In fond memory of one of my sweetest patients with fibromyalgia who recently passed away from a massive stroke. Listen to her explanation of how she coped with her rheumatic condition over the years.

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A patient fights her rheumatoid arthritis with prayer, family, and medication.

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A patient with lumbar disc disease and osteoarthritis of the knee shares some personal stories with Dr. Rutstein.

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The Role of Calcium and Vitamin D in Postmenopausal Women A report from the Women's Health Initiative has evaluated whether supplemental calcium and vitamin D provide any significant benefit in osteoporosis treatment. The study investigated whether the supplements provided any significant protection against future bone fractures. The study has a number of design flaws, which are pointed out. These include the fact that the control group was allowed to take calcium and vitamin D on their own along with hormonal therapy, bisphosphonates, and miacalcin. Scientists question whether the vitamin D dose of 400 I.U.s per day used in this study is really sufficient for women. Compliance in taking the calcium carbonate and vitamin D prescribed in this study was associated with a decreased rate of hip fracture, but unfortunately in those patients who failed to comply the benefits were not seen. The study re-emphasizes the need to be evaluated with bone mineral density measurements (DEXA scan) to see if you are truly osteoporotic. Taking calcium and vitamin D does not substitute for a proper evaluation by your physician for the presence of osteoporosis. Calcium and vitamin D are considered important background medications, but osteoporosis needs to be treated with more specific and stronger therapies including bisphosphonates (Fosamax, Actonel, Boniva), Forteo, Miacalcin nasal spray, or Evista.

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Special Series of Podcasts on the Diagnosis and Treatment of Osteoporosis: Part IV: Other Treatment Considerations in Managing Osteoporosis Dr. Rutstein interviews Dr. Raj Marwah, a rheumatologist and Clinical Professor at the Department of Internal Medicine at Texas Tech Health Sciences in El Paso. Topics include: What is the current thinking on the role of estrogens in the development and prevention of osteoporosis? What about the use of the selective estrogen receptor modulator (SERM) called Evista? How does it work? Is it beneficial in fracture prevention? Can it be combined with other treatments? Are there any special side effects that should concern the patient? Is there a place for the use of the intra-nasal spray called Miacalcin in the treatment of osteoporosis? What are side effects of using this medication? What is Forteo and how does it work? Which patients are particularly good candidates to receive this treatment? Why is Forteo limited to two years of treatment only? What is Dr. Marwah's overall assessment of the current status of the diagnosis and treatment of osteoporosis in the United States?

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Special Series of Podcasts on the Diagnosis and Treatment of Osteoporosis: Part III--The Use of Bisphosphonate Medication for the Treatment of Osteoporosis Dr. Rutstein interviews Dr. Raj Marwah, a rheumatologist and Clinical Professor at the Department of Internal Medicine at Texas Tech Health Sciences in El Paso. Topics include: What are bisphosphonates and how do they work? Are there advantages of one bisphosphonate over another? (Fosamax vs. Actonel vs. Boniva) What special instructions should the patient follow in taking these medications to ensure maximum absorption of the drug with the fewest side effects? What adverse side effects are seen with use of bisphosphonates?

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Special Series of Podcasts on the Diagnosis and Treatment of Osteoporosis: Part II--Diagnosing and Monitoring Osteoporosis and the Importance of Calcium and Vitamin D Dr. Rutstein interviews Dr. Raj Marwah, a rheumatologist and Clinical Professor at the Department of Internal Medicine at Texas Tech Health Sciences in El Paso. Topics include: How is osteoporosis actually diagnosed? What are bone turnover markers and how can they help physicians in monitoring patients with osteoporosis? What are the proper amounts of calcium to consume? Are there advantages of dietary versus supplemental calcium? How important is it to have adequate vitamin D levels and how can a vitamin D deficiency be diagnosed? How should patients be monitored while being followed and treated for osteoporosis? What information did we learn from the Surgeon General's report on bone health?

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Dr. Rutstein interviews Dr. Marwah, a rheumatologist and Clinical Professor at the Department of Internal Medicine at Texas Tech Health Sciences in El Paso. Topics include: What exactly is osteoporosis? How does it differ from osteopenia? What are some of the important risk factors involved in developing this condition? What is the likely future course of a patient who develops an initial fracture due to osteoporosis? Plus more!

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Dr. Rutstein discusses some helpful suggestions on dealing with the Medicare Prescription Drug Plan.

