2011年3月22日星期二

Calcium: Myths and misconceptions

Calcium is no stranger to controversy, and its important role is often tarnished by unfounded contradiction. Its silent participation in troubled waters put its reputation in jeorpardy, wrongly accused of misdeeds it has not committed.

The guilty verdict dished out is often based on circumstantial evidence of its presence at the "crime scene". The most common type of kidney stone is composed of calcium oxalate. A senior citizen who has seen some miles often has opaque calcification of the artery leaving the heart (aorta) in a chest x-ray. In cardiovascular disease, the underlying fires of inflammation within the artery walls instigates deposition of calcium, making it an indirect predictor of the No.1 killer.

None of the above is the direct result of calcium causing mischief, but merely its response to disease and injury.

Calcium101

Calcium is the most abundant mineral in the body, and if it were possible to gather it all in a bag, it will weigh about a kilogram. About 99% is banked in the bones and teeth, and only 1% circulates freely in the blood, within cells, and the fluid between cells.

Calcium has an undeniable role in building up bone density, giving strength and integrity to our supporting framework. What many are unaware of is the myriad other cellular functions of calcium that keep us alive.

It plays a constant role in controlling traffic of incoming supplies of nutrients and the exit of biochemical wastes from the cells, the making of hormones, and the transmission of messages from one nerve cell (neurons) to another.

Last, but not least, is its involvement in muscle contractions, working in concert with another important player, magnesium, in the cellular "see-saw" where one comes in and the other goes out, alternating between muscle contractions and relaxation.

The daily movement of calcium commences with ingestion, where after dispersion and absorption in the gut, it meanders its way to the bones to build up "hardness", while a small portion is utilised for metabolic functions.

When demand exceeds supply, the mineral is withdrawn from the bone bank, the bones.

Installed within us is an automatic alarm system that keeps calcium levels within a physiologic range. Failure of this hardware will lead to disease if the calcium levels swing too high or drops too low.

Behind the thyroid in the neck is a gland (parathyroid) that secretes parathyroid hormones, which elevates blood calcium when its level drops, mobilising the shift from the bones into the circulation. Calcitonin is another regulatory hormone that moves calcium back into the bones.

Active vitamin D is the gatekeeper to the entrance of calcium, its presence being a prerequisite for effective absorption of the mineral. The dietary precursor of vitamin D is activated in a three-step process, with the initial ignition in the skin, aided by sun exposure, thus earning the label "sunshine vitamin".

A second process occurs in the liver, and the final step of activation is effected by the kidneys. Lack of sun exposure, liver or kidney disease will lead to poor calcium absorption, auguring the development of porous bones (osteoporosis).

Consumption matters

The average daily diet confers 350mg to 400mg of calcium. Gulping down a glass of milk adds another 250mg of calcium. However, absorption of dietary calcium is only about 40%. Infants to children aged five years require 300mg to 600mg calcium daily; those six to 10 years old require 800mg; those 11 to 18 years require 1,300mg; 19- to 50-year-olds require 1,000mg; those above 50 years/pregnant/lactating require 1,200mg; while perimenopausal women require 1,500mg. (The safe upper limit for children and adults is 2,500mg per day).

Calcium rich foods include dairy products (milk, cheese, yoghurt, eggs), tofu, sardines, and vegetables like cabbages, kale, and broccoli. One may also choose a "good" calcium supplement in the right dosage and right form to meet the dietary shortfall.

Calcium supplements are the most widely used and prescribed mineral supplement, and confusion abounds in choosing the right type, based on dose, form, and combination.

The capacity to absorb calcium from the gut is limited to 500mg at one pass. The most common and cheapest form is calcium carbonate (inorganic salt), and the absorption rate is about 30%, whereas calcium citrate is said to be better absorbed.

As the former enters the cavernous stomach, it drops into a pit of acid juices (hydrochloric acid), which react with the carbonate to form a "champagne-like" foam. Calcium carbonate has the notorious tendency to cause heartburn.

