The Apple Watch and Medicine

I just tried on the new Apple Watch and was immediately impressed.

I put the 42 mm space gray Apple Sport version with an aluminum case and black strap on first.  The display was crisp despite the bright sunlight that was streaming into Palo Alto store.  The Apple employee tapped the watch twice and it went into demo mode.  It scrolled through a bunch of its functions including various displays, messaging options and of course the heart rate monitor.  I was fascinated and ready to run out the store with my new toy.  I also tried on the Apple Watch version with the stainless steel case and the Milanese band.  (See video below).  That version was a little heavier than the sport version but the band was simply sublime.  It has a magnetic clasp and can be easily adjusted.  It felt like a high end watch you could wear out to a fancy event.


Both of these watches are expensive ($399 and $699).  Are they worth it?  I am not sure just yet.  I am in the process of trying to figure out if I will order one.  You can't buy in the store and it is now back ordered online until June or perhaps even July.  I do want to replace my chest strap heart rate monitor that is hooked to my iPhone.  Glacing down at my watch would be a much simpler way to figure out if I am at my target zone especially during a bike ride.  I can also see how it would be useful for patients who need to closely monitor their heart rates during exercise because of its simplicity.

Let me know what you think if you have tried it on and if the watch will have any specific medical or exercise applications that will be significantly useful.

AM
TotalTendon

Acupuncture with Gold for Knee Osteoarthritis

I have treated thousands of patients with knee arthritis and never heard of gold acupuncture as an option.  In the most recent issue of the New England Journal of Medicine, a case report discusses the topic.

Gold Acupuncture Knee X-ray

From the NEJM, 2013, See Link Below

Apparently, this form of treatment is common in some Asian countries.  As you can see from the x-ray above, it looks like a a bunch of pine needles or staples have invaded the knee.  I do not know of any data supporting this type of approach but it does make for a very interesting x-ray.

Here is a link to the New England Journal of Medicine Case Report:

http://www.nejm.org/doi/pdf/10.1056/NEJMicm1202540

Yoo and Yoo NEJM 2013

Please post any comments or links to data about this topic below.

AM

Epigenetic Marker for Osteoarthritis Discovered

Epigenetics refers to chemical modifications surrounding DNA that result in alterations of how that DNA is expressed.  In English, changes in epigenetics can affect how much of a protein is produced by the underlying DNA.  In a newly published study, from Newcastle in the United Kingdom, researchers discovered less methylation (an epigenetic chemical modification) at a specific spot along the DNA led to increased production of the destructive enzyme MMP-13.  This all sounds very complicated and it is but this discovery may lead to a new class of drugs to treat osteoarthritis.  Interesting and potentially very exciting news for millions of arthritis patients.

Allan Mishra, MD

"Scientists discover an epigenetic cause of osteoarthritis"


"New research in the FASEB Journal suggests that DNA methylation is responsible for switching on and off a gene that produces the MMP13 enzyme that is known to be important in the destruction of cartilage

Bethesda, MD—In what could be a breakthrough in the practical application of epigenetic science, U.K. scientists used human tissue samples to discover that those with osteoarthritis have a signature epigenetic change (DNA methylation) responsible for switching on and off a gene that produces a destructive enzyme called MMP13. This enzyme is known to play a role in the destruction of joint cartilage, making MMP13 and the epigenetic changes that lead to its increased levels, prime targets for osteoarthritis drug development. In addition to offering a new epigenetic path toward a cure for osteoarthritis, this research also helps show how epigenetic changes play a role in diseases outside of cancer. This finding was recently published online in the FASEB Journal."

"We've already seen how epigenetics has advanced our approach to cancer. Now we're seeing it with other diseases and even exercise." said Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal. "This study not only lays the groundwork for a new understanding of osteoarthritis, but also shows that the old 'either/or' nature v. nurture argument is outdated: epigenetics teaches us that nature (the daily wear and tear of joints) regulates nurture (the genes in our cartilage) to cause arthritis."

See Full Press Release