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Are glucosamine and chondroitin sulfate supplements really of any value? The results of the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) were reported at the American College of Rheumatology meeting in San Diego. Tune in to hear these long awaited results. At Arthritis Central we have been touting the benefits of a good exercise program including walking. Can walking on a regular and frequent basis add years to your lifespan? Check out a report by Dutch investigators to find out the answer. Researchers are discovery key pathways involved in the development of osteoarthritis in rodents that may eventually have implications in the treatment of human beings. Milk advertising strategies are changing as a result of so many food and beverage companies making claims regarding their calcium benefits. You may be amused by this new approach. On a personal note, Dr. Rutstein is pleased to tell you about his mother's recovery from a lumbar fusion. This was a "tough haul" for an 83 year old woman. Dr Rutstein so pleased that she made it through without any unforeseen complications. If you can take better care of yourself and stay out of hospitals, you are far better off!

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Are you having problems with rudeness from the front office staff in your doctor's office? If you are, apparently you are not alone. Hear more about this problem and how you can actually help cut down on the likelihood of experiencing this on future visits. Are you taking Zanaflex (tizanidine hydrochloride) for muscle pains or spasms? You will want to listen to this alert about the Zanaflex capsules versus a tablet form of tizanidine. If you are giving your child supplements without your pediatrician's knowledge, then you may be putting them at risk of potential side effects. Dr. Rutstein reviews some of the problems that have been encountered with some of these over-the-counter products. Where do these free samples of medications in your doctor's office come from? HMOs are now participating in a program to put ATM like generic medication dispensing machines in your physician's office. Learn more about why they are going to this effort and expense.

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Should you sign up for the Medicare prescription drug plan? Which one is best for you? Listen for answers to these and other questions. Visit www.medicarerxeducation.org for more information. More information can also be found in Podcast #25. Scientists have uncovered an "inflammation" gene that may be an important key to various chronic diseases including arthritis, heart disease, diabetes, cancer, and Alzheimer's disease. Do placebos really work? How can a sugar pill or salt water be so helpful in relieving pain? A new study sheds light on this process. You may be able to save money on your Arava (leflunomide) with this latest FDA approval of generic tablets. Endomorphin I is a natural pain reliever found in the joint itself. Is there any evidence that it might be helpful in a chronic problem like osteoarthritis? Hear the results from this most recent study. OxyContin has been fraught with problems because of its abuse. A new drug called Remoxy may be on the way, which will avoid the OxyContin abuse potential. If you have severe chronic pain then you will want to hear the latest news about Remoxy. This may be something that eventually could help to control your pain once it is available on the market.

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Depression in individuals over 65 is a significant health issue. A Wall Street Journal written by Laura Landro is reviewed shedding light on this subject. For more information on this subject, visit www.nimh.nih.gov, wwww.depressionscreening.org, www.positiveaging.org, and www.aagpgpa.org. Are you having difficulty falling asleep at night? A new drug now out on the market may be 'just the ticket". Some patients with scleroderma (systemic sclerosis) may develop lung (pulmonary) involvement. Researchers compared cyclophosphamide (Cytoxan) with a placebo to determine if this drug offers any improvement in lung function and in skin tightness scores. The results of the study and issues about side effects are discussed. Are there any indications that osteoarthritis actually starts long before it becomes symptomatic to the patient or obvious to your physician? Abbott's Humira drug has received new FDA approval as a first-line treatment in rheumatoid arthritis. Does Lympho-Stat-B hold any promise for systemic lupus patients? Hear about the results of the most recent study. A new synthetic version of a cell surface protein called PLAD (pre-ligand assembly domain protein) may offer patients an alternative approach to the treatment of inflammatory forms of arthritis. Will this turn out to be safer than the currently used anti-TNF therapies (Enbrel, Remicade, Humira)? Who should be taking a new formulation of Fosamax that incorporates 2800 units of vitamin D3? How many women in North America have been found to be vitamin D deficient? If you are already taking vitamin D daily, must you switch to this new Fosamax tablet? Make sure that you find out from your doctor whether you have osteoporosis or osteopenia and whether or not you need to be on therapy.

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A Wall Street Journal article written by Kelly Greene stimulates a discussion of how Baby Boomers will be re-shaping life in the next two or more decades. Should you pay for assisted living down the road or just go on a year long cruise? Are the costs that different? What are "brain gyms" and "cognitive fitness centers" ? Are there really ways to improve your memory? Listen to the news about how some people are just "dying" to tell you their life stories. Learn about research into a new form of methotrexate combined with a protein called albumin. This may increase the amount of methotrexate getting into your cells and into the joints. We alert you about a recent report of increased cardio-vascular risk with the combination of vitamin B-6 and folic acid. How disconcerting and confusing these reports can be! Should you be considering ordering your medications through a Canadian Internet pharmacy? Is it even legal to do so? Are brand-name medications cheaper when purchased in Canada than in our large drug store chains? Why haven't electronic medical records (EHR) been accepted and instituted by more doctors' offices and in our hospitals? What's gumming up the works? When will all of your doctors be able to easily access the same information about your health?

