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Hopkins News For You
This is a service for our friends around the world from Johns Hopkins International. To receive reports, please send e-mail to patientnewsletter@jhmi.edu or visit our website at www.jhintl.net.
September 2004
Reducing Danger of Bee Stings in Children
Restless Legs Not Just a Nervous Habit
Problems Diagnosing Endometrial Cancer
Using Your Medications Safely
Cystic Fibrosis and Osteoporosis
Reducing the Danger of Bee Stings in Children
Although most children outgrow allergies to bee, wasp and other insect stings, Johns Hopkins doctors say that almost one in five who had allergic reactions when stung as children are likely to have reactions later in life. "The good news is that for children with moderate to severe reactions, allergy shots will lower the risk of serious reactions to stings even 10 to 20 years after treatment is stopped," says allergist David Golden, M.D. Allergy shots give purified bee or other insect venom in small doses that build up over time. They are recommended for children who have moderate or severe reactions, including dizziness, breathing difficulty and lowered blood pressure. There is little need for shots in children with milder reactions, such as minor swelling and hives, said Golden.
Restless Legs Aren't Just a Nervous Habit
Have you ever just settled down in your armchair or snuggled into bed, only to be seized by the feeling that you simply must move your legs? If so, you may have restless legs syndrome, a condition that affects up to 10 percent of the population. Hopkins neurologist Christopher Early says many people with the condition are never properly diagnosed but that effective therapy is available. "The standard anti-Parkinson medications, the dopamine agonists, all seem to be relatively effective in treating the disorder," he says. One drawback, Early says, is that patients seem to develop a tolerance to the medications, and symptoms may worsen if they are on the medications chronically. Early is conducting clinical trials on the use of intravenous iron to treat the disorder, since an underlying iron metabolism problem is suspected as a possible cause.
Problems Diagnosing Endometrial Cancer
Endometrial or uterine cancer is the most common cancer affecting the female reproductive tract, yet there is wide disagreement even among experts when it comes to identifying cancerous lesions, called atypical endometrial hyperplasia. A recent study concludes the reason may be because tissue samples taken from the lining of the uterus in office procedures cannot be easily analyzed, says study author and gynecologist Connie Trimble, M.D. "We have to figure out better ways to diagnose endometrial cancer. It means that a woman with a diagnosis of atypical hyperplasia should probably get a second opinion."
According to the study, women who had a D and C (dilation of the cervix in order to scrape away abnormal tissue) instead of an office procedure had slightly more accurate diagnoses. Dr. Trimble says researchers are working to find molecular and genetic markers to better identify endometrial cancer. For now, she recommends that patients seek someone very experienced with this type of cancer to make the diagnosis.
Using Your Medications Safely
When properly used, medications can work wonders but they can be harmful if used or stored improperly, especially if you are being treated by more than one doctor or travel often. The following tips will help you use your medications safely.
1. Keep a list of all medications you take, including prescription and over-the-counter medications, herbal supplements and home remedies. Some combinations can be harmful.
2. Tell your doctor how you actually take your medicine, for example, if before, with, or after meals. The timing can affect their effectiveness.
3. Request written information about the drug and possible side effects. Question anything you don't understand and tell your doctor if you experience unexpected changes. Ask if you should avoid certain foods or beverages, other medicines or activities while you are taking any medication.
4. Keep all medications in their original containers so you know exactly what they are. Always turn the lights on when giving or taking medicines.
5. Use child-resistant caps and avoid calling medicine "candy" when administering to children. Children like to imitate adults, so it's best to avoid taking medicines in front of them.
6. Check medications periodically for expiration dates.
7. When traveling, keep your medications with you so they don't get lost and to protect them from extremes in temperature in checked luggage. If you will travel across time zones, discuss the dosing schedule with your doctor.
8. Many medications cause sunlight sensitivity, so pack sunscreen to ensure a pain-free vacation.
9. If your medication requires a syringe (like insulin), you may be asked to show your prescription to pass through airport security. Check with your airline before leaving home.
10. Be sure to carry enough of your prescription medication to last for your entire trip.
11. When traveling to a hot, humid climate, keep medications in a cool, dry container away from sunlight.
12. Always keep a list of your medications in your wallet and include contact information for immediate family members and the names and regimens of all your medications.
Cystic Fibrosis and Osteoporosis
Thanks to breakthroughs in research and treatment of patients with cystic fibrosis, many are living much longer, with average survival up from age 5 in the 1950s to the early 30s today, with some living much longer. Hopkins' oldest is 65. But with increased survival have come unexpected problems such as osteoporosis, or loss of bone density.
Most often associated with aging, the condition afflicts young CF patients, leading to painful rib and spinal fractures that disrupt physical therapy to break up mucus in the lungs, the main symptom of CF. Worse, it can exclude a patient from a lung transplant, the only option for many patients.
One reason for this premature bone thinning is because CF patients have trouble absorbing vitamin D, which is critical for building bones. Another is a medicine used to treat CF: glucocorticoids. Almost all young patients on this therapy suffer accelerated bone loss.
That's why pulmonologist Michael Boyle of the Cystic Fibrosis Clinical Research Center at Hopkins has been targeting this problem in younger CF patients, in the hope of developing new therapies to reduce patients' risk of osteoporosis and fractures. Boyle is measuring the impact of high doses of vitamin D in young patients. The standard recommendation for those who are deficient is a twice-a-week supplement for two months, but Boyle has found that does little to increase vitamin D stores.
Now he's going to higher doses to find an effective, well-tolerated level. Boyle is also studying medicines called bisphosphonates to prevent bone thinning. Working closely with Hopkins pediatric pulmonologists, Boyle is optimistic that new therapies to delay or prevent bone thinning will be developed. His young patients, who must deal with these life-threatening issues when their peers are worrying about college and finding a job, motivate him to find the answers.
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