Medical Articles by Dr. Ray

Feb

2006

Using Cell Phone Not Causing Brain Cancer

By Ray Schilling | Cancer, Health, Prevention

Of all the common brain tumors in adults, gliomas are the most common cancers. The prognosis for patients who are diagnosed with this type of brain cancer is extremely poor. Researchers are still attempting to pinpoint the reasons why these tumors are starting to grow, as they have a very distinct formation of cells and seem to be different from other brain tumors.
In the recent past, a lot of attention has been focused on the aspect of mobile telephones and a possible risk of gliomas and other brain tumors associated with their use. The energy of the radio frequency fields emitted by cell phones is thought to be insufficient to cause DNA damage to brain cells that lead to the formation of cancer cells.
Epidemiologists have done studies on users of mobile telephones and have not generally reported an increased brain cancer risk in overall or long-term use. Individual studies have found positive associations between high-grade astrocytoma (glioma) and phone use, brain tumor and phone use in rural areas and use of analogue mobile phones.
A large population based case-control study of 966 patients with glioma in the United Kingdom was designed to investigate cell phone use and the risk of brain tumors. It was part of the Interphone project, which is an international collaboration of 13 countries that concerns itself with the risks of cell phone use and tumors. The south east of England as well as four areas to the north and southern Scotland was the area studied with a total catchment, which amounts to 48.3% if the UK population of 28.4 million. Cases with intercranial tumors were ascertained from various sources, hospital departments (neurology and others) as well as cancer registries. The study was introduced as one to examine risks factors for brain cancers without stressing cell phone use. During the interview those who were mobile phone users were asked detailed questions on cell phone use, which included the recording of all makes and models of phone. Regular phone use was defined as a period of at least six months in the time frame of more than a year before the patient had been diagnosed with glioma.

Using Cell Phone Not Causing Brain Cancer

When all the data had been evaluated, there was no association of risk with lifetime years of use, cumulative use or cumulative hours. There was also no association with cell phone use in urban or rural areas and high or low-grade gliomas. The use of analogue phones was also scrutinized and there were no significant odds ratios with any exposure.
This study has nearly twice as many cases as the previously largest study on glioma patients and the use of mobile phones. In addition it has a large amount of comprehensive and relevant collection data. The results are also consistent with findings from investigations of mobile phone use in the US, Denmark and Sweden. Overall there are no substantially raised risks of of glioma in the 10 years after first mobile phone use. Only future studies will be able to address longer latency periods.

More information on brain cancer: http://nethealthbook.com/cancer-overview/brain-cancer/

Reference: Brit. Med. Journal (doi: 10.1136/bmj.38720.687975.55; published January 20, 2006)

Last edited October 30, 2014

Feb

2006

Herpes Medication Successful In Mononucleosis

By Ray Schilling | Infectious Disease

Infectious mononucleosis is a common infectious disease that affects teenagers and young adults. The nickname “Kissing Disease” sounds rather funny, but getting sick with mononucleosis- and the affected persons may not have been kissed at all! – is no fun. The virus can leave the patient unwell and lethargic for several weeks. Missing study hours or being unable to work can be a bad set back.

There is no vaccination against the Epstein-Barr virus, which is the culprit in mononucleosis, and as it is the case with viral illnesses, antibiotics are of no use. The approach so far has been the treatment of symptoms: take over-the counter medicine to bring down a high temperature, drink fluids, use an over-the counter remedy to help against a sore throat and rest. In time mononucleosis would resolve.

Dr. Henry Balfour, who is a herpes specialist at the University of Minnesota, investigated the antiviral drug acylovir (Valtrex) as an intervention for documented Epstein-Barr infections. Students who presented with symptoms of Mononucleosis within 7 days of onset were receiving 3g of valacylovir per day for 2 weeks. Samples of saliva showed a two-fold decrease of the virus load in 8 out of 10 patients. Only one student who had been untreated showed the same result. This effect points to the possibility of reducing or eliminating oral virus transmission by administering Valtrex. The other effect was a decrease in the severity of the illness. The group on medication got better faster. Dr. Balfour pointed out that the current study does have some limitations, due to the small number of participants.

