E-news broadcast 28 June 2007 No.372

ADHD:  It could just be a breathing problem

If you know a child with learning difficulties or who’s hyperactive, the chances are that he or she also suffers from breathing problems at night.

Breathing difficulties and snoring are now being seriously considered as a cause of ADHD behavioural patterns.
Unfortunately, most parents don’t even realize their child has problems breathing properly at night – and even if they did, they wouldn’t have thought it was anything to do with hyperactivity or learning problems.

But scientists have discovered that sleep-disordered breathing (SDB), as it’s known, may be the unsuspected cause of ADHD-spectrum problems – or it may be misdiagnosed as ADHD. 

Symptoms of ADHD tend to appear early on in a child’s life, and the chances are that there is an associated breathing problem that goes with it.

Scientists have discovered that children whose breathing problems are tackled early also go on to enjoy greater academic success.  In one study of 19 children aged between six and 16, those with breathing problems also had lower IQ levels than children who were able to breathe properly at night.

In another study, brain scans of children who had breathing problems revealed neural injury in the area associated with learning and memory.

Often, neither doctors nor parents realize that ADHD may be a wrong diagnosis, and that the underlying problem relates to breathing problems.  Once these are treated and cleared, the supposed ADHD problems also go away.
Snoring is the most obvious sign of a breathing problem, and it affects around 1 in 5 children.  However, this is for mild cases where the child snores around three times a week.  Severe cases, where the child snores frequently every night, affects just 1 in 20.

Other signs might include laboured breathing, or snorting and gasping; others again may adopt unusual sleeping positions, or suffer from nightmares of drowning or choking.

If your child has SDB and ADHD, the choices offered by medicine are limited.  At one extreme there’s surgery to remove the tonsils and adenoids, but this often doesn’t work on its own.  Another option is ‘continuous positive airway pressure therapy’, which involves an electronic device that delivers constant air pressure via a nasal mask.

(Source: Journal of the American Medical Association, 2007; 297: 2681-2).


CAESAREANS: Give the mother the facts, and the rate drops

Caesarean rates in the USA and UK have rocketed to around 25 per cent of all births, usually because of a cautious ‘just-in-case’ approach.

This rate is also driven by the obstetrician’s mantra of ‘Once a caesarean mother, always a caesarean mother’.
In reality, it’s reckoned that just 5 per cent of all births need surgical intervention to protect the life of the mother or unborn baby, and the World Health Organization has stated that every country should be looking at caesarean section rates of no more than 10 per cent.

So what happens when the mother-to-be is given all the facts, and is allowed to decide on the method of delivery herself?
This radical idea has been tested by a group of mavericks from Bristol University, who tested the theory on 742 pregnant women who all had a caesarean section before.

Convention would have dictated that all would have had a caesarean, but once the women had been given all the facts, 158 – or 21 per cent - went on to have a natural birth.  Just 63 had an emergency caesarean – in other words, the surgery was necessary – and the rest had an elective caesarean, in which they chose the procedure.

Amazing what happens when you let people in on the know.

(Source: British Medical Journal, 2007; 334: 1305-9).


SURGERY:  Heart problems not helped by drugs


Around 1 million people suffer heart complications, such as heart attack, angina and heart failure, every year after surgery. Of these, 250,000 die.

These complications – which affect around 1 per cent of the 100 million patients who have surgery every year worldwide - are a direct result of the operation itself as, in each case, the person had a healthy heart.

To try to reduce the risk, anaesthetists routinely give patients beta blockers and statins.  This procedure was based on some very early studies that soon became the by-word for good practice.

But doctors have been noticing that the drugs don’t seem to help at all, and so researchers have been looking at the practice again with the help of 1520 patients, who were assigned to one of three separate trials.

In one, 921 patients in Denmark were given the beta blocker metoprolol after surgery – but it did nothing to help prevent post-operative heart problems during the 30 days after surgery.  The drug was equally as ineffective when it was given to 103 patients in the UK over the same period, and to 496 patients, who were monitored for six months after surgery.

(Source: British Medical Journal, 2007; 334: 1283-4).


FIBROMYALGIA:  It becomes a ‘real’ disease when there’s a drug to sell

Fibromyalgia has always been one of those Cinderella diseases.  Its symptoms seem real enough to the sufferer, who complains of chronic and widespread pains in the muscles, and fatigue.

Doctors – and the medical establishment in general – have taken a less than sympathetic view, and have treated the fibromyalgia sufferer in the same disdainful way they have ‘treated’ the ME patient.

In short, the patient is a nervous worrier, and whatever is wrong with him or her is located almost entirely in the mind. 
The experience is distressing and frustrating for the patient who knows full well that he or she is suffering from a genuine problem.  But how to change the entrenched views of the medical establishment?

Step forward one resourceful drug company, part of an industry that has never knowingly passed up on a marketing opportunity.

The American drug watchdog, the Food and Drug Administration (FDA), has just approved the very first drug to treat fibromyalgia.  Pfizer’s Lyrica (pregabalin), which was originally licensed to treat neuropathy and neuralgia, also “reduces pain and improves daily functions for some patients” who suffer from fibromyalgia, says the agency.

And, hey presto, a condition that’s “all in the mind” suddenly becomes a recognized, and treatable, condition.
Thank you, Pfizer.

(Source: The FDA website).


OSTEOPOROSIS DRUGS:  Too often they weaken the bones

It’s common for drugs to have a “paradoxical effect”.  This is medicalese for stating that the drug can cause the very symptoms it’s supposed to be treating.

Another example of the paradoxical effect has just been uncovered by researchers, who’ve been reviewing bone-strengthening drugs known as biophosphonates, which are regularly given for osteoporosis.

In addition to helping build bone density, the drugs are also supposed to treat cancer-related bone lesions, and elevated calcium levels in the blood.

In fact, they very often do the reverse, and they can dramatically increase the risk of jaw or facial bone deterioration or infection.

Researchers examined the data on 14,000 cancer patients who were treated with one of two types of biophosphonates – pamidronate or zoledronic acid – and compared their progress with 28,000 patients who weren’t given the drugs.

After six years, around 5.5 per cent – or 770 – of those taking the drugs needed facial or jaw bone surgery, or were diagnosed with inflammation of the jaw bone, compared with just 0.3 per cent of the non-drug group.

(Source: Journal of the National Cancer Institute, 2007; 1016-24).


PROSTATE CANCER:  You can beat it with a healthy diet, even if you have a genetic predisposition

Can we beat nature?  The good news seems to be that we can.  Even people with a genetic predisposition for a disease can reduce the risk with a healthy diet, researchers believe.

The theory has been successfully tested on a group of mice that had a genetic mutation that put them at increased risk of prostate cancer.

But those who were fed a diet rich in omega-3 fatty acids – the ‘good’ fats found in fish, nuts, seeds and vegetable oils - had slower tumour growth and lived longer than those fed the omega-6 fatty acids, or the ‘bad’ fats.

The researchers also think they know why the diet is so beneficial.  Omega-3, or ‘good’ fat, contains a protein known as ‘Bad’, which kills off cancer cells.

Got that?  Let’s hope it works in humans, too.

(Source: Journal of Clinical Investigation, 2007; published online: June 21).

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