Medical Articles by Dr. Ray

Apr

2008

Short Daily Exercise Helps Chronic Pain Patients

By Ray Schilling | Arthritis, Fitness, Health, Pain

Chronic pain can be an affliction that turns normal living and functioning upside down. Quality of life will be negatively affected, and often depression and anxiety are resulting mental problems. Effective pain relief is crucial, but often there are undesirable side effects to pain medication, and the patient will explore other avenues that bring a measure of relief. Amy Burleson, Psy.D. of the Cleveland Clinic’s chronic pain rehabilitation program found that chronic pain patients were physically deconditioned due to chronic pain and a chronic lack of physical activity. Depression and other mood disorder also were very common. A 10 minute exercise program was added to the treatment of a group of 28 patients who suffered of various chronic pains: back pain, fibromyalgia, neuropathy and migraines. Patients started a simple routine of walking on a treadmill, starting with a low speed of 1 mile per hour and increasing the speed every few minutes, till they walked at a speed of 3 miles per hour, a speed which was manageable for all patients. After 3 weeks patients found that their physical endurance had increased. They also experienced less depression and anxiety. Even more remarkable was the fact that the patients’ pain perception had diminished.

Short Daily Exercise Helps Chronic Pain Patients

Likert scale scores which were used in the assessment of pain perception showed a drop from 7.32 in the beginning of the program to 2.75 at 3 weeks. It is obvious that even mild exercise has benefits for patients with chronic pain: the overall well being receives a noticeable boost through an approach that has no pharmacological impact, no side effects and has no high cost of health care.

More information on the right dose of exercise: http://nethealthbook.com/health-nutrition-and-fitness/fitness/right-dose-exercise/

Reference: Pain Medicine, Volume 9, Issue 1, Page 88-141 (January/February 2008)

Last edited November 3, 2014

Apr

2008

High-intensity focused ultrasound (HIFU) Treatment For Prostate Cancer

By Ray Schilling | Cancer

High-intensity focused ultrasound, also known as HIFU is a treatment that prostate cancer patients are seeking out. The treatment technique is minimally invasive, has low risks of impotence and urinary incontinence and can be done on an outpatient basis. It is a two to three hour procedure which can be done with some mild sedation and spinal anaesthesia, and generally men can resume their normal lives immediately after surgery with the knowledge of being cancer-free. Dr.Ian Brown, the medical president of the Niagara HIFU clinic in Niagara Falls, Ontario likens the technique to the effect of a magnifying glass that focuses sunrays on a leaf and burns it. Except there is no sunlight, but a pulse of high-energy ultrasonic waves focused onto a specific area of the prostate. Temperatures reach approximately 90 °C (= 194 °F), until the cancer cells are dead. The transducer is equipped with ultrasonic imaging, so the treating physician can see the entire prostate gland on a monitor, and as a result surrounding nerve structures that are responsible for erectile function are not damaged. There is some inconvenience for the patient after the surgery. He has to wear a catheter for two to three weeks until he can urinate on his own. Like any prostate cancer treatment, HIFU also has potential side effects like retrograde ejaculation or urethral fistula.

High-intensity focused ultrasound (HIFU) Treatment For Prostate Cancer

Reports state that these side effects are minimalized with HIFU, but they are not eliminated. This treatment is not suitable for every patient. Patients with early stage prostate cancers are suitable candidates. HIFU is not available in the US at present, but has been approved by Health Canada in 2004 based on European data. It is not covered by health insurance, and at $20,000 this new costly option is not affordable for everybody.

More information about prostate cancer: http://nethealthbook.com/cancer-overview/prostate-cancer/

Reference: National Review of Medicine, March 2008, page 35, 39

Comment: Here is an update regarding FDA approval in the US. According to the FDA panel there is not enough solid data to confirm effectiveness or safety, so it was not approved in 2014.

