Yoga for Occasional Constipation

by Beth

Nervous People Eating By Ernst Ludwig Kirchner

Fortunately for me, my digestive health takes after my mother’s, daily bowel movements first thing in the morning, every morning. This remained true for her until she passed at the age of 102. It is still true for me but occasionally it isn’t. When my son was a baby, the stress of being a wife, a new mom, and a “working girl” did throw things off balance from time to time. Missing a day or two raised the yellow flag of caution, but when one or two days became three or more the red flag of alarm and discomfort flew high and stayed there until the situation resolved itself or I resolved it by taking a laxative.

After I began practicing yoga and understood more about the interrelationship of digestion, stress, and overall health (see Why You Should Care About Your Digestive System), I began to pay closer attention to my occasional bouts of constipation and wanted to find a yogic way of dealing with them instead of taking laxatives. Today I’m going to share with you what I’ve learned.

But first let me distinguish between occasional and chronic constipation. According to the Mayo Clinic, constipation is generally defined as having fewer than three bowel movements a week. Occasional constipation is very common but chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer and may require medical attention.

Now, in a nutshell, here is what I learned about the relationship between stress, overall health, and digestion: 

• Our emotional reactions and our digestive systems are linked. Our intestines are lined with smooth muscle coated in mucus, rich in neuropeptide receptors (protein-like molecules that influence the brain and the body in specific ways). When we are under stress these mucus secretions in the digestive system are reduced, reducing our capacity to eliminate. 
• Stress can cause a contraction of the smooth muscles of the digestive system and shunt needed blood from the digestive system to the extremities to prepare the body to fight, flee, or freeze. 
• The body will do this in light of good stress, bad stress, severe danger (“Lions, tigers and bears, oh, my!”) or everyday situations (work or relationship stress, holidays, or a stalled car). 
• Research is finding that the stress associated with unprocessed negative emotions can inhibit the natural digestive process. We have language that illustrates this relationship between digestion and stress, including “gut wrenching,” “nervous stomach,” and ‘gut reaction.” 
• Ayurveda, the sister science of yoga and the oldest known medical system in the world, teaches that health and well being depend upon our ability to digest everything we take in. This includes not only food and drink, but also our experiences, emotions, and the impressions we take in via our five senses. Agni is the Sanskrit term for the “digestive fire” that breaks down food and other things we ingest from the environment, assimilating what is useful, and eliminating the rest. 
• Yoga can play a major role in helping us promote and strengthen the health of our digestive system. The overall approach to choosing yoga tools for healthy digestion has two primary goals: 1) stress reduction through movement and meditation and 2) strengthening the ability to witness and digest (accept, adapt, or change) situations and habits that may contribute to our personal stress response patterns. 

In terms of my ability to witness and digest, now that I have no K.P.P.P. (Kids, Partners, Pets, or Plants) at home, I realized that my current bouts of constipation occur most often during the holidays. Given the major changes in my daily routine at this time, it not surprising. Social gatherings of family and friends (functional and dysfunctional), changes in diet (more sugar, alcohol, fat, and carbs), decrease in exercise (the gym is closed, I’m too tired, my to-do list is too long, etc.), shopping (crowded malls and loud music), and travel (driving in traffic or dealing crowded airports and long security lines). 

So I now practice yoga tools that help me prevent or shorten my occasional bouts of constipation, and I am happy to share them with you. Caution: If you suffer from chronic constipation, please consult your doctor or medical practitioner first.  

Seated Spinal Rotations 

This asana enhances digestive fire by increasing heat and compression, massages the internal organs, and increases peristaltic motion in the intestines. Contraindication: diarrhea. 

I’ve been teaching this technique to my students for year and after trying it on their own, they say things like:

• “Did you hear toilets flushing all over town after last night’s class?” (this one is my favorite) 
• “I’ve been blocked for days. Thank you!”
• “It really works.” 

Instructions: 

1. Sit in a comfortable position on the floor or in a chair with your spine comfortably aligned. 
2. With your hands on the knees or thighs, begin rotating your torso in circles. You can imagine that you are drawing circles on the ceiling with the top of your head. Your circles can small and tight or large and easy. Let your breath come and go naturally and pick a pace that feels comfortable for you: slow medium or fast. 
3. Continue for 3 minutes in one direction and 3 minutes in the opposite direction. 
4. Rest for a few rounds of breath before getting up. 
5. Repeat one or two times during the day if needed.

