A clever pill to swallow

 

It’s reminiscent of Fantastic Voyage, the sci-fi story (both a film and a novel) in which a team of scientists gets tiny and travels through a human body to fix a blood clot. But in real life there are these little pill/cameras that can take pics of what’s going on in the digestive system, from the inside instead of endoscopically, a relatively minimally invasive way of diagnosing intestinal ills. Instead of going under sedation and having the colon probed from that end, you swallow a largish “pill” and wear a special belt and harness for a few hours while the camera travels through your gut, snapping pics.

The latest development in this futuristic technology is Olympus’ Endocapsule, which visualizes the small intestine by the use of a pill-shaped camera and an antenna belt that gets a wireless video signal from the capsule and shows video of the photos on a handheld device that controls it. Improvements on the new Endocapsule include a lighter, smaller over-clothes harness that is said to be more comfortable than previous systems that required being placed directly on the skin. More developments include a 160-degree field of view, a twelve-hour battery life and a three-dimensional tracking function that shows the progress of the capsule either in real time or downloadable for later.

In 1868 German physician Dr. Adolph Kussmaul figured out how to illuminate the process of endoscopy when he examined an open-throated sword swallower, using a light source made of an alcohol and turpentine mixture. However, until 1970 barium x-rays were used much more, in part due to the unpleasant nature of having a scope pushing against the powerful gag reflex, although sometimes inflatable scopes helped with that.

Although Olympus introduced the world’s first gastrocamera in 1950, several other companies have jumped on board since then. Given Imaging, from Israel (now being bought by an Irish company), introduced the M2A, or PillCam, in 2001. And later the same year the Japanese did them one better with the NORIKA3 that turned digestive forces into power to fuel the capsule with an on-board generator. Three years later Given Imaging came back with a capsule that could see the esophagus, and a year after that a Japanese company RF Comp Ltd introduced Sayaka, with higher resolution images. But at that time the large intestine was still unexplored by camera capsules, with nothing yet FDA-approved, mostly because of the folded nature of the organ, which allows growths to hide unseen by the cameras. So the endoscope, with air to puff up and unfold the tube, was still the best bet. But since it got FDA approval earlier this year, Given Imaging’s PillCam Colon can go through the large intestine in about eight hours, taking photos at close to four frames a second, increasable to six — remotely — if it’s going too fast. While some other capsules are still powered by mini-generators, the Colon uses a battery, so it’s a little bigger than its predecessors. The MIRO from the Korean company Kist can also see the large intestine. And Japan has been working on “Mermaid” capsules that can “swim” into the intestinal folds by use of a flapping tail.

Conditions that might call for capsule endoscopy include symptoms like bleeding, chronic abdominal pain, or unexplained anemia or weight loss that can be the result of digestive disorders like inflammatory bowel diseases or benign or malignant tumors. Although benefits of these devices include less discomfort or need for sedation or surgery, as well as less radiation exposure, one risk is a potential loss of the capsule necessitating surgical removal.

The device is contraindicated in patients with pacemakers or other cardiac electronic devices, who have any structural abnormality in the intestine that would hinder the passage of the pill, and for people who are pregnant or have swallowing disorders. And if the traveling capsule finds anything suspicious — a growth or a polyp — it can’t just snip it out as during the traditional endoscopic procedure.

Horseradish healing

horseradish photo by Jerry Pank
Horseradish photo by Jerry Pank

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Can that little jar of horseradish in your fridge cure cancer?

Like its cousins, the other cruciferous veggies like broccoli and cabbage, fiery nose-tingling horseradish has high levels of glucosinolates (more than ten times broccoli’s). These chemicals — in horseradish’s mustard oil — break down inside us into indoles and isothiocyanates, which are said to provide anti-cancer benefits by helping the liver rid itself of cancer-causing substances and even slowing down tumor growth. The processing, or grating, of horseradish breaks it down and helps release enzymes that make it more effective. Although many studies have supported this effect, more clinical trials with human subjects may be needed to confirm it.

