From the office of Robert S. Grimshaw Jr MD FACP Internal Medicine 3535 Hill Blvd Yorktown Hts NY 914 962-3180 NEWS Recognized Provider  “With Distinction” by the American Diabetes Association/National Committee for Quality Assurance 2/99-2/02

48     May 2001

Every 20 seconds, according to the National Osteoporosis Foundation, someone breaks a bone due to "brittle bones" or osteo-porosis. A recent study of women 55 and over who had broken their wrists found that less than 1/4 had been tested for osteoporosis. We know that 20% of women who have a vertebral (back) fracture will have another fracture in the next year. If you break a hip and you’re over 50, you have a 24% chance of dying in the next year. And 41% go into a nursing home.

• Eat right - lots of calcium and vitamin D

• Work out with weight-bearing exercise
• Stop smoking and drink moderately
• Get a bone density test

We’ll be having periodic bone testing available in our office - we can put you on our list and call you with the dates and times.

Dementia: Short Survival

We’ve known for some time that anything that causes loss of thinking abilities shortens lives. Now a Canadian research groups says that the effect is worse than we thought. Writing in The New England Journal of Medicine, Dr Christina Wolfson of McGill University and others studied 821 patients. Those with probable Alzheimer’s disease survived a median 3.1 years, for those with possible Alzheimer’s, 3.5 years and for those with dementia from multiple strokes (vascular), 3.3 years. Previous estimates were 5-9 years.

The winner is – well, it depends. A Dutch group studied 1200 patients randomized to surgery or a metal scaffold or stent placed in heart arteries during angiography. Writing in The New England Journal of Medicine, Dr. Patrick Serruys and colleagues say that at 1 year both groups had the same rates of death, stroke and heart attack. Many of the stented patients (16.8%) required another procedure, compared to 3.5% of the surgery patients. Stenting cost less, though.

More Winners: Rose Brown & Walter Bridgewater are the latest winners in our March & April movie drawings from those who got their colon cancer screening cards in promptly. Each wins 2 tickets to the movies. You can be a winner, too; send in your cards to help us stamp out this highly preventable tumor.

1) Ranolazine for angina: The first of a group of agents called partial Fatty Acid Oxidation (pFOX) inhibitors, this could be the first new medication group in over 20 years for chronic heart pain (angina pect-oris). There are some 7.2 million such patients in the U.S. The drug works by increasing the energy avail-able to the heart. It’s a bit complic-ated, but most chronically ill hearts switch from burning sugar (glucose) to burning fatty acids. Ranolazine forces the heart back to sugar, which is a more efficient energy source. Its big advantage over other medications is that it doesn’t affect heart rate or blood pressure. Studies so far have shown an increase in exercise ability; side effects include dizziness, nausea and constipation.

2) Rosuvastatin for chole-sterol: Crestor may be the most powerful cholesterol lowering drug yet. Data on this "statin" were presented at the American College of Cardiology meeting in Orlando, Florida. 10 mg of the drug produced a 49% drop in the "lousy" LDL cholesterol in one study, 43% in another. In addition, it raised the "good" HDL cholesterol by 12%. Crestor is expected out soon. Its safety is similar to currently available drugs: Lescol, Lipitor, Mevacor, Pravachol & Zocor.

As many of you know, my mother, Albertta Fisk Grimshaw, died last month.

She died at home and had the help of the excellent staff at the Hospice of Western Connecticut.

In many ways, her death was unnecessary. Like many people of her era, she did not like going for medical exams. And she did not want to have mammograms. Further, when she found a lump herself, she did nothing and told no one for a year and a half.

Then she said, "If I had known there would be pain, I would have done something earlier."

Breast cancer IS painful when unchecked; it caused skin and bone pain in my mom; then she became very short of breath, until we had to practically carry her from room to room.

Regular readers of these pages know that some 182,800 women will have this disease diagnosed this year; 40,800 - like my mother - will die of it.

Most women (80%) who get it do NOT have a relative with breast cancer; although, if you DO have a mother, sister or daughter with it, your risk IS higher.

More than 75% of cases are diagnosed in women over 50.

Other relative risks include having no children or 1^st child at age 30 or more; drinking more than 2 drinks a day, early menopause and early menarche; obesity; history of chest radiation as a child or young adult; history of non-cancerous proliferative breast disease and recent use of oral contraceptives or (more controversial) use of estrogen replacement therapy.

Most breast cancers can be picked up earliest by mammography; still, some women will have symptoms. The most common is, of course, a lump - usually painless, hard and with irregular edges. Some cancers ARE tender soft and rounded, though. A generalized swelling of the breast can

also be found with no distinct lump. Sometimes there’s skin or nipple irritation or dimpling or turning inward or a discharge.

If detected early, 97% of women will live 5 years. In the 1990s, the death rate from breast cancer dropped by the largest amount in 65 years.

Don’t let this go - PLEASE get a mammogram - for yourself and your family and for me, and my mom.