February 25, 2003
Chicago hospitals are already making changes to the way they treat some patients with blood clots, after a study released this week showed a safe and inexpensive way to prevent future clots using an established blood thinning drug.
"Obviously it's pretty clear this will benefit patients, so we're incorporating it into practice immediately," said Edith Nutescu, assistant director of the University of Illinois at Chicago's Wellness Center.
But, she said, this therapy is only for patients who have never had a blood clot before, and so-called "idiopathic clotters," who are not known to have the normal risk factors for blood clots.
The study released Monday showed that in a clinical trial, people with an idiopathic first-time blood clot could reduce their risk of a second blood clot by 64 percent by taking a low dose of the blood thinning drug coumadin, also known by its chemical name warfarin, over a long term.
The trial was stopped early because findings were so positive that the study's authors felt it would be unethical to withhold treatment from the patients who had received a placebo during the trial.
A blood clot in the thigh or calf, known by the medical name deep vein thrombosis, can block blood supply, causing pain, swelling and fever. Pulmonary embolism, a potentially life-threatening event associated with a blood clot, happens when the clot breaks away from the wall of the vein and travels through the blood stream to the lung where it blocks an artery.
After a person's first blood clot, the risk of another blood clot in the following year is about six to nine percent. This risk increases as time goes on.
Nutescu said the major risk factors for blood clots are: taking birth control pills; being pregnant, obese or over age 45; having major surgery; or having congestive heart failure or certain genetic blood clotting disorders.
Idiopathic blood clots can be caused by one of these factors that has not been diagnosed, or may have another cause.
Before the results of Monday's study were released, Nutescu said, patients with idiopathic blood clots were treated for six months with a higher dose of coumadin.
Now, she said, "We know those patients can benefit from extended therapy. This means they'll benefit from getting treatment for longer than 6 months, that it will further decrease their chances of getting another clot."
But long-term treatment with a low dose of coumadin is not for everyone.
"[The new study] doesn't mean that everybody who gets a blood clot now walks in and gets coumadin," Nutescu said. "It has to do with the patient's risk factors and history. We determine the best course of treatment." Coumadin is a useful and well-known drug, but it can also be dangerous because too much blood-thinning will cause excessive bleeding.
"Coumadin requires very specific laboratory monitoring and dose control," Nutescu said. "This study is good; it provides us new data for extended use, but you need specialized care when you take blood thinners."
This necessary specialized care will mean that not all hospitals will be able to implement the long term coumadin treatments for every patient that might benefit from it. Stroger Hospital's coumadin clinic director, Peter Clarke said even though he is excited about the study, the county hospital does not have the capacity to monitor every patient who could use the low dose treatment.
"We have a limited capacity for care," he said. "So we have to pick the higher risk people for [blood clot prevention] therapies."
"For the [coumadin] clinic, we won't follow patients after 6 months, while they are in the maintenance phase of the preventative therapy. We'll have to ask them to return to their general practitioner after that."
The study results were released on the New England Journal of Medicine website Monday, and will be published in the April 10, 2003, issue.
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Plan ahead to protect garden from late winter's temperature swings
February 13, 2003
As the city braces for another cold snap this week, Chicagoland's gardens face a rollercoaster of late winter temperatures and hope for the best.
Local horticultural experts say the coldest part of winter is a breeze for most shrubs, trees and perennials that are zone 5 hardy. These can withstand temperatures down to 20 below zero.
But as the first hints of winter's end arrive and temperatures go from the 40s to the 20s and back, even northern Illinois' tough local flora can experience some upheaval - frost heave, to be exact, according to Ron Wolford, coordinator of the University of Illinois Extension's master gardener program in Chicago.
Hardy plants become dormant in the fall and handle Chicago's winters quite well, even if the ground freezes deeply as it did this winter, Wolford said in a telephone interview. But with the dramatic temperature swings Chicago sees in February and March, freezing and thawing cause the ground to "heave" or push up the root systems of perennials, plants that come back year after year.
"You would see where your perennial was, you'll be able to see where part of the roots have heaved up maybe 2-3 inches. It's not like a plant has popped out," Wolford said. So why is that a problem? The root system is exposed to freezing temperatures that could kill it, Wolford said.
"The best thing is to put the mulch on in December when the ground freezes," he said. "Usually in midwinter it's not the most pleasant time to be out in the garden."
Still, he said, some local gardeners may have counted on this winter being as mild as the last few, and not mulched. In that case they might consider making sure at least their favorite plants are protected and mulching them now.
But you have to plan way ahead to protect trees that suffer when sun, wind and cold temperatures attack.
Those sunny winter days that fool us into leaving our hats at home also fool tree bark into thinking it's springtime, causing cracking from sunscald, says Ted Knights, horticulture specialist at the Chicago Botanic Garden.