Cancer-fighters or not, these glucosinolates subdue bacteria that cause disease. They have been proven as a natural antibiotic for many ills, from urinary-tract to sinus infections. They also increase blood flow and reduce waste products.

We’ve been turning to horseradish for health for about 3000 years. The ancient Greeks used it as an aphrodisiac and to ease lower back pain. It became one of the five bitter herbs used at Passover, and later was used to treat TB, coughs, colic and scurvy. In the Middle Ages the English and Germans brewed horseradish ale with tansy and wormwood, and today a horseradish vodka — Referent — is distilled in Wisconsin. In the colonial era of this country we embraced it, started bottling it in 1860, and now we produce about six million gallons per year of prepared horseradish.

The horseradish plant Armoracia rusticana, along with radishes, kale, mustard, cauliflower and Brussels sprouts, is in the family Brassicaceae. This cold-hardy perennial needs little fussing in the garden, just dividing every few years, and the flavor of the freshly grated root trumps the jarred variety.

Every part of the plant from root to leaves has medicinal value, but it’s worth seeking out for its nutrition benefits alone. Free-radical fighting vitamin C is abundant in horseradish, so consuming it can fight off signs of aging on the skin, build collagen for healing muscle and bone cells, strengthen immunity and stave off inflammation, heart issues and cancer. Low-cal, fat-free and full of fiber, it also has potassium and calcium, plus iron, zinc, manganese, magnesium, phosphorus and a bit of B vitamins.

Healthy winter skin

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When you were a kid, did anyone ever tell you, “Your epidermis is showing?” Maybe you looked down at yourself trying to figure out what that was, before you learned it meant the outer layer of your skin and it was all over.

Well, although less of it shows in the winter, you may want it to look the best it can, and even the parts that are covered with sweaters and warm pants should be comfortable, supple and free of itches or cracks. Many people, from dermatologists to experts in natural supplements, have opinions on what can help skin ravaged by winter air, whether the cold outdoor kind or heated indoor, both of which take a toll on our tender but strong outermost layer.

At about eight pounds, give or take, the skin is the largest organ in our body, although as a 22-square-foot, tissue-thin layer that covers us, it hardly resembles the bloody masses we imagine our internal organs to be. But an organ it is, as essential for life as heart or brain. Many burn victims who lose much of their skin do not survive. When I worked in a hospital 20 years ago, patients with more than 50 percent of it burned didn’t usually survive. But with modern treatments 90 percent body burn patients can survive, per the American Burn Association.

This amazing organ protects our body’s interiors from sunlight, heat, cold, chemicals and infection. It is waterproof. It is insulator, protector and shield. It is conduit and translator as the brain’s interface with the world, and like the eyes, part of our sex appeal. It contains natural antibiotics and is an important part of the immune system. As part of the endocrine system it makes vitamin D, which is actually a hormone that helps calcium make our bones strong.

Although it changes in structure and thickness over different parts of the body, the skin has three layers. That epidermis — what shows — is very thin and constantly renewing itself. Underneath is the dermis, with sebaceous glands for perspiration, and elastin and collagen for flexibility and strength. The innermost layer is the subcutaneous fat layer, or subcutis, which helps cushion, protect and insulate us.

The thinner skin of the fairer sex is a little more dainty and delicate than men’s. It is less oily and sweaty, making us more prone to damage from the elements like sun, wind and drying air. Cold winds, drying indoor heat and drinking less because we’re less hot and thirsty in the winter all combine to cause dry skin. Sometimes the condition goes beyond mild discomfort to very unpleasant itching, eczema or cracks and fissures in the skin.

Quitting smoking

No one can deny that tobacco use is one of our biggest public-health issues and that healthcare practitioners need to do all they can to help cut it down.

