May 30, 2008
NIH Podcast Episode #0059
Balintfy: Welcome to the 59th episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health--the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode: a new resource to help seniors eat healthily, and an interview about Leprosy. But first, a report on stroke awareness. That's next on NIH Research Radio.
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Stroke Awareness Month
Balintfy: We’ve talked in recent episodes about how May is Older Americans Month. In this report from Wally Akinso, we learn how one NIH institute focuses on stroke awareness.
Dr. Koroshetz: May is a special month for our institute because it’s Stroke Awareness Month.
Akinso: Dr. Walter Koroshetz is the Deputy Director of the National Institute of Neurological Disorders and Stroke.
Dr. Koroshetz: “Stroke is a major problem in the United States throughout the world and it’s an amazing opportunity to get the message out both in terms of prevention and treatment of stroke.”
Akinso: Dr. Koroshetz defines a stroke.
Dr. Koroshetz: “Stroke is due to a vascular accident inside the brain. They’re two main types. One is a vascular blood vessel that becomes blocked, that’s called an ischemic stroke. And the other one is when a blood vessel burst causing bleeding into the brain, that’s called a hemorrhagic stroke.”
Akinso: Each year in the United States, there are more than 780,000 strokes. Stroke is the third leading cause of death in the country and causes more serious long-term disabilities than any other disease. Nearly three-quarters of all strokes occur in people over the age of 65 and the risk of having a stroke more than doubles each decade after the age of 55. He points out some of the signs and symptoms of a stroke.
Dr. Koroshetz: “If the blood vessel that’s going to your speech area becomes blocked by a clot of blood, that’s a stroke. And the symptoms will be that, that brain area which sub-serves language will not work and all of a sudden you’ll be unable to talk or unable to understand what people say to you because that brain area stops working. If you have a blood vessel that burst in the part of the brain where the wires are—that go down and control the function of your muscles in your arm, you’ll become paralyzed in that arm. So the symptoms and signs depend on where in the brain the trouble lies but there all very sudden onset and it’s the loss of an ability to do something that you could do a second ago.”
Akinso: Dr. Koroshetz offers tips to prevent a stroke.
Dr. Koroshetz: “Diet and exercise and trying to keep your weight in range of your ideal body weight, these are all things we think will prevent strokes in the long run.”
Akinso: Dr. Koroshetz adds that NINDS has a wide range of materials and useful information to offer.
Dr. Koroshetz: “The NINDS is a very active program in education about stroke. We have our own website www.stroke.ninds.nih.gov . We have materials that are relevant to the lay public to understand the stroke risk and how to decrease their risk, on how to know when their developing the warning signs of a stroke. We also have materials for physicians to help them in their care of patients and in their research.”
Akinso: In addition if you would like to join a clinical trial which deals with stroke, you can go to NINDS’s stroke website or visit www.clinicaltrials.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
NIH Senior Health Website: Eating Well As You Get Older
Balintfy: The NIH Senior Health Website, at www.nihseniorhealth.gov, recently added a new topic. Wally Akinso has the story:
AKINSO: How should you eat as you get older? Which foods are likely to keep you healthy and which ones should be limited? Is it possible to eat well and stay within a healthy weight? These are just a few questions that are addressed in “Eating Well as You Get Older,” the latest topic added to the NIH Senior Health website. Dr. Judy Hannah, a Health Science Administrator at the National Institute on Aging, says the new section has valuable information on this important issue.
HANNAH: This is a series of short sections for the general public to help them and there families with making decisions for best ways to purchase, prepare, and consume foods.
AKINSO: Dr. Hannah provides some insight into why it’s not easy for older adults to eat healthy.
HANNAH: A lot of times there’s somewhat a loss of appetite, loss of interest in preparing foods—especially if the individual is alone—and sometimes mobility, even being able to get to the store and shop. So there are a variety of issues.
AKINSO: Dr. Hannah says it’s important that this information be used.
HANNAH: It doesn’t do any good if it’s just posted on a website. What you need to do is be able to get these tips out to the general public. Hopefully it will help people with their purchasing and consumption.
AKINSO: According to Dr. Hannah, eating a well-planned, balanced mix of healthy foods every day may help prevent heart disease, type 2 diabetes, bone loss, some kinds of cancer, and anemia. The NIH Senior Health website was jointly developed by the National Institute on Aging and the National Library of Medicine for older adults and their families. If you would like to read up on this topic, visit www.NIHSeniorHealth.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Balintfy: When we come back, do you know what leprosy is? We’ll get insight from an expert, right after this.
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Balintfy: A recent newspaper article in the Washington Post reported on a teenager from Baton Rouge, Louisiana, who contracted Leprosy. To learn more about this infectious disease, Calvin Jackson interviewed Dr. Christine Sizemore from the National Institute of Allergy and Infectious Diseases. The first question: what exactly is Leprosy?
Dr. Sizemore: Leprosy is an infectious disease that's caused by a mycobacterium. It's called Mycobacterium leprae, and that bug is a cousin of the Tuberculosis bacillus, Mycobacterium tuberculosis.
Jackson: Now, you know, most people think of Leprosy as a skin disease, but the lesions associated with it really are just a symptom. The real damage is caused by the mycobacteria.
