Medical Articles by Dr. Ray

Sep

2006

Prostate Cancer Recurrence Linked To Obesity

Prostate cancer affects a significant percentage of male patients in the higher age groups. Early diagnosis and treatment has shown good success rates. Early surgery in the form of a radical prostatectomy has given patients virtually a new lease on life. Radiotherapy as an alternative form of treatment has been an option for those who could not undergo surgery. Once the treatment is completed there is reason for optimism, if the tumor could be removed in total.

Dr. Sara Strom, PhD and research colleagues from the M.D. Anderson Cancer Center in Houston, Texas analyzed findings of 873 patients over the course of 14 years with localized prostate cancer who had received external beam radiotherapy as their sole treatment. The objective was to determine, whether all patients were doing well, or whether some could be more at risk. It turned out that those with normal body weight fared best. 27% of them experienced a recurrence of the disease. Those who were overweight had recurrence rates that jumped to 55%. Those who were obese were most severely affected with recurrence rates of 99%. The researchers believe that there is a difference of tumor behavior between patients with normal body weight and those who are overweight or obese.

Prostate Cancer Recurrence Linked To Obesity

Future studies will be needed to evaluate the relationship of obesity with dietary factors, genetic modifiers of steroid androgen metabolism, insulin and insulin like growth factors. This will clarify the underlying mechanism of action in the development of prostate cancer.

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

Reference: The Medical Post, August 22, 2006, page 41

Last edited November 1, 2014

Sep

2006

Cartoons Help Kids Deal With Pain

By Ray Schilling | Cancer, Pain

Shots in early childhood are often approached with a sense of trepidation by parents. It means almost without fail, that there is crying and resistance. All the well meaning comments, that it is “only like a little mosquito bite” to get a shot at the clinic are of not much use.
Italian researchers were able to confirm that children feel significantly less pain from blood draws when their mother was at their side. But this study from Siena, Italy also suggests that there are additional ways to distract children from pain. Sixty-nine children aged 7-12 were observed, and the study suggests that TV cartoons have an even greater power to distract youngsters from pain. Researchers took note that children whose attention was focused on a cartoon reported only one-third of the pain reported by controls of those who did not watch a cartoon.
The practical application could be useful in labs or clinics, where children are receiving injections or may experience pain and discomfort. A funny cartoon may take some of the sting out of the dreaded shots!

Cartoons Help Kids Deal With Pain

The study originally appeared in the August 17 online edition of Archives of Diseases in Childhood.

More information about pain: http://nethealthbook.com/neurology-neurological-disease/pain/

Reference: National Review of Medicine, August 30,2006, page 11

Last edited November 1, 2014

Sep

2006

Food Choices Can Boost Good Cholesterol

By Ray Schilling | Health, Nutrition, Obesity, Prevention

Dr. Andrew Pipe, a cardiologist at the University of Ottawa Heart Institute, sees a lot of people with cardiovascular problems. He also has found that telling patients to “reduce their cholesterol and get the triglycerides down” is not very helpful. Dr. Pipe is aware that we are living in a world where people are constantly tempted by junk food, and it is not surprising that obesity is one of the consequences.
It sounds daunting to a person with a lifetime of poor food habits and poor lifestyle choices to make changes. He believes that simplifying advice for healthy living can be brought down to 5 F’s for healthy living:

-Fruit and vegetables, 3-4 each day
-Fish, 3-4 per week
-Fibre, 5 per day
-Fat, 3-6 per day. Monounsaturated fats are best
-Fast food: avoid it!

Food Choices Can Boost Good Cholesterol

To this list Dr. Pipe added two more Fs:
– “Fysical” activity, 30-40 minutes per day. This may be a misspell, but it is the best way to increase your good cholesterol (HDL)
-Fun, unlimited. Your food choices and exercise need to be enjoyable and appealing or the plan does not work in the long run.

Here is a blog about slowing aging and avoiding disabilities: https://www.askdrray.com/slow-down-aging-and-prevent-disabilities/

Reference: National Review of Medicine, August 30,2006, page 10

Last edited November 1, 2014

Sep

2006

Moral Preaching Is Not Enough In AIDS Intervention

By Ray Schilling | Infectious Disease, Men's Health, Prevention, Women’s Diseases

