E2
Health CONSUMER REPORTS INSIGHTS Getting to the bottom of toenail fungus Rarely does the lowly toenail
generate much interest. But quite the opposite is true in the drug marketing field. Millions of dollars are spent each year on ads for medications to be used in mostly futile attempts to eradicate onychomycosis, or nail fungus, a hardy, microscopic organism that infects about 35 mil- lion people in the United States. The deformed, grayish-green- ish-yellowish toenails of fungal in- fection are hard to miss or misdi- agnose, according to Marvin Lip- man, a clinical professor of medicine emeritus at New York Medical College, though occasion- ally the condition is confused with psoriasis. In advanced cases, the nail can be crumbly or difficult to cut. Treatment is not often medically necessary, and then mostly to pre-
In partnership with
vent secondary bacterial infec- tions. That’s especially true for dia- betic patients, who seem to be more affected, and for those with compromised immune systems. Most people treat toenail fungus for cosmetic reasons.
DO IT YOURSELF? A Google search on toenail fun- gus treatments produces more than a half-million hits, with plen- ty of ads for do-it-yourself topical liquids, salves and creams. Several of the treatments contain ingredi- ents loosely regulated by the Food and Drug Administration and cat- egorized as supplements, such as acetic acid, and a variety of oils, in- cluding jojoba, lavender, lemon- grass and tea tree. Some are ca- pable of killing some fungi. All clamor for your attention and dol- lars. Some offer money-back guar-
antees that expire long before you’re able to see any success. Ran- domized, controlled trials are lack- ing, and evidence for cures is scant. Two popular remedies are wa- ter-diluted vinegar foot soaks and applications of Vicks VapoRub. De- tails of use are up to you since nei- ther treatment comes with in- structions for treating toenail fun- gus. Because it is relatively cheap and nontoxic, Consumer Reports thinks that VapoRub, which con- tains eucalyptus, menthol, cam- phor and other oils, may be worth atry.
PRESCRIPTION OPTIONS If you decide to treat with a pre- scription drug, it will cost you. Bear in mind that there is no medi- cine that is effective or safe for everyone. Two oral antifungal
drugs, terbinafine (Lamisil and its generic cousins) and itraconazole (Sporanox and generic), have been in use for several years and have been shown to be effective for up to 50 percent of users. Monitoring is necessary, since either can be toxic to the liver. Costs for a three- month course of treatment can run up to several hundred dollars, not including doctor’s visits and costs of tests.
Ciclopirox (Penlac Nail Lacquer
and generic) is a less effective paint-on medication that has to be applied daily for at least four months and probably longer. Laser treatment recently arrived on the scene, and a single treatment, usu- ally by a podiatrist, may be effec- tive nearly 90 percent of the time, but at around $1,200 a pop. Copyright 2010. Consumers Union of United States Inc.
KLMNO
V1 V2 V3 V4
TUESDAY, JULY 13, 2010
The Checkup
6voices.washingtonpost.com/checkup
Do toning flip-flops really shape your legs? Although toning sandals have been around for a few years,
I focused on them recently when a Fitflops poster caught my eye in a Metro station. “Get a workout while you walk,” it promised. Like its competitors, Fitflops are made with built-in instabilities that make certain muscles work harder than usual. All simulate walking on a pliable surface — “like walking barefoot in the sand,” in the words of Kathleen Stone, president of the American Podiatric Medical Association. Stone says the toning flip-flops “increase your use of
certain muscle groups.” But, she warns, “we don’t have a lot of data yet that really supports the [manufacturers’] claims.” Toning sandals are “not a substitute for the gym.” She also warns that people with foot and ankle problems can worsen their condition with these flip-flops. “Just putting these on and wearing them 24-7,” Stone says, “is like doing leg pushes 24-7. You’re going to end up with an overuse problem, just like any other exercise.”
— Leslie Tamura
For further guidance, go to
ConsumerReportsHealth.org. More-detailed information — including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products — is available to subscribers to that site.
QUICK STUDY
House calls: An old idea that may make a comeback INSURING YOUR HEALTH
Michelle Andrews F
rom the back window of his rowhouse, Karl Schwengel can see the Capitol. But the 11 blocks might as well be so many miles, because he can barely walk across his bedroom, let alone go for a stroll. Schwengel, 79, has congestive
heart failure and arthritis. And although he lost 60 pounds during a recent hospital stay, he still weighs in at 260 pounds. Last year, he was retaining so much fluid that his calves were “almost the size of basketballs,” he says, and walking became nearly impossible. Getting to a clinic or hospital for treatment was a nearly impossible ordeal. All that began to change about six months ago, when a community group put him in contact with the Medical House Call Program at Washington Hospital Center. Now a doctor or nurse practitioner visits him every month to check his vital signs and medications, and to work with him to improve his health. A physical therapist recently joined the team, and now Schwengel is practicing using a walker at home. “The doctor says we’re going to work on one problem at a time,” he
ISTOCKPHOTO
says. In this era of assembly-line appointments, when you’re lucky to get 10 minutes of face time with a physician, the idea of doctors making house calls seems old-fashioned. But for frail, elderly people with multiple health problems, bringing the medical establishment to the patient makes sense. Because it’s hard for these
patients to get to the doctor, small problems languish and turn into larger ones. Eventually some of these people land in the emergency room or hospital. They may recover, but often the cycle starts over again. Home visits make financial sense as well, notes Jim Pyles, a Washington lawyer and member of the board of directors of the
OPEN24HOURS
Together, we may be able to help put insomnia to bed for others in the future.