Hakini Mudra and Affirmation 

This technique helps you set a positive intention for a healthy lifestyle and witnessing; puts a focus on releasing negative emotions and managing stress. The mudra and affirmation can be practiced separately or together. The quality realized here is balance and integration, excellent goals to work toward when dealing with occasional constipation. Contraindications: none. 

Affirmation: “I take in and take on only what I can digest.” 

Hakini Mudra Instructions: 

1. Sit with your spine comfortably aligned, and soften your chest and shoulders. 
2. Hold your hands facing each other a few inches away from your solar plexus. 
3. Touch the tips of the fingers and thumb of your left hand to the corresponding fingers and thumb of your right hand, and create space between your hands as though you are holding a ball. Relax your hands in your lap, with the pinky sides of your hands, your wrists, and your forearms on your thighs or in your lap. 
4. Close your eyes, or keep them slightly open and gaze down at the floor.
5. Hold the mudra and sit quietly for 2 - 5 minutes as long as you are comfortable, focusing on your natural breathing process. 
6. If you are combining the mudra with the affirmation, repeat the affirmation silently or out loud for a long as you are comfortable. 
7. When you are ready, release the mudra and stretch your body in any way that your body needs to stretch.

 For more information about mudras, affirmations and their uses, I recommend Mudras for Healing and Transformation by Joseph & Lilian LePage.

General Awareness 

One key to managing occasional bouts of constipation is the ability to consciously: 

• Recognize when you are stressed. 
• Understand what the stressors are, for example, food choices, work, relationship, or environment.
• Choose the right response instead of the wrong habitual reaction.

That’s my yoga groove for a smooth move. Here’s hoping you find yours!

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How to select a healthy diet plan for grade 1 fatty liver illness

By Charles Rodriguez

Grade 1 fatty liver If neglected, the surplus building up of fat can injure your liver. That explains why an efficient diet plan is excellent for grade 1 fatty liver condition the diet method should includes foods that can help improve your liver conditions and make you healthy. Among the most simple ways to reverse grade 1 fatty liver illness is eating a well balanced liver diet.

As you possibly know, grade 1 fatty liver is due to excessive blubber increase in your liver. Throughout the early phases grade 1 fatty liver sickness routinely has no signs. It is frequently found on a constant clinical test.

Many individuals don't directly feel the symptoms of grade 1 fatty liver you want to comprehend that too much fat buildup in your liver causes inflammation and swelling. That's when you start spotting the symptoms.

You can feel a burning pain or leaden ache, in your abdomen as your liver becomes inflamed and irritated. Swelling and swelling implies when grade 1 fatty liver is starting to become worse.

You could similarly experience other symptoms such as low grade fevers revulsion, and typically feeling worn out and fatigue.

Before Starting Your Liver Diet Plan For Grade 1 Fatty Liver.

It's highly important to understand how the liver of somebody plays a duty in our well-ness and wellbeing. The human liver has one or two functions like blood circulation and detoxification.

Our liver aids emulsify fat by breaking down massive fat globules into smaller sized ones, which are then broken down in addition by enzymes. Your liver helps and maintain your blood sugar level in your body. It similarly filters out compounds and excretes the poisons in your piss. Finally your liver helps process the proteins and fats in the foodstuffs you eat.

Therefore , it's mandatory to remember that the sort of diet plan we eat as humans is the main aspect in grade 1 fatty liver condition. It's the secret to damaging or healing your liver.

Not so long ago, having a grade 1 fatty liver disease was thought on the point of being harmless, and progressed into a harsh wellbeing issue and life threatening condition. Nonetheless, many people have this illness and experienced issues like fibrosis and hepatitis. In one or two cases, these issues have become a unsafe condition that influence our wellness as people.

Supplements For Grade 1 Fatty Liver Additions.

There is a supplements called Omega-3 it's been study by health institutes that these omega 3 additions can avoid a range of nourishment related conditions like grade 1 fatty liver and cardio illness or adhd. Current studies disclose that fish oil can likewise ease grade 1 fatty liver condition which troubles a significant range of people who fight with non-alcoholic fatty liver condition. Grade 1 fatty liver disorder is not caused by excess alcohol use, though it's not unusual for alcohol drinkers to experience this illness. Rather, non-fatty liver condition is hooked up to a high level of triglycerides and low amounts of omega-3 fat in the diet.