At a recent conference of the International AIDS Society in Toronto the full spectrum of the disease was covered: science, community, activism, and people with AIDS.
News Canada data released before the conference suggests that HIV infection remains a serious problem. There were somewhere between 2,300 and 4,500 new cases of HIV in Canada. The numbers are up from the estimated 2,100-4,000 cases that came up in 2002.
There is one statistic that can be a source of hope: the number of deaths from the infection has shown a steep decline in the mid-90’s. This effect is largely due to the discovery and application of three-drug antiretroviral therapy. The widespread use of this therapy has also reduced the viral load, and as a result infectiousness may be reduced.
UBC epidemiologist Dr. Evan Wood sees the encouraging development, but he emphatically spoke of the horrendous effect of AIDS. He stated, ” HIV remains the biggest threat to humanity globally.” He feels that the threat of terrorism pales in comparison to the carnage HIV results in every day. In this light it is short sighted and non-supportive of Canada’s PM, not to appear at this conference, as he had other commitments.
This year also marks the 25th anniversary of AIDS’ discovery, but it is known that the disease was ravaging Africa at least 25 years before it first appeared in the West.
The diagnosis of HIV infection does no longer sound like a death sentence. Things have been improving, but not fast enough, says Dr. Wood. Also one of the speakers, Bill Gates, spoke against naïve insistence on abstinence as a primary weapon in the battle against AIDS.

Moral Preaching Is Not Enough In AIDS Intervention

Dr. Wood shared this sentiment. He stated that while the whole idea is well intended, sexuality is part of normal human behavior, and everybody knows that abstinence cannot exist forever.

More information about AIDS: http://nethealthbook.com/infectious-disease/sexually-transmitted-disease/aids-introduction/

Reference: National Review of Medicine, August 30,2006, page 14

Last edited November 1, 2014

Aug

2006

Non-Hormone Alternative Against Hot Flashes

By Ray Schilling | Hormones, Women’s Diseases

Hormone replacement therapy has its positive and negative effects, and the proven risk of breast cancer has stopped many women from choosing hormone replacement for menopausal problems. Yet menopausal problems can be a source of suffering and frustration for those women who are affected. Menopausal hot flashes can be bothersome, and if they are severe, frequent and go on for years, women find it difficult to cope with this condition. Even if hormone replacement is not an option because of the risk factors, relief of those symptoms is very much needed. Herbal remedies are often not sufficient. As a result the day to day functioning of the patient is affected and even a restful night is interrupted by sweating.
Dr. Sireesha Reddy from the department of obstetrics and gynecology at the University of Rochester’s school of medicine and dentistry has led a study of 60 postmenopausal women. A medication called gabapentin was used in a randomized study. Three equal groups were observed: the first received gabapentin titrated to 2,400 mg per day. The second group received 0.625 mg per day of estrogen, and the third group was given a placebo. The gabapentin group and the estrogen group achieved similar results, namely a 71% reduction, versus 72% in the estrogen group. The placebo group reported a 54 % reduction of hot flashes.
Dr. Reddy states that gabapentin against hot flashes is a good alternative. It works for patients who only have these particular problems, as it does not address other indications where estrogen is prescribed.

Non-Hormone Alternative Against Hot Flashes

Dr. Reddy also added that it might not be necessary to titrate to 2,400 mg gabapentin per day, because some women metabolize it at a higher rate than others.
Specific side effects such as headaches and dizziness occurred more frequently in the gabapentin group, but they were not statistically significant.

Reference: The Medical Post, July 18, 2006, page 4

Comment on Nov. 13, 2012: This is an example of symptomatic therapy for one symptom, in this case hot flashes, but the trade-off are side effects like headaches and dizziness, which were discussed away because they were “statistically not significant”. Women in menopause have a lack of estrogen and progesterone, which is sensed by the receptors for both of these hormones throughout the woman’s body. The solution is bio-identical hormone replacement with specific hormone measurements as discussed under this link.

Last edited December 6, 2012

Aug

2006

New Screening For Cardiovascular Disease

By Ray Schilling | Health, Heart Disease, Nutrition

Checking out the patient’s heart disease risk factors used to be very basic. Lifestyle questions were one aspect: was the patient smoking? Did he have a lack of exercise? Did he have a risk of heart disease in the family? The patient’s diet was analyzed and the body weight was assessed. Cholesterol and triglyceride levels were the basic labs that provided more information. The risk factor assessment, as exemplified by criteria from the Framingham study, made a lot of sense.

In the meantime cardiologists are concerned that all these points are no longer sufficient in identifying individuals at risk for heart disease. Dr. Morteza Naghavi, president for the Association for the Eradication of Heart Attacks, is concerned that it is not only obesity and hypertension that bear the risk for heart attacks, but atherosclerosis. A lot of heart attacks occur in the low- and moderate risk groups. As far as he is concerned, every man aged 45-75 and every woman from 55-75 needs to be screened. We are better equipped to do something for people who have a high plaque burden (deposits in the blood vessels.) Statins are the medication of choice to help these patients.