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Are people who have a lot of contact with mineral oils more at risk to develop rheumatoid arthritis? A study from Sweden addresses this issue. Does this apply to men and women? What is the relationship to rheumatoid factor antibodies? Learn the fate of Pfizer's drug application for Paracoxib for the treatment of post-operative pain. Paracoxib is an intra-venous "pro-drug" of Bextra, which was itself previously taken off of the market by the FDA. Aromatase inhibitors have been an extremely welcome addition for breast cancer patients. Now we report on a recently reported side effect of this family of medications and tell you what you can do about it. The mystery of psoriasis and the differences behind the cutaneous form and arthritic manifestations are discussed in this piece involving a new mouse model of this disease. This information will help explain why TNF inhibitors like Enbrel, Remicade, and Humira are helpful in treating this disease. Eating a portion of fish at least once a week may help stave off mental deterioration in later life (dementia). It's not some "fish tale" to say that adding fish to your diet may add years to your life. Obesity, hypertension, and elevated cholesterol levels may each double your risk of becoming demented. Having all three together in middle age jumps the risk factor up even more. It's time to take action to combat these treatable problems. A report from Duke University gives us better parameters on just how much brisk walking a person needs to do in order to be fit and decrease one's cardio-vascular risk. You will be surprised to hear whether it's necessary to lose weight or not in order to achieve these benefits.

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In this program the subject of the under treatment of pain is discussed. Physicians have a number of fears about prescribing narcotics, which are addressed. Patients worry about potential addiction and the possibility of side effects. A piece written by Barry Yeoman in AARP, The Magazine is reviewed. Physician and patient concerns are contributing to under treating pain in one half of all cancer patients, even in the final days of patients' lives. This is totally unacceptable. A very exciting breakthrough in stem cell research has been reported by investigators in Boston. This technique involves using one's own skin. This may pacify many opponents of stem cell research, who have been concerned about using stem cells derived from human embryos. Can varying your activities and stimulating your various senses result in an increase in the connections among brain cells or even an increase in the number of nerve cells? The subject of "neural reserve" and how to improve it is discussed. A series of helpful techniques to keep you sharper and more alert is presented. An AARP article written by Kelly Griffin is critically reviewed dealing with this important area. For those of you interested in learning to spell words using your hands, visit www.iidc.indiana.edu/cedir/kidsweb/amachart.html. A New York Times article written by Gina Kolata challenges the rapidly increasing usage of vertebroplasty or kyphoplasty to treat compression fractures in the spine. Is it possible to get patients to enroll in a placebo-controlled study when the response to an injection of cement into the vertebral body may be so dramatic in promptly reducing severe back pain? Kevin Trudeau's best seller "Natural Cures They Don't Want You to Know About" may be a "hot" book, but does it contain scientific and valid information? Dr. Rutstein cites quotes by Dr. Dean Ornish and others from a recent New York Times article by Melanie Warner that suggests that the author and his material may not be all that they appear. Kevin Trudeau's "dark" past life certainly casts a shadow over this best-selling book. Dr. Rutstein cautions those of you who are feeling frustrated and desperate not to throw your money down the toilet with unproven remedies. Keep abreast of alternative therapies that have some validity and certainly discuss your feelings with your own physician.

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This is the second part of a special two-part program with Dr. Rutstein interviewing Dr. Scott Zashin about his book, "Arthritis Without Pain: The Miracle of TNF Blockers." Dr. Zashin is a board-certified rheumatologist practicing in Dallas, Texas. Each of the TNF blockers is specifically addressed in this program (Enbrel, Remicade, and Humira). Injection site reactions from Enbrel are addressed. Concerns about potential infections associated with TNF inhibitors are discussed. This includes comments about the assessment and treatment of tuberculosis in the face of biologic agents. Can TNF inhibitors affect your red cell, white cell, and platelet (clotting cells) counts? Is there a higher risk of cancer with these drugs? Dr. Zashin and Dr. Rutstein touch on these subjects. Is there an increased likelihood of problems if TNF blockers are administered to multiple sclerosis patients? Should TNF inhibitors be utilized in patients with a confirmed diagnosis of congestive heart failure? The issue of the high cost of biologic therapies is discussed with differences in insurance coverage among the three existing drugs pointed out. What are "infusion reactions" which may occur with Remicade, and how are they managed? Do some patients receiving TNF inhibitors form lupus symptoms or lupus antibodies? What should patients on TNF drugs know about flu and pneumovax vaccinations? Are "live" flu vaccines dangerous in this setting? How hard is it to overcome a patient's fears of having to self-inject medication under the skin? If you fail to respond to one particular TNF inhibitor, is it possible to respond to one of the other two TNF blockers? How long should patients expect to continue on a TNF inhibitor if it is effectively controlling their disease? Future biologic therapies are also discussed, which will offer arthritis patients even more treatment options in the coming years.