The Insomnia Study is conducting a research study to evaluate an investigational drug designed to work differently than available treatments. If you experience episodes of insomnia or are dissatisfied with your current insomnia treatment, youmay be eligible to participate.
There are risks associated with any investigational drug. The study doctor will discuss with you the potential benefits and risks that may be associated with participation in this clinical research study.
To learn more, contact:
Sleep Disorder Centers of The Mid-Atlantic
703-752-7881
American Academy of Home Care Physicians. “We found that you could afford to treat a patient for a whole year at home by avoiding just one hospitalization,” he says. Washington Hospital Center’s
program, which started 11 years ago and serves roughly 600 patients, has reduced expected hospitalizations among participating patients by almost two-thirds, says gerontologist George Taler, co-director of the program. Now, that program and similar ones may get their turn on a national stage. The health-care overhaul
creates a three-year demonstration project to test the home-visit concept on 10,000 of the sickest, most-expensive- to-treat Medicare enrollees. To be eligible for the project, called Independence at Home, patients must have multiple chronic conditions and be unable to perform normal daily activities such as bathing and dressing. They must also have been hospitalized or needed other high-cost care in the past year. Participating health-care organizations won’t receive any money upfront. If they succeed in cutting treatment costs by 5 percent, improving health outcomes and getting positive patient reviews, the groups share in any further savings. The program is slated to begin
by January 2012, but some supporters are pushing for a faster start. Making a success of these programs is no simple task.
Although Medicare pays practitioners more for home visits than for clinic visits, it doesn’t pay for time spent traveling or for coordinating patients’ care. Clinicians working for
Chicago-based Home Physicians visit just 10 or 11 patients a day, far fewer than the 30 or more an office-based doctor would typically see, says Craig Reiff, chief executive of Home Physicians, a 15-year-old company whose 60 clinicians — including primary-care doctors, podiatrists, nurse practitioners and physician assistants — serve 12,000 patients in Chicago and Baltimore. To make the visits pay, Reiff
says he has to schedule his clinicians’ visits carefully, even though urban patients live relatively close to each other: “It could be very difficult to make it work in rural areas,” he says. Practitioners have had no trouble reaching Karl Schwengel’s home in Washington. “They’ve done everything in the world for me,” he says. With their help, he hopes to lose weight and walk again. “There are so many things I want to do,” he says. “I want to take my dog for a walk across the park.”
Or maybe to the Capitol.
This column is produced through a collaboration between The Post and Kaiser Health News, an editorially independent news service.
Free Hearing Tests set for
Northern Virginia Area Age 55+
Free electronic hearing tests will be given from
Monday, July 19 through Friday, July 23 at select locations in Northern Virginia.
Tests have been arranged for anyone who suspects
they are losing their hearing. Such persons generally say they can hear but cannot understand words. Testing with the latest computerized equipment will indicate if you can be helped.
Everyone, especially adults over 55, should have an
electronic hearing test at least once a year. If there is a hearing problem, hearing tests may reveal that newly developed methods of correction will help, even for those who have been told in the past that a hearing aid would not help them.
If you suspect you have hearing loss, call for a free
AUDIOSYNC HEARING INNOVATION TOUR! Are you or someone you know struggling with hearing loss? Join us for a FREE Hearing Technology EXAM, as we feature our AudioSync Hearing Innovation Tour, to see the next generation in hearing aid technology and get back the sounds you’re missing.
3 DAYS ONLY! Monday-Wednesday • July 19, 20 & 21
AudioSync Audiology & Hearing 1320 Old Chain Bridge Rd. • Ste. 185 • McLean, VA 22101
Please call immediately to schedule your evaluation to determine if you are a candidate for this program!
Call 703-259-8822 Today!
hearing test appointment. Our licensed specialists are trained in the latest auditory testing methods and will be the first ones to tell you if you don’t need a hearing aid. If you do have a hearing loss, we will explain your results and provide you with a list of options.
Free hearing tests available only at a location listed below. One week only: Monday, July 19 — Friday, July 23.