Screening techniques have become less invasive, as imaging technology has made large progress in recent years. The condition of the carotid artery can be assessed by ultrasound (carotid intima-media thickness or CIMT). Coronary calcification score (CACS) can be measured by CT scanner. The tests are done in a few minutes, and the cost at the most is a few hundred dollars. A patient would only be screened every five years. Screening procedures work and save lives, as demonstrated in the screening for breast cancer. The SHAPE team (The Screening for Heart Attack Prevention and Education) has calculated that the screening cost is even better than breast cancer screening. There are other tests that improve the sensitivity of traditional criteria, like the blood test for C-reactive protein, but in assessing the patient’s risk, it does make sense to go to the source of disease. The striking color image that demonstrates the atherosclerotic burden will allow the patients to see the problem with their own eyes.

New Screening For Cardiovascular Disease

It may be a healing shock that has a beneficial effect on the compliance of patients. Test results of laboratory work are words, but here a picture is worth a thousand words when it comes to encourage the patient to actively work on prevention.

More information on heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

Reference: National Review Of Medicine, July 30, 2006, page 7

Last edited November 1, 2014

Aug

2006

New Aphrodisiac Nasal Spray

By Ray Schilling | Men's Health

Sildenafil and other phosophodiesterase-5 inhibitors(PDE-5 inhibitors) have taken the drug market by storm for erectile dysfunction. Viagra-just to name one of the drug names- has certainly enhanced the treatment possibilities for a male problem that was difficult to treat in the past. The market has had its heyday with splashy TV commercials, creating hype like seldom before. The truth remains, that any drug has also possible side effects that are not mentioned in the upbeat commercials, and patients with preexisting heart disease have experienced heart attacks. The medications for the treatment of erectile dysfunction are not recreational fun, but serious prescription drugs.
In the meantime these drugs are facing competition from a new class of erectile dysfunction drugs, the melanocortin agonists.
They claim to have remarkable properties due to the fact that they will not only help men but also women with a range of sexual disorders, including lack of desire. Contrary to the previous drugs they are not working through the vascular system but through the central nervous system. Through receptors in the brain area called hypothalamus, they stimulate areas of the brain associated with sexual arousal. Preliminary experiments have shown that they are increasing libido, but also help a man to get better erections.
The melanocortin agonist closest to the market is known as bremelanotide. Previously known as PT-141, the nasal spray has been tested in about 300 men up to phase II with promising results. A study on women has been too small in numbers to give detailed results, but significantly more women reported increased libido after bremelanotide treatment as opposed to placebo. The drug’s half-life is only two hours, but women have reported effects lasting 10 to 12 hours. They also reported that the quality of their sexual encounter had improved. The older group (women over 34) responded slightly better than their younger counterparts.

New Aphrodisiac Nasal Spray

Bremelanotide still has some way to go till it will be on the market, but it is getting some positive press in magazines as the “first equal-opportunity aphrodisiac”. Palatin Technologies, the manufacturer of the drug is more cautious and does not want bremelanotide to be perceived as a leisure drug, even more so as it has not seen its approval at this point.

National Review Of Medicine, July 30, 2006, page 11

Comment on Nov. 13, 2012: The FDA did not approve this drug due to reports of elevated blood pressure in a minority of test subjects. However, the drug has been synthetized by other pharmaceutical companies around the globe and is actively traded in Argentina, Armenia, Aruba, Australia, Austria, Azerbaijan, the Bahamas, the United Arab Emirates, United Kingdom and Uruguay.

Last edited December 6, 2012

Aug

2006

Autism Not Linked to MMR Vaccine

By Ray Schilling | Other neurological conditions

The fear that there could be a connection between the measles-mumps-rubella (MMR) vaccine and the development of autism (PDD or pervasive developmental disorder) has stopped many concerned parents to have their children vaccinated against these common childhood diseases.
Canadian research found out that a different picture emerged. Dr. Fombonne and his team from Montreal calculated that PDD prevalence increased by about 10 % every year. The MMR coverage decreased by about 4%. From these figures it is clear that the MMR-autism connection has been a myth. The consequences of the scare however, have been severe after the 1998 scare that came from an article in the Lancet. MMR vaccination has dropped from 95% to 85%, and the UK is currently experiencing its worst measles outbreak in 20 years. Measles is not a “harmless” disease that affects small kids. People have to remember that measles are a disease that kills, and not just in developing countries.
The next item was the hypothesis that mercury exposure from vaccines could pose a problem. Mercury exposure however has dropped to nil ever since a compound called thimerosal that was used as a preservative has been discontinued and eliminated from vaccines in 1996.
Autism (PDD) and its increase still keep researchers busy. The vaccination myth has been debunked as the culprit for autism.

