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Medical Edge Newspaper Column from Mayo Clinic

PARTIAL LUNG REMOVAL HELPS SOME EMPHYSEMA SUFFERERS

DEAR MAYO CLINIC: I have severe emphysema and nothing the doctors do seems to help. I wonder if it can be surgically removed. — Fargo, N.D.

ANSWER: Emphysema is a chronic, progressive, disabling condition characterized by destruction of lung tissue. This destruction causes more work for the lungs and for the muscles that inflate them, resulting in reduced airflow into and out of the lungs.

Before considering surgery, exhaust all traditional treatment options: Stop smoking; try bronchodilators, oxygen and antibiotic therapy; get vaccinated to protect against pneumonia and influenza; and participate in a pulmonary rehabilitation program. If these treatments fail to provide adequate relief from shortness of breath, you may need to explore a surgical option.

There are two surgical procedures that offer hope for this disabling condition: 1) Lung transplantation is an option for some patients; and 2) a new surgical procedure — lung volume reduction surgery — has recently been found to be helpful for some patients. During LVRS, the surgeon removes the most damaged lung tissue — typically 20 to 35 percent of both lungs. This improves the function of the remaining lung tissue, and improves exercise tolerance and quality of life for many people.

The effectiveness of LVRS was recently confirmed in a federally funded, multi-center study called the National Emphysema Treatment Trial. It showed that patients with emphysema confined primarily to the lungs’ upper lobes were the best candidates for LVRS. However, some patients with non-upper lobe emphysema can benefit from the procedure, depending on their exercise capacity after pulmonary rehabilitation.
Careful evaluation is key in selecting patients who can benefit from LVRS. If you are interested in learning more about the procedure, ask your doctor to refer you to an LVRS center for further evaluation.

James Utz, M.D., Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Emphysema
Appointment Information
More Information on Emphysema
Surgery for Emphysema

DEAR MAYO CLINIC: I have a question that seems so trivial when you consider all the health concerns a person really could have these days. But I am a 52-year-old healthy woman, and I noticed lately that my hair is thinning in the front. Is that normal? Could it be the sign of a disease? Is it permissible to use the hair-growth lotion my husband does? — Palmdale, Calif.

ANSWER: Hair loss is a normal part of aging. By age 50, about 50 percent of men and women have some noticeable baldness. Men generally start to show signs of hair loss between their late teens to early 30s. For women, hair loss begins later — in the late 20s to early 40s.

Beyond aging, there are many reasons for hair loss. Heredity is a big one. And yes, disease and ill health can affect your hair. Types of hair loss include:

— Alopecia areata is an autoimmune disease with unknown cause. It produces hair loss in patches, and in rare instances, complete baldness.

— Infections such as ringworm and syphilis can result in hair loss.

— Telogen effluvium is a sudden temporary hair loss caused by a change in the normal hair-growth cycle. Biological stressors such as pregnancy, surgery, nutritional deficiencies or eating disorders can cause it. Hair often comes out in handfuls, though it grows back once the stress is managed.

— Chemotherapy results in toxicity-induced hair loss.

— Illnesses such as diabetes, lupus and thyroid diseases can cause hair loss.

Your medical provider is in the best position to evaluate your hair loss because he or she knows your overall health, family history, current lifestyle habits and stress levels.

As for using hair-regrowth agents: Please keep in mind that the topical scalp medication minoxidil (Rogaine) is the only U.S. Food and Drug Administration-approved drug for hair growth in both men and women. It is an effective treatment. Studies show it increases both hair counts and hair weight when used for more than 32 weeks. These positive effects end when patients stop using minoxidil. The 2 percent minoxidil solution has been approved for women, and the 5 percent solution is approved for men.

Remember to evaluate carefully all hair treatment claims you encounter — there are many circulating — and be especially wary of those not approved by the FDA.

Gabriel Sciallis, M.D., Dermatology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment for Hair Loss
Appointment Information
More Information on Hair Loss

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.