Last edited November 3, 2014

Apr

2008

High Blood Pressure Decreases Cognitive Function

By Ray Schilling | Heart Disease, High Blood Pressure, Prevention, Stroke

It is known that high blood pressure that is left untreated gives rise to a host of health problems, some of which are heart attacks and strokes. It is not surprising to Dr. Jose Luchsinger of Columbia University Medical Center in New York that high blood pressure (hypertension) can be related to all kinds of cognitive impairment, which is connected to vascular damage in the brain. A cohort study which was published in the December issue of Archives of Neurology included 918 subjects age 65 or older with no history of mild cognitive impairment (MCI) or dementia at baseline. All participants underwent neurophysical and medical testing every 1 ½ years for more than 4 ½ years. The majority of the individuals had high blood pressure. During the course of the study 334 of the participants developed MCI. 174 cases had impairment in domains such as language and executive function or visual-spatial elements were impaired. 160 individuals had amnestic MCI (affecting memory), which is thought to have the strongest link to Alzheimer’s disease.

High Blood Pressure Decreases Cognitive Function

The study showed that hypertension played a significant role in the higher risk of developing any form of cognitive impairment. Detection of hypertension and proper treatment will not only protect against strokes, but certainly also extend its benefits to cognitive function.

More information how strict blood pressure control prevents trouble: http://nethealthbook.com/news/stroke-risk-present-even-borderline-high-blood-pressure/

Reference: The Medical Post, February 5, 2008, page 65 and Dec.2007 issue of Archives of Neurology

Last edited November 3, 2014

Apr

2008

Eat Your Veggies To Protect Your Eyes

By Ray Schilling | Eye Diseases, Nutrition, Vitamins and supplements

A study at Brigham and Women’s Hospital in Boston has shown that nutrition impacts eye health. Over a stretch of 10 years Dr. William Christen followed a group of 35,551 health professionals age 45 and older. They provided him with detailed information about their dietary habits and vitamin supplements-they were permitted to take multivitamin but were requested not to take vitamin A, vitamin E or beta-carotene. None of them had cataracts in the beginning of the study, but 2,031 did develop cataracts during the follow up period. Dr. Christen and his team analyzed the data and found that those individuals who were the highest consumers of carotenoids- individuals with an intake of 6,617 mcg of lutein and zeaxanthin- were 18% less likely to develop cataracts than those who consumed only 1,177 mcg per day. Also, the group that consumed higher amounts of vitamin E (intakes of about 262.4 mg per day) was 14% less likely to develop cataracts. Lutein is a substance that is found in high concentration in eye tissue. It is readily available in many foods, such as green and yellow vegetables, yellow-fleshed fruit and in egg yolks.

Eat Your Veggies To Protect Your Eyes

New research from the National eye Institute in Baltimore has also confirmed the benefits of carotenoids for healthy eyes. Lutein and zeaxanthin offer protection against age-related macular degeneration. There is no need to shop for supplements. Just bring on the green vegetables: broccoli, brussels sprouts, kale, collard greens, and spinach. Add some corn, the spice saffron and some eggs, and enjoy the taste and the health benefits.

More information about cataracts: http://nethealthbook.com/eye-diseases-and-eye-related-topics/cataract/