Dr. Sizemore: The bacteria affect the skin and do infect the nerves, and what happens is that you lose sensation in your fingers, and as a result, any injuries to fingers, toes or other parts of your body can get infected with other bacteria, and then basically you start losing -- and you have so much damage to your skin and your underlying bone that you can get secondary infections and then those body parts basically can retract or go away, which leads to what's known as the disfigurements in Leprosy that people have missing toes, missing fingers, missing noses, but it's often a secondary cause of Leprosy and not the primary affliction.
Jackson: Now, you know, I think, like a lot of people had assumed that Leprosy was one of those diseases that had sort of been eradicated, but apparently not. How many new cases of Leprosy are diagnosed annually?
Dr. Sizemore: Annually in the world there are still over 300,000 cases diagnosed. In the U.S. it's a couple hundred. So Leprosy has not gone away. It's still prevalent in lots of places in the world. It's not distributed all over the world, but there are certain countries that have very high rates, and the U.S., unfortunately, has not been immune and there are still cases in the U.S. of Leprosy.
Jackson: And so I guess a lot of people would think, well, why are we so concerned about Leprosy in this country if we have so few cases, but this really is a worldwide problem.
Dr. Sizemore: Absolutely, and especially with the globalization. In a large, global community there are individuals who are born in countries where Leprosy may be prevalent and then come to the U.S. and are basically diagnosed in the U.S. with the disease. But Leprosy can also be contracted in the U.S., especially in regions in the South, Louisiana, Texas. There are cases that are thought to originate in the U.S. and are not coming from other countries.
Jackson: And can you tell me a little about, I guess, the armadillo connection there?
Dr. Sizemore: Armadillos are known to carry Leprosy naturally, and armadillos create somewhat of a -- what's called an environmental reservoir for Leprosy. It's not known to what extent armadillos transmit the disease to humans, but they're one of those few animal species where the bug can be found naturally, which, for research, is a great advantage because you can use the armadillo actually as a model to research the disease.
Jackson: Well, it seems as though Leprosy, at least in its early stages, can be mistaken for other conditions, such as a common rash. How difficult is it to diagnose Leprosy?
Dr. Sizemore: It's not trivial, and there are probably several instances where Leprosy is being mistaken for those rashes and not diagnosed properly until it has progressed pretty far. As a physician you basically need to be aware that skin lesions or skin patches, once they start becoming anesthetic, that means you lose sensation on them, might warrant a referral to an expert to potentially diagnose Leprosy. So, yes, you need to be a very well-trained physician, you need to have experience in the disease, and you need to think about the possibility of Leprosy actually afflicting your patient. That's why it's so important to know that Leprosy is not a disease of the past and still exists in the U.S.
Jackson: Now, you know, of course, when I hear of Leprosy I always think about, you know -- I don't know if you remember that movie Ben-Hur, where the main character's mother and sister are exiled to a colony. How -- because people were so afraid that it was contagious. How contagious is the disease?
Dr. Sizemore: It's actually surprising to note that, although everybody is afraid of Leprosy greatly, it's not very contagious at all. The instances where, for instance, in a family, the husband has Leprosy and the wife lives with the husband for many, many decades and never contracts the disease. So while it is very scary once you might have contracted Leprosy, it's very unlikely that you will do so, and only very prolonged contact and a natural susceptibility to the disease would be necessary before you actually come down with Leprosy.
Jackson: So Leprosy isn't really contagious, but I know there's still a stigma associated with Leprosy and that oftentimes people are cast out of their homes or isolated.
Dr. Sizemore: That is true and that actually makes the diagnosis and proper management of Leprosy all over the world very difficult, because of course patients are reluctant to seek medical care, because once they're diagnosed with Leprosy, they are indeed still shunned. They're thrown out of their families; they're often completely isolated from society, which of course makes it difficult for someone to say, "Hey, something isn't right. I'm having those skin patches, I start losing sensation in my fingers and all." They don't want to go seek medical care, and then they, of course, continue to be a reservoir for potential transmission of the disease. So working on the stigma and making people in all parts of the world recognize that Leprosy is a treatable disease and that with your proper care, especially early in the disease manifestation and disease progress, you can indeed lead a normal, happy life and not have to deal with the severe disabilities and really loss of functionalities that would normally happen in Leprosy.
Jackson: Now, is there any new research on the horizon that may give us more of an insight into the causes and possible treatments for Leprosy?
Dr. Sizemore: I'm actually very glad you asked that question, because there's a lot of exciting new research going on and coming up in Leprosy. One thing that has helped tremendously make that research possible is that the genome of the Leprosy bacillus has been sequenced not too long ago, and also the genetic content of other mycobacteria, you know, its cousins like the TB bacillus, are also known, so it allows us to do a lot of comparisons and also figure out what really makes that bacterium tick. What's different between it and its much faster growing bugs? Leprosy bacteria cannot be grown in the laboratory, so you're dependent on propagating and getting the live bugs out of animals, and that has always been a prerequisite to really doing research with it, because you can't get a hold of them very easily. They're very, very hard to manipulate and manage in the laboratory. But a lot of those technologies are now available that allow us to really assess what -- how does the disease progress? The armadillo, as I said earlier, is a great model for Leprosy. It shows the full spectrum of disease as it is present in humans, so it allows us now, together with the genetic information of the bacterium, to really assess what causes those different manifestations of Leprosy and what are the weak areas of the bug that we may be able to attack to either produce vaccines or better treatment, treatment for that disease.
Balintfy: Thanks to Dr. Christine Sizemore and Calvin Jackson for that interview.
Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, June 13th when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.