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This special podcast is part I of Dr. Rutstein's interview with board-certified rheumatologist and author, Dr. Scott Zashin, discussing his book "Arthritis Without Pain: The Miracle of TNF Blockers" (published by Sarah Allison Publishing Company, Dallas, TX) and available at ArthritisMall.com. Biologic agents offer patients hope of better outcomes than were seen previously with standard disease modifying drugs. Although a small percentage of patients will truly wind up without any significant pain after biologic therapies, a greater number will have some reduction in their joint pain and swelling associated with their rheumatic conditions. The book includes important background information about different types of arthritis, as well as traditional treatments (including NSAIDS, disease modifying drugs such as methotrexate, and corticosteroids). Newer drugs such as Celebrex, Mobic, Arava, and Kineret are also discussed. The book then focuses on the currently available TNF inhibitors Enbrel, Remicade, and Humira. Potential side effects are discussed in detail. Dr. Zashin describes each of the TNF inhibitors in separate chapters and helps to compare and contrast the three TNF inhibitors currently on the market. A self-testing questionnaire in the book helps indicate whether you would be a good candidate for TNF blocker therapy. More specific issues dealing with TNF inhibitors will be discussed in more depth in part II of Dr. Zashin's interview in our next podcast. If you enjoy our podcasts, don't forget to cast your vote at podcastalley.com so that other arthritis sufferers will be able to easier discover our podcasts as well.

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Can yoga truly help people reduce their weight? Or are yoga enthusiasts just more health conscious? It appears from a recent study that pain is having a significant impact on work productivity and absenteeism. If a person's pain is properly addressed and treated this can result in improved productivity and may make your supervisor happier as well. Sexually provocative and flirtatious behavior may not achieve the desired results at work. It appears that women who do sexually arousing things at work have fewer promotions and earn less money than women who avoid these activities. The controversy of whether non-steroidal anti-inflammatory drugs (NSAIDS) interfere with bone healing is discussed following the release of a new study out of Boston. Are the use of NSAIDS or narcotics just a reflection of the fact that the patient is in pain and that a bone fracture is not healing properly--rather than an actual cause of non-union of a fracture? Women appear to have lower exercise capacity than men and it is declining at the rate of 1% per year. Does a lower than expected ability to exercise for your age translate into an increased death rate? Dr. Rutstein addresses that issue as well as stressing the critical importance of including exercise as one of the "12 critical steps" to "take back control of your arthritis."

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Should rheumatoid arthritis patients be doing more rigorous resistance exercises to do more to increase muscle mass? A small study out of Wales suggests that this may be beneficial and cut down on disability. The importance of exercise as part of the treatment of rheumatoid arthritis and other rheumatic diseases is discussed. Hospitals can be "dangerous" places. This might be your conclusion after you hear some statistics about infections in Pennsylvania's hospitalized patients. Do optimists do better on average than pessimists when it comes to chronic illnesses? What is the relationship with the immune system? Find out why being optimistic about your condition may increase your chances of living longer with a better quality of life. A potential diagnosis of osteoporosis may literally leave you "dangling by your fingernails." A new tool to screen for osteoporosis based on fingernail clippings is in the testing phase. A Los Angeles Times reporter breaks a story about an investigation into 120 deaths in patients treated with a Duragesic (fentanyl) patch for pain. Possible other explanations for these fatalities is offered, along with warnings of how to use the patch correctly to avoid serious complications including death. Anyone currently using the patch or considering it should certainly be familiar with these critical points. I love milk chocolate--not dark chocolate, That's why I was ticked that Italian investigators found that dark chocolate (milk chocolate wasn't tested) helped reduce blood pressure in a small study of 20 patients. Learn why dark chocolate may be healthy for you. If you enjoy our Arthritis Central News and Views podcasts don't forget to cast your vote each month at Podcast Alley. This will increase our ranking among podcasts and enable others with arthritis and rheumatic disorders to find our program. Thanks for taking the time to do this.