Herpes Medication Successful In Mononucleosis

He hopes to study the effect of another antiviral agent, valganciclovir (Valcyte) that has a longer intracellular half-life and for this reason should be even more effective.

More information on infectious mononucleosis: http://nethealthbook.com/ear-nose-and-throat-diseases-otolaryngology-ent/throat-problems/infectious-mononucleosis/

Reference: The Medical Post, page 1, 61, January 10, 2006

Last edited October 30, 2014

Jan

2006

Combination Of Drugs Helps Rheumatoid Arthritis

By Ray Schilling | Arthritis

Several treatment options have become available to patients suffering from rheumatoid arthritis, but side effects can be a problem. Corticosteroids are still needed, and methotrexate has been added. While anti-tumor-necrosis factor therapy (TNF alpha antibody) is a very beneficial form of treatment, there are patients who fail to respond or have toxicity to these therapy forms.
Dr. Stanley Cohen, a clinical professor of internal medicine at the University of Texas Southwestern Medical School in Dallas investigated 520 patients who had not adequately responded to methotrexate and anti-TNF therapy. The patients received the genetically engineered monoclonal antibody, rituximab (Rituxan), which so far has been used to treat Hodgkin’s lymphoma. It was found to be highly effective for active rheumatoid arthritis when given with methorexate in patients who experienced an inadequate response to anti-TNF therapies.
The patients were randomly selected and received either a single dose of 1000mg rituximab or placebo on days one and fifteen. All patients received a corticosteroid prior to the infusion. They also took a short course of oral corticosteroids between the two injections. For the patients on rituxmab, the medication proved beneficial. It was also well tolerated. Statistically 51% of the patients on rituximab had at least a 20% improvement on the swollen and painful joints and at least 20% improvement in 3 to 5 other criteria, like general well being, disability or laboratory tests of C-reactive protein.
Only 18% of the placebo group showed any improvement. It was also noted that the effects of this one-time treatment could last up to 15 months.
As good as the current medication is, there are treatment failures. Dr. David Karp, chief of Rheumatic diseases at the same university but not involved with this study finds the development very valuable.

Combination Of Drugs Helps Rheumatoid Arthritis

He concludes that it becomes important in this area to personalize the treatment plan. The future is to look at the patients’ blood or gene makeup and prescribe specific therapies directed at their particular problem.

More information regarding treatment of rheumatoid arthritis: http://nethealthbook.com/arthritis/rheumatoid-arthritis/treatment-rheumatoid-arthritis/

Reference: The Medical Post, December 20, 2005, page 33

Last edited October 30, 2014

Jan

2006

Plastic Surgery For Men

By Ray Schilling | Anti-aging medicine, Cosmetic surgery, Men's Health

Makeover TV shows are very common, but it is usually women who are featured in them.
The fact that males are not talking as much about makeovers, Botox, Restylane and face lifts does not mean that cosmetic surgery is a topic only reserved for women. In 2004 1.2 million procedures were performed on men according to statistics from the American Society of Plastic Surgeons. The number of surgical procedures rose by 16% from 2000, and in 2004 there was also a 43% increase in minimally invasive treatments for men.
The reasons for this shift of attention may have several reasons. Men feel that there is more pressure on them to look vibrant, youthful and energetic. There is a lot more exposure of plastic surgery in the news media. Information about cosmetic surgery is also disseminated on the Internet.
An executive who has experience and skills and looks tired and old may be at a disadvantage on the career ladder, observes Dr. Lorne Tarshis, a Toronto plastic surgeon. If drooping eyelids convey the look of defeat and tiredness, it is not likely a reflection of how the patient really feels. As a result, men in this category will often opt for a blepharoplasty. Women are more willing to talk about plastic surgery to their doctor. Men are more reluctant than women to go to the doctor’s office and ask about procedures. They are more likely to get their information on the net and walk into the office of the plastic surgeon with their minds made up. Dr. Arie Benchetrit, a plastic surgeon from Pointe Claire, Quebec finds that men are more pragmatic, whereas women are more open to discuss options. Men are looking for “natural” results, meaning in this case, that they want to look great but they don’t want people to know why they look great. As a result they prefer less dramatic procedures. It does not mean that men are less nervous or anxious about their appearance than women, but mostly they won’t talk about it, because admitting vulnerability in a competitive context goes against male culture.