Knights said sunscald happens when the trunk of the tree warms up from exposure to direct sunlight. In the direct sun the interior of the tree can heat up 30 degrees over the air temperature, he said, so sunscald will always be on the south and west sides of the tree.
Because water expands when it freezes, the bark expands as temperatures drop, splitting into a long, thin vertical crack. Knights said this usually affects young landscape trees that don't have shade from the canopies of other trees.
Exposure can also be dangerous for broadleaf evergreens such as boxwoods and rhododendrons, leading to windburn, a kind of damage that causes leaves to wither and drop long after the cold temperatures have gone. Knights said when the ground is frozen or dry, broadleaf evergreens get a kind of split personality. At the top, their leaves feel the warm sun and begin to "breathe," he said. The wind steals away moisture the leaves exhale, but at the root level it is still deep winter.
"The ground is frozen and they can't replace the moisture they lose from their leaves," Knights said. "The damage is done now, but the effects will show later, when the leaves get brown in the spring."
Planning a garden right is the key to preventing sunscald and windburn. "If you pick the right plants for the right location, you can avoid either," Knights said. "Broadleaf plants should be on the east side of the house rather than the west side with afternoon sun."
Using native and zone-5-hardy plants will always mean less worry in the winter, he said. "Plants that aren't native are going to be more susceptible to problems with the cold weather," Knights said. "The native plants have all adapted to it."
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Grocery shoppers want to know what is in their food until debate over GM foods is settled
February 6, 2003
Genetically engineered foods may be out of sight and out of mind, but they are definitely on the table.
Although 30 to 50 percent of the corn and soy in Americans' food comes from genetically altered crops, grocery shoppers in downtown Chicago Tuesday said they don't think about how much genetically engineered corn and soy is in the food they eat. They also agreed that genetically modified foods should be labeled even if they are totally safe.
"I hadn't given much thought to [genetically engineered ingredients]," said retired teacher Ethel Martin Tuesday, standing in the cereal aisle while her adult son Ricardo pushed her shopping cart. "I don't think people are aware of it. They just want to get their groceries and go home."
Martin said she usually reads labels to get product information - although it's like "reading a doctor's handwriting," she said - but has not seen any food labeled as having genetically engineered ingredients.
Fructose, corn oil and soybean oil come from corn and soy, but appear only in the small print of the sodas and processed foods that use these ingredients. Gene Grabowski of the Grocery Manufacturers of America, a trade group in Washington, D.C., said in a telephone interview that up to half of the corn and soy that goes into making these and other products comes from genetically engineered stock.
Grabowski said surveys of food company toll-free numbers echo Ms. Martin's sentiments. Very few Americans are worried about genetically modified, or biotech, crops.
"About two and a half years ago, when biotech was a big issue, about a half a percent of consumer calls that came into our big companies were about biotech," he said. "But biotech has not been a concern for about a year and a half."
In genetically modified, or GM, crops, a gene from one organism is inserted into the DNA of another. The soil bacteria Bacillus thuringiensis, or Bt, produces an insecticide, so organic farmers have long used the bacteria to protect their crops. But the genetically modified crop know as Bt corn has the Bacillus thuringiensis insecticide gene inserted into the DNA of corn.
DNA is a kind of universal language for all living things, so the Bt corn can "read" the bacterial gene and produce the insecticide. This reduces pesticide use while protecting the crop from insects.
So do we need protection from GM crops? Grabowski says no. "Humans are immune to Bt toxin," Grabowski said, and added that the more processed the food is, the less Bt toxin is present.
Jeff Cronin of the Washington, D.C.-based Center for Science in the Public Interest, agrees, for the most part. "[GM foods] do seem to lose their properties when they're cooked," Cronin said in a telephone interview. "So since corn and soy are almost always cooked, the gene products are usually broken down."
But Cronin said his group would like for GM foods to be tested more rigorously before they reach the market. Earlier this month the Center for Science in the Public Interest issued a report stating that although existing GM crops appear to be safe, the FDA relies too much on food companies to test new GM foods.
"We have a problem with the process, but none of the foods appears to be unsafe," Cronin said. "We are proponents of the [GM] technology, but we don't think the way it's tested now is something people should place a lot of faith in."
In the grocery store dairy aisle Tuesday, Tomika Jones said that is why GM foods should be labeled. On her day off from her job as a security guard at O'Hare airport, she said as long as the jury is out on GM foods, people should be able to choose whether they buy it or not.
"From what I've heard on the news, there are conflicting opinions on the side effects [of GM foods]," Jones said. "Of course it should be labeled."
Martin, the retired schoolteacher, had said it would "scare the bejeezus out of people to see it on the label," but Jones said that is a chance worth taking.
"If you educate people, and label the food, it would be anyone's choice," Jones said. "It's just nice to know what's being put in your food."
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