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Have you ever experienced rudeness from a doctor? Then you will be interested in hearing about the inclusion of the teaching of communication skills and improved "bedside manner" to medical students. There may even be a relationship between how well you do medically and how your doctor interacts with you. In Take Back Control of Your Arthritis: The 12 Critical Steps, Step 1 is entitled "Find a Doctor You Can Trust." Your having the right doctor is the "foundation" of all of your subsequent treatment. Statin drugs used to lower serum cholesterol levels may also offer patients an additional side benefit. Dr. Rutstein tells you about a recent study demonstrating fewer deaths from pneumonia in patients taking one of the statin medications. Fibromyalgia patients may derive significant benefit from a drug used to treat Parkinson's disease. Mirapex (pramipexole) stimulates levels of dopamine in the brain. A study in fibromyalgia is discussed, which resulted in reduced levels of pain, improved functional activity, and clearer thinking. Although this is a small study, it is a promising one for those suffering with fibromyalgia. Balacet 325 is a new pain medication that combines propoxyphene (Darvon) with a reduced amount of acetaminophen (Tylenol). Dr. Rutstein explains how this may allow those of you in pain to more safely take increased amounts of propoxyphene without an increased risk of liver damage. A very important study comparing CellCept (mycophenolate mofetil) with Cytoxan (cyclophosphamide) and Imuran (azathioprine) for the treatment of systemic lupus erythematosus with kidney involvement is now underway. CellCept has been touted as a superior and safer way of treating lupus renal disease (lupus nephritis). A study out of Sweden suggests that biologic therapy with TNF inhibitors like Enbrel or Remicade may actually have a "protective" cardio-vascular effect in rheumatoid arthritis patients. This runs counter to prior concerns about cardio-vascular risk secondary to these biologic agents. The Medicare drug coverage plan is almost here and Dr. Rutstein brings you an update about this. For more information we suggest that you call 1-800-MEDICARE or visit their website at www.medicare.gov. You can also call the Medicare Rx Education Network at 1-800-670-9006 or visit their website at MedicareRxEducation.org. We hope that you will be able to get the information that you need in order to figure out whether this will be beneficial for you. If you enjoy our shows, don't forget to vote for our podcast. This will help other rheumatic disease patients find us and get all of this important information.

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Many patients with rheumatic diseases are overweight or even obese. This can create significant long-term problems with arthritis involving the weight-bearing joints in the lower extremities. Obesity increases the risk of diabetes, hypertension, and heart disease as well. It is, therefore, important to talk about weight reduction, diet, and exercise on our program. Dr. Rutstein is devoting this program to a discussion of bogus weight loss products and false advertising claims made by these over-the-counter product companies. Cortislim is the most recent product to gain notoriety. An article in the Los Angeles Times by Roy Rivenburg uncovers some of the scandalous information behind this product. You may be surprised to learn about "Dr" Greg Cynamoun's true past. The Cortislim story illustrates some of the way other bogus products are "hawked" to the public. People liked the empathetic message--'It's not your fault that you are overweight!" It's stress and increased cortisol that's the culprit. Dr. Rutstein explains how the 1994 Dietary and Health Education Act has allowed unscrupulous companies to get away with these bogus claims and products. Dr. Rutstein reiterates the importance of caloric intake and the number of calories you are burning through your daily activities and your exercise. If you like our Podcasts, please remember to cast your vote each month at PodcastAlley.com. This will help bring our Podcast to the attention of other rheumatic disease patients. Thank you for your support!

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Lance Armstrong's seven Tour de France victories should not only be an inspiration to cancer patients, but also to chronic rheumatic disease sufferers. Read Lance's book "It's Not About the Bike: My Journey Back to Life" and use it to motivate you. Dr. Rutstein's daughter Dr. Jessica has delivered his grandson, Colin Benjamin Hughes. Her determination to deliver the baby and avoid a C-section exemplifies the type of persistence you should demonstrate in battling your arthritis. In newly developing countries, it appears that obesity is becoming an ever-increasing health problem. The people in these countries are subsequently at greater risk of diabetes mellitus, hypertension, and heart disease. In fully developed countries, it appears that lower socio-economic groups are the ones more at risk of poor eating habits and weight problems. Can losing weight cause you to make more money and be wealthier? You may be surprised to hear about the results of a recent study on this subject. Poor children in early developing countries were the ones more at risk of future health problems based on a recent report in the British Medical Journal. When you lose weight, how much decrease in the force applied on your knees is there? If you think that it's just pound for pound--you're wrong. Hear more about how the combination of weight loss and exercise can help you with your ability to function. A simple device put over the outside of the soles of your shoes can help reduce the risk of falling out of doors due to ice, snow, wet surfaces, etc. This device is called the Yaktrax Walker (Yaktrax Inc., Port Orchard, Washington at www.yaktrax.com or 1-866-YAKTRAX). Dr. Rutstein recounts his last few weeks dealing with fears about his daughter's pregnancy, his wife's malignancy, and his mother's back and leg pain. What looked somewhat bleak one month ago has now brightened considerably. This shows you why you need to keep your chin up and try to be optimistic in spite of what sometimes seems insurmountable odds. If you enjoy the Podcast, please don't forget to cast your vote. Thanks for your support!