Before (above) and after (below) blepharoplastyDr. A. Carruthers from Vancouver reports that some patients with facial wasting as a result of HIV benefit from cosmetic fillers like restylane and silicone oil. Some of them were well enough to work. Their condition was stable, they felt fine, but they were sent home and told to go on disability because they looked too sick to be seen in the workplace. “Getting their faces back” had an immense emotional impact on those patients, who no longer felt stigmatized. Dr. Carruthers reported that in the past cosmetic surgery was looked at with skepticism. When Sigmund Freud heard that someone wanted to undergo a cosmetic procedure, he responded by prescribing psychoanalysis. But times have changed. Cosmetic procedures are more about well being, and the word “vain” is a four-letter word.

More on cosmetic surgery: http://nethealthbook.com/dermatology-skin-disease/cosmetic-surgery/

Reference: The Medical Post, December 20, 2005, page 31

Last edited October 30, 2014

Jan

2006

Colon Cancer Associated with H. Pylori

By Ray Schilling | Cancer

The prevalence of Helicobacter pylori has been identified as a risk for the development of stomach cancer. Infection with this microbe has come under more scrutiny, as patients who are seropositive to H. pylori are more likely to develop colorectal cancer than those patients who are seronegative. The green colored bacteria on this image are H. pylori in the gastrointestinal tract.

Dr. Akio Inui from Kagoshima University in Japan has investigated the relationship of this microbe in the development of colon cancer by analyzing data from 332 patients who were screened by virtual colonoscopy (high-resolution colonoscopy) and serological testing for H. pylori. Of the patient group 42 % with H. pylori antibodies had tubular adenomas (precancerous colon cancer lesions) but only 19% of the negative group had colonic cancers. The researchers concluded that more investigations and long-term prospective studies are needed to explore the biological basis of Helicobacter infection and colon cancer.

Colon Cancer Associated with H. Pylori

In the meantime it is important to eradicate infection in order to prevent stomach and colon cancers.

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

More info on colon cancer: http://nethealthbook.com/cancer-overview/colon-cancer/

Reference: Int. J. Cancer 2005; 117: 1058-1059

Last edited October 30, 2014

Jan

2006

Prevent Foot Problems In Diabetics

By Ray Schilling | Diabetes, Hormones, Prevention, Skin Disorders

Diabetes has reached epidemic proportions in North America. Two million Canadians (about 20 million in the US) have diabetes, and the number is expected to rise dramatically. At one time or another about 15-20% of patients with diabetes will need hospitalization with a diabetic foot complication. The conditions, which are of concern, are diabetic foot ulcers, severe infection and circulation problems in fingers and feet (peripheral circulation). Health budgets are stretched, as the cost of treating a single foot ulcer has been estimated at $2,183, so the total cost over the lifetime of current diabetics will exceed $650 million (about 6.5 billion $ in the US). Foot ulcers appear like a small item considering the fact that the need for amputation of a lower extremity is the next severe problem that can arise. The average patient who undergoes a below knee amputation will spend 84 days in hospital and another 38 days in rehabilitation.
To prevent the development of foot ulcers, it is important to screen diabetic patients for predisposing factors like the loss of protective sensation in the feet (diabetic neuropathy) as well as structural changes resulting in areas of increased pressure. A study conducted in southwestern Ontario found that only 15% of patients with type 2 diabetes were screened to identify those at risk for foot ulcers. Screening is the first step, after which a podiatrist will have to take over. Footwear prescribed by a podiatrist can be an avenue of prevention, but ongoing podiatric care as well. The small number of diabetic foot screenings shows that podiatric medicine has not been used as a tool to recognize and treat diabetic foot problems.

Prevent Foot Problems In Diabetics

The proactive approach of seeking the input of a podiatrist early will translate into significant benefits for the patient with type 2 diabetes.

