.

Are you choosing between food, gas and meds?

We know that some of you are very hungery.
Here are some ways to get some food.
Bless you.


Food Assistance for Disaster Relief
FNS’s Food Distribution Division has the primary responsibility of supplying food to disaster relief organizations such as the Red Cross and the Salvation Army for mass feeding or household distribution. Disaster organizations request food and nutrition assistance through State agencies that run USDA’s nutrition assistance programs. State agencies notify USDA of the types and quantities of food that relief organizations need for emergency feeding operations.
Food Stamp Program
The Food Stamp Program helped put food on the table for some 10.3 million households and 23.9 million individuals each day in Fiscal Year 2004. It provides low-income households with coupons or electronic benefits they can use like cash at most grocery stores to ensure that they have access to a healthy diet.
National School Lunch Program (NSLP)
School districts and independent schools that choose to take part in the lunch program get cash subsidies and donated commodities from the USDA for each meal they serve. In return, they must serve lunches that meet Federal requirements, and they must offer free or reduced price lunches to eligible children. School food authorities can also be reimbursed for snacks served to children through age 18 in afterschool educational or enrichment programs.
School Breakfast Program (SBP)
The School Breakfast Program operates in the same manner as the National School Lunch Program. School districts and independent schools that choose to take part in the breakfast program receive cash subsidies from the USDA for each meal they serve. In return, they must serve breakfasts that meet Federal requirements, and they must offer free or reduced price breakfasts to eligible children.
Senior Farmers' Market Nutrition Program (SFMNP)
The Senior Farmers’ Market Nutrition Program awards grants to States, United States territories, and federally-recognized Indian tribal governments to provide low-income seniors with coupons that can be exchanged for eligible foods at farmers’ markets, roadside stands, and community supported agriculture programs.
Special Milk Program (SMP)
Participating schools and institutions receive reimbursement from the USDA for each half pint of milk served. They must operate their milk programs on a non-profit basis. They agree to use the Federal reimbursement to reduce the selling price of milk to all children.
State Processing Program
The State Processing Program allows States and eligible recipient agencies such as school districts to contract with commercial food processors to convert bulk or raw USDA commodities into more convenient ready-to-use end products. Most of the commodities processed through this program go to schools participating in the National School Lunch Program. Once the donated food is made available to States, the overall organization and administration of the State Processing Program become the responsibilities of the State agency.
Summer Food Service Program (SFSP)
SFSP is the single largest Federal resource available for local sponsors who want to combine a feeding program with a summer activity program. Children in your community do not need to go hungry this summer. During the school year, nutritious meals are available through the National School Lunch and School Breakfast Programs. But those programs end when school ends for the summer. The Summer Food Service Program helps fill the hunger gap.
Team Nutrition
Team Nutrition is a USDA initiative to provide training and technical assistance for foodservice, nutrition education for children and their caregivers, and school and community support for healthy eating and physical activity. Team Nutrition's Goal is to improve children's lifelong eating and physical activity habits by using the principles of the Dietary Guidelines for Americans and the Food Guide Pyramid.
The Emergency Food Assistance Program (TEFAP)
Under TEFAP, commodity foods are made available by the U.S. Department of Agriculture to States. States provide the food to local agencies that they have selected, usually food banks, which in turn, distribute the food to soup kitchens and food pantries that directly serve the public.
Women, Infants and Children (WIC)
The Special Supplemental Nutrition Program for Women, Infants, and Children - better known as the WIC Program - serves to safeguard the

http://www.fns.usda.gov/fns/services.htm

Serious Illness? Learn How to Navigate the Health Care System

David Landay's Parental and Partner Losses Prompted His Consumer-Oriented Site

Hit Broadway producer David Landay watched cancer kill both his parents and HIV/AIDS snatch several close friends, and eventually his partner.
It seemed that dealing with death had become a frequent and unwanted aspect of his life.
"It was so common that my friend Sally came home and found this note on her refrigerator: 'Rich called. John is dead.' And it had just become that common," he said. "My partner David died, and after that, I decided I had to help full-time."
After navigating the difficult pathway of serious illness and the health care system, Landay wanted to help others do the same. So he launched a Web site, survivorshipatoz.org.
He developed the site to serve as a one-stop shop to help people dealing with cancer, AIDS or any other serious illness as they navigate the health care system.
"The idea would be to give people all the legal, financial and practical information they need; so that when you first got that diagnosis and all these questions come charging at you, the answers would all be there," said Landay, who produced the Broadway show "Woman of the Year" with Lauren Bacall, Raquel Welch and Debbie Reynolds.
He recognized that when people get hit with devastating news they are often are confused about what to do. They may not have enough savvy about the health care industry to debunk common myths.
"Health insurance is the most important asset you have, but one of the myths is you can't get it. Well, you still can get health insurance," Landay said.
Even with health coverage, meeting medical financial obligations can be difficult.

Read the rest and watch podcast. Click Here

Help advance pain care in our country

Take Action Now
Make Your Voice Heard!
Join forces with APF, other organizations and thousands of others across the United States who are committed to raising public awareness and promoting the best pain policy, legislation and practice.By uniting, mobilizing and leveraging our collective voices, we can improve pain management. It is not acceptable that 76 million Americans suffer pain and the majority do not receive appropriate care! Click here for more information on the latest National Pain Legislation and how you can Make Your Voice Heard!

There are FOUR critical actions you can take right now that will help advance pain care in our country.

Ask your Representative to co-sponsor the National Pain Care Policy Act of 2007 (HR 2994) - CLICK HERE.
The Veterans Pain Care Act, HR 6122, was introduced in the House of Representatives - CLICK HERE.
Request that your organization endorse the Consensus Statement for the National Pain Care Policy Act of 2007 - CLICK HERE.
Request that your organization endorse the Consensus Statement for the Military and Veterans Pain Care Acts - CLICK HERE.

From: The American Pain Foundation