Medical Articles by Dr. Ray

Nov

2006

Body Can Fight Weight Loss

By Ray Schilling | Nutrition, Obesity, Weight loss

Embarking on a weight loss program needs long-term commitment and persistence. Many dieters have experienced the yo-yo effect of good initial results in losing weight, after which the weight loss stopped, and gradually the weight was gained back. Often dieters blame themselves for their lack of success or are criticized for a lack of self-control.
The “plateau effect” has been discussed and documented before, and now an Australian study has found that “it is not just you”. After initial success and weight loss the human body is designed to strongly resist attempts to lose weight. Dr. Neil King from Queensland University of Technology does research on appetite regulation and energy balance. He conducted studies on groups of people who were overweight and obese people. He found that weight loss from exercise and calorie restriction stops at a certain point, and this plateau remains firmly in place for a prolonged time, despite continuing dieting and exercise.

In the first study 30 obese men and women from Britain took part in a 12-week, laboratory based exercise program in which they exercised five times a week. The second study observed the weight loss in 200 Australian men who were enrolled in a commercial weight loss program, which involved both an exercise program and dietary advice. Although both groups followed different plans, their weight loss still plateaued. The first group averaged a loss of 3 kg during the first 8 weeks, and weight loss in the next 4 weeks was markedly reduced (0.7 kg). The second group had a variable pattern of weight loss, but it, too, showed a plateau.

Body Can Fight Weight Loss

Researchers believe that the human body is designed to cope with famine. As a result there is a built-in mechanism responsible for weight loss resistance. It may be a source of frustration to people on a weight loss program in a society where there are no food shortages, but it is meant to be a lifesaver in times when there was a shortage of food.
For the person who wants to lose weight it involves taking a closer look at the caloric output. Longer exercise times, higher intensity or cross training can combat the plateau effect, but patience is also needed along with the determination to carry on with the program.

More information about weight loss: http://nethealthbook.com/health-nutrition-and-fitness/weight-loss-and-diet/

Reference: The Medical Post, October 10, 2006, page 19

Last edited November 1, 2014

Nov

2006

Diverticulitis Associated With Obesity

By Ray Schilling | Gastrointestinal Disease, Nutrition, Obesity

Medical textbooks used to describe acute diverticulitis as a disease that was mostly seen in adults over 50 years of age. Researchers at the University of Maryland Medical Center have assessed the medical records of 104 patients ages 22 to 88 years with the condition of diverticulitis diagnosed between 1999 and 2003. 56 patients (54%) were age 50 or younger, and the remaining 48 (46%) were over 50. The researchers found that a significantly higher proportion of patients (88 %) with abdominal obesity were present in the younger age group with diverticulitis.
Acute diverticulitis is a condition characterized by the chronic inflammation of sacs in the intestinal tract. The condition causes constipation and severe abdominal pain. It is usually related to a low fiber diet containing refined carbohydrates or processed foods.
Dr. Barry who was leading the study observed that the younger the patients with diverticulitis are, the more obese they are likely to be.

Diverticulitis Associated With Obesity

Also, he found the younger they are when they get the disease, the more likely they will get recurrent attacks, and he sees the most important point in diverticulitis prevention is a change to healthy eating habits without over-processed food from fast food outlets.

More information about diverticulitis: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/diverticulitis/

Reference: The Medical Post, October 10, 2006, page 1 and 60

Last edited November 1, 2014

Nov

2006

Houseplants Responsible For Allergic Reactions

By Ray Schilling | Allergies, Asthma

Generally house dust and dust mites, pet dander, feathers, moulds and ragweed are meantioned, when it comes to the topic of allergies. Nuts and peanuts have also been associated with violent allergic reactions.
With skin prick tests (SPT) the allergists can very clearly determine what substances the allergy sufferer is sensitive to.

A small study, which appeared in the September edition of Allergy has shown that allergic rhinitis in a patient, can have its origin in exposure to houseplants. Allergic rhinitis with a runny nose and sneezing is often neglected, as-opposed to asthma or an urticarial rash. It is perceived as more of a nuisance than a threat. Allergic rhinitis sufferers were subjected to SPT’s along with a healthy control group. 78 % of allergic rhinitis patient had a positive STP to at least one plant, while none of the control group developed significant reactions to any of the tested plants.

Houseplants Responsible For Allergic Reactions

The plants that produced the most frequent sensitization were Ficus benjamina, yucca, ivy and palm tree.