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The FDA has ruled that Pfizer must include a strong ("black box") warning about the cardio-vascular risks associated with Celebrex in its package insert. Other labeling changes are also discussed. Simultaneously the FDA granted approval for a new indication for the use of Celebrex in ankylosing spondylitis. Dr. Rutstein discusses the scope of treatment options available to you for the treatment of nerve pain (neuropathy), which is often seen in association with diabetes mellitus or with shingles. A new and exciting treatment is being studied to help treat specific joint flare-ups in rheumatoid arthritis. A novel type of joint injection may be able to block the tumor necrosis factor (TNF) in the joint that is inciting joint inflammation. An interesting observation has been noted regarding the association of diffuse musculo-skeletal pain and low vitamin D levels in the bloodstream. Vigorous exercise may not be able to stop your decline in "aerobic capacity" that worsens as you get past your 70's, but it may help you to remain functional and independent. Knee pain, when associated with pains elsewhere in the body, may have worse implications regarding your overall ability to function, as well as with increased feelings of depression. Learn why we should be specifically focusing more on ridding a patient of knee pain. Please remember to cast your vote for Arthritis Central News and Views if you are enjoying these podcasts. This will help others in pain to find us. Thanks for your support!

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Controversies regarding celebrity disease awareness ads are discussed. Celebrities feel that they have the "right" to speak about specific diseases and/or medications based on personal experience or that of a family member or friend. FDA rules have not required that side effects and potential dangers of these treatments be included with these direct-to-consumer disease awareness ads. Dr. Rutstein contrasts this with stricter Congressional requirements for disclosure of risks in customary pharmaceutical industry advertising. What percent of patients do you think will ask their doctor to prescribe a medication as a result of one of these ads? What per cent of doctors would you guess will then comply with a patient's request? Why isn't there a requirement of proper disclosure of the fact that the celebrity is being paid for the ad? Would this change patients' opinions of these ads? Simple hand washing with plain or anti-bacterial soap can make a significant difference in disease prevention according to a recent study. Apparently not everyone has gotten the message about the need to limit their vitamin E intake.Palladone (hydromorphone) has been pulled off of the market by the FDA due to the potential for severe side effects (including death) when this drug is taken with alcohol. Communications problems with "hospitalists" following hospital discharge can pose a risk for patients.

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What happens when post-menopausal women go off of their estrogen and progestin hormones? Dr. Rutstein discusses some observations discovered as part of the Women's Health Initiative dealing with the menopause and hormonal therapy. Hydration, cooling down with air conditioning or a fan, exercise, yoga, and meditation may all be helpful adjuncts in treating post-menopausal symptoms. Dr. Rutstein comments on whether musculo-skeletal symptoms are truly part of menopause or not. The ancient Chinese custom of walking on cobblestones to improve balance is now re-visited with a study from Oregon showing potential benefits on balance and blood pressure. Yet another potential problem with NSAIDs has been brought to physicians' attention with a new study in men over age 45 who develop acute urinary retention after starting on anti-inflammatory drugs. The first Vioxx trial has begun in Texas. Some unusual aspects of this case are reviewed, along with some of the accusations that are likely to be hurled at Merck Pharmaceuticals during the course of this and the other 3800 future trials dealing with Vioxx. A new study challenges the belief that "distant" or remote prayer may be beneficial. If your name is on a prayer list in some far away location, can individuals who do not even know you make a difference in the outcome of your health? This study attempts to evaluate this issue. Now a recent study suggests that statins used to lower cholesterol may not simultaneously prevent dementia or Alzheimer's disease. Prior studies had shown the opposite, so which conclusion is correct? Perhaps the length of use of statins is a critical factor. Why do African-Americans do worse than Caucasians when afflicted with rheumatoid arthritis? A study out of St. Louis suggests that this is a socio-economic and educational issue and not strictly a racial one. Can more education and greater confidence that a person can "take back control" of his or her arthritis lead to a better outcome? Dr. Rutstein gives his thoughts on how patients may be able to have a greater impact on their rheumatic illness. If you enjoy these podcasts, don't forget to vote on the first day of each month at www.podcastalley.com. This will ensure us a top ranking amongst health podcasts so that rheumatic disease patients can find us and learn how to "take back control."

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Are Teflon-coated pots and pans dangerous? Dr. Rutstein passes along a warning about the possible cancer risks of a substance found in Teflon. Can soybean protein cookies reduce your blood pressure? A recent study suggests that soybean might slightly reduce your systolic and diastolic blood pressure readings. Is acupuncture beneficial for fibromyalgia patients? A study that compared legitimate acupuncture with "sham" (fake) treatments is discussed. Disappointing news about green tea and shark cartilage in cancer prevention is presented. Cancer cells are devious and produce a substance called grp 78 to help them "outwit" our cancer treatments. This may be a target of future cancer therapy. Believe it or not someday soon we may actually use injections of viruses into people to help kill off cancer cells. For personalized dietary recommendations from the new food pyramid, visit www.mypyramid.gov. Then click on "my pyramid" and put in your own information to get personal recommendations. The prevalence and risks of osteoporosis are reviewed. DEXA scans heighten awareness of osteoporosis and lead to increased compliance and reduced fractures. Concerns about knee replacement surgery in young individuals are raised. Alternative treatments to postpone knee surgery are reviewed. Some patients are giving up on exercise when they start on pain and anti-inflammatory medications. Dr. Rutstein warns against doing this and re-emphasizes the importance of exercise in combatting rheumatic conditions. Dr. Rutstein comments about a British study dealing with the relative cardio-vascular risks of traditional NSAIDS (Motrin, Voltaren) versus COX-2 inhibitors (Vioxx, Celebrex). The risks of herbal remedies and the potential interactions with prescription drugs used to treat rheumatic disorders are highlighted. Echinacea, ginko biloba, garlic, devil's claw, glucosamine, and chondroitin are some of the herbal products discussed.