About the Author:

My name is charles Rodriguez I've been helping folk naturally reverse their fatty infiltration of liver for over 10 years. In that time i have gained a huge quantity of knowledge on the subject of the most highly effective strategy for remedying simple enlarged liver symptoms . As a proponent of natural health and well-being, it's my goal to help anyone who would like to permanently reverse their fatty liver problem.

Treatment for eye floaters

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Surgical Cosmetics for Men

It did not used to be so important for men to stay looking young. Often, men gained a distinguished appearance with age. A few wrinkles, a touch of gray hair, and a stern brow can help men to look more masculine. These days however, it's even more important for men to stay professional and competitive by looking younger to remain attractive. This is partly why men's plastic surgery is gaining popularity. In fact, men are becoming more and more likely to opt for image-enhancing surgical procedures, and there's a widely-expanding market for male cosmetic surgeries.

The popularity of cosmetic surgery has been rapidly rising. As new options are developed and available techniques are refined, cosmetic surgical procedures are becoming more common. Male cosmetic surgery is still one aspect of cosmetic surgery about which little is understood by the public, despite the fact that what was once taboo is becoming the social norm. More and more men are undergoing their own cosmetic surgical procedures, although it is typically thought of as being the exclusive domain of women. Many of the false notions men have come from a lack of information on what conditions are treatable with cosmetic surgery. But it's more common for modern men take pride in doing all they can to look their best, and the new trend in male cosmetic surgery is providing an answer for many men seeking to improve their appearance through cosmetic surgery.

Cosmetic surgery for men is a much different procedure than cosmetic surgery for women. Male bodies have unique aspects, particularly in the nose, face, chest and abdomen, and unique cosmetic surgery procedures are available to improve men's appearances and restore self-confidence in all of these areas.

Many studies suggest that more men also seek to emulate the internalized media ideals of beauty. For example, one study has shown that 84% of college-aged men expressed some level of body dissatisfaction, compared to 69% of their adult counterparts.

Any cosmetic surgery involves some risks. To have the best experience possible, it is crucial that you make your decision to undergo cosmetic surgery with realistic expectations and a full understanding of the procedure itself. It often cannot easily be undone, so take some time to make this decision.

In the end, it is obvious that cosmetic surgery is not just for women now. It has become not only acceptable but increasingly popular for men to regain their youth through surgical procedures like the ones listed above, in a society that primarily judges on appearance and demands perfection. In fact, the main question is no longer "Should I get cosmetic surgery?" but instead "Which cosmetic surgery is best for me?"

About the Author:

By Stina Delance

See lose weight with hcg here. Or visit our www.serenityrejuvenationcenter.com specials.

Multi vitamin Supplements They are really necessary for Perfect Wellbeing

By Brian Hing

Vitamin supplements: you simply can't live without all of them, that's for sure. The question, after that, will be: exactly where can you buy them via? Within the classic days' (which may have experienced your own grandparent's technology, however possibly significantly more again) we have the vitamin supplements and also other diet through totally natural sources: sunlight, the lake we all sipped, and also the foodstuff we consumed.

Currently, and this is not a secret, our foods and whatever we beverage, just does not group exactly the same punch because it does in the ancient days and nights. Many reasons exist for this, i don't wish to publish any dissertation about it. But, for instance, many of us obtain each of our food through dirt it's not as abundant since it had been. And also the a lot of chemical compounds which can be utilized on most of the food we have been prone to eat might diminish the diet a little more forward, or otherwise add some needless toxins to the eating habits. Also it usually arises from far away where we reside, therefore it could possibly have misplaced even more of their dietary content material on how below.

Therefore, just what don't let carry out? Well, 1 common approach is usually to consider vitamin supplements. This see offers both backers as well as detractors.

Just lately, according to the San Antonio Periods, 1 ex- detractor on this tactic has changed its perspective.

They will observe that your AMA is advising most grownups to consider at least one multi-vitamin every day -- the reversal of their long-standing anti-vitamin policy.

Their plan is different it seems like, due to advancements within analysis about the results of vitamins. That currently seems that individuals which find enough nutritional vitamins have a decrease chance of several common chronic illnesses such as cancer, coronary disease as well as weakening of bones.

Maybe their particular adjust associated with view will be reflecting that relating to the particular United States community. As an illustration, 2 decades back your AMA simply prompted nutritional vitamins pertaining to women that are pregnant and people who are chronically ill.

I recall, while i was younger, there ended up some multi-vitamins available on the market and a few additional nutritional and vitamins and minerals furthermore, nonetheless they were not your own widespread fare. And when I began planning to health food stores, I came across a whole barrage associated with unusual supplements that will I might never been aware of inside chemistry and biology courses.

