Medical Articles by Dr. Ray

May

2005

Dialysis At Home Now Possible

Kidney failure and the need for dialysis has been a burden that many patients had to live with in the past. Invariably the quality of life would suffer, as every week brought trips to the hospital and a four-hour hook-up to the dialysis machine there. The times of travel or recreation were usually a thing of the past, as dialysis took precedence over other things.

Dr. Stephen Korbet, professor of nephrology at Rush Presbyterian Hospital in Chicago has been using a new dialysis device to stable chronic patients since 2003.The 33 cm machine called Nx Stage System One has some significant advantages over the conventional machines. The treatment is done on a daily basis for 2 hours. There is better clearance of potassium and phosphates, and there seem to be fewer side effects. The system is portable, can also be taken on trips, and no special water processing or electrical requirements are needed. Those who wish to use the system have to be medically stable and train for two weeks with a partner who can assist with set-up and watch for adverse effect.

Dialysis At Home Now Possible

The Nx Stage System One offers the patient freedom and independence. At this point it is not yet available in Canada.

More information on pyelonephritis, which can lead to kidney failure: http://nethealthbook.com/infectious-disease/urinary-tract-infection/pyelonephritis/

Reference: The Medical Post, April 26,2005,page 45

Last edited October 28, 2014

May

2005

Inflammation Connected To Sudden Heart Death

By Ray Schilling | Diabetes, Heart Disease, Prevention

It is a well-known fact that certain diseases go together, for instance diabetes and heart disease. Every effort has to be made for this reason to control a disease in order to minimize the risk for other associated illnesses.
New research from rheumatologist Dr. Sherin Gabriel at the Mayo Clinic points to another health condition. Patients affected by rheumatoid arthritis have a higher risk of early death than others, and these deaths are mostly due to cardiovascular disease. The relationship between these two diseases is complex, reports Dr. Gabriel, and the common denominator between heart disease and rheumatoid arthritis seems to be systemic inflammation.

Research from the Mayo Clinic in Rochester, Minnesota, has been published in March, and it was found that inflammation documented by laboratory tests such as an erythrocyte sedimentation rate of over 60mm per hour increased the risk for heart disease by a factor of two. Rheumatoid arthritis vasculitis increased the risk to 2.4, and RA lung disease showed a risk increase of 2.3. Traditional risk factors for heart disease like smoking, alcohol, obesity and diabetes were accounted for, yet the more dramatic risk factor in the population with RA (rheumatoid arthritis) was the aspect of inflammation. The results of this research are based on data from the Rochester Epidemiology Project, in which 603 persons with rheumatoid arthritis were followed over 15 years. In this time span 364 of these patients died, and heart disease was the primary cause of death in 176 of them. The subjects of this group were three times as likely as an age-matched population to have been hospitalized for a heart attack and had five times the risk of having an unrecognized heart attack. This group is also more vulnerable, because patients with rheumatoid arthritis suffer of joint pains, receive painkillers, and often chest pain can be masked by pain medication and go unrecognized.

Inflammation Connected To Sudden Heart Death

Co-author Dr. Hilal Maradit points out that rheumatoid arthritis remains a multifactor problem, and one factor alone does not explain the entire story, but in the meantime the link of inflammation in RA to cardiovascular disease is an important step closer to early recognition and successful control.

More info about:

Rheumatoid arthritis: http://nethealthbook.com/arthritis/rheumatoid-arthritis/

Gingivitis: http://nethealthbook.com/dentistry/gingivitis/

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

Reference: National Review Of Medicine, April 15, 2005, page 3

Last edited October 28, 2014

May

2005

Burgers, Fries and High Healthcare Costs

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

“Everything in moderation” and “A little bit cannot harm” are the deceptively soothing terms that can lull consumers into the belief, that fast foods cannot be so bad after all. A study, called the” Coronary Artery Risk Development in Young Adults” however gives us the facts, that paint a more realistic picture: the “little bit” actually has fairly serious consequences!
In this U.S. study a wide cross section of young adults were followed in four U.S centers: Birmingham, Ala., Chicago, Minneapolis and Oakland Calif. 3031 people in the age of 18 to 30 years were recruited in 1985 and followed until 2001.

Lifestyle habits, such as smoking, watching TV and intake of other foods were recorded, and insulin resistance was measured. In addition there were detailed studies of weight, height, waist size and other body measurements. Some interesting facts emerged: women ate fast foods less frequently than men. Fast food intake was associated with lower education, more TV watching, lower physical activity, high intake of trans fats and alcohol intake. In short: fast foods and other unhealthy lifestyle choices were correlated.

