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Carpal tunnel syndrome (CTS) is the most expensive of all work- related injuries. Over his or her lifetime, a carpal tunnel patient loses about $30,000 in medical bills and time absent from work. In 1998, an estimated 3 of every 10,000 workers took time off from work because of CTS. Half of them missed more than IO workdays.

CTS typically occurs in adults, with women 3 times more likely to develop it than men. The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in assembly- line workers in manufacturing, sewing, finishing, cleaning, meatpacking, and similar industries. Contrary to the conventional wisdom, according to recent research, people who perform data entry at a computer (up to 7 hours a day) are not at increased risk of developing CTS.

What Is CTS?

CTS is a problem of the median nerve, which runs from the forearm into the hand. The median nerve provides sensation to the palm side of the thumb, index, and middle fingers and regulates the function of some small muscles in the hand that move the fingers and thumb. CTS occurs when the median nerve gets compressed in the carpal tunnel-a narrow tunnel at the wrist-made up of bones and soft tissues, such as nerves, tendons, ligaments, and blood vessels. The compression may result in pain, weakness, and/or numbness in the hand and wrist, which radiates up into the forearm. CTS is the most common of the "entrapment neuropathies"-compression or trauma of the body's nerves in the hands or feet. A similar condition in the foot is called tarsal tunnel syndrome.

What Are the Symptoms?

Symptoms usually begin gradually. Burning, tingling, itching, and / or numbness in the palm of the hand and thumb, index, and middle fingers are most common. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. When this happens, some people feel the need to "shake off the numbness." As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.

Why Does CTS Develop?

Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, over- activity of the pituitary gland, hypothyroidism, diabetes, inflammatory arthritis, mechanical problems in the wrist joint, poor work ergonomics, repeated use of vibrating hand tools, and fluid retention during pregnancy or menopause. In some cases, no cause can be identified.

How Is It Diagnosed?

To avoid permanent damage to the median nerve, CTS should be diagnosed and treated early. A standard physical examination of the hands, arms, shoulders, and neck can help determine if your symptoms are related to daily activities or to an underlying disorder. Your doctor of chiropractic can use other specific tests to try to produce the symptoms of carpal tunnel syndrome. The most common are:

* Pressure-provocative test. A cuff placed at the front of the carpal tunnel is inflated, followed by direct pressure on the median nerve.

* Carpal compression test. Moderate pressure is applied with both thumbs directly on the carpal tunnel and underlying median nerve at the transverse carpal ligament. The test is relatively new.

Laboratory tests and x-rays can reveal diabetes, arthritis, fractures, and other common causes of wrist and hand pain. Sometimes electrodiagnostic tests, such as nerveconduction velocity testing, are used to help confirm the diagnosis. With these tests, small electrodes, placed on your skin, measure the speed at which electrical impulses travel across your wrist. CTS will slow the speed of the impulses and will point your doctor of chiropractic to this diagnosis. These tests can also help determine if some other condition is causing your complaints.

What Is the CTS Treatment?

CTS treatment should begin as early as possible under a doctor's supervision. Initial therapy includes:

* Resting the affected hand and wrist

* Avoiding activities that may worsen symptoms

* Immobilizing the wrist in a splint to avoid further damage from twisting or bending

* Applying cool packs to help reduce swelling from inflammations.

Some medications can help with pain control and inflammation. Studies have shown that vitamin Ek supplements may relieve CTS symptoms.

Chiropractic joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, soft-tissue mobilization techniques, and even yoga can be helpful. Scientists are also investigating other therapies, such as acupuncture, that may help prevent and treat this disorder. Your doctor of chiropractic can discuss those therapies with you and help you prevent the return of CTS.

Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon releases the ligament covering the carpal tunnel. Today, this outpatient procedure is typically done with an endoscope-a camera that the surgeon uses to see inside the carpal tunnel.The majority of patients recover completely after treatment, and the recurrence rate is low. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences.