However, for instance, the value of folate in protecting against several birth disorders and also heart problems is actually identified.

The person been aware of folate 20 or even Thirty years in the past?

Of course it's not only that food has much less nourishment these days, but in addition that we're not too alert to looking after with regards to your own nutrition and the way it relates to wellness. The particular AMA says that practically 80 percent of Americans do not eat the actual recommended a few areas of fruits and vegetables every day to supply necessary nutrient elements.

Recommendations the situation, we need to get the nutritional supplements via anywhere. Also it looks like nutritional vitamins are actually accepted with the professionals along with doctors which should know with regards to this stuff.

Yet another thing in which professionals are being familiar with is the advised day-to-day annuities pertaining to supplements may need rethinking.

Doctor. Jeffrey Blumberg, involving Tufts University's Man Nourishment Analysis Center on Growing older declared dieticians are concerned that recommended daily considerations for a lot of vitamin supplements are extremely low. RDAs were originally established to prevent signs of vitamin-deficiency issues. Yet facts continues to grow that greater numbers of a lot of supplements are important for maximum health.

And also, as we know, in the event that these kinds of nutritional vitamins will not are derived from our foods, we'd like all of them through someplace, for example nutritional vitamin supplements.

Dr. Robert Fletcher involving Harvard University or college agrees. He or she reflects that lots of people thought basically we had been maturing that a sensible diet plan might take care of our own supplement requires. However, he admits that, the brand new evidence is that vitamins also avoid the normal ailments many of us take care of daily, (including) coronary disease, cancer malignancy, weak bones along with delivery disorders.

Even so, authorities, and others of us with wise practice, keep in mind that nutritional vitamins can be a dietary supplement to our eating plans. They do not replace a well-balanced diet. So, you should eat a balance diet, however, if you want to reduce your probability of being infected with the common continual illnesses today it could even be a good idea to include a great multi-vitamin supplement in your diet.

About the Author:

Brian Hing specializes in the world of sports activities diet, is really a partner regarding quamtrax and all sorts of goods on this label of athletics health supplements.

Practicing Yoga for Depression An Overview

by Nina

Morning Glory by Hiroshige

Last week in my post Can You Guide Me Online?, I promised I would write something about how to use yoga for depression. And today’s the day! But because I’ve already written several posts about depression over the years, I decided that today I’d just provide overview of the topic, with links to relevant posts from the past. And because I feel that it’s beneficial to take your time to understand your particular situation and needs rather than just jumping into practice, I’m going to recommend approaching practicing yoga for depression in a series of steps. 

1. Start by determining whether you have tamasic (clinical) or rajasic (agitated) depression. Read Tamasic and Rajasic Depression. If you can’t decide based on this post (though I hope you can!), discuss it with your doctor, therapist, or health care provider. These two forms of depression are very different, so you’ll probably find that different poses and practices will help you. While everyone with depression needs some uplifting, people with tamasic depression may benefit from energizing poses and practices while people with rajasic depression may need calming poses and practices. My post discusses why and makes some suggestions.
2. Learn as much as you can about depression and also about your nervous system because having a deeper understanding about your body and your condition will help you learn more about what is going to help you. See Learning About Yoga for Depression for some ideas.
3. Practice stress management. Because stress can cause and/or exacerbate depression, I recommend incorporating stress management practices into your daily life. See Stress Management for When You're Stressed. Experiment with different techniques to see what works best for you, and practice whatever you find effective or just prefer. If you don’t already have a strong meditation practice that doesn’t cause you to brood or you aren’t working with a teacher who is experienced at teaching people with depression, it may be wise to skip meditation practice for now because being alone with your thoughts can cause a downward spiral in some people. 
4. Learn about the emotional effects that poses and breath practices have on you. See Balancing Your Emotional Body with Counter-Poses to get a general idea of how poses typically affect practitioners and Balancing Your Emotions with Your Breath for information on breath practices, but keep in mind that your own experience is key, even if your personal experience seems to contradict what I or any other teacher says.
5. Using your knowledge of what makes you feel better, either on your own or with help from your teacher, combine these poses and practices into sequences that uplift you, energize you, or calm you as needed and practice them. You can just use these on an as-needed basis, or you can practice them regularly during bad periods. 
6. Don’t do what makes you feel worse, even if someone tells you it should make you feel better. See When Relaxing Isn’t Relaxing for some alternatives to poses and practices that may not be not be working for you. 
7. If you are combining yoga with other forms of treatment for depression, please try to let go of any shame about that. Shame about needing more than just yoga can be generated internally (see Yoga is a great thing but...) or even externally (see No Shame Please! (Western Medicine and Yoga Are Complementary)). But these negative judgments are not helpful for your healing. Try instead to cultivate gratitude for whatever is helping (that’s what I’ve done) or use the technique of cultivating the opposite. See It's not finding gratitude that matters; it is remembering to look for it in the first place. and Transforming Unhelpful Core Beliefs.