More information about:

1. asthma: http://nethealthbook.com/lung-disease/asthma-introduction/

2. stuffy nose: http://nethealthbook.com/ear-nose-and-throat-diseases-otolaryngology-ent/nose-problems/stuffy-nose/

Reference: The Medical Post, October 10, 2006, page 2

Last edited November 1, 2014

Nov

2006

Think Feet With Diabetes

By Ray Schilling | Diabetes, Prevention, Skin Disorders

This article is about “think feet with diabetes”. About 2 million Canadians are currently living with diabetes. It can be a “silent” disease, as patients may have few symptoms. Once diagnosed with diabetes it is of great importance to be vigilant of lifestyle and nutrition to keep the condition under control. A common problem for about 15% of diabetics is the development of a diabetic foot ulcer. Of those afflicted 14-24% will require an amputation of a lower extremity as a result. In addition to this the mortality rate of patients with below knee amputation due to the complications of a diabetic foot ulcer is 19-55% after three years.
Even though these statistics sound ominous, patients can do a lot in the way of prevention. According to the Canadian Diabetes Association guidelines, a diabetic patient should have a foot exam performed at least annually. Diabetic peripheral neuropathy is the leading cause of diabetic foot ulcers. The physician can examine the feet for loss of sensation. He will check for foot calluses and will debride those, which are pre-ulcer state. The physician also checks for poor circulation in the foot at that time.
If there is no loss of protective sensation, an annual exam will suffice, but if there is loss of sensation, several exams per year may be needed. A vascular surgeon may have to assess the patient to see if the foot circulation is sufficient. Infection is a warning sign and has to be treated promptly. Finally, any source of pressure to the foot needs to be removed or offloaded.
A proactive approach to keep the feet healthy starts at home.

Think Feet With Diabetes

The following points are important especially to the patient with diabetes:
-Inspect your feet on a daily basis. Check for sores, blisters or cracks that don’t heal.
-Check your footwear. If there is debris (sand, pebbles) remove promptly.
-Wash your feet daily with warm, not hot water and dry them well, especially between your toes.
-Trim your toenails. If you have difficulties doing that, seek out the help of a podiatrist. Also don’t use the homemade approach cutting corns and calluses.
-Keep the circulation to your feet going: put up your feet when you sit. Wiggle your toes, move your ankles, don’t cross your legs for long stretches of time.
-Shop for suitable footwear! Ask the sales clerk to measure both of your feet in order to determine the proper size. Shop in the afternoon, as your feet can swell during the day.
-Don’t break in a tight fitting new shoe! This may injure your feet. A new shoe should be comfortable right away.
-Don’t delay looking after problems. If a cut, sore, bruise or blister does not start to heal after a day, see a physician.

Reference: Parkhurst Exchange, October 2006 Edition, page 26

Last edited November 1, 2014

Oct

2006

Antiviral Drugs Not For Flu Prevention

By Ray Schilling | Infectious Disease, Lung Disease, Prevention

With the arrival of the fall and winter season concerns about viral illnesses crop up. The most common ailment is the flu, which occurs seasonally. Prevention measures come in the forefront, and over-the-counter remedies and herbal supplements make their appearance.
Yet at this point the most effective measures remain very basic: good hygiene, hand washing, non-exposure to people who have the flu and non-sharing of personal items that could carry the virus. Flu shots for flu prevention remain the single most effective way to prevent widespread epidemics.
Antiviral agents zanamivir (also known as Relenza) and oseltamivir (Tamiflu) have come under discussion. They have been very effective in the treatment of influenza symptoms. It is not too late to treat with oseltamivir after the patient has been infected with the flu, as the drug prevents lower respiratory tract complications. For the symptomatic relief of influenza 75 mg per day were 61% effective, and 150 mg were 73% effective. Using the drugs strictly as a prophylaxis proved to be a fallacy. Results showed that neither zanamivir nor oseltamivir prevented influenza-like illnesses.

Antiviral Drugs Not For Flu Prevention

Even though both antiviral agents are not 100 % effective, they still can be useful in the setting of a flu pandemic. They are also of help in population groups with chronic health problems or immunocompromised persons to whom any viral infection can be serious.

More info about the flu: http://nethealthbook.com/infectious-disease/respiratory-infections/flu/

Reference: The Medical Post, September 1, 2006, page 61

Last edited November 1, 2014

Oct

2006

Kidney Transplant Tourists At Risk

By Ray Schilling | kidney disease

Long waitlists for a kidney transplant have caused some people in need of the procedure to venture overseas. Many kidney recipients are reluctant to share information about the source of human organs transplanted overseas, but this is just one problem. Once the patient returns home, proper follow-up care is often hindered by the fact that there is a lack of communication between the foreign transplant team and the physician in North America.
There may be a sheet of paper stating that the kidney transplant went well. Often important information about what medications were given at the time of transplant is missing, and there is little or no information about the donor.
A Canadian study found that 33% of the patients who went abroad came back without medical documentation. The other 67% had often incomplete records. A study that was presented at the World Transplant Congress in Boston showed, that one third of the patients required immediate hospitalization upon their return, primarily for sepsis. More worrisome is the fact that many of the patients had poor long-term outcomes due to sepsis, systemic fungal infections and compromised grafts. All of them had received their kidneys from non-biological or emotionally related donors. Dr. R. Prasad of the University of Toronto examined the three-year graft survival at the Toronto center. Where patients received the kidney from a relative, the results were best, as the graft survival was 98% over 3 years.

