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Approximately 150 million people worldwide have diabetes. Individuals that possess the highest risk include African-Americans, Hispanics, Native Americans, Pacific Islanders, and East Indians.

Diabetes type 2 causes vague symptoms such as excessive thirst and urination, blurry vision and fatigue. Since most patients do not feel pain, they do not seek medical attention and the disease can go undiagnosed for up to 10 years. While the disease progresses unnoticed however, eye, kidney, and nerve damage develops insidiously. By the time diabetes is discovered, irreversible organ destruction has already begun. Thus, the most important weapon we have against diabetes is awareness and prevention.

A fasting blood sugar of greater than 126 establishes the diagnosis of diabetes. However, if this value is less than 126, but greater than 110, an individual has what we call "impaired fasting glucose." Similarly, someone with normal fasting blood sugars, but elevated levels after eating (greater than 140) has "impaired glucose tolerance." Unfortunately, like diabetes, both "impaired fasting glucose" and "impaired glucose tolerance" can cause an increased risk of hear attacks and strokes.

To ensure that one does not develop the consequences of diabetes, we must remain aware and vigilant of the disease. As such, all individuals with a family history of diabetes and those in high-risk ethnic populations should seek yearly diabetes screening. Lifestyle changes including eating a balanced diet and daily exercise should be of utmost priority to prevent its onset.

Galdys F. Palomeno, M.D., Endocrinology & Metabolism
Diplomate, American Board of Internal Medicine
Member, South Bay Independent Physicians Medical Group, Inc.

Since there is no fool-proof way of predicting whether or not a polyp is or will become malignant, total removal of all polyps is advised. The vast majority of polyps can be removed by snaring them with a wire loop passed through the instrument. Simply touching them with a coagulating electrical current can destroy small polyps.

Most colon examinations using the flexible colonoscope, including polyp removal, can be performed on an outpatient basis with minimal discomfort. Large polyps may require more than one treatment for complete removal. Some polyps because of their size or position, cannot be removed with instruments; surgery is then required.

Stuart R. Grant, M.D., F.A.C.S., F.A.S.C.R.S.
Diplomate, American Board of Colon & Rectal Surgery
Member, South Bay Independent Physicians Medical Group, Inc.
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However, it is very difficult to watch TV or read magazines and not believe in miraculous results. In medicine, the proper diagnosis leads to the appropriate treatment. Hence, if you notice jowls or sagging neckline, weakness of deeper support tissues of the face and neck is the cause. Only a repair of those muscles and tissues via a surgical facelift will resolve problems.

Recent results with non-surgical tightening of muscles utilizing radio-frequency devices or certain lasers have been short-term and disappointing. However, "MicroLasser Peel" can be used effectively to solve problems with fine lines, large pores and age spots. This technique links multiple minimally invasive treatments with minimal downtime to achieve results similar to older aggressive lasers without complications and lengthy recovery. With all these choices, seek consultation with an expert knowledgeable in all options so the proper therapy is instituted.

Harold J. Kaplan, M.D., FACS Diplomate,
American Board of Facial Plastic Surgeons Member,
South Bay Independent Physicians Medical Group, Inc

My 29-year-old daughter has had Narcolepsy for 10 years. Is there anything new about this condition?

Yes. Narcolepsy is a condition that causes severe sleepiness and may also be accompanied by sudden episodes of weakness lasting a few minutes, often during periods of emotion such as surprise or laughter. There are two new developments in understanding narcolepsy. The first is the recent finding that genetic abnormalities in some animals can produce a condition that greatly resembles human narcolepsy. A gene called the Orexin-hypocretin gene can be experimentally deleted from the DNA of a mouse; this results in the mouse having episodes of loss of muscle activity and sleep attacks that mimic the cataplexy and sleep attacks experienced by a person with narcolepsy. This animal condition has been called the "Orexin-hypocretin knock-out" mouse, because the gene is knocked out or deleted. Whether human narcoleptics actually have the specific defect of the Orexin-hypocretin knockout mouse is being studied at several research centers. Such studies may lead to a better understanding of why and how humans develop narcolepsy.

The second development is the 1999 approval by the U.S. Food and Drug Administration (FDA) of a new medication, Modafinil, specifically for the treatment of patients with narcolepsy. Modafinil is the first new medication for this condition in over 50 years. Modafinil has the advantage over the older amphetamine-type stimulants of not being habit-forming or addictive, not causing the feeling of "speeding" and not producing high blood pressure or sweating. Almost all my patients with narcolepsy who have switched from amphetamine and Ritalin to Modafinil prefer it to the older medications.

Recently the FDA approved Xyrem (gamma-hydroxy butyrate or GHB) for the treatment of narcolepsy. This is taken at bedtime and after four hours of sleep in order to counter act the fragmented sleep that narcoleptics often experience.

Lawrence W. Kneisley, M.D.
Diplomate, American Board of Sleep Medicine
Member, South Bay Independent Physicians Medical Group, Inc.

Mittleman article

My twelve-year-old son has had plantars warts on both feet for some time. We have tried several over the counter remedies without success. Someone said they are caused by a virus, what can we do about it?

Plantars warts are common in adolescents and are caused by the human papiloma virus. This is similar to the virus that causes the common cold. They often appear as a thick painful callous growth on the sole and will frequently appear in different locations on both feet. Treatment for warts can be frustrating because they may be stubborn to resolve. Most current treatments employ the destruction of the wart tissue by use of chemical, freezing, or burning methods. There has been a lot of talk in the news about the treatment of warts with "duct" tape, but this alone does not appear to be effective.

There are many treatments that we employ in our practice for these stubborn viral growths. Most smaller warts can be resolved with local treatment with an agent called "Canthardin" which is a vesicant, causing a local irritation of the skin and blister formation around the warts. The warts "die" within the blister and are easily shaved away on a follow up visit. Many warts are resolved with on or two simple treatments of this chemical.

We also employ the use of an oral medication, Cimetidine (trade name Tagamet) this medication is known to help in stomach problems, but also is very effective at irradiating warts in children and adolescents by its action on histamine release. In recalcitrant cases we use the CO-2 (Carbon Dioxide) Laser which can be used to selectively destroy the wart tissue with minimal scarring of surrounding skin. There are other new and older agents available for wart treatment including Aldara cream, Bleomycin injections, and the old stand by Salicylic Acid, which is in most over the counter wart remedies. In summary, most warts respond to treatment, but it can take a variety of methods to resolve an individual case.

Marc G. Mittleman, D.P.M. Diplomate,
American Board of Podiatric Surgery Fellow,
American College of Foot and Ankle Surgery Member,
South Bay Independent Physicians Medical Group, Inc