How Can CTS Be Prevented?

The American Chiropractic Association recommends the following tips:

* Perform on-the-job conditioning, such as stretching and light exercises.

* Take frequent rest breaks.

* Wear splints to help keep the wrists straight.

* Use fingerless gloves to help keep the hands warm and flexible.

* Use correct posture and wrist position. If needed, your doctor of chiropractic can assess your work situation and advise you on restructuring your workstation, job tasks, and handling tools or tool handles, to help you position your wrists naturally during work.

* Your doctor of chiropractic can help educate your employer about CTS. To minimize workplace injuries, jobs can be rotated among workers. Employers can also develop programs in ergonomics-the process of adapting workplace conditions and job demands to workers' physical capabilities.

Your doctor of chiropractic has the knowledge, training, and expertise to help you understand what your problem is and, in many cases, manage it successfully. Remember, however, that the treatment program can be successful only with your active participation. If your doctor of chiropractic feels that he or she cannot help you, he or she will direct you to another health care provider.

U.S. Department of Health and Human Services

NATIONAL INSTITUTES OF HEALTH

NIH News

National Center for Research Resources (NCRR) http://www.ncrr.nih.gov/

FOR IMMEDIATE RELEASE
Thursday, October 28, 2004

CONTACT:
Joyce McDonald
And Ann Puderbaugh
NCRR
301-435-0888

Charles Casey
UC Davis Health System
916-734-9048

Karen Pridmore
Department of Veterans Affairs
925-372-2346

NIH FUNDS NEW GENERAL CLINICAL RESEARCH CENTER IN SACRAMENTO

BETHESDA, MARYLAND -- The National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), announced today it will fund a new General Clinical Research Center (GCRC) with the University of California, Davis at the Sacramento Veterans Affairs Medical Center. NCRR will award about $5.5 million to support five years of clinical research at the new GCRC including operating expenses, hospitalization and ancillary laboratory costs, and salaries of key personnel.

The new center will join the national network of 80 other GCRCs that provide optimal settings for medical investigators to conduct safe, controlled, state- of-the-art, in-patient and out-patient studies of both children and adults. The Sacramento GCRC will focus on areas of clinical research that reflect the scientific strengths at UC Davis and the Department of Veterans Affairs (VA) including AIDS, cancer, vascular biology, bone metabolism, and neuroscience.

Proposed clinical trials for the new GCRC include the study of mucosal immunity, one of the key issues in HIV vaccine development; research into a newly identified neurodegenerative disorder that strikes males over 50 who possess the fragile X mental retardation 1 (FMR1) gene; and a test of the effectiveness of isoflavone-rich soy extract in protecting the bones of postmenopausal women.

"We are pleased to support the collaboration between these two esteemed institutions so that they can create a vibrant and dynamic clinical research community in the Sacramento area," said NCRR Director Judith L. Vaitukaitis, M.D. "It is our hope the new GCRC will serve as a critical catalyst to expand and focus the many research initiatives already in place at UC Davis and VA."

The UC Davis Medical School has been affiliated with the Veterans Affairs Northern California Health Care System (VANCHCS) since 1974, with all medical students, residents and fellows completing clinical rotations at the veterans' facility. In keeping with the mission of this NIH-sponsored program, this GCRC will extend its mentoring initiatives to foster development of the clinical research skills of physicians and dentists to enhance their ability to become independent, clinical/patient-oriented investigators.

"This is an honor and a terrific opportunity to increase the type of work we've been doing for years," said Dr. Joseph Silva, dean of the UC Davis School of Medicine. "Research is the foundation for improving medical care, and being part of this national network means now we have an even better ability to explore ways to prevent and treat diseases and disabilities that affect everyone's health."

The University of California, Davis Health System (UCDHS) and the VANCHCS serve a highly diverse region approximately the size of Pennsylvania, with a population of over four million people. The two institutions have been developing the necessary infrastructure for the new GCRC since March 2000. A state-of-the-art clinical research unit was constructed, with 7,500 square feet designated for the GCRC clinic, lab and administrative space.

