Predictive Medicine

By Amy Price PhD

Predictive medicine can change our tomorrows today. Regenerative medicine can replace artificial body parts with lab grown technologies while genetic breakthroughs can save families from generations of genetic disability. It is possible that new knowledge of human genetics and cell biology is likely to transform medical practice. Three likely scenarios could evolve:

•Genetics will lead to the classification of diseases on the basis of the underlying genetics or biochemistry, rather than by symptoms alone leading to preventive rather than crisis orientated treatments.
•Genetic information will identify people who are likely to respond to drugs, or to be harmed by them (pharmacogenetics). This is already possible with certain psychotropic drugs on an experimental level but has not trickled down into mainstream medicine.
•Genetic variation will be a new ‘susceptibility factor’, permitting monitoring and early treatment or, perhaps prevention, of an increasing proportion of common, multifactorial diseases, such as coronary heart disease, hypertension, stroke, cancer, diabetes and Alzheimer's disease. Even stress management can be amplified with knowledge of individual genotypes

It is the genetic variation susceptibility factor which is considered to be the change maker for the advent of predictive medicine. This could lead to regenerative medicine on a cellular (somatic) level or even in vitro gene manipulation (germ line therapy) which could prevent intergenerational transfer of genetic disabilities.
Predictive medicine, when it comes, will be based on a much wider use of genetic testing, at present the gap between what the healthcare system is geared up and trained to deliver and what is scientifically viable is huge. For example there are treatments approved for traumatic brain injury that are effective but most be given within a couple of hours of trauma. This can’t happen now because emergency room personnel are not adequately trained or equipped to diagnose MTBI... As with any new technology applied to health in the context of a complex delivery system, implementation is not going to be simple.

First, of course, there needs to be demand from medical personnel and the general public. Typically wide spread change will only take place after the following criteria are established:

•Demonstration of clinical effectiveness and patient safety – through statistically valid clinical trials
•Cost-effective for general use – through economic analysis of trials and other data;
•Standardization of technology, and quality control – generally through outside regulation of suppliers and laboratories;
•Allocation of resources;
•Recruitment and education and training (or retraining) for health workers – including specialists, MDs, nurses, counselors and technicians. For instance a surgeon who makes a good living performing spinal fusions and cervical repairs will need significant convincing, retraining and motivation to become an early adopter of treatment that makes the previous way of doing business obsolete.

Predictive, regenerative medicine may be the wave of the future. History teaches us that the way to greatness is to find a way to serve many. My dream is to witness a generation of scientists and medical professionals join in unity with a foundation of integrity to build a tomorrow for the patients and public who have make their careers possible.

References:

Materials adapted from Open University Course Materials (accessed july,2009)

Instant stem cells...Freeze Dried Anyone?

By Amy Price PhD

I recently shared some posts on umbilical cord banking information. Dr Fran Verter of the Parent’s Guide to Cord Blood Foundation shared with us how this works. It seems storage and transport can introduce complications so I wondered what would happen if we eliminated those high tech freezers and freeze dried the stem cells instead. Could they be reconstituted and retain the integrity needed to reproduce?

I located a journal article on Plos One along with others who are using these techniques. Apparently the first generation reproduced DNA accurately which is no surprise as this is a forensics basics but the other portions of the cell needed for healthy growth didn't survive. They are now getting success rates in the 90% range for cells they have reconstituted and then reproduced. The University of Rochester, Image above, is showing some interesting research on using freeze dried cells for bone repair and tissue engineering

This solves a lot of storage problems, should reduce costs and cells could last for years. The ones used in the studies were three years old and over. It is anyone's guess how long this could take to become a viable option for human adult stemcell storage but what a great concept...Stemcells To Go

Immediate Post Surgery Wound Care Hints

By Amy Price PhD

After surgery wound care could be better addressed. The advice is usually to ice the area for twenty minutes at a time and don't get it wet for 48 hours to 21 days depending on the procedure because of infection risks. Who are they kidding...After bleeding, being washed down with iodine and being touched,probed,cut and stitched by hands I have no personal relationship with all that I want is a bath or a shower!

The risk of infection is serious as it can travel to your bones or become systemic and cause more damage than the original problem. It can travel through open places in the wound or through the stitching which acts as a wick. Until the area has healed over it is best not to swim or use a hot tub because of bacterial risks. It is important to follow your doctor's advice for changing dressings etc. If the area becomes hot to the touch, swells rapidly,starts pulsing or you start to run a fever get your doctor's advice.

To shower after spine and cervical surgery I purchased a silicon swim cap as this is completely waterproof and less irritating than latex. I cut generous pieces which I placed over the wound and taped it in place with duct tape. For arms and legs I used umbrella bags, big ones for leg and smaller for arm areas. I placed them over top of the dressing and bandage and taped this in place. You will still need to exercise care and try not to get the area wet...a bath could be a bad idea! If it gets a little damp in spite of all precautions gently dry the area, put on topical antibiotic and replace the dressing.