Reference: The Medical Post, March 8, 2008, page 25

Last edited November 3, 2014

Apr

2008

H. Pylori Can Be The Culprit For Indigestion

By Ray Schilling | Abdominal Pain, Gastrointestinal Disease, Infectious Disease

Indigestion, heart burn, bloating and stomach discomfort are common problems. Often the reason is simple. Too much food and drink at a party, a plateful of deep fried Buffalo wings or a midnight order of double-pepperoni pizza will contribute to stomach upset and a bad night’s sleep. A few over the counter antacids will come to the rescue. If indigestion is a faithful but miserable daily companion, the excuse of “just having a sensitive stomach” becomes a form of denial and a dangerous form of self diagnosis. Something is wrong, and it is time to seek medical attention instead of over the counter meds. The first line of defense will be prescription drugs called “proton pump inhibitors” (PPI). They are designed to eradicate excessive acid production in the stomach. If symptoms are more severe, e.g. weight loss, a gastroscopy will be necessary. Even though the prevalence of a stomach infection with Helicobacter pylori (H.pylori) is declining, about 30% of patients with chronic stomach upsets test positive for an infection with these bacteria. This can cause recurrent stomach pains. In this case it becomes necessary to treat this with a combination of PPI’s and antibiotic medication. Eradication of H.pylori can mean a cure from a stomach ulcer. It also reduces the risk of developing gastric adenocarcinoma, a form of stomach cancer that could have developed out of an untreated gastric ulcer. Just because a person has heartburn does not mean that the condition is due to gastro-esophageal reflux of stomach acid. If after treatment with a PPI the problems of indigestion, heartburn, bloating or stomach aches reoccur, lab tests can give more information. According to a prospective trial conducted by Dr. Delaney and others the H.pylori serology (a blood test) is unreliable, but other H.pylori tests like urea breath test or stool antigen are reliable tests to establish whether a stomach infection with H.pylori is present or not.

H. Pylori Can Be The Culprit For Indigestion

If the bacterium is present, its eradication with antibiotic therapy will stop the stomach problems in a high percentage of cases with one treatment protocol. What was surprising was that after one year the treatment result of the treatment group with PPI/antibiotic combination was as successful as the control group that was treated with PPI’s alone. It was concluded that in the more severe cases with weight loss, vomiting, or overt bleeding an upper gastrointestinal endoscopy should be performed where a direct H.pylori test from samples is also done. However, in the vast majority of cases with minor symptoms can be treated safely by the general practitioner with PPI’s and follow-up examinations in subsequent visits. Treatment failures can then be referred to a gastroenterologist, if necessary.

More information about gastritis and H. pylori: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/gastritis/

Reference: British Medical Journal 336:623-624 (March 22, 2008)

Last edited November 3, 2014

Mar

2008

Early Breast Cancer Diagnosis With PET/CT Scan Combination

By Ray Schilling | Cancer, Women’s Diseases

Breast cancer remains a disease that can strike women in any age group. Despite the immense amount of ongoing research and new treatment modalities, the disease presents puzzles to researchers and treating physicians and enormous challenges to patients. Early diagnosis, accurate staging of the disease and prompt treatment remain the most important points. Breast self examinations on a regular basis are just one aspect. Mammography screening can pick up the disease earlier, and a biopsy of any suspicious area can tell more about the type of cells that cause it. A particularly aggressive type is inflammatory breast cancer. It is not characterized by a suspicious lump. The only symptom is diffuse redness and swelling in the breast of the patient.

This type of cancer can metastasize within six months. It accounts for 1 to 5% of all breast cancers in North America and has a five year survival rate of 25 to 50% of the patients. A team of researchers from the University of Texas M.D.Anderson Cancer Center in Houston led by Dr. Selin Carkaci examined a combination approach of high tech tests for early diagnosis and treatment. Dr. Carkaci pointed out that breast cancer is not a localized disease, but one that is systemic involving the entire body. Based on this knowledge 41 patients with the highly aggressive form of inflammatory breast cancer were examined with a combination PET/CT whole body scan. It was possible to identify cancer in patients’ lymph nodes with 98% accuracy. Early metastasis could be found in 49 % of patients.

Early Breast Cancer Diagnosis With PET, CT Scan Combination

Nodule in lung. A: PET scan . B : CT scan. C : PET, CT scan combo.

PET/CT scan combinations detect cancer in its earliest stages, when changes are happening at the cellular level. Other tests like mammograms, ultrasound and MRI scans can only identify disease when there is destruction of the normal anatomy. The accurate depiction of the cancer within the body is important for an effective treatment plan. PET/CT combination scans are used in cancer diagnosis for a variety of tumors where distant metastases are expected (the image above shows a nodule in one of the lungs). It is especially significant for inflammatory breast cancer patients, where it offers a promise for earlier diagnosis resulting in more effective treatment plans.

