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Acupuncture eases tamoxifen-related hot flashes

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Acupuncture eases tamoxifen-related hot flashes

“Acupuncture appears to be at least as effective as drug therapy,” Dr. Eleanor M. Walker of Henry Ford Hospital in Detroit and her colleagues report, “and it may provide additional and longer-term benefits without adverse effects.”

Breast cancer patients with estrogen-sensitive tumors are typically given estrogen-blocking drugs for years at a time. These drugs, which include tamoxifen, bring on menopausal symptoms like hot flashes and night sweats.

The antidepressant drug Effexor (venlafaxine) is the standard treatment for these symptoms, Walker and her team note in the Journal of Clinical Oncology, but it can have unpleasant side effects, including dry mouth, nausea, and constipation. Non-drug treatments with few or no side effects are “urgently needed,” they add.

To investigate whether acupuncture might be an option, Walker and her team randomly assigned 25 women to receive Effexor or acupuncture for 12 weeks, following them for up to year after the end of treatment.

The researchers also point out that Effexor could impair the effectiveness of tamoxifen in some patients, because it can block the body’s metabolism of the drug.

Acupuncture, they conclude, is a “safe, effective and durable treatment” for hot flashes and other menopausal symptoms stemming from anti-estrogen hormone therapy in women with breast cancer. They hope this study will “lead to a change in the pattern of practice” of treating these symptoms in patients with breast cancer.

Eighteen women in the Effexor group had side effects, such as dizziness and anxiety, while none of the women given acupuncture had such side effects. About a quarter of the women given acupuncture said their sex drive had increased. “Most women also reported an improvement in their energy, clarity of thought, and sense of well-being,” Walker and her team note.

The researchers also point out that Effexor could impair the effectiveness of tamoxifen in some patients, because it can block the body’s metabolism of the drug.

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No treatment ‘not an option’ for ailing mum

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No treatment ‘not an option’ for ailing mum

Palmerston North’s Tarsh Stanton has run out of free options in her fight against cancer, and is looking for help to get to Melbourne to take part in a potentially lifesaving trial.

Within a year she has gone from being an active mother of two girls to what she describes as a steroid-puffed “blowfish”.

She’s in hospice care but determined to overcome stage four relapsed lung cancer that has spread to other organs.

She’s still working full time as ACC and non-residents co-ordinator at the MidCentral District Health Board, but chemotherapy and radiation treatment have failed to deliver on the 15 to 20 per cent chance of beating the cancer.

Only ever having had a few social puffs on cigarettes years ago, she said her cancer diagnosis came as a shock after what was either a lucky or unlucky cold.

She came home from a school camp at Whakapapa with her daughter Jazmin with an illness that became worse and made breathing difficult. Elder daughter Chelsea took her to the doctor, and the roller-coaster ride began.

Her heart beat was way too slow, and she was transferred to Wellington. She had a heart block that had to be corrected with a pacemaker last September.

X-rays showed shadows that were diagnosed as lung cancer adenosquamous non-small cell carcinoma. She was 36.

She’s had chemotherapy and radiation treatment, which has shrunk the cancer, but not stopped its spread to her other lung and bronchial tube, liver and stomach lining.

Reluctantly agreeing to be referred to the hospice team to fast track the process when she needs help with symptoms, such as the pain caused by the fluid building up between her ribs and lungs, she’s not ready to give up.

“The hospice is where you go to die, and I’m not going there,” she said.

“I’m quite relaxed. It’s not denial. I know what I’ve got, and I’m fully informed.

“I don’t like it much, but I can’t change it, and there’s no point in being sad and unfocused.”

Supported by a group of well-wishers led by her cousin Kelly Retter, Mrs Stanton has researched her options all of which cost money.

“No treatment is not an option.”

Her best hope in New Zealand is the unsubsidised drug Tarceva, which works like a sort of cling wrap encasing and constricting cancer cells, and offers a 40 per cent hope for patients who respond well. It costs about $28,000 a year.

But even more attractive is a phase II clinical trial at the Peter MacCullum Cancer Centre in Melbourne that combines Tarceva with a new biological ingredient that doesn’t even have a name yet.

Although participation is covered by drug company Roche, Mrs Stanton faces travel and accommodation costs for herself and a caregiver to travel to Melbourne for 25 appointments over two years.

Moving to Australia, where Tarceva is subsidised, is not an option.

“I’m a Kiwi. I live here, I work here, and I want to keep working. Time is precious, that’s one of the things this teaches you.

“If you only have so long to live, why would you want to spend it in Australia?”

At the moment Mrs Stanton is back in chemotherapy at Palmerston North Hospital because her cancer is too advanced to do nothing.

But once she gets the all-clear for the trial, she has to be chemo-free for a month before starting.