Subsequently, the partly dissolved tablet exits the stomach into the first part of the small intestines, where further down is a short segment that acts as the window of absorption. The activated form of vitamin D brokers the entry of calcium into the cells by a process called active transport, akin to an electrical pump.

Even as the remnants of calcium leave the site of active absorption, some still manage to gain entry by a different manner, called passive diffusion, and the rest makes its way to the rear exit.

If much of the calcium is poorly absorbed, the result is unpleasant constipation.

Other forms of calcium tablets include calcium gluconate and lactate.

There is such a complex interplay of factors that scientists are not in total agreement about calcium requirements. Even if adequate calcium is made available to the body, there is no guarantee that it will be incorporated into the scaffolding of the bone’s architecture.

The combination of activated vitamin D, magnesium, boron, silicon, copper, zinc and other trace minerals are required for calcium to be translated into improved bone density. Calcium is like the brick, but to cement them together, we need at least 20 other known nutrients to form the mortar to glue it together.

Unfortunately, how many of us are cellular scientists, and how many supplement makers understand the science?

Amidst all this scientific jargon brews confused hearsay, misconceptions and myths. Perhaps this is the forum to address some common issues.

2011年3月20日星期日

Gently Does it - Safe and Gentle Stone Retrieval

Around 5-10% of adults in Central and Western Europe suffer from kidney and ureteral stone

disease. These solid formations occur when substances that normally dissolve in the urine are

separated out and deposited as fine crystals in those organs. Such stones can be found in the

renal calyces, renal pelvis and lower urinary tract (ureter, bladder, urethra).

About 80% of all kidney stones pass out of the body with the urine. In the remaining 20%,

medical assistance is required for removal. Men are affected twice often as women.

Formerly, the treatment of kidney and ureteral stones was performed mostly by ESWL in the

last 15 years.

Due to immense improvements of the equipment for and training in ureteroscopy this is

currently the therapeutic procedure carried out more and more often. Ureteroscopy is a

minimal invasive intervention by which a flexible endoscope is passed through the urethra

into the ureter to capture stones and/or stone fragments.

With its complete portfolio and its innovative Sur-Catch NT retrieval basket, Olympus

provides a specially developed, gentle and fast treatment for kidney and ureteral stone

removal.

Thanks to its tipless design with rounded wires, the basket is extremely soft and smooth to

prevent bleeding and injury to the tissue. The Nitinol material gives the basket the

additional advantage of the ultimate flexibility to move easily and safely toward to the

stone - even in patients with difficult anatomy. Nitinol is a nickel and titan shape memory

alloy and possesses properties like biocompatibility and high flexibility. Even when changing

its shape, Nitinol can remember its previous form and change back.

Because the stones can be completely removed in just a single session in almost all cases,

the procedure is highly effective.

The additional portfolio supplied by Olympus enable surgeons to render accurate and exact

diagnoses while accomplishing a fast, safe and effective intervention:

- the flexible endoscope (ureteroscope) produces crystal clear and 3-times larger images,

allowing visibility directly onto the stone and its location.

- The new NBI function enables a better diagnosis of suspicious structures and simulates a 3D

view of the mucosa.

2011年3月14日星期一

R.I.P. Cloe the Snow Leopard: All Big Cats Go To Heaven

Several months ago, I wrote about Cloe, the magnificent snow leopard, living at the loving

sanctuary, Big Cat Rescue in Tampa, Florida, who was treated for kidney stones with

lithotripsy.

Unfortunately, the day my husband and I visited Big Cat Rescue, the weather was extremely hot

and humid. Cloe was ensconced in her air-conditioned den, napping away the afternoon. While I

was deeply disappointed that I didn't get to meet Cloe, I often thought about her and hoped

that on my next trip I would have the opportunity to visit her.

So I was deeply saddened the other day to learn that Cloe had died shortly before her 14th

birthday. Even though the choice was difficult, since Cloe was suffering from kidney failure,

having her put to sleep was the final gift of love Carole Baskin, the founder of Big Cat

Rescue, could give this beautiful cat. According to Carole, Cloe had lived longer than most

snow leopards. Along with the sadness of Cloe's death, the words Carole wrote soon after the

snow leopard passed touched me so deeply I felt compelled to share them here.