More information about diagnosis of breast cancer: http://nethealthbook.com/cancer-overview/breast-cancer/breast-cancer-diagnosis/

Reference: The Medical Post, December 18, 2007, page 15

Last edited November 3, 2014

Mar

2008

The Culprits For Periodontal Disease

By Ray Schilling | Dentistry, Heart Disease, Men's Health, Substance abuse, Women’s Diseases

When people think of hazards to dental health, the first thought will be about tooth decay, lack of brushing and flossing and eating candies and other sugar-laden foods. Periodontal disease is often neglected, and yet it is just as threatening to teeth and gums. Destructive periodontal disease will lead to loss of the supporting tissues of the teeth and as a result, there will be loose or shifting teeth and ultimately tooth loss. Generally these findings were seen in older population groups. It was thought that the disease would rarely occur in patients younger than 35 years of age and the theory was that dental plaque was the likely cause. Lifestyle choices were not thought to play a large role. Recent findings told a different story. A cohort study consisting of 903 participants examined self-reported tobacco and marijuana smoking and dental examinations were also done. The authors of the study found that tobacco smoking as well as cannabis (marijuana) smoking was linked with a higher incidence of destructive periodontal disease before the age of 32 years.

The Culprits For Periodontal Disease

In comparison to this dental plaque was not contributing to a higher incidence of periodontal disease in this younger age group. Another risk for destructive periodontal disease in the youngest age group (as young as 12 to 18 years of age) was impaired glucose intolerance (a condition leading to diabetes). Due to those findings it is obvious that brushing and flossing are not the only weapons against periodontal disease. Healthy eating habits and cessation of smoking are equally important for dental health. This is particularly important as heart disease, which is also an inflammatory condition is closely linked to inflammatory disease of the gums and you likely have heard that heart attacks can be prevented by brushing and flossing teeth.

More information about periodontal disease: http://nethealthbook.com/dentistry/periodontitis/

Reference: Journal of American Medical Association 2008; 299(5): pages 574-575

Last edited November 3, 2014

Mar

2008

Kids With Sleep Apnea May Need Surgery

By Ray Schilling | Sleep apnea

Obstructive sleep apnea can have a significant impact on those who suffer from it. The condition is often ignored or dismissed with the comment that the sleeper is just “a bad snorer”. What will be alarming to a parent is the fact that children with the condition called “obstructive sleep apnea” stop breathing periodically throughout the night and snore very loudly. Another consequence may be a child who is chronically tired and as a result is doing poorly in school. Ron Mitchell, MD, professor of pediatric otolaryngology at St.Louis University likens the impact of obstructive sleep apnea on the quality of life to conditions similar to chronic asthma or rheumatoid arthritis. In normal weight children the condition stems from the enlargement of tonsils and adenoids, which can aggravate upper airway collapse during sleep. Obstructive sleep apnea affects boys and girls equally.

About 2% to 4% of children aged 4 to 6 have the condition, but Dr. Mitchell suspects that the number is probably higher, as parents don’t always recognize and report the problem.

Kids With Sleep Apnea May Need Surgery

For those children in whom sleep apnea is caused by the enlargement of tonsils and adenoids surgery, a tonsillectomy and adenoidectomy, provides dramatic relief. The study from St. Louis University found that it was successfully resolving sleep problems for 80% to 90% of affected children.

More information about adenoids: http://nethealthbook.com/ear-nose-and-throat-diseases-otolaryngology-ent/nose-problems/adenoids/