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A medical advisory panel in Canada has recommended that Vioxx be brought back on the market in that country. Important points made by the panel regarding Vioxx, Celebrex, and Bextra, as well as the traditional NSAIDS are discussed. The panel also suggested that ibuprofen be removed from the over-the-counter shelves and require a prescription from a physician, due to its own possible side effect problems. The lack of a protective effect of aspirin when used in conjunction with these NSAIDS is addressed. This positive panel recommendation may provide Merck with ammunition in its defense against numerous lawsuits that it is facing. Obese arthritis patients who "stroll" rather than walking briskly may actually derive greater benefit with less potential damage to knee joints. Potential benefits from the use of the antibiotic doxycycline (a form of tetracycline) for the treatment of osteoarthritis of the knee is debated. Short-term versus long-term improvement in osteoarthritic knees with "real" versus "sham" acupuncture treatments is discussed following the publication of an article on this subject. The pros and cons of the preventive use of aspirin and vitamin E in women for cancer and heart disease is discussed following the publication of a 10-year study involving 40,000 female patients. The potential benefits of using COX-2 inhibitors like Celebrex for the treatment of lung cancer will be investigated in a new study being done at M.D. Anderson Medical Center in Houston. Possible mechanisms for COX-2 inhibitors helping to combat cancer are discussed.

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A new vaccine (Zostavax) to help prevent shingles, as well as reduce the pain following this condition is pending approval by the FDA. Dr. Rutstein presents information about shingles (herpes zoster infection) and why it is important to try to avoid developing this condition (to avoid post-herpetic neuralgia, blindness). A gene, Foxo3a, has been discovered that may represent a potential treatment target in rheumatoid arthritis. Blocking this gene may allow detrimental white blood cells to die and thereby stop them from further damaging the joints. What is the "appropriate" way to grieve about one's own health or the loss of a loved one? Dr. Rutstein suggests that this should probably be based on an individual's preferences rather than some established standard. Some people prefer to grieve privately and then move on with their lives. Obesity may be less of a health risk factor than it used to be because of better control of hypertension and high cholesterol levels. The controversy regarding obesity as a risk factor for dying is re-visited. Enbrel gets a couple of additional "kudos" in its role in the treatment of psoriatic arthritis. Improved physical function and the prevention of radiographic damage in the joints are discussed. Concerns about bone damage to the jaw secondary to bisphosphonate medications is heating up with the recent filing of a class action lawsuit against Merck and litigation against the manufacturers of other bisphosphonates (including intravenous forms). Depression appears to be a separate risk factor in contributing to deaths in rheumatoid arthritis patients. It needs to be adequately addressed by RA patients and their physicians. The myth that exercise is somehow "bad" for arthritis is dispelled. A poll from Spine-health.com revealed that slightly over half the patients polled chose to avoid exercise as an essential part of their treatment. The advantages of participating in an exercise program are discussed.

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A study out of England addresses the relative interest of patients in assuming greater control over their own treatment management. The severity of their rheumatic condition and the age of the patient are two different factors in whether patients want to be given this control. New American College of Rheumatology guidelines regarding the use of non-steroidal anti-inflammatory drugs (NSAIDS) are discussed. Options include low dose Celebrex, traditional NSAIDS in conjunction with proton pump inhibitors (PPIs), or non-acetylated salicylates. High risk patients with prior ulcer disease or GI bleeding, or in patients on Coumadin therapy are a major concern. Climbing the ladder of pain medications (analgesics) is another alternative to NSAIDS. For more information, see Step 3 in Take Back Control of Your Arthritis: The 12 Critical Steps (available at www.ArthritisMall.com). The negative effects of discontinuing exercise in depressed individuals are presented. The positive benefits on depression from increasing the frequency of an active exercise program are discussed. The improvement with exercise can rival the results with anti-depressant medication. Investigators are now questioning the wisdom of prior recommendations regarding avoidance of sun exposure due to renewed interest in increasing patients' vitamin D levels. Vitamin D may not only protect against osteoporosis, but also may play a role in the prevention of certain forms of cancer. Conservative treatment of carpal tunnel syndrome versus a surgical approach to this condition are compared. Dr.Rutstein takes a call from a patient with osteoarthritis, lumbar disc disease, and a total knee replacement. The patient describes problems with continued pain in the operated knee and this is briefly discussed. Her positive attitude comes across in the interview as she describes her battle with breast cancer, in addition to her osteoarthritis. Recent gastro-intestinal problems with Mobic and improvement with a proton pump inhibitor medication are reviewed. The patient feels that the knowledge that she gained from reading Take Back Control of Your Arthritis: The 12 Critical Steps regarding medications for the treatment of arthritis has helped her immensely.