“I tell our physicians that discussing smoking cessation with their patients may be the most important conversation of their patients’ lives,” said Dr. Walter Woodley, who practices at the Kingston Family Health Center and is regional medical director for the Institute for Family Health (IFH). The IFH, along with Hudson River Health Care (HRHC), which serves residents of Ulster, Dutchess and Sullivan counties, plus Peekskill and parts of Long Island, are local centers that offer health care — primary and preventive care with access to pharmacy, dental and mental-health services — to low-income and underserved New Yorkers of any insurance status, whether they are able to pay or not.

Tobacco use is much higher in low-income and underserved communities than in the general population, according to the state health department’s Bureau of Tobacco Control, with 26.7 percent of Medicaid recipients and 21.8 percent of uninsured adults being smokers compared to 12.1 percent of adults with private insurance.
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photo by Sardinelly
photo by Sardinelly

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The local health centers address this priority when they interface with patients. The IFH, established in 1979 to address a shortage in the mid-Hudson region, now trains 30 physicians a year in a residency training program in family medicine, Dr. Woodley said. Integrating smoking cessation into the primary-care visit when needed is key.

Though a state smoking ban in restaurants and bars a decade ago and other measures have helped bring numbers of smokers down by 28 percent, more than 25,000 state residents still die each year because of smoking. The leading cause of death for New Yorkers is cardiovascular disease, and smoking contributes to much of that.

Medical markup

[wide]dollar health[/wide]The cost of medical care to consumers is nothing short of outrageous. A Houston cancer center billed a patient $7 each for alcohol prep pads used for injections, while a box of 200 is $1.91 online, according to a Time report published in February. And that’s just the tip of the iceberg of bill padding and fattening from both profit-making and so-called nonprofit institutions. Hospital administrators make multi-million-dollar annual salaries, and the labs and the manufacturers of medicines, medical supplies, devices and diagnostic equipment are getting rich from the high price of health care, all at the patient’s expense.

Even people who think they have good insurance can get hit with eye-popping amounts of money owed after medical care. Staggering bills from the briefest of hospital stays are based on nickel-and-diming everything that was provided. The charges for each line item are based on a huge computer file called a chargemaster — unique to every institution. Bills that are exorbitantly inflated to make up for all kinds of payers and non-payers are presented to all patients, regardless of their insurance status.

What Medicare pays for things gives us an idea of just how high that is. A hospital might bill a patient $333 for an x-ray while Medicare only pays $23.83 for the same thing, a very sizeable difference. On another bill described in the Time report, a patient was charged $6538 for three CT scans that Medicare would have paid $825 for. On another, a CT scan with radioactive dye to the tune of $7997.54 would have been paid only $554 by Medicare.

Online prices for medical supplies are telling as well. A patient having surgery may be billed $39 for the surgeon’s gown, or $32 for the use of a reusable blanket that goes for $13 new on eBay. Medicare either won’t pay for blood and urine tests or will pay $7 to $30 for them, but patients are billed $30 to $333 for them. Medicare won’t pay for incidentals that are part of other costs, but patients are billed for them anyway. It’s common for double- and triple-billing to occur, like when saline solution and oxygen or something normally included in the daily room charge are billed separately. An ICU kit can be billed as a unit and then each tool in it billed again.

Niacin tablets that cost about five cents each in drug stores go up to $24 when they appear on a hospital bill, and a Tylenol pill is billed for $1.50 when 100 pills go for $1.49 on Amazon, and often hospitals receive them for free from the maker.

IV solutions that you can buy online for $5.16 a bag are billed to patients at $84 to $134 per. Online you can get a box of diabetes test strips for about 55 cents each that hospitals bill $18 for. A patient was billed $13,702 for a dose of Rituxan that cost the hospital about $3000 to $3500. It cost the manufacturer only $300 to make it, test it and ship it to the hospital, a manufacturer whose CEO made a salary of over $11 million in 2011.