"I shut off the snow leopard cave air conditioner for the last time tonight- 3/8/11. Cloe the

snow leopard had just left her exquisite body and was bound for that place where all good

cats go when they die. As I walked into the office, the chorus of lions stopped me in my

tracks to listen. An over-sized butterfly began circling me and then perched on a branch

right above my head for a long moment, before disappearing high into the boughs of the tree

and darkening sky. I felt it was Cloe; happy to finally be free and wanted to share the

moment with you. She kept circling before stopping to say, 'good-bye', and leaving. Thank

you, everyone, for giving her, and all of these cats, the best lives possible."

The ability to love that deeply is truly a precious gift that should never be taken for

granted. At the same time, it is always risky for us to allow our hearts to open to an animal

and share that special bond. For at the precise moment we open to that love, we also open to

the grief we will eventually suffer when that animal dies.

It doesn't really matter if the beloved animal is a dog, cat, bird or fish, or any other

member of the animal kingdom. When we have been blessed with such a joyful relationship, we

cannot avoid the extraordinary pain and sadness that comes at the time of loss.

2011年3月13日星期日

Boy who says he visited heaven draws crowd at Lexington church

A child who is the subject of a New York Times best-selling book made a quiet visit to

Lexington on Sunday to talk about his experience with the afterlife.

Colton Burpo is like any normal 11-year-old but finds himself thrust into the national

spotlight. Stiff and shy, he generally keeps his eyes low, speaking in short, excited bursts

when a subject comes up in which he's well-versed, such as computers.

But when he was 3 years old, Colton had a near-death experience on an operating table in

Nebraska during an emergency appendectomy. He pulled through, and during the ensuing months

and years, his family said they came to realize that Colton's seemingly childlike

observations about heaven and angels had more substance than they could have imagined.

What Colton calls his face-to-face meeting with Jesus is documented in the book Heaven Is for

Real, written by his father, Pastor Todd Burpo, and published by Thomas Nelson, a Christian

publishing company in Nashville.

Since hitting shelves in November, Heaven Is for Real has found national recognition, mostly

through word of mouth. The book is No. 1 on The New York Times best-seller list in paperback

non-fiction and has been for 10 weeks. Todd Burpo said his publisher has printed 1.5 million

copies to meet demand.

The Burpos flew to Lexington from Imperial, Neb., on Sunday to speak at The Bridge Church, a

congregation that worships in a former storefront on Dennis Drive.

Colton nervously sang an inspirational hymn before departing to the Sunday school class. His

parents, Todd and Sonja, sat down with The Bridge's pastor, Lee Claypoole, for a roundtable

discussion.

What has become the most inspirational moment in the family's lives began with one of their

worst years, Todd Burpo said.

Burpo had broken his leg, suffered kidney stones and had a serious operation, preventing the

self-described workaholic from working at his garage-door business.

Once he finally recovered, the family took a trip to Colorado to celebrate. It was there that

Colton and his sister, Cassie, got sick. Doctors thought it was the flu.

"The problem is, his sister got better. He didn't," Burpo said.

Time and again, doctors diagnosed Colton with the flu. During the next two weeks, his

condition worsened until doctors finally ran tests and discovered he had appendicitis. By

that time, doctors estimated Colton's appendix had burst five days earlier.

"His little body was just full of poison," Burpo said.

In his role as a pastor, Burpo has held the hands of many dying people.

"You can see the organs start to shut down, their skin color start to change. You can see the

dark circles under their eyes, and I was starting to watch that in my kid," he said, fighting

tears.

Miraculously, Colton pulled through after an operation at Great Plains Regional Medical

Center. Months later, as the family was driving by the hospital, they said they were

surprised when, from his car seat, Colton, then 4, said, "That's where the angels saved me,"

Sonja Burpo recalled.

The family had noticed what appeared to be an increased spirituality from the boy since he

recovered, but that was the first time they paid attention, Burpo said. She and her husband

began asking more questions, pressing Colton for information.

