Friday, June 08, 2007
Fit Buddies update
The CNN Fit Buddies have made it through another week in their weight-loss and fitness challenge. Here's an update on their efforts to eat better and exercise more. Read about their successes and frustrations every Friday here on the Paging Dr. Gupta blog. And join the Fit Buddies by accepting the Fit Nation Challenge (details here).

Ed Lavandera, CNN Correspondent

I pull into the parking lot of the Denver hospital where TB patient Andrew Speaker is in isolation. We've come straight from the airport and we're racing to get our first live report on the air. I rip my suitcase out of the rental car and grab my blue sports coat. I haven't worn this jacket in several weeks. When I put it on it hangs like a clown suit. The only thing missing from this outfit are big red shoes. My producer just laughs and says, "Wow, you have lost a lot of weight!"

I've written a lot about motivation and the importance of finding fresh ways to keep myself focused on losing weight. This might sound weird, but even though I knew in the back of my mind that if I lost a lot of weight I would need a new wardrobe, I never suspected to get such a rush out of seeing it happen.

Right now, I have no suits that fit me properly. (Some creative photography made that blue sports coat in Denver look presentable on television.) I've had to poke new holes in some belts. Pants and shirts are oversized now.

So if you need some motivation just remember that when you lose weight, you get to go shopping!

Stacia Deshishku, Director of Coverage CNNUS

This week has been another struggle -- getting back on track after a week off. My workout on Monday was a KILLER! My thighs, five days later, still are screaming at me. Just goes to show that a few days off often feels like starting all over again.

One thing I have started this week -- brace yourself -- is running. Yes, me, running. I can't believe it. It started out as one minute of running and one minute of walking - back and forth. Then two minutes, with a one minute break in between. Then three and so on and so on. I can't believe it. I'm strong enough to run! For years I have given myself 100+ reasons not to run: I have flat feet. It gives me shin splints. I don't have the "wind" for running. My chest double bounces, as does my backside! The list goes on and on. Additionally, back in the recesses of my memory are those horrible days in junior high when we would have to run around the track as discipline. I hated it. Therefore I hated running. Period. That feeling has stayed with me for more than 20 years.

When I see a woman in really great shape, the odds are that she is a runner. It makes the body look long and lean. Though I'm only 5 feet 2 (barely) my muscles can still look longer and less bulky. I'm hoping running will do this for me. I'm just starting out so I’m not running long or far, but I am running. Most importantly it is something I can do anytime, anywhere. No gym membership needed. No trainer. No special tools. Just me and my running shoes. Wish me luck!

Robert Dothard, Fitness Trainer

What's your motivation for starting an exercise program? For the Fit Buddies, the incentives have changed a bit since the program began. I once heard a motivational speaker say, "People will do more to avoid pain than they will to seek pleasure.' In my line of work, I always have people responding to a negative, the client is out of shape,,or even worse, a medical condition has brought them to me.

Whatever your reason for joining the Fit Nation, remember "AAA": Assess your health, which should always include an annual physical; Accept the results of the assessment, even if it is as simple as 10 extra pounds, or a comment from a concerned loved one; and then Act. It's great to have programs like this one with CNN, but let's get real - a lot of times we need something negative to get us to do something positive!

I hope like Stacia, you have strong family support and a spouse who is now a workout "machine," or maybe you are like Ed, who had no choice because of his family medical history. The fact that he has young children means he has needed almost no motivation from me. And finally Matt, who has a whole life that he is starting with someone else. I don't think motivation will be his issue for a while. Well if she says "yes," that is!

I wish you good luck, and good health.

Matt Sloane, Medical News Producer

It's vacation time (finally!!) and I'm headed to the islands. Sounds great, but I'm a little concerned about how I'll behave while I'm there. I've already made one commitment to myself: exercise! My dad will be there, and he's been on a diet as well, so he suggested that we all take long walks into town and play tennis whenever the weather is not too hot . Thanks, Dad!

My other enemy here is food! Luckily, Bermuda doesn't really have any must-have native foods, though they do have some great drinks. The plan is to cook as much as we can, and eat out only a few times in the hopes that by having more control, we'll eat more healthy stuff.

