DEAR DR. ROACH: My 32-year-old daughter has been diagnosed with Devic disease. A year ago, she had five days of intravenous steroids to deal with optic neuritis. The optic nerve is 100 percent healed, but she still has pain. Antibodies show up in her bloodwork. She is about to undergo two treatments, two weeks apart, of rituximab, hopefully killing the antibodies. What little information I have found online is not very helpful in understanding this disease and what we can expect in the future. — S.M.Y.
ANSWER: Neuromyelitis optica, also called Devic disease, is a neurological condition that causes inflammation of both the optic nerve and the spinal cord. It can look very similar to multiple sclerosis, but the presence of the NMO antibodies is helpful in distinguishing NMO from MS.
NMO appears, like MS, to be an autoimmune disease, with the antibody representing the attack of the body on the nervous system. Both steroids and rituximab suppress the immune system. Several studies, one published just a few weeks ago, show very promising results for NMO using rituximab whenever a specific type of immune cell is detectable in the blood. The antibodies themselves aren’t destroyed, but the cells that make the specific antibodies are suppressed.
In the study, 60 percent of patients had no relapse, and 93 percent had improvement or stabilization.
DEAR DR. ROACH: About four years ago I bought a vibration machine. I’m a 64-year-old female with major back issues, but I can exercise on the vibration machine with no problems. In fact, when I went in for my last bone density check, my bone density had increased over 14 percent! My doctor said it was unbelievable.
I understand that many retirement homes may have this machine. My ultimate wish would be that hotels would all put one in their exercise room! Ten minutes on the machine equals 4 miles of jogging. — L.J.
ANSWER: Vibration machines have been around for years, but the data supporting them is patchy. Some studies have found that they do not improve osteoporosis; others show a slight improvement. Many studies have shown an improvement in low back pain and in strength. The machines are generally safe, but they can cause injuries, especially in the elderly.
Although vibration machines can improve fitness, I don’t believe that 10 minutes on an exercise machine gives you all the benefits of 4 miles of jogging. Bone density levels show a lot of variation, so a single large increase doesn’t always mean a sustained gain.
I think it’s too early to recommend vibration therapy as a standard treatment for osteoporosis. It may have a role for people who are unable to do other kinds of exercises.
DEAR DR. ROACH: In a recent column, you said, “Some people can’t absorb fructose.” I’d like to know more about that. What are the side effects of the inability to absorb fructose? How does that happen? — I.N.
ANSWER: Fructose is a sugar naturally found in fruits, but also in sweeteners, especially honey and high-fructose corn syrup. Other sugars, such as glucose, improve fructose absorption. Few people get symptoms just from natural foods, because these contain the other natural sugars that improve fructose absorption. On the other hand, sorbitol (a “sugar alcohol”) decreases fructose absorption.
Almost half the population cannot completely absorb fructose, and the more fructose people take in, the greater the risk of the symptoms of malabsorption, including diarrhea, gas and bloating.
I recommend against HFCS for many reasons, but this is another one. For people with symptoms of malabsorption, I recommend a trial of reducing fructose and sorbitol.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
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