Autumn Sees More Women With Bunion Problems

(HealthDay News) -- With the transition from summer to fall, doctors note an increase in bunions among their female patients, according to the American College of Foot and Ankle Surgeons.

Experts say this may have to do with the transition from open-toed shoes and sandals to winter footwear.

In the summer, "like everybody else, I like to wear flip-flop sandals, open-toed shoes, a nice pedicure with good nail polish," Elaine Power, a 49-year-old South Carolina hospice nurse who has bunions, said in an ACFAS news release.

But, when fall arrives, Powers and many others begin wearing closed-in shoe styles, which can be painful.

"Even after you take your shoes off, or put your feet up, it's just a throbbing. It's almost like every time your heart beats, the bunion throbs," Powers said.

In addition to changes in footwear, Dr. Karl Collins, a foot and ankle surgeon in St. Louis, said there may be two other reasons for the annual trend of more women with bunion problems.

First, women are closer to meeting their insurance deductibles at the end of the year. Second, people are more active in the summer and may be waiting until fall to address their foot problems.

"People are very active in the summer," Collins said in the news release. "They're always outdoors, they're always at the pool or whatever, so they will decide to get their bunion fixed in the winter, because in their mind, they're not missing anything fun."

Many people with bunions do not experience any pain. But for those who do, shoe changes, foam- or gel-filled shoe padding, orthotics, anti-inflammatory medications, and injections for bursitis, nerve irritation, or joint irritation may be prescribed to address the pain.

As for shoe changes, avoiding high heels and styles that crowd the toes together can help. Also, shoes can be adjusted to better fit the foot.

"If they have a shoe that fits well everywhere else, but there's just a little bit of irritation in one spot, we may recommend that they have the shoe modified" by a shoe repair shop, Collins said.

While shoe adjustment and other techniques may be able to help relieve pain, only surgery can truly correct a bunion, according to the college news release.

More information
The American College of Foot and Ankle Surgeons has more about bunions.

Oregon's Assisted Suicide Law May Overlook Depressed Patients

(HealthDay News) -- Oregon's physician-assisted suicide law may not adequately protect the one in four terminally ill patients with clinical depression , a new study says.

The Death with Dignity Act was passed by the state in 1997, and there's been intense debate about the extent to which potentially treatable psychiatric disorders may influence a patient's decision to hasten death, according to a news release about the study, published online Oct. 8 by the British Medical Journal.

The act does contain several safeguards to ensure patients are competent to make the decision to end their life, including referral to a psychologist or psychiatrist, if there's concern that a mental illness may be impairing a patient's judgment. However, depression is often overlooked in mentally ill patients.

In 2007, none of the 46 people in Oregon who used physician-assisted suicide were evaluated by a psychologist or psychiatrist, the news release said.

For the new study, researchers at Oregon Health and Sciences University checked for depression or anxiety in 58 terminally ill patients who'd requested physician-assisted suicide or had contacted an assisted death organization. Fifteen of the patients met the criteria for depression and 13 for anxiety.

By the end of the study, 42 patients had died. Of those, 18 received a prescription for a lethal medication, and nine died by lethal ingestion. Of those who received a prescription for a lethal medication, three met the criteria for depression. All three died by lethal ingestion within two months of being assessed by researchers.

While most patients who request physician-assisted suicide do not have a depressive disorder, the study authors suggested that "the current practice of Death with Dignity Act may not adequately protect all mentally ill patients." The authors called for "increased vigilance and systematic examination for depression among patients who may access legalized aid in dying."

While it's important to protect vulnerable patients, it can be difficult to determine if depression is impairing the judgment of terminally ill patients, Dr. Marije van der Lee, of the Helen Dowling Institute in the Netherlands, wrote in an accompanying editorial.

Depression doesn't necessarily impair judgment, van der Lee said. "We should focus on trying to 'protect' patients from becoming depressed in the first place, rather than focus on protecting patients from assisted suicide," she wrote.

More information
The U.S. National Cancer Institute has information about end-of-life issues.

Obesity, Insulin Level Impact Prostate Cancer Survival

(HealthDay News) -- Men who are overweight and who have high insulin levels when they are diagnosed with prostate cancer may be more likely to die from the disease, research shows.

This striking finding, published early online and expected to be in the November issue of The Lancet Oncology, is yet more reason to continue fighting the battle of the bulge, experts say.

"I don't want to be sensationalist, but obesity effects and the insulin effects are so big that I think if you had to choose between being thin and having a low insulin level or having access to the best chemotherapy, you would be more likely to survive without chemotherapy," said study senior author Dr. Michael Pollak, professor of oncology at McGill University in Montreal, Quebec, Canada.

"Tens of thousands of men are taking chemotherapy for prostate cancer -- as they should, because it is a good treatment. Doing so is actually helping," he said. "But potentially, dealing with insulin, obesity may one day be of more benefit."

The findings also have scientific import, giving researchers a clue that could lead to new prevention and treatment strategies.

Experts have long known that androgens, or male hormones, play a critical role in spurring prostate cancer.

In fact, these cancers are often treated with approaches that deprive the tumors of testosterone.

Smaller reports have suggested that obese patients with prostate cancer have a worse prognosis than patients of regular weight, though weight hasn't been related to actually developing a malignancy.

"We found in a large sample that obesity has a very important influence on prostate cancer outcome," Pollak said. "Then the question becomes, why would obesity make the outcome worse?"

Pollak and his colleagues looked at information on more than 2,500 men who had been followed for 24 years as part of the Physicians' Health Study. Information on body mass index (BMI) was available for all of these men, while information on C-peptide concentration (a marker of insulin levels in the blood) was available for 827 men.

Overweight men (those with a BMI of 25 to 29) had a 47 percent higher risk of dying from prostate cancer, while obese men (BMI of 30 or over) were more than two-and-a-half times more likely to die of the disease, compared with men of healthy weight (BMI under 25).

Men with the highest C-peptide concentrations also had more than double the risk of dying from their cancer compared with men with the lowest levels, the study found.

Finally, men who had a BMI of more than 25 and high C-peptide concentrations had quadruple the risk of dying from their cancer compared with men who had lower BMIs and lower C-peptide levels, the researchers reported.

"This suggests that there may be a whole new story to tell, whereby not just androgens have something to do with cancer behavior, but also insulin," Pollak said.

The insulin hormone may be latching onto insulin receptors located on prostate cancer cells, he speculated.

Some pharmaceutical companies are already testing drug candidates that target insulin signaling, Pollak added.

And the findings could have broader implications for other cancers, said study lead author Dr. Jing Ma, of Harvard University's Channing Laboratory.

"The simple things are still the important things. Don't drink, don't smoke, exercise, and eat well," said Dr. Ganesh Palapattu, assistant professor of urology, pathology and oncology at the University of Rochester School of Medicine. "This is yet another piece of evidence suggesting that obesity is not a good thing for many reasons."

"Obesity is the second leading cause of cancer death in this country next to tobacco," emphasized Dr. Jay Brooks, chief of hematology/oncology at Ochsner Health System in Baton Rouge, La. "Two years ago, I would never have told my patients that obesity is increasing their risk of death from cancer. Today, I do."

More information
There's more on prostate cancer at the U.S. National Cancer Institute.