Dr. Fombonne explains that there is increasing evidence for genetic factors giving rise to the disorder, but there could be contributing environmental factors.

Reference: National Review Of Medicine, July 30, 2006, page 3

Link to chapter on autism in my Net Health Book with more info about autism: http://www.nethealthbook.com/articles/autism.php

Last edited December 6, 2012

Aug

2006

Do Not Mix Migraine Medications With Antidepressants

By Ray Schilling | Mental Health, Other neurological conditions, Pain

Headache medications that are available over the counter in the local drugstore are ineffective when it comes to a migraine headache, and migraine sufferers have received great help from medications that are targeting a migraine attack. They are non-narcotic prescription drugs, some of which have to be injected. They are available under names like Amerge, Axert, Frova, Imitrex, Maxalt, Relpax or Zomic, and the medication group is known in pharmacists’ language as “triptans”.
The medications are generally well tolerated, but the FDA has issued a warning.
In combination with another medication group, life threatening side effects can occur.
Any patient who is receiving medication for the treatment of depression in the form of a Selective Serotonin Reuptake Inhibitor (SSRI’s) is strongly warned, not to take any of those listed triptans for migraine. The anti depressive drugs are Celexa, Fluvoxamin, Paxil, Prozac and Zoloft. Two other medications, namely Effexor and Cymbalta are Selective Serotonin/Norepinephrin Reuptake Inhibitors (SSNRI’s), and they carry the same risk when taken in combination with the triptans.
The combination of the two medications can lead to a dangerous condition known as Serotonin syndrome. It occurs when the body has too much serotonin, a chemical found in the nervous system. Serotonin syndrome symptoms may include restlessness, hallucinations, loss of coordination, fast heartbeat, and rapid changes in blood pressure, increased body temperature, overactive reflexes, nausea, vomiting, and diarrhea. Serotonin syndrome may be more likely to occur when starting or increasing the dose of a triptan, SSRI or SNRI.

Do Not Mix Migraine Medications With Antidepressants

It is up to the prescribing physician to carefully weigh the advantages against the serious side effects, and it can be a difficult choice, as both conditions, migraine as well as depression, need to be treated effectively. Any patient who has to take both medications has to be closely watched. The patient also has to be alert to any side effect.

Reference: FDA/Center for Drug Evaluation and Research, July 19, 2006

Link to chapter on migraines in Net Health Book: http://nethealthbook.com/neurology-neurological-disease/common-causes-headaches/migraine-headache/

Last edited Nov. 1, 2014

Jul

2006

Better Blood Pressure Control With New Drug

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

Numerous medications for blood pressure control are in circulation. Treatment of high blood pressure patients is crucial in the prevention of strokes, but despite the multitude of drugs that are on the market, the treatment has its challenges. Some of the drugs have side effects, like an irritating cough, and a suitable medication has to be tried out first. Even, when all is well and there are no unpleasant side effects, many patients have a problem with compliance. Pills that have to be taken several times per day are forgotten. As a result, the patient will have poor blood pressure control.
Blood pressures must be controlled on an ongoing basis. Ideally there are no big fluctuations, whether it is day or night. For this purpose, a medication has to stay in the system of the patient long enough. This time stretch is called the half-life of a drug.
The first drug in a new class of agents for the treatment of high blood pressure does exactly that: it has a long half-life, so blood pressure control is smooth and continuous, day or night. The oral direct renin inhibitor aliskiren has the potential to protect the heart and other organs with a once-daily dosage of 150 mg or 300 mg. The drug is being developed by Novartis, and clinical trials are on their way.
The medication in combination with a diuretic provides significant additional blood pressure reduction. The agent at work is a renin inhibitor (also known medically as “renin antagonist” as it blocks the effects of renin). In the past, renin inhibitors for treatment of hypertension (high blood pressure) could only be used as intravenous solution and this was only effective for a short time.

Better Blood Pressure Control With New Drug

The new development is a breakthrough, as the medication is taken by mouth and it continues to work even when the drug is gone from the blood stream. It is ideal for daily dosing, and there is no apparent buildup in the body.

More information about hypertension (high blood pressure): http://nethealthbook.com/cardiovascular-disease/high-blood-pressure-hypertension/

Reference: The Medical Post, June 13, 2006, page 38

Comment on Nov. 13, 2012: Aliskiren (brand name “Tekturna”) was approved by the FDA in March of 2007. However, as all drugs, it does have some side-effects like headaches, cough, angioedema, skin rash, elevated uric acid with gout etc. (see this Wikipedia link).

Last edited Nov. 1, 2014

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