If this was an emergency room visit remember emergency rooms will only stabilize you, they have no obligation to provide treatment beyond this. An emergency room visit needs follow up with a doctor. At emergency if you have tendons exposed insist on being seen by a specialist on call. I had three fingers all with tendon avulsions stitched up with no repairs. It took a year of occupational and physical therapy to get the function back. A word to the wise...if you have broken something and they have splinted, cast or wrapped it and it starts to smell bad or the exposed areas turn dark and lumpy go back to the hospital. They don't mean literally black, if it darkens substantially, swells and get worse rather than better have this checked out. With a temporary cast the swelling can cut off the circulation and the tissue starts to die. I almost lost a hand this way as I was told if it turns black come back, since it cost me 10,000 dollars for the emergency room appearance and 273 dollars for a bandage available at the dollar store.I really wasn't up for a repeat visit!

The ice is easy in principle but not so easy for the drugged and injured to apply. Some people travel for surgery and it is a considerable time before they are at home to ice. Do yourself a favor and buy some instant ice at a pharmacy before your procedure or get the surgery to supply you with a couple of extra packs for the trip home. The ice takes down swelling and eases pain while helping your body heal. At home consider the wound site. An awkward area like the elbow,knees or shoulders may be best with a bag of frozen peas which will bend to the shape. A posterior neck surgery may benefit from an emptied and refilled with water large soda bottle (don't freeze the soda it explodes). Ask a family member or friend to do ice duty day and night. If you are like me and don't want to ask anyone for anything consider that you can buy them a gift, take them to dinner or return the favor. It is an investment in your healing. Be nice to those who care enough to be available, they do not benefit from you getting an attitude because you feel bad that you need the help and being thankful can go along ways towards preserving relationships

There will be a follow up post on scar care soon. This information is for educational purposes only and does not constitute medical advice. That is your doctor's assignment.

Dyslexia FMRI implicates Cerebellum

Dyslexic individuals seem to struggle with pattern learning. Reading is like pattern learning on steroids. Recent research compares a group of adult dyslexics with a control group of normal readers in the learning of a simple sequencing task. Participants pressed one of four buttons that corresponded to a visual stimuli that appeared in a predictable pattern during an fMRI scan. Previous studies had found that dyslexics are worse at learning this simple sequence and the researchers were interested in the differences in brain activity between the two groups.

The study found that there was a notable difference in brain activity between dyslexics and non-dyslexics. Significantly the cerebellum was more active in the dyslexics than it was in the non-dyslexics.

Research suggests that the cerebellum plays a key role in learning by comparing what the brain expects to happen with what actually happens. As the subjects learn the sequence, the difference between expected and actual results diminishes and the work load on the cerebellum reduces. In the non-dyslexic brains, the cerebellum is more efficient at this process so sequence learning and the corresponding drop off in cerebellum activity occurs sooner.

It is of interest that expert learners such as chess champions and experts at logic games can play with a lot less cognitive loading, thus freeing up other processing resources for memory, attention and learning. Even for experts this takes hours of practise. Perhaps a focus on effective categorization and efficient filtering rather than endless attention and working memory games could produce skills that would transfer to new areas of learning.

MRI News and Views

contrast mriMRIs have gone through a lot of changes and improvements in the last few years. A first class radiologist is the best way to get an accurate diagnosis but great equipment helps too. People ask us at SIF how can I know that my radiologist does quality work? The best way is to ask who others consider the best. Ask at your Doctors, at physio and at the hospital. Soon you will find some names come up over and over again. It is important to find out what kind of MRIs they are best at reading. Some specialize in the brain, tumors, or spines. all radiologists are not considered equal so choose with care! For an explanation of how they work and the history of MRI click here

Before you agree to an MRI it is good to find out who will be explaining the results and the technical terms in your report to you. At SIF we get multiple requests to explain results of MRIs. We can not help with this as an MRI is only a part of the picture, diagnostics are made in conjunction with detailed physical examinations and patient/physician consultation. If you come across an unusual term in your MRI you can try the Read My MRI feature in the members section of SIF


MRI machines work with magnets and the strength is measured by Tesla. The Tesla strength can vary anywhere from .046 to 8 Tesla. Before you book an MRI ask what the strength is of the machine they will use for your scan. The strongest Tesla in common use outside of research settings is a 3 Tesla. The stronger the Tesla the clearer the image. Large herniations can be seen with an .02 Tesla. Using a 3 Tesla even ligament damage is quite visible. Click here It used to be thought that 7-8 Teslas would not be safe for patients because of the radio frequency but these fears proved groundless click here and this Tesla strength is used for revealing vascular structure and for detailed brain scans.


MRIs can be with or without contrast. A contrast MRI makes it easier for the diagnostician to see scar tissue that may have formed because of the injury. The contrast is a small amount of water soluble dye that is injected at the time of your MRI. MRIs can be static or functional (fMRI) fMRIs measure function. Oxford University has an interesting and informative site detailing how fMRI works and the strengths and perceived weakness of this approach click here


Technology combining MEG (measures brain's electrical activity) and fMRI are bringing hope for treatment in previously uncharted territory Click here Software can convert images into 3D For more info and to see axonal motion in 3D click here The software technology in detail click here
Stand Up MRIs are thought to show structural patterns more clearly and can signpost where a client is feeling pressure. Some ligament damage can also be shown more accurately with the stand up MRI. Click Here Research done on this method click here A new and promising technology is on the horizon to reduce MRI costs and also create a machine that can be used for those with metal implants or even to assist in surgery! Click here

Thought For Today “" “Nobody can go back and start a new beginning, but anyone can start today and make a new ending.”- Maria Robinson quote