Reference: February 13, 2008 issue of The Laryngoscope

Last edited November 3, 2014

Mar

2008

High Death Rate In India Due To Smoking

By Ray Schilling | Cancer, Heart Disease, Infectious Disease, Lung Disease

Dr. Prabhat Jha of the Centre for Global Health Research, Toronto has published research regarding the risk of mortality associated withs smoking in India, involving data from 1.1 million Indian homes. Data of deceased individuals, all of them in the age group between 30 and 69 years of age, showed that 37% of the men and 5% of the women had been smokers, and smoking doubled the risk for both sexes due to medical causes. Smoking did not only rate as a risk for lung and respiratory cancers but also for tuberculosis, vascular and respiratory disease. Smoking as a causal relationship was estimated to be responsible for 1 in 5 deaths in men and 1 in 20 deaths in women. With the population growth in India the number of death in the age group of 30 to 69 related to smoking is estimated to increase by 3% per year. Currently available data suggests that the rate of smoking is high especially among men in India. Data from other nations show, that smoking bans in public places are effective in turning these statistics around. Italy used to be one of the European nations, where smoking in public was common and as a result the exposure to second hand cigarette smoke was not only an inconvenience but a serious health risk. Cardiovascular events like heart attacks showed a decrease among men and women in Italy after the smoking ban in public places was put into effect in 2005. The findings were related to the improved indoor air quality.

High Death Rate In India Due To Smoking

There was an increase of sales in stop smoking aids like nicotine replacement products. Sales of cigarettes showed a decrease. Giulia Cesaroni from a local health unit in Rome remarked that even a small reduction in the incidence of cardiovascular disease can have enormous public health implications, as coronary artery disease is the leading cause of deaths in Italy. Compared to before the ban heart attack rates of middle aged (35- to 64-years) Italians dropped by 11%, 65- to 74-year-olds had a reduction of 8%, but those in the 75-84 year age group showed no benefit (as coronary artery disease in them likely was irreversible).

More information about:

1. Chronic obstructive pulmonary disease: http://nethealthbook.com/lung-disease/chronic-obstructive-pulmonary-disease-copd/

2. Causes of lung cancer: http://nethealthbook.com/cancer-overview/lung-cancer/causes-lung-cancer/

3. Heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

References: The Indian data based on www.nejm.org (February 13, 2008); the Italian study was published in Circulation 2008 (Feb. 11)

Last edited November 3, 2014

Mar

2008

U.S. Dietary Guidelines May Have Contributed To Obesity

By Ray Schilling | Nutrition, Obesity

Dr. Paul Marantz of the Albert Einstein College of Medicine, New York has taken a closer look at the current obesity epidemic. He and his coauthors are observing that Americans have listened to the recommendations to reduce their fat intake. This recommendation which first made its appearance in 1980 pointed out the risk of a high fat diet and its connection to cardiovascular disease. Even though there is enough evidence that a modification of fat intake could reduce cholesterol, the government guidelines against fat have not managed to improve cardiovascular disease outcome. The authors of the publication noted that Americans have slightly reduced their fat intake, but their carbohydrate and total calorie intake have actually increased. The consequence is logical: higher calorie intake is contributing to the rise in obesity and the increase in adult onset diabetes. Dr. Marantz drew on records from the Centers for Disease Control and Prevention to arrive at these results. From 1971 to 2001 fat intake has decreased by 9% in women and 5% in men, but carbohydrate intake went up by 6% in women and 7% in men. Total daily caloric intake went up by 335 calories in women and by 168 calories in men. Both genders showed an increase in obesity. While 55% of men and 41% of women were overweight or obese in 1971, by 2001 the rate had risen to 70% in men and 62% in women. The reasons for this are very likely due to many factors. Aggressive marketing of low-fat foods may have given the public the impression, that these foods can be consumed without consequences.

U.S. Dietary Guidelines May Have Contributed To Obesity

Obesity on the rise since the 1970’s

Another reason likely is that fat in the diet can induce satiety and stop us from eating excess calories. It has not helped to label fat in the diet as an enemy instead of pointing out that small amounts of heart healthy fats in the daily diet are an important part of our nutritional team players and allies in the quest to good health. Key to successful dieting is to consume a low fat diet, rich in unrefined, low glycemic carbohedrates. Caloric intake has to be restricted for successful weight loss.

More information about:

Refined carbs: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/carbohydrates/

Metabolic syndrome: http://nethealthbook.com/hormones/metabolic-syndrome/

Reference: American Journal of Preventative Medicine, Feb. 8, 2008

Last edited November 3, 2014

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