The center will be managed and administered by UC Davis faculty and staff with Lars Berglund, professor of medicine and assistant dean for clinical research at the UC Davis School of Medicine and a physician at VANCHCS, serving as program director at the new center.

Investigators who have research project funding from NIH and other peer-reviewed sources may use GCRCs so they can benefit from collaborative, multidisciplinary research opportunities. To ensure research diversity at the GCRCs, no single group of investigators at a center may utilize more than 33 percent of the resources. Last year, the GCRC network supported almost 12,000 research scientists who pursued more than 7,800 studies. A complete list of GCRCs is available in the Clinical Research Resources Directory http://www.ncrr.nih.gov/ncrrprog/clindir/crdirectory.asp. GCRCs also offer opportunities in career development http://www.ncrr.nih.gov/clinical/cr_crcd.asp.

NCRR is part of the National Institutes of Health, an agency of the Department of Health and Human Services. NCRR is the nation's leading federal sponsor of resources that enable advances in many areas of biomedical research. NCRR support provides the scientific research community with access to a diverse array of biomedical research technologies, instrumentation, specialized basic and clinical research facilities, animal models, genetic stocks, and such biomaterials as cell lines, tissues, and organs. Additional information about NCRR can be found at http://www.ncrr.nih.gov.

This NIH News Release is available online at: http://www.nih.gov/news/pr/oct2004/ncrr-28.htm

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Date: October 28, 2004
For Release: Immediately
Contact: HHS Press Office
(202) 690-6343


HHS IDENTIFIES MORE INFLUENZA VACCINE
Department Takes Steps To Acquire Foreign Vaccine, Redirect Government Doses

HHS Secretary Tommy G. Thompson announced today significant progress toward expanding the nation's supply of vaccines for flu season: the Food and Drug Administration (FDA) has identified about 5 million doses of influenza vaccine from foreign manufacturers; HHS has been able to recoup an additional 300,000 doses of the injectable vaccine originally bought for federal employees and the military; and a major pneumonia vaccine manufacturer plans to triple its production.

Secretary Thompson said these medicines would add to the nation's growing supply of vaccines and medicines to protect Americans during the coming flu season. These new doses would add to the 61 million doses of vaccine already available, including 58 million doses of vaccine from Aventis and 3 million of FluMist nasal spray from MedImmune. Additionally, the nation has a supply of antiviral medicines, potentially enough for more than 40 million people that can be used to prevent or treat the flu.

With the news of additional supply, the Secretary stressed again that millions of influenza vaccine doses are still to be distributed to states this flu season. Specifically, about 17 million of the Aventis vaccine is still to come (about 3 million doses a week are being distributed), as well as 2 million doses of FluMist.

"We're continuing to build our arsenal of vaccines and medicines to confront the coming flu season," Secretary Thompson said. "We are encouraged about the potential for some 5 million doses of vaccine from foreign manufacturers and we're sending our inspectors to those facilities. We're redirecting vaccine originally purchased by the government for federal employees and the military to priority populations throughout the country.

"We're growing stronger each week in our supply of vaccines and medicines, which makes us optimistic about our ability to protect the American public as we go into flu season," he added.

Secretary Thompson said FDA inspectors would be traveling to two foreign manufacturing facilities -- GlaxoSmithKline's facility in Germany and IDBiomedical's facility in Canada -- to inspect their manufacturing plants and products. The inspection teams will confirm the availability of the 5 million doses, assure that the vaccine can be used safely, and then make arrangements to acquire them. The department is still exploring the potential of additional doses of vaccine from other foreign sources as well.

The vaccine from foreign manufacturers would be distributed according to greatest need at the time of acquisition this flu season. These doses would most likely have to be distributed as an investigational new drug (IND), requiring recipients to sign a consent form and follow-up with a health care worker.