Please let me know if any of these recommends help you. And if any of you have experiences or recommendations you’d like to share with others, please tell me! 

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OCD A Guide for the Newly Diagnosed Review of Michael Tompkins Book for Consumers

When New Harbinger Publications asked if I would consider reviewing Michael Tompkins book, OCD: A Guide for the Newly Diagnosed, I was heartened to know that there was a new book on this topic. The introduction is by Jeff Bell, who wrote an insightful memoir about OCD called Rewind, Replay Repeat, which I took to be a good sign.

The book fits nicely in the hand, and adds to the approachability for those who have just found out they have OCD. Actually, Tompkins starts with describing the process of getting a diagnosis, and I'm glad he addressed the difficulty of finding mental health professionals who are actually familiar with the many forms OCD can take. I would argue that the comprehensive diagnostic process described in this book really only happens with therapists who are specialists in OCD, or who have trained in Exposure Therapy, and have treated a lot of people with OCD. The therapist who diagnosed me basically said, yes, it sounds like you have OCD.

Tompkins does an overview of Exposure and Response Prevention Therapy(ERP), Cognitive Therapy, and medication as well as other treatments, as well as what questions to ask a potential therapist, and how to get the most out of sessions.

I particularly liked the chapter on developing a "Recovery Attitude" including accepting such things as uncertainty, imperfect outcomes, imperfect knowledge, learning to approach discomfort in order to get through to the other side, turning away from debate with your OCD, seeking support, not reassurance, and practicing everyday. As someone who has struggled with perfectionistic OCD, I constantly battled with the fear that I wasn't doing my treatment perfectly or that I didn't have perfect knowledge of my OCD. Tompkins points out that "good enough" treatment is indeed "good enough," and OCD is demanding perfection that doesn't exist.

The book closes with information about unhealthy coping, school and work issues, a list of treatment centers, and recommended reading. It's difficult to fit everything into an introductory book, an at times I wanted more detail, or found too much squeezed into a section, but overall this book would be an excellent addition to a public library's mental health collection, as well as college libraries and hospital consumer health libraries.

Michael Tompkins, PhD, is a licensed psychologist at the San Francisco Bay Area Center for Cognitive Therapy.

Avastin Lucentis Update 45 Avastin Drug Treatment for ROP Better than Laser

A new study, published earlier this month in the New England Journal of Medicine, describes the use of intravitreal Avastin to treat Retinopathy of Prematurity (ROP) in premature infants.

This study was widely covered by the press, but I would like to reproduce just a few of the presentations to provide you with the information necessary to best understand the results of this study.

Quick Summary:

A quick summary of the study was reported by Review of Ophthalmology, Retina Online.

Treatment of ROP with IVB

A prospective, controlled, randomized, stratified, multicenter trial was conducted to assess intravitreal bevacizumab (IVB) monotherapy for zone I or zone II posterior stage 3+ (i.e., stage 3 with plus disease) retinopathy of prematurity (ROP).

Infants were randomly assigned to receive IVB (0.625 mg in 0.025 ml of solution) or conventional laser therapy, bilaterally, and the primary ocular outcome was recurrence of retinopathy of prematurity in one or both eyes requiring retreatment before 54 weeks' postmenstrual age.

A total of 150 infants (300 eyes) were enrolled; 143 infants survived to 54 weeks' postmenstrual age, and the 7 infants who died were not included in the primary-outcome analyses. It was noted that ROP recurred in 4 infants in the bevacizumab group (6 of 140 eyes [4%]) and 19 infants in the laser-therapy group (32 of 146 eyes [22%], p=0.002). A significant treatment effect was found for zone I ROP (p=0.003) but not for zone II disease (p=0.27).

IVB monotherapy, as compared with conventional laser therapy, in infants with stage 3+ ROP showed a significant benefit for zone I but not zone II disease. Futhermore, development of peripheral retinal vessels continued after treatment with IVB, but conventional laser therapy led to permanent destruction of the peripheral retina. This trial was too small to assess safety.