Dialysis Patient Awaiting Kidney Transplant

Patients you received a kidney from an emotionally related donor had an 86% success. In the patient group who went abroad and underwent non-biological or emotionally related kidney transplantation the 3- year graft survival
dropped to 62%.
Reference: The Medical Post, September 1, 2006, page 19

Last edited December 5, 2012

Oct

2006

Good Nutrition Is Gender Specific

By Ray Schilling | Cancer, Health, Heart Disease, Nutrition, Prevention, Stroke

It is well known that various health concerns are related to the gender of a person, but there are findings that suggest that even nutrition has to be tailored to the needs of males or females.
Calcium is known to be beneficial to bone health, and while high calcium diet may protect a woman from osteoporosis, it does not have the same evidence for men. As a matter of fact, high calcium intake in males may increase their risk of prostate cancer. For the male it means that calcium should be used in moderation and vitamin D intake could help to offset some risks.
Fat choices, mostly sources of monounsaturated fats in the form of olive oil are important for both, men and women, and for both the omega-3 fatty acids that are found in fish are excellent. Men, especially those with a risk of prostate cancer, should be cautious about loading up on flaxseed and canola oil. Alpha-linolenic acid in these two oils may be a problem for the prostate.
Iron is also emphasized in healthy nutrition, but men need less than women. In the presence of an abnormal gene, excessive iron can accumulate to harmful deposits in various organs.
Social habits, for example the drinking of alcohol seem to have more grave implication to women than to men. The glass of wine that may help reduce the risk of heart attacks and certain strokes may seem harmless enough, and average men don’t seem to develop health problems, as long as the alcohol intake is low. Larger amounts will increase the risk of many ills for males and females alike, but even low doses of alcohol may increase a woman’s risk of breast cancer.
“Super Foods” have made headlines, and all of them are known because of their high content in antioxidants. A recent study from the University of Oslo, Norway, under Dr. Bente Halverson examined, which of them are ranking highest. At the top are, in the order of strength: blackberries, grape juice from Concord grapes, artichoke hearts, walnuts and strawberries. The researchers came up with a list of high oxidant foods on the basis of typical serving sizes.

Everybody needs to find healthy food

These are the winners among the super foods and spices: blackberries, walnuts, strawberries, artichokes, cranberries, brewed coffee, raspberries, pecans, blueberries, ground cloves, grape juice and unsweetened baking chocolate. Males as well as females of all age groups will benefit from those.
Dr H. Simon, associate professor of medicine at Harvard Medical School points out that there are fundamental facts in nutrition that apply to everyone. But there is also a fine print, which varies according to gender, age and medical conditions.

More information about nutrition: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/

Reference: The Medical Post, September 19, 2006, page 25

Last edited November 1, 2014

Oct

2006

Successful Gene Therapy For Melanoma

By Ray Schilling | Cancer, Skin Disorders

Scientists at the National Cancer Institute in Bethesda, Md. have developed a modality of gene therapy to treat patients with melanoma.
The therapy alters the patients’ own lymphocytes to recognize and attack cancer cells. Dr. Steven Rosenberg and his team developed the new technique by drawing a blood sample containing normal lymphocytes from an advanced melanoma patient. Next the cells are infected with a retrovirus, which delivers genes that target specific receptors on T cells. Once the cells are infused back into the patient, these receptors attach themselves to the molecules on tumor cells and activate the lymphocytes to destroy the cancer cells. This method is called “adoptive cell transfer”. In early experiments there seemed to be little or no benefit, but researchers refined the methods and found valuable and promising aspects regarding the treatment of melanoma patients. It is crucial to administer the cells in their most active growth phase. This was shown in a group of 14 patients, where 2 terminal melanoma patients experienced cancer regression. Dr. Jeffrey Medin, head of the clinical research program in gene therapy at the Ontario Cancer Institute in Toronto agrees that this new therapy is a breakthrough as it has virtually brought terminal patients “back from the brink”. It is also exciting to see that the researchers could refine the techniques in order to create a more successful therapy. As a result the method will be more applicable to other cancers and broader populations.

Successful Gene Therapy For Melanoma

Although adoptive cell transfer has only been used in melanoma patients so far, the researchers have shown ways to engineer cells of the immune system in a similar way to attack breast, liver cancer or lung cancers.