Additionally, the department has recouped about 300,000 doses of influenza vaccine that had been purchased by the federal government for federal employees and the military this flu season.

This includes 200,000 doses of vaccine purchased originally for the military, which will now use FluMist thus freeing up the injectable vaccine for the priority populations who cannot take FluMist. This shift will not affect the timing or supply of vaccine for members of the military who are eligible to receive the flu vaccine. Additionally, HHS has recouped nearly 100,000 doses from the Federal Occupational Health service. All of these doses will now be redirected to states based on need for their priority populations.

Secretary Thompson also announced that Merck & Co. is tripling its production of pneumococcal vaccine used to prevent one of the major complications of the flu, pneumonia. The company, which typically sells 6 million to 7 million doses of Pneumovax 23, will increase its production to between 17 and 18 million for this flu season. The vaccine is for adults and children ages 2 years and older who are at increased risk for pneumonia.

Pneumovax is not a substitute for the influenza vaccine, but can help shield people against flu complications. A single dose can protect against 23 different types of Streptococcus pneumoniae bacteria that are responsible for causing more than 90 percent of pneumonia cases. Many people who fall into the priority groups for the influenza vaccine should also get the pneumonia vaccine, including seniors.

Secretary Thompson said the Centers for Disease Control and Prevention (CDC) is making flu vaccine data available for state health commissioners on a secure Web site to help them track supplies coming to their states. He noted that the data is proprietary information that Aventis asked be protected through the secure Web site. The Web site is the result of efforts by the CDC and Aventis to redirect undistributed vaccine to places of greatest need.

The CDC also has asked states to submit their high-risk needs that are not being met as soon as possible, so that this information can be used to distribute remaining doses to where they are most needed.

Furthermore, the Secretary wants states to be clear that vaccines and medicines will be covered through Medicaid and Medicare for the populations those programs serve. This includes children in Medicaid and seniors in Medicare. In fact, Medicare will reimburse seniors who received their vaccine from a provider who is not enrolled in Medicare, and it will cover the costs of antiviral medicines that can prevent or treat the flu.

Secretary Thompson thanked the American public for its cooperation in making sure the flu vaccine goes to those in priority groups. He reminded the public that the priority groups for influenza vaccination are all children aged 6 months to 23 months; adults aged 65 and older; persons aged 2 to 64 with underlying chronic conditions; all women who will be pregnant during influenza season; residents of nursing homes and long-term care facilities; children aged 6 months-18 years on chronic aspirin therapy.

"On behalf of the President, I want to extend the administration's appreciation to citizens across America, who in accordance with CDC guidelines, are forgoing the flu shot so that someone in a priority category can get one," Secretary Thompson said. "Working together, we can make sure that the vaccine doses go to those who are most vulnerable."

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RESEARCH STUDIES AVAILABLE

1) A study to compare the Efficacy and Safety of Pegvisomant to that of Sandostatin LAR Depot in Patients with Acromegaly. This study is being conducted in:
    - Boston, MA (http://www.centerwatch.com/patient/studies/stu65424.html)

2) Osteoporosis Research Study.. This study is being conducted in:
    - Mogadore, OH (http://www.centerwatch.com/patient/studies/stu65501.html)

3) Fibromyalgia Research Study.. This study is being conducted in:
    - Philadelphia, PA (http://www.centerwatch.com/patient/studies/stu65516.html)

Additional educational resources that may be of interest to you:

Informed Consent: A Guide to the Risks and Benefits of Volunteering for Clinical Trials. http://www.centerwatch.com/bookstore/pubs_cons_infconsent.html

Volunteering for a Clinical Trial, a brief educational pamphlet. If you would like to order this pamphlet click here: http://www.centerwatch.com/bookstore/pubs_cons_brochureform.html

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Your patients may qualify for research studies in the Neuroendocrine Clinical Center, Massachusetts General Hospital, Boston, MA 02114. We are currently accepting the following categories of patients for screening to determine study eligibility. Depending on the study, subjects may receive free testing, medication and/or stipends.