"What happened to our son during those 17 days? What did he see, and what did he hear, and

how does he know about angels and Jesus so close?" Sonja Burpo said.

Colton eventually revealed more details that the family couldn't explain. He said he had met

his great-grandfather, who died long before he was born. He suddenly had knowledge of his

sister, who died in the womb; his parents had never told him about the miscarriage, they

said.

Colton told his father that he watched Dr. Timothy O'Holleran operating on him from Jesus'

lap. He said he saw his father praying alone in a hospital room during the operation.

"My wife didn't know I prayed that prayer. She didn't know where I was, and here my son was

telling me about it," Todd Burpo said.

He acknowledged there are many skeptics about the book.

"If you Google my name, you'll see the f-word beside it so many times," he said.

Burpo was skeptical, too, he said, until his son spoke of things he should have had no way of

knowing.

"Sometimes you need the miracle-working God in your life," he said.

Throughout the presentation in Lexington, Burpo regularly spoke directly to the congregation

about lessons he learned from the tragedy-turned-blessing and gave sermons that led many

church members to cry and hold hands over their hearts.

The event drew about 150 new visitors to The Bridge Church. Some drove from West Virginia,

Illinois and Tennessee to see the Burpo family speak, Claypoole said.

The church regularly has an attendance of about 300 people, a significant leap since

Claypoole started the church in a hotel room with 18 members two years ago, he said.

After the discussion, Colton sat silently in Claypoole's office, waiting for his family. When

asked if he felt blessed to be able to inspire so many people, he smiled, looked up briefly

and nodded.

2011年3月9日星期三

Reduce risk of kidney stones through lifestyle change

HOUSTON – Kidney stones can be very painful but according to a Baylor College of Medicine

expert, some lifestyle changes can help prevent them.

Men in their 30s or 40s who are overweight and eat a high protein diet are most at risk for

kidney stones. In addition, a family history of kidney stones increases the risk and so does

drinking less than two liters of water per day, said Dr. Alexander Pastuszak, a resident

physician in urology.

Prevention strategies include drinking more water, losing weight and decreasing protein and

salt intake.

Symptoms of kidney stones include blood in the urine and urinary tract infections, as well as

vague, intermittent back or flank pain on the side of the kidney that contains the stones.

Most of the time, kidney stones only trigger symptoms when they make their way into the

ureters, which results in significant pain in the back and flank, and can cause backup of

urine into the affected kidney if the stones obstruct your ureter.

Most kidney stones will pass on their own, particularly if they’re smaller than 5 mm;

however, larger stones may require surgery to remove them. In addition, if you have had

kidney stones more than once, a urine analysis should be conducted to help guide further

treatment and prevention.

2011年3月7日星期一

Edwards aces thrill ride with Sprint Cup win in Las Vegas

Carl Edwards jumped off the Stratosphere Tower 10 days ago and flew with the Air

Force Thunderbirds on Thursday.

His latest adventure in Las Vegas was celebrating in Victory Lane on Sunday after

winning his second NASCAR Sprint Cup race in four years at Las Vegas Motor Speedway

before an estimated crowd of 140,000.

Quite the Vegas vacation, indeed.

"I've had a blast. I don't know what I'm going to do next weekend," Edwards said,

adding he plans to award the Kobalt Tools 400 winner's trophy to the Thunderbirds,

who he said inspired him.

The resident of Columbia, Mo., was flying high after winning for the 19th time in the

series and earning his Roush Fenway Racing team $401,541.

Edwards and crew chief Bob Osborne are the hottest duo in the series. They won the

last two races of 2010 and were second in the season-opening Daytona 500.

"This is the best start to a season that I've ever had," Edwards said. "We have been

performing really well, and it's just a joy to drive these race cars right now. The

Fords are back and are strong."

The victory was the seventh in 14 Las Vegas Cup races for Roush Fenway Racing.

Edwards, who won the 2008 Cup race here, finished 1.246 seconds ahead of Tony

Stewart, who led a race-best 163 of 267 laps in a Stewart-Haas Racing Chevrolet that

was clearly dominant.