I'll have a lot to report when I get back - I hope all good news! As Robert alluded to, there's another big thing in the works, but more on that later... after I get her answer! (Ed told me that if she says no, I have his permission to eat whatever I want!! Thanks, bud, but let's hope I'm still on a diet when I get back!)

Thursday, June 07, 2007
Meeting of the minds on cancer
Although I have so far been spared the diagnosis of cancer, I did watch my mother die from lung cancer. That was less than eight years ago. But so much has happened in cancer research and treatment in that short time. Had she received her diagnosis today, I'm confident she would have lived longer than the three months she had between diagnosis and death. Because of medical advances in treatment and therapy, we now have more cancer survivors in the United States than ever - 10 million - and experts believe that number can double in the next decade.

Earlier this week, more than 32,000 cancer specialists met in Chicago, Illinois, to present and learn about the latest successes (and a few failures) in cancer research and treatments. Over 4,000 new studies were presented at the annual American Society of Clinical Oncology meeting. There were no blockbuster breakthroughs or discoveries, but a lot of studies were presented, showing - as Dr. Archie Bleyer, a Bend, Oregon, oncologist, put it, "Investment in cancer research is paying off."

For the first time, researchers have found a way to treat advanced liver cancer and extend survival (Nexavar - Full Story). Doctors also reported on better, more tolerable treatments for some of the other, more difficult cancers - like ovary, thyroid and kidney. Until recently, there were no good treatments available for these cancer patients. But according to many cancer specialists, this progress is in danger of seriously slowing down. That's because the funding of cancer research is dwindling.

Dr. Allen Lichter, ASCO's vice president & CEO and former dean of the University of Michigan's Medical School, told reporters at the beginning of the conference, "We are now in the midst of the longest sustained period of flat funding in research in decades." He says in real dollars, the funding of the National Cancer Institutes has actually declined 12 percent over the past four years.

Many doctors I spoke with at this conference are concerned about the lack of research funding. Some are finding alternative resources such as the Lance Armstrong Foundation. But these alternatives cannot replace what the federal government can offer. Armstrong, a cancer survivor himself, told you earlier this year how he's running out of patience on this funding issue and wants congressional leaders to act. (Full Story)

Slowing down the pace of cancer research and breakthroughs can be devastating to those suffering from the disease. "1,500 people will die from cancer today," Lichter told reporters. But there are only so many tax dollars to go around.

Next June, more than 32,000 cancer specialists will gather in Chicago again. Will cancer research funding be an even bigger issue then? What should be done? Should more tax dollars go to cancer research? Should, as Lance Armstrong suggests, cancer research be a more prominent topic discussed among our elected and potentially future elected officials? .
Wednesday, June 06, 2007
Voting for better health care
Some of the biggest highlights from the Republican debate last night revolved around immigration and the war, and even religion. Lightning actually interfered with Rudy Giuliani's microphone as he answered a question about his support for abortion rights. That was a little unsettling. Still, something else caught my attention. Sen. Sam Brownback reminded us that "the leading cause of fear in America today is that you'll get cancer." He went on to say, "This one is actually within our reach and it something we can go at and we should go at, and it touches a lot of Americans." That is so true. In fact, it even touches a lot of presidential candidates.

Sen. John McCain had melanoma, and Elizabeth Edwards, wife of Sen. John Edwards, has stage 4 breast cancer. Giuliani has a history of prostate cancer that may have been the reason he dropped out of his senate race a few years ago. Sen. Hillary Clinton's mother-in-law died of cancer, and former Vice President Al Gore (who has not announced) lost his sister to cancer years ago. Former Sen. Fred Thompson, who is widely anticipated to enter the race, has a type of lymphoma.

Last night, we finally started talking about an issue that is a concern of millions of Americans - health care. Former Wisconsin Gov. Tommy Thompson had the numbers at his fingertips. We spend 2 trillion on health care, which is 16 percent of the gross national product, and 93 percent of those dollars go into caring for someone after they are sick. Less than 10 percent goes into actually keeping people well. Thompson's plan focuses a lot on shifting money toward preventive care to cut costs in the long run.