Source: Mintz-Hittner HA, Kennedy KA, Chuang AZ; for the BEAT-ROP Cooperative Group. Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. N Engl J Med 2011;364(7):603-615.

In addition, Retina Online also provided a discussion of the accompanying editorial from the NEJM:

Bevacizumab and ROP: Editorial

This editorial discusses the use of bevacizumab in the treatment of retinopathy of prematurity (ROP), with particular focus on the study above by Mintz-Hittner and colleagues, which compares intravitreal bevacizumab (IVB) to conventional laser therapy. It points out that in comparing IVB to an effective, established treatment, there are three concerns: efficacy, safety and practicality and that with regard to the Mintz-Hittner, et al. study, as compared with conventional laser therapy in treating patients with zone I ROP, IVB represents a true breakthrough in disease management.

The editorial also notes that the safety of therapy for ROP involves not only the eye, but also potentially profound systemic issues. Bearing in mind the pharmacokinetics of bevacizumab, the extensive experience with adults taking this drug and the study by Mintz-Hittner and colleagues, it seems reasonable to assume that IVB is safe; however, continued vigilance will be important as use of the drug continues. With respect to ocular health with the use of IVB, the editorial mentions that timing of the injection is critical, as injection too early in the disease process may interfere with necessary retinal vascularization and injection too late may accelerate the cicatricial phase of ROP and lead to early retinal detachment.

In light of previous work and its confirmation in a robust clinical trial, the use of IVB as monotherapy is superior to laser therapy in treating zone I ROP and is possibly superior in treating posterior zone II disease, the editorial concludes. The author goes on to speculate that IVB therapy will prove to be at least equal to laser therapy in clinical effectiveness for most forms of ROP and that, as our experience with the drug grows, its indications and relative contraindications will be refined. In the meantime, IVB should become the treatment of choice for zone I ROP.

Source: Reynolds JD. Bevacizumab for retinopathy of prematurity. N Engl J Med 2011;364(7):677-678.

However, the most complete coverage of the study results were reproduced in Medical News Today, and was the work of a representative of the University of Texas Health Science Center at Houston, Meredith Raine, where the study took place.

Medical News Today

In Treating A Leading Cause Of Childhood Blindness, Drug Therapy Shows Significant Benefit
18 Feb 2011 

A readily available, inexpensive drug therapy showed a significant benefit in treating premature infants with the worst and historically most difficult-to-treat cases of retinopathy of prematurity.

The results of a multicenter clinical trial led by researchers at The University of Texas Health Science Center at Houston (UTHealth) are published in the Feb. 17 issue of The New England Journal of Medicine.

Retinopathy of prematurity is a leading cause of childhood blindness worldwide. In the immature retina of babies born before 30 weeks' gestational age, the disease results in disorganized growth of retinal blood vessels, which can lead to scarring and retinal detachment.

In this study, Helen A. Mintz-Hittner, M.D., the Alfred W. Lasher, III, Professor in the Department of Ophthalmology and Visual Science at the UTHealth Medical School, and colleagues compared the use of intravitreal bevacizumab, an anti-vascular endothelial growth factor, to conventional laser treatment.

The study investigators treated infants with acute retinopathy of prematurity affecting zone I and posterior zone II - the retinal zones with the highest rate of treatment failure.

Data on the outcomes of 143 infants enrolled in the study showed that, among infants with zone I disease, the recurrence rate was 6 percent with intravitreal bevacizumab and 42 percent with conventional laser therapy. The drug therapy resulted in mild anatomical retinal abnormality in just one eye of 31 infants, whereas conventional laser treatment resulted in a mild structural abnormality in 16 eyes and severe abnormality in two eyes of 33 infants.

"When I started working with babies almost 40 years ago, there was nothing we could do for those with retinopathy of prematurity," said Mintz-Hittner, the study's principal investigator. "We've gone from nothing to a real solution. It you are careful and administer this therapy appropriately in stage 3+, you can get wonderful outcomes."

Mintz-Hittner, an attending physician at Children's Memorial Hermann Hospital and the Robert Cizik Eye Clinic, stressed that timing is critical with this drug therapy. If administered too early, in stages 1 and 2 of the disease, it can cause retinal dystrophy. Given too late, in stages 4-5 of the disease, the drug can accelerate retina detachment.