More information about treatment of melanoma: http://nethealthbook.com/cancer-overview/skin-cancer/melanoma/treatment-melanoma/

Reference: The Medical Post, September 19, 2006, page 1 and 61

Last edited November 1, 2014

Oct

2006

Lowering Cholesterol Aggressively Saves Lives

By Ray Schilling | Diabetes, Heart Disease, Obesity, Stroke

A 5-year multinational prospective study (“Treating to New Targets or TNT Study” involving top cardiologists from around the world has found significant benefits in using higher doses of statins. They investigated the effects of increasing the statin concentration (a cholesterol lowering medication) and have now come to new insights how to approach the metabolic syndrome, which is the metabolic derangement associated with obesity. Of 10,001 patients aged 35–75 years with clinically proven heart disease 5,584 patients had metabolic syndrome at the same time. Half of them were put on 10 milligrams of Atorvastatin (brand name: Lipitor, made by Pfizer Inc.), the other half on 80 milligrams per day. They were followed for 5 years and many questions were asked, blood tests done and statistics kept. Of particular concern was whether survival rates and numbers of heart attacks or strokes would be different for the various groups. The major focus of interest was on people who were over weight or obese.

As the image above shows, percentages of complications (heart attacks and strokes) were used as clear end points of cardiovascular complications to measure the response to the statin. The results showed that two subgroups of obese patients, those who have at the same time diabetes and those who don’t, were both benefitting from the higher dose of Lipitor in an equal manner (about a 30% relative reduction of risk).

The amazing result was that dosage of the statin mattered very much. In the past it was thought that taking a pill for high cholesterol was all that mattered. However, now we know that physicians need to watch the blood level response of the bad cholesterol (LDL cholesterol) and titrate the abnormal levels down to a normal level by using adequate dosing. The authors came to the conclusion that metabolic syndrome patients with heart disease, and particularly those where diabetes was present at the same time, would need more intensive statin therapy (higher dosage) than patients who were only having cardiovascular disease. The new goal post for lowering the low-density lipoprotein cholesterol (LDL cholesterol) of 1.8 mmol/L (70 mg/dL) was recommended.

5-Year Study Shows Further Reduction of Major Cardiovascular Complications In Patients
(Expressed as %) With Metabolic Syndrome Using Higher Doses of Atorvastatin(P. Deedwania et al. Lancet 368, No. 9539: 919-928, Sept. 9, 2006)

This study showed that there was a 44% increase in absolute risk for an adverse outcome in coronary heart disease patients who also have metabolic syndrome than those without metabolic syndrome. This justifies a very aggressive treatment with Lipitor down to the new target blood values indicated above that your doctor needs to monitor. In high risk patients for heart attacks and strokes where more than 3 cardiovascular risk factors are present the patient’s outlook (longer survival) can be improved by several years. This was shown with treatment using the higher dose of Lipitor when blood levels and cardiovascular complications were compared between 5 years of treatment and the treatment results after the first year of the study.

More information on:

1. Treatment of a heart attack: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/treatment-heart-attack/

2. Metabolic syndrome and obesity: http://nethealthbook.com/hormones/metabolic-syndrome/

Reference: The Lancet 2006; 368:919-928 (09 September 2006)

Last edited November 1, 2014

Sep

2006

Suppression Of Estrogen Affects Cognitive Function

By Ray Schilling | Uncategorized

Female patients with gynecological problems such as fibroids and endometriosis can be treated with leuprolide acetate depot (LAD) or Lupron. LAD suppresses ovarian function and decreases estrogen to the levels of postmenopause. In menopause estrogen levels show a natural drop. In this group the estrogen levels were chemically suppressed. The patients ranged in the ages 25 to 40 years of age-all of them well before the age of menopause. The researchers were able to observe the effects of estrogen on cognitive function without the brain changes associated with normal aging.
Dr. Barbara Sherwin, PhD, professor for psychology and obstetrics at Mc Gill University in Montreal stated that previous research has shown a connection between decreased estrogen and the deterioration of verbal memory. Taking estrogen during menopause can prevent this deterioration. The current study also showed a significant decrease in working memory and scores regarding mood in the women who are taking LAD.
Dr. Sherwin suggested also that some research points to a window of opportunity around the time of menopause where estrogen will protect.

Suppression Of Estrogen Affects Cognitive Function

Effects of estrogen (=E2) on the brain

But beyond that time, such as at the age of 65 or older, estrogen treatment does not provide these benefits. As shown in the Women’s Health Initiative study it may be detrimental.

Reference: The Medical Post, August, 22, 2006, page 45

Comment on Nov. 13, 2012: There is a big difference between conventional hormone replacement therapy (HRT) and replacement of hormones with bio-identical hormones. The former (HRT) is what was proven by the Women’s Health Initiative study to be detrimental to postmenopausal women; the latter (bio-identical hormone replacement) is what a lot of European women have done for decades and what has benefitted them tremendously without side-effects whatsoever. Inform yourself and read more about treatment of menopause under this link (Nethealthbook).

Last edited December 6, 2012

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