More information on complications of diabetes: http://nethealthbook.com/hormones/diabetes/complications-diabetes/

Reference: Parkhurst Exchange, December 2005, page 162

Last edited October 30, 2014

Jan

2006

Face Transplants For Disfigured Patients

By Ray Schilling | Cosmetic surgery, Health

Patients with severe burns to their face have been treated with skin transplants in order to help them cope with common body functions which the average person takes for granted, like opening and closing of eyelids or breathing. Patients have to undergo numerous skin grafts, where skin is transplanted from other body areas. The process can take years, as multiple surgeries are needed. Facial skin is also more tender and pliable, making it different from the type of skin in other areas of the body, and plastic surgeons are working to make the facial appearance of the patient less mask-like. The journey to recovery becomes a long and difficult one, which can be likened to an emotional roller coaster: there is surgery and the time to heal, after which more surgery is required.
The possibility of a face transplant sounded like a futuristic item till a short time ago, but French doctors have used new techniques to restore the facial features of a 38-year-old woman, whose face had been mauled by a dog. The partial transplant was done using the mouth, nose and chin of a brain dead donor.
Maria Siemionow, the director of plastic-surgery research at the Cleveland Clinic states, that facial transplant can only be considered as a treatment for severely disfigured patients who have exhausted all conventional options. The procedure itself remains controversial and risky. It involves harvesting the face from a brain-dead organ donor in a 4 to 6 hour surgery. In the following 10 to 15 hour procedure the face is draped over the bones and muscles of the recipient. Following surgery the transplant patients needs to take medication to prevent the rejection of the transplant. Even though the risk is not any different than the risk, which goes along with a kidney transplant, there is the possibility of transplant rejection and of side effects from immunosuppressants. Patients, who take this medication that will cost about $2000 per month, are more susceptible to infection, cancer, metabolic disorders, and liver and kidney damage. The psychological impact on the patient will also be significant, as there could be a feeling of having a different identity. Dr. James Zins, chairman for plastic surgery at the Cleveland Clinic, insists that there are no races to be won and the approach to this new option should be methodical and slow.

Face Transplants For Disfigured Patients

Before and after face transplant

Not all potential candidates for the surgery are willing to take the risk of life-long immuno-suppressants and it is only a consideration for physical as well as psychologically suitable patients who are willing to take the risk of receiving a new face after devastating accidents.

Reference: December 12, 2005 issue of Newsweek, pages 60-61

Last edited December 6, 2012

Dec

2005

Jetlag Helped By Bright Lights and Melatonin

By Ray Schilling | Health, Prevention

The effects of long distance travel can be unpleasant: once several time zones are crossed, people are struggling to adjust to a different wake-sleep pattern, and what is know as the “circadian rhythm” has to readjust.
Eating light meals, avoiding alcohol during travel and drinking plenty of water are the suggestions, which are frequently heard. The other suggestion for travelers is adjusting their sleep times before the trip, namely going to sleep one hour earlier for each hour of time difference when traveling east. This method alone is not always practical, especially when a sudden trip with time differences of more than 8 hours are involved.
Previous research has also shown that light box therapy works and that melatonin is a useful tool in people with jet lag.
Dr. Charmane Eastman (PhD) from Rush University Medical Center has authored a study that shows that light therapy in combination with melatonin works better than light therapy alone. Dr Eastman and colleagues studied 44 healthy adults who were divided into three groups. The first group received placebo (meaning” fake” pills), the second group took 0.5 mg melatonin, and the third group received 3.0 mg melatonin. All three groups were given three days of advancing sleep-dark period with a wake time one hour earlier each morning. They also got bright light on awakening, namely four 30-minute bright-light pulses alternating with 30 minutes of room light. There were significantly larger phase advancements with 0.5 mg or 3.0 mg of melatonin, as opposed to placebo. A slightly larger shift was obtained with the 3.0 mg dose of melatonin as compared to 0.5 mg, but this difference was too small to be statistically significant.

Jetlag Helped By Bright Lights and Melatonin

The researchers concluded, that afternoon melatonin, morning intermittent bright lights and a gradually advancing sleep schedule was able to advance the circadian rhythm almost an hour a day. It was also found, that the lower dose of melatonin would be adequate, and as melatonin is pretty harmless compared to most drugs prescribed, people should not be afraid to use it (even the higher dose) to cope with jet lag.