"In that window, as the abnormal vessels begin to proliferate but before the retinal begins to detach, that's when you want to treat," Mintz-Hittner said.

In addition to the significantly reduced recurrence rate for patients with retinopathy of prematurity in zone I, Mintz-Hittner said, compared with conventional laser therapy, the drug therapy appears to do the best job preserving vision. Plus, when administered, there is no need to intubate the baby and there is a faster recovery.

"Our first available treatment for babies with retinopathy of prematurity was cryotherapy," Mintz-Hittner said. "It was very painful and it wiped out all posterior ocular layers. The visual field was decreased and myopia or nearsightedness occurred. It was a long procedure - 2 to 3 hours - requiring intubation. With laser treatment, you still had to intubate, which could cause major setbacks for the baby, and field loss and myopia still occurred, but it was less painful and only destroyed the inner retinal layers."

"With this drug therapy, we use a few drops of anesthetic to numb the eye. We take a syringe with a tiny needle and administer a small amount of the drug directly into the eye. The whole process takes two to three minutes, and you begin to see results within 24 hours," she said. "The abnormal vessels virtually disappear and then normal vessels begin to grow out again. The field of vision is preserved and myopia is less."

The results of the study were so promising that Children's Memorial Hermann Hospital has discontinued the use of conventional laser therapy and now offers only the drug therapy to premature infants with this type of retinal disease.

"As compared with conventional laser therapy in treating patients with zone I retinopathy of prematurity, intravitreal bevacizumab represents a true breakthrough in disease management," James D. Reynolds, M.D., wrote in an accompanying editorial in The New England Journal of Medicine."...Intravitreal bevacizumab should become the treatment of choice for zone I retinopathy of prematurity." Reynolds is with the Department of Ophthalmology at the University of Buffalo in Buffalo, N.Y.

Compared with laser therapy, Mintz-Hittner cautioned, the drug therapy does require longer follow-up, "You must follow the child for at least 16 weeks following the injection to make sure there isn't a recurrence. Approximately 4 percent of patients (one in every 25 patients) may require a second injection. I explain to parents that it's like a cancer. It can come back and if it isn't treated in time, it can lead to blindness - so follow-up is very important."

The next steps in research, Mintz-Hittner said, will be to further evaluate the drug therapy's safety, refine the dosage and timing of follow-up and also study long-term visual function.

Notes:

Mintz-Hittner led the research with Kathleen A. Kennedy, M.D., M.P.H., the Richard Warren Mithoff Professor in Neonatal/Perinatal Medicine at UTHealth; and Alice Z. Chuang, Ph.D., the Gibson and Martha Gayle Professor in the Department of Ophthalmology and Visual Science at UTHealth.

In addition to UTHealth and Children's Memorial Hermann Hospital, other hospitals in the Houston area that participated in the clinical trial included Memorial Hermann Southwest Hospital, Clear Lake Regional Medical Center, and St. Joseph Medical Center. Other Texas hospitals were Driscoll Children's Hospital in Corpus Christi; Baylor University Medical Center in Dallas; Del Sol Medical Center, Las Palmas Medical Center and R.E. Thomason Hospital in El Paso; and Cook Children's Medical Center in Fort Worth. Other trial sites were Huntington Memorial Hospital in Pasadena, Calif.; Presbyterian-St. Luke's Hospital and Rocky Mountain Hospital for Children in Denver, Colo.; Children's Hospital of Illinois and OSF St. Francis Medical Center in Peoria, IL; and Palmetto Health Baptist Hospital and Palmetto Health Richland Hospital in Columbia, S.C.

The study, titled "Efficacy of Intravitreal Bevacizumab for Stage 3+ Retinopathy of Prematurity," was supported by grants from Research to Prevent Blindness, the National Eye Institute, the Hermann Eye Fund, research funds from the Alfred W. Lasher III Professorship and a grant from UTHealth Center for Clinical and Translational Sciences-Clinical Research Center.

Source:

Meredith Raine
University of Texas Health Science Center at Houston


And, finally, the coverage by the Wall Street Journal, which discusses why Avastin was chosen rather than Lucentis.

Drug Shows Promise For Newborn Blindness Treating Babies With Avastin Surpassed a Usual Therapy

By JENNIFER CORBETT DOOREN
Wall Street Journal, FEBRUARY 17, 2011

An inexpensive drug therapy far surpassed a conventional laser procedure in fixing a leading cause of blindness in babies born prematurely, according to a new study.