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This is a special Arthritis Central News and Views Program reviewing a unique topical cream called MyoRx. This was developed by our featured guest, Dr. Barry Bockow, a clinical rheumatologist from Seattle, Washington. Omega-3 fatty acids and their role in our health is discussed. MyoRx cream contains omega-3 and omega-6 fatty acid, along with methyl salicylate and capsaicin. Dr. Bockow compares and contrasts this cream with other available topical creams on the market. The lack of any significant side effects with MyoRx is noted. One study with a number of different rheumatic disorders revealed an extremely high percentage of responders versus no response with a placebo cream. A 12 ounce jar costs approximately $12 to $13. It can be obtained through certain physician offices or even through your pharmacist (McKesson is the distributor, EconoLink #: 2129716). Information about the product is available through their website at www.MyoRx.com or by calling 1-888-987-3272. MyoRx cream can be used as a primary form of treatment or as an adjunct to other existing forms of therapy. A physical therapist can also use ultrasound or electrical stimulation to help more of the MyoRx cream penetrate into the deeper tissues. MyoRx certainly offers patients a very safe alternative for the treatment of osteoarthritis, fibromyalgia, other forms of arthritis, tendinitis, and bursitis (and even leg cramps according to Dr. Bockow). Normally one jar will last for two months of treatment so this is a relatively inexpensive form of treatment compared to the expense of some of the medications we use in the treatment of rheumatic disease.

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A review of a recent report on the prevalence and treatment of pain in the U.S. The role of acupuncture in the treatment of pain and the philosophical theory of why it's supposed to work. Commentary about recent research using acupuncture for low back pain, as well as knee pain in osteoarthritis. Alternative approaches to control pain including massage, exercise, laughter, and adequate sleep are discussed. The power of prayer in combatting rheumatic conditions and controversial viewpoints about why this may work. Racial differences in coping with pain and suffering, with different religious interpretations and perceptions of pain. Combining prayer with other "standard" forms of treatment. Issues involved with direct-to-consumer advertising by pharmaceutical companies. Are they really capable of policing themselves even if it is financially detrimental to them? The role of exercise in fighting depression is highlighted. The length and frequency of exercise seem to be important factors. Negative aspects of commonly used anti-depressant medications need to be considered by patients versus the absence of these with plain exercise. Information on how to get started with our aquatics program or our new 15 minute home exercise program.

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The issue of pool temperature and any stimulation to appetite and caloric intake following cold water exercise is discussed. Congress is lashing out at Merck and suggesting that their conduct was inappropriate in alerting patients and physicians about potential cardio-vascular side effects from Vioxx. Merck has defended itself against such accusations. In the meantime, the FDA's role in all of this is also being scrutinized. Key points from a book dealing with "burnout" in the workplace called "Banishing Burnout" by Michael Leiter and Christina Maslach are reviewed. These points are then specifically applied to the arthritis sufferer. "Lack of control" at work for the arthritic patient can have to do with even simple items as the temperature level in the office, as well as having an ergonomically correct chair. "Inadequate reward and recognition" can be a problem when the effort that you are making to even get up and come to work in spite of your pain and stiffness is not appreciated. "Breakdown in community" deals with a lack of support by other employees when you are experiencing a flare-up. "Lack of fairness" may occur when you are passed over for advancement because of your disability or infirmity. "Contradictory values" can occur when a company's goals does not take into consideration your own personal goals to overcome your arthritis and yet make a meaningful contribution to your company. More information is available in Step 8: Take Back Control of the Workplace, which is just one of the twelve steps in the "road-map" provided for you in Dr. Rutstein's book, "Take Back Control of Your Arthritis: The 12 Critical Steps" available at www.ArthritisMall.com. Dr. Frank Arnett, a rheumatologist at the University of Texas Medical Center in Houston has created a stir with his suggestion that Christopher Columbus succumbed to a form of arthritis called "reactive arthritis." This could have followed a bacterial dysentery outbreak that reportedly occurred on one of his many voyages. Remember to visit PodcastAlley.com to cast your vote for our Podcast if you are finding it interesting and educational.

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