Monday – Friday, 8:30 a.m. – 4:30 p.m. Evenings and Saturday by appointment Falls Church, VA
Beltone Hearing Aid Centers Sterling, VA
Leesburg, VA Rock Spring Professional Cntr.
5657 Columbia Pike, Suite 100 46440 Benedict Dr., Suite 101 19465 Deerfield Ave., Suite 109 (703) 533-8008
Sterling Medical Office Park (703) 444-4667
Burke/Springfield, VA Manassas, VA Rolling Valley Office Park 9312D Old Keene Mill Rd.
(703) 455-1431
10565 Crestwood Drive (703) 368-8200
Lansdowne Office Park (703) 724-3533 Woodbridge, VA
Crestwood Professional Cntr. Woodbridge Professional Center 14904 Jefferson Davis Hwy.
(703) 368-8619 TESTOSTERONE
For older men, supplementation may have cardiovascular risks
THE QUESTION Testosterone supplementation has been shown to build muscle and strength in older men, who often experience a drop in this male hormone. But does it do the same if the men are not fully healthy? THIS STUDY involved 209 men, who averaged 74 years old and had low testosterone levels and mobility problems. High blood pressure, obesity, diabetes, high levels of blood fats and heart disease were also common in the group. They were ran- domly assigned to apply a testosterone gel (Testim) or a place- bo gel daily. After six months, those using testosterone record- ed greater improvements in lower-extremity strength and physical functioning. However, twice as many men in the tes- tosterone group were evaluated for a medical problem. This included 23 men who had a cardiovascular problem (includ- ing high blood pressure, arrhythmia, stroke and a need for stenting), compared with five men in the placebo group, and seven (vs. one) who had an atherosclerosis-related problem (including heart attack, angioplasty and coronary artery by- pass).
WHO MAY BE AFFECTED? Older men. Testosterone, which the body produces naturally, is key to the growth and functioning of male sexual organs and for the development of male char- acteristics. A decline in testosterone level that often accompa- nies aging can lead to low energy and loss of sexual desire as well as a loss of muscle mass. Supplementation is sometimes used to replace what the body no longer produces. CAVEATS The study was stopped early because of the high in- cidence of cardiovascular problems among men using the tes- tosterone gel. The study authors noted that, because of the relatively small number of problems, “the differences detec- ted between the two trial groups may have been due to chance alone.” The gels used in the study were provided by Auxilium Pharmaceuticals; one of the study’s 26 authors received fees from the company. FIND THIS STUDY July 8 issue of the New England Journal of Medicine. LEARN MORE ABOUT testosterone therapy at http://my.
clevelandclinic.org and
www.mayoclinic.com.
— Linda Searing
The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment’s effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.
HEALTH SCAN PERSONAL HEALTH
The blight stuff “HYPOCHONDRIAC’S HANDBOOK: SYNDROMES, DISEASES AND AILMENTS THAT PROBABLY SHOULD HAVE KILLED YOU BY NOW” (SKYHORSE PUBLISHING, $12.95) This novelty book of 29 bizarre ailments could be the worst thing to happen to hy- pochondriacs since WebMD. There’s so much more to fear than cancer, Alzhei- mer’s and meningitis! (Though it’s best not to worry, because that can lead to headaches and ulcers.) Is that small cut in- fected with flesh-eating bacteria? Is that bump on your ear the beginning of cuta- neous horn? Some of the disorders are iffy, such as carrot addiction and electric hu- man syndrome. (Author Ian Landau
writes in a disclaimer that “most scientists deny the possibil- ity that people can become electrified.”) If you’re not a hypo- chondriac, this is a very amusing book.
FITNESS
God loves a loser “THE 90-DAY FITNESS CHALLENGE” (HARVEST HOUSE PUBLISHERS, $13.99) Fans of TV’s “The Biggest Loser” may re- member South Carolina couple Phil and Amy Parham, who lost a combined 250 pounds on the sixth season of the show in 2008. The Parhams are sharing their se- crets (relyingon God . . . and eating less) in
their Christianity-based dieting program “The 90-Day Fitness Challenge.” The book offers only a little behind-the-scenes “Loser” dirt, but it confirms criticism that the show’s weight- loss tactics are excessive: “The things the producers don’t show you are the blisters that cover the contestants’ feet, the toenails that fall off, the knees that are braced, and the ankles that are wrapped. They don’t show the contestants crawling to the bathroom because they are too sore to walk.”
— Rachel Saslow
Thursday in Local Living Eat, Drink and Be Healthy’s Jennifer LaRue Huget examines that summer staple, mayonnaise. The MisFits talk to cyclists on a cross-country ride that includes injured and disabled war veterans.
The column is on vacation this week. It will resume July 27. AnyBODY
JUMPON
THEBUS!
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