Reference: The Medical Post, November 22, 2005, page 49

Last edited December 6, 2012

Dec

2005

Food Habits Related To Asthma

By Ray Schilling | Asthma, Nutrition, Prevention

High quality dietary data have made it possible for a research team in North Carolina to address how a diet rich in meat, salt, starches (=refined carbohydrate) and fat can have an impact on respiratory problems and asthma.
Stephanie London and her team examined the data of 52,535 people between the ages of 45 and 74 years of age. A baseline examination was started in 1993, and follow-ups were done in 1999. All of the participants lived in Singapore. After adjustments were made for age, gender, smoking and education. It was observed that dietary habits could make a difference to respiratory health. Two eating patterns emerged: one group gravitated towards dim sum, meat and noodle dishes, whereas the other group favored fruit, vegetables and soy products. The “meat and dim sum” group had a 1.43 times higher risk of developing breathing problem, new-onset cough and phlegm formation. There was also a link to chronic respiratory disease and asthma.

The researchers concluded also, that the habits observed in the Singapore study are very much in keeping with dietary habits in western countries, where one group consumes foods high in starch, fat, meat and sodium and a second group has a more health conscious approach preferring, vegetables, fruit, legumes, fish, poultry and whole grains.
As a result the same recommendations are applicable to in western countries: stick to food choices with a low glycemic index and skip the noodle dishes. Stay away from trans fats and limit the saturated fats, which means turning away from deep-fried foods and limiting meat intake. Choose fish, vegetables and legumes, and avoid the high sodium content, which is common in many premixed and prepared foods. If you are doing the cooking, go easy on salt, and ban the saltshaker from the dining table.

Food Habits Related To Asthma

A lot has been said about good food habits and a reduction in cancers and heart disease. What is new is the fact that food habits also have an impact on the health of our respiratory system.

More on inflammation as a cause of arthritis, asthma, cardiovascular disease and cancer: http://nethealthbook.com/about/overview/

Reference: Am J Respir Crit Care Med 2005

Last edited October 29, 2014

Dec

2005

Hospital Cafeterias Need Healthier Food

By Ray Schilling | Health, Nutrition, Prevention

Cafeterias and fast food restaurants have come under scrutiny for offering food choices that are not compatible with healthy living. In a place where healthcare is the prime concern, like in the cafeteria of a hospital, one should hope that promoting good health should be the norm.
A U.S. wide survey tells another story: hospitals are falling short of providing meals that are healthy and heart-friendly. There are some trends, such as the availability of fresh fruit and wholegrain products, but the overall picture points to an urgent need for improvement. The survey was conducted by the Physicians Committee for Responsible Medicine (PCRM, for short). This advocacy group for ethical and preventive medicine distributed questionnaires, inquired about sample menus as well as recipes for one of the “healthiest menu items available from the hospital’s main eating establishment”. It turned out that sixty-two percent of the “healthiest entrée” choices derived more than 30% of calories from fat, and a few derived more than 50% of calories from fat.

Although at least 80% of responding hospitals offered wholegrain products, sugar-free snacks and fresh fruit, less than a third offered a daily salad bar. Artery-clogging fats in hospital food also prevailed. Fried chicken was the top selling item in 24% of the hospital cafeterias and hamburgers in 12% of the surveyed cafeterias. Other top sellers included pizza, enchiladas and meatloaf. Less than one third offered non-dairy options or soymilk.
The recommendations to promote more health conscious food were very much common-sense: food services should offer daily salad bars, use fresh rather than canned vegetables, incorporate organic ingredients and hearty vegetarian soups daily. Fatty or cholesterol-laden add-ons such as bacon, mayonnaise, croutons and sour cream should be optional. Beans should also be offered as well as healthy items from other countries’ cuisines.

Hospital Cafeterias Need Healthier Food

In the meantime it is up to the consumer to be prudent in making the better choices. This may involve turning a cold shoulder to cafeteria food and seek healthier choices elsewhere. For the visitor it may mean that bringing a brown bag or a take-away with a salad would be more appropriate than bringing a bunch of flowers for a loved one in the hospital.

More on processed foods: https://www.askdrray.com/caution-processed-food-ahead/

Reference: The Medical Post, October 25, 2005, page 15

Last edited October 29, 2014

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