In the United States, we pay the most and get the least of any industrialized nation, with regard to our health. Most of the candidates have some sort of plan, whether it is heavy government subsidies, requiring employers to help finance health care or even raising taxes. Some even want to appeal to the pharmaceutical companies to drive down prescription drug costs. What do you think? We have had a broken health care system for decades. Is it fixable and how do we achieve that?
Tuesday, June 05, 2007
Defining contagiousness
As a general rule, doctors hate saying "maybe." It shows a lack of confidence and a degree of uncertainty to which medicine is unaccustomed. So, you can imagine my consternation when I had to say it repeatedly this morning on television. The question: Is Andrew Speaker contagious or not?

Well, maybe... sort of. Alright, yes is he is contagious, but not very. Make sense? There are several things doctors look at when determining whether someone is likely to transmit an infectious disease. One is whether he or she is sick (coughing, sneezing with fever). A second is whether a sputum test is positive - meaning bacteria are present in the saliva. In Andrew Speaker's case, both those tests suggested he was not contagious, and may not be now. He did, however, have a third test come back positive, which is a culture test. That means, doctors had Speaker cough onto a slide, and, although no bacteria were initially present, after a few days they did show up when placed in a culture medium. Based on all of that, the hospital where Speaker is staying issued a statement saying he is "relatively non-contagious" and may even consider taking him out of isolation, although he would still wear a mask.

To be clear, there is still a lot of concern surrounding Speaker. Here is one way of looking at it: When examining risk, you really have to balance the likelihood of transmitting the bacteria with the seriousness of the disease. In this particular case, it sounds like the likelihood of spread is low, but the potential consequence is very high. That is especially true with XDR-TB, where there are very few treatment options.

So, now after hearing all of this, which is admittedly confusing even for the medical establishment -- does it make you more or less understanding of Speaker's decision to fly internationally?
Monday, June 04, 2007
TB case: Could you have done the same?
"Mom, I really don't want to go. I'm so itchy," I whined.

"You have to go. That's the plan. Your aunt is expecting you," my mother told me as she wrapped a scarf around my neck and put sunglasses on my little head to cover up the marks. I was 8 years old.

"But I'm not allowed on the airplane with chicken pox. If I had school, I wouldn't be allowed to go there," I pressed.

"You'll be fine. Just don't talk about chicken pox," my mother commanded as she nudged me on that plane alone headed toward Mississippi for summer vacation.

For good or bad, my childhood experience has made me question how differently I would have acted had I been in Andrew Speaker's shoes.

For sure, tuberculosis and chicken pox are very different. Just a few facts on your average tuberculosis (less serious than Speaker's "extensively drug-resistant," or XDR-TB): About a third of the world's population is infected with tuberculosis and most cases are latent, or not active.

Tuberculosis kills approximately 1.6 million people a year. The bacteria take over your body and keep it from functioning properly. "It's been called consumption because people literally waste away. You end up looking like a concentration camp victim," says Dr. Max Pomerantz, a TB expert and surgeon at University of Colorado at Denver Health Sciences Center.

Each person with tuberculosis infects 10 to 15 other people, usually by coughing germs into the air, according to the World Health Organization. Once inside a new host, TB develops in 5 percent to 10 percent of healthy people. In the remaining people it can be carried around for years or decades without causing any symptoms. The dormant TB can be triggered to activity by a disruption in the immune system.

To be clear, extensively XDR-TB is no more virulent or contagious than non-resistant tuberculosis. It's more dangerous because it does not respond to some of the strongest antibiotic treatments in existence. It's very difficult and very expensive to treat. Andrew Speaker faces a two-year course of treatment and his doctors in Denver approximate it will cost at least $250,000 to $350,000 for his care at National Jewish Medical Center.

So armed with all that information, I'd like to say that I wouldn't have tried to get on a plane home after authorities warned me I was a health risk, but to be honest I'm not absolutely certain. Speaker apologized to his fellow passengers on "Good Morning America" on ABC: "I don't expect those people to ever forgive me. I just hope they understand that I truly never meant them any harm."

How would you have acted? Would you have stayed in a foreign country's hospital after being warned? If you didn't have symptoms, would you have believed you were a public health threat? Do you think Andrew Speaker should be held liable? Do you have more questions about tuberculosis? Do you think the TB case merited so much media attention?
Get a behind-the-scenes look at the latest stories from CNN's chief medical correspondent, Dr. Sanjay Gupta, and the CNN Medical Unit producers. They'll share news and views on health and medical trends -- info that will help you take better care of yourself and the people you love.
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