The results of the study, to be published this week in the New England Journal of Medicine, were so significant that the 15 hospitals participating in the research have stopped using lasers in favor of the drug, Avastin, which is injected into the eyes of the affected newborns. Avastin, made by Roche Holding AG's Genentech unit, is designed to be used for treating cancer, and the company doesn't promote its use for any eye conditions.

Babies born before 30 weeks of gestation have immature eyes and are at high risk of developing a condition called retinopathy of prematurity that is caused by uncontrolled growth of blood vessels in the eye. The blood-vessel growth can lead to scarring and detachment of the retina, which causes blindness.

The study's lead researcher, Helen Mintz-Hittner, an ophthalmology professor at the University of Texas Health Science Center at Houston Medical School, says retinopathy of prematurity is traditionally treated with a laser procedure that requires general anesthesia. Some babies need several treatments over time, and in most cases peripheral vision can't be saved.

Dr. Mintz-Hittner estimates there are about 3,000 to 4,000 cases of retinopathy of prematurity in the U.S. each year. The numbers are increasing as more premature babies survive.

An injection of Avastin stopped blood-vessel growth. In many cases, the drug was able to successfully treat retinopathy in premature babies with just one treatment. Babies get a small amount of anesthetic to numb the eye before being injected.

Avastin was designed to help treat cancer by choking off blood vessels to tumors, and doctors have been using it to treat some eye conditions. Genentech also markets a drug called Lucentis that's similar to Avastin and is approved by the Food and Drug Administration to treat age-related macular degeneration, which is the leading cause of blindness in older adults.

Dr. Mintz-Hittner says such a small dose of Avastin is used for premature babies that it costs about $40 to treat both eyes. A comparable dose of Lucentis would be about $2,500, she says. Avastin also is preferable to Lucentis for retinopathy in infants because of the way it's designed. Avastin is considered a large-molecule drug, so it can't easily travel outside the eye area. Dr. Mintz-Hittner said a theoretical concern with Lucentis, which is a smaller molecule, is that it might travel to other parts of the body and impact necessary blood-vessel growth in babies.

A Genentech spokesman said there's limited safety information about uses of Avastin in treating eye diseases. "We don't support or promote the off-label use of Avastin," he said, noting that Avastin is not approved for use in the eye.

About 150 premature babies were enrolled in the Houston-led study from March 2008 through August 2010. Half were randomized to receive Avastin and the other half received laser treatment. Seven babies died of causes unrelated to the eye treatments. The remaining 143 babies were followed for several weeks after their initial treatments to see if the retinopathy returned.

Overall, retinopathy recurred in four infants treated with Avastin compared with 19 infants treated with the laser, which translates into a 20% reduction in the risk of recurrence. The results were even more significant for babies with a harder-to-treat form of the disease called zone 1, in which abnormal blood vessels form at the very back of the eye. Among infants with this form of the disease, the recurrence rate was 6% with Avastin compared with 42% for laser therapy.

James D. Reynolds, an ophthalmology professor at the University of Buffalo, wrote in an accompanying editorial that Avastin should be the treatment of choice for babies with zone 1 retinopathy of prematurity.

Bradley and Kelly Henry, who had two daughters born prematurely, saw first hand the outcomes of the different treatments. Their daughter Grace was born in 2004 at 24 weeks' gestation, weighing under two pounds. She was later diagnosed with retinopathy of prematurity and had several laser treatments under Dr. Mintz-Hittner's care. Grace's left eye eventually burst after she developed glaucoma, and it had to be replaced with a glass eye. She has enough vision in the right eye to attend regular school but is considered legally blind."It's hard to watch your daughter walk into a flagpole because she can't see," Ms. Henry says.

By the time the Houston-area family's other daughter, Evelyn, was born early last year at 26 weeks' gestation, the Avastin study was under way. Evelyn wasn't enrolled but was able to receive Avastin after she was diagnosed with retinopathy.

Ms. Henry says she remembers being "elated" that Evelyn was able to receive Avastin. "I knew what the effects of laser treatment were," she says. Evelyn, now 13 months old, had just one treatment with Avastin and so far appears to be developing normally, Ms. Henry and Dr. Mintz-Hittner say.

The oldest children in the Avastin study are now nearly 3-years old and appear to be developing normally, Dr. Mintz-Hittner says, adding that so far she hasn't seen any significant side-effects from the drug. She says doctors need to be careful not to administer Avastin too early before the abnormal blood vessels fully develop, nor too late after the blood-vessel growth causes the retina to detach.