Even Edwards doubted he would have won without a blunder by Stewart's team on lap

151. Stewart fell from first to 23rd when NASCAR assessed a stop-and-go penalty after

his car dragged a piece of equipment out of the pit box during a stop.

"We just gave one away today," Stewart said. "I don't even know what to say. We just

gave one away. (Our car) was the baddest thing on the West Coast today. Second

sucks."

Stewart regained the lead on lap 200 after his team saved time by changing two tires

and other front-runners took four. But that cost him on the last stop with 32 laps

remaining when he had to change four tires and Edwards took two and beat him onto the

track.

"It definitely didn't hurt the decision-making process to see them run extremely well

with two tires," Osborne said. "I thought our only opportunity was to leapfrog them

on the track and hope we could hold them off."

Stewart took the points lead through three races with 113, tying him with Kurt Busch,

who finished ninth after rebounding from a spin on lap 103. Edwards is third.

The last 32 laps provided the drama missing during the first 235, not counting a fire

when the engine in Kyle Busch's car detonated or Jeff Gordon's day ending when he

crashed into a wall.

After a record number of lead changes in the season's first two races, there were 21

on Sunday -- seven fewer than the track record -- and nearly all were products of pit

stops. Cars ran single file for nearly all the race with only a smattering of green-

flag lead changes.

For much of the day it would have been easier for a driver to pass a kidney stone

than another car.

"Anybody out there today knew that passing was nearly impossible," said Denny Hamlin,

who probably passed the most. A post-qualifying engine change dropped him to the rear

of the 43-car field to start and he finished seventh.

"Hopefully when we come back here (Goodyear) will soften the tire up, and that's when

you'll see a lot of side-by-side action," Hamlin said.

Edwards, though, said excitement was not lacking from his vantage point.

"I can tell you, from the driver's seat there are no more exciting tracks to drive

on," he said of Las Vegas. "This place has a lot of character. You slide the car at

200 mph through the corner and there are multiple grooves.

"Some days we will have races that are more single file and some days we won't. I

think the savvy fans know what's going on."

Spoken like a driver who had just won the race.

2011年3月2日星期三

'Stabbing' pain barely hurts

Celebrity coroner Dr. Cyril Wecht -- who's consulted on the deaths of everyone from

JFK to Elvis Presley to Anna Nicole Smith -- told a Manhattan jury yesterday that

getting stabbed in the heart is only "moderately" painful, at worst.

"Yes, there is pain, but it's not great pain, such as a kidney stone, or a gall stone

in the bile duct, or a break in a big bone," Wecht testified in the sensational

"Harlem Kevorkian" murder trial, which goes to a jury today. "It's really just minimal

to moderate pain."

Wecht, 79, was the only defense witness called on behalf of Kenneth Minor, an East

Harlem man "hired" off the street by Long Island self-help motivational speaker

Jeffrey Locker to kill him in a fake mugging so his family could collect $18 million

in insurance.
KEVORKIAN DEFENSE: Kenneth Minor, in court yesterday, is accused of killing a

motivational speaker he says hired him to stab him in the heart.
Steven Hirsch
KEVORKIAN DEFENSE: Kenneth Minor, in court yesterday, is accused of killing a

motivational speaker he says hired him to stab him in the heart.

Both sides agree that the debt-plagued Locker, 52, hired Minor to "Do a Kevorkian" by

helping stage the fatal mugging in Locker's Dodge sedan in the predawn hours of July,

16, 2009.

Prosecutors call Minor a contract killer who plunged a knife seven times into Locker's

chest.

But Minor insists through his lawyer, Daniel Gotlin, that he only held the knife

against Locker's steering wheel as Locker repeatedly impaled himself.

Minor hopes to be acquitted of murder under an assisted-suicide defense.

Toward that end, Wecht testified that it's entirely possible for very despondent

people to repeatedly stab themselves, even in the heart, because it doesn't take much

strength and only causes "minimal to moderate" pain.

At least one of history's very few survivors of such an injury would disagree.

"I was just in extreme, excruciating pain," Christopher McCarthy, who was stabbed in

the heart in January 2009 by a crazed man on the subway, testified.