It’s a balancing act, as she has to be sick enough to qualify, yet well enough to tolerate the travel and treatment.

She’s hoping for Christmas in Palmerston North with husband Darren, and the girls, now aged 13 and 17, but if the trial schedule demands she be in Melbourne, she will be.

It’s a course she’s setting out on full of optimism.

“Eighty-six is my goal. It’s just a good number for sitting back in your rocking chair, drinking vodka.”

Her fundraising team is organising an October concert and a November auction to help pay for the $60,000 travel and expenses bills she’s likely to face.

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Feet surgery

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Feet surgery

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The podiatric surgeon is taught to approach foot surgery by keeping the knowledge of normal foot function and biomechanics in mind. Because of the weightbearing nature of the foot, surgical procedures must be designed to be as stable as possible to withstand the forces of everyday standing and walking. Care is taken to understand the cause of the problem so as to provide a long-lasting cure, when possible. Greater than 99% of podiatric surgery is done in an outpatient setting such as a hospital outpatient department, a freestanding surgery center or in the podiatry office. Most procedures allow for immediate walking with a surgical sandal. Some procedures may require the use of a cane, crutches, or a cast. Specific surgical treatments for many common (and some less common) foot conditions will be discussed.

Flat Feet (Pes Planus)

Surgery for flat feet is generally reserved for the most symptomatic cases. Orthotics are often the first line course of treatment. Many people have what are referred to as “Flat Feet” but are relatively asymptomatic. Flat feet may result in significant foot pain and deformity because of excessive pronation which causes joint instability. Flat foot procedures are designed to provide for a more stable foot which pronates less. Most flat foot surgery is performed on patients in the adolescent age group. There are a large variety of specific surgical procedures that may be used. They may be grouped according to the region of the foot that is treated. Often, 2 or 3 procedures may be performed together from the different groups.

Rearfoot osteotomies
These are procedures which are designed to change the position of the heel into an inverted or supinated position (the opposite of everted and pronated which are found in flat feet.) An osteotomy is a surgical cut in the bone. Often, a wedge of bone is removed to change the angle of the heel bone (calcaneus). Other procedures are transpositional and involve sliding of one part of the bone along the other part of the bone. (E.g. the Koutsogianis procedure). Other procedures involve adding a bone graft and opening the wedge to change the angle of the calcaneus.( E.g. the Evans Procedure). These osteotomies are generally held together with special screws, pins or bone staples and require a period of casting and immobilization for several weeks.

Medial column stabilizations
These procedures involve fusing two or more of the bones along the medial side (inner side) of the foot. Common fusion sites are the navicular and medial cuneiform. These bones have often dropped in a flat foot and fusing them provides more stability. These osteotomies are generally held together with special screws, pins or bone staples and require a period of casting and immobilization for several weeks.

Tendon transfers
Sometimes the insertion sites of tendons are detached and then reattached to bones at different locations. The result is a dynamic stabilization. Repositioning of the tendons allows the muscles that pull them to exert their force in a more beneficial way to help support the arch. The Young tenosuspension procedure reattaches the Tibialis Anterior tendon to a better position beneath the medial arch where it can pull up on the arch to support it.

Tendon lengthening
Often, the Achilles tendon is tight and is a major deforming force contributing to flat foot conditions. A condition associated with a tight Achilles tendon is known as equinus. An Achilles tendon lengthening procedure is often effective at reducing this deforming force. The calf is made up of 2 gastrocnemius muscle bellies as well as the soleus muscle. The Achilles tendon attaches to all three. An Achilles tendon lengthening lengthens the whole group together. Sometimes, the gastrocnemius muscles are tight while the soleus is not. In this case, a gastrocnemius recession can be performed to lengthen only the gastrocnemius while leaving the soleus alone.

Arthroeresis
These are procedures in which a peg made of plastic or titanium is placed in front of a bone to limit its motion. A common location for placement of such a device is the Sinus Tarsi which is a cone-shaped space between the talus and calcaneus bones. The peg helps to limit pronation. This is often just a temporary measure with the peg left in for a few years and then removed.

Arthrodeses
An arthrodesis is a fusion of two bones. In addition to the medial column stabilization fusions discussed above, rearfoot bones may also be fused. Rearfoot fusions are generally reserved for the most severely deformed, arthritic and painful feet . A Triple Arthrodesis is a fusion of the Talo-calcaneal, Talo-navicular and Calcaneo-cuboid joints. This is one of the most complex foot surgeries performed since all three joints must be aligned and fused properly to achieve a satisfactory result. In addition, because motion in the rearfoot is eliminated, the ankle joint and other joints in the foot may be forced into compensating to provide additional motion which could result in future symptoms in those places. These fusions are generally held together with special screws, pins or bone staples and require a period of casting and immobilization for two or three months.

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