SUBJECTS	STUDIES	CONTACT 617-726-3870
Newly diagnosed acromegaly patients	Evaluating preoperative medical treatments	Dr. Laurence Katznelson
Patients with acromegaly requiring medical therapy	Evaluating two different medical therapies	Karen Szczesiul, R.N.
Patients with history of cured acromegaly and current hypopituitarism	Investigating GH effects in patients with history of cured acromegaly and GH deficiency	Dr. Catherine Beauregard Dr. Anne Klibanski
Patients with hypopituitarism (panhypopituitary or partial hypopituitarism)	GH deficiency/replacement studies	Dr. Beverly M.K. Biller Dr. Karen K. Miller
Women with anorexia nervosa	New hormonal therapies	Dr. Karen K. Miller Dr. Anne Klibanski
Adolescent girls with anorexia nervosa	Evaluating bone density and the effects of estrogen replacement	Dr. Anne Klibanski Dr. Madhu Misra
Women with hypopituitarism, ages 18-50	Testosterone replacement therapy study	Dr. Karen K. Miller
HIV positive women with weight loss or fat redistribution	Evaluating testosterone therapy Evaluation of bone loss Evaluation of cardiovascular risk markers	Dr. Steven Grinspoon
HIV positive men and women with fat redistribution	Novel treatments to redistribute fat Determination of growth hormone levels and efficacy of GH secretogogues Novel lipid lowering therapy	Dr. Steven Grinspoon Dr. Colleen Hadigan Dr. Polyxeni Koutkia

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Dr. Roberto Salvatori at Johns Hopkins has received a large grant from NIH to study the consequences of lack of growth hormone and it's affects on heart function, bone density, muscle strength, and fat metabolism. It is a wonderful study but he has run into a problem with a delay in receiving the funding. It apparently had to go through the Brazilian Gov. which is where the study will take place in a population of dwarfs that genetically have no growth hormone (a perfect study sample). Receipt of the funds may be delayed anywhere from three to six months.

The study began July 1 and an Endocrinology fellow, Dr. Danilo Fintini from Italy, was hired to do the research and begin July 12th, however there are no funds available yet to pay him. NIH grants require that the work be completed within a framework of time. To delay the project may cause a loss of the grant.

Any donation is tax deductible and greatly appreciated. $11,210 will be needed for the first three months and then another $11,210 for the next three months. This research when completed will help patients that are hypopituitary be treated with greater knowledge of the problem and insights in to how to help them recover strength, normal heart function and fat metabolism.

For more information about this study and Dr. Salvatori, in Word format: please click here to download.

Thank you for your consideration in this matter. Please do not hesitate to ask for more verification or information about the project. I look forward to hearing from you soon.

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We welcome your articles, letters to the editor, bios and Cushing's information. Submit a Story or Article to either the snailmail CUSH Newsletter or to an upcoming email newsletter at http://www.cushings-help.com/newsletter_story.htm

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Newest Bios:
To add or edit your bio, please click here »
Barbara S	Barbara is not yet diagnosed.	Beecher, IL, 40 miles south of Chicago
Leeben	Leeben had a comprehensive workup for Pheochromocytoma (adrenal) but was diagnosed with Rathke's Cleft Cyst (pituitary).	Phoenix, Arizona originally from South Africa
Norma L	Norma had surgery to remove her pituitary tumor on October 13, 2004	Washington, IN
Rita B	Rita is not yet diagnosed.	Beaverton, MI
Roberta "Bert" P	Bert is not yet diagnosed.	Norton, OH (Akron area
SusanM (Sally2)	Susan M has been diagnosed with cyclical pituitary Cushing's. at surgery, she was found to have pituitary hyperplasia. Post-op, she learned that she wasn't cured and now has congestive heart failure.	West Springfield, MA

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