Dr. Mark Pereira, PhD of the University of Minnesota School of Public Health, who is one of the authors of the study, points out that it is extremely difficult to eat in a healthy way in a fast foods restaurant. The menus still include foods high in fat, sugar and calories and low in fiber and nutrients. Dr. Arne Astrup from the RVA University in Copenhagen found the same issues: besides the fact that serving sizes have increased two to five fold over the past fifty years, the energy density is twice as high in fast foods as compared to food in healthy diets. Dr. Astrup also points out in his publication, that humans have only a weak innate ability to recognize foods with high energy density and then down-regulate the amount eaten to meet and not exceed energy requirements.

Burgers, Fries and High Healthcare Costs

If a person ate more than 2 fast food meals per week, which would be a modest increase of the control group that ate less than 1 fast food meal per week, the 2 meals per week group was about 5 kg heavier after 15 years, as opposed to 11 kg in the control group. The insulin resistance increased by an alarming 230 %. This finding is of significance, as insulin resistance (=metabolic syndrome) promotes the occurrence of cardiovascular disease and cancer, especially breast and colorectal cancers. The data are showing that even a modest increase has a unique effect in increasing the risks for these disease patterns, and the message is, that health care costs will only come down, if the root cause of disease is attacked at the societal and lifestyle level.

More information about the metabolic syndrome (insulin resistance): http://nethealthbook.com/hormones/metabolic-syndrome/

Reference: The Medical Post, March 8, 2005, page 20

Last edited October 28, 2014

May

2005

Bird Flu Can Affect Humans

By Ray Schilling | Infectious Disease, Lung Disease

Avian Influenza has received significant attention in the media: some articles label it as the new threat in influenza viruses, while others dismiss it as ” only a flu that will infect birds.” Outbreaks have been reported mainly from Asia, but the nasty virus has made it into poultry farms in North America. There is concern that avian influenza could be transmitted from uncooked birds or bird products onto humans. Avian influenza A has indeed been detected in imported frozen duck meat and infected poultry eggs.
Of particular concern is the virus strain H5N2, as it has the propensity to mutate rapidly. At this point the risk of human-to-human, and transmission remains low, but acquiring the infection from sick birds is a reality. The course tends to be more severe in people older than 12 years, while the disease in children tended to be milder and self-limiting. The symptoms in the adult age group presented as follows:
-Fever (100% of the affected patients)
-Upper respiratory tract infections (67%)
-Pneumonia (58%)
-Gastrointestinal symptoms (50%)
Abnormal laboratory test results were:
-Elevated serum aminotransferases (50%)
-Pancytopenia and bone marrow hemophagocytosis (16%)
Guidelines from the Center for Disease Control suggest that travelers to countries experiencing outbreaks of avian flu should avoid areas with live poultry (live animal markets or poultry farms).

Bird Flu Can Affect Humans

Hand hygiene in the form of soap and water or alcohol-base hand sanitizers is important. All poultry products should be cooked, as heat is effective in killing viruses. It is also important to inform the health care provider about flu-like symptoms associated with recent travel; so avian influenza can be considered.
The current influenza vaccines have no protective value against the avian flu. Studies suggest that anti-viral prescription medication may work. As the viruses are becoming resistant to current medications, they are expected to have limitations in successful treatment.

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

Reference: The Canadian Journal of CME, April 2005, page 49

Look for more info about the bird flu at the CDC site of the US

Last edited October 28, 2014

Apr

2005

Pre-eclampsia Is Predictable

By Ray Schilling | High Blood Pressure, kidney disease, obstetrics, Women’s Diseases

Pre-eclampsia is a condition, which can threaten a woman’s health and also the unborn baby. It can occur in the second and third trimester. These latter stages of pregnancy (there are 3 stages) are where the doctor should check for early pre-eclampsia signs. In the past this would go unchecked and develop to the full-blown condition of eclampsia and be a significant cause of maternal mortality rate
and fetal mortality rate. With prenatal visits and check-ups the early signs are easily recognized: the pregnant woman would complain that her rings would not fit her any more. Significant weight increase due to fluid retention where her legs and the area of her shinbone would be puffy, is called edema. The dipstick test would tell more: it would indicate the presence of protein in the urine sample. These changes are a cause of high blood pressure, which is another important clinical sign and can be readily checked. For these reasons it is imperative that regular pre-natal visits take place at the doctor’s office.

Pre-eclampsia occurs, when substances are released from the placenta into the bloodstream of the mother, and they affect the kidneys. If the condition progresses to eclampsia, it can lead to kidney damage and seizures, and the outcome will be fatal.
For a long time it was a puzzle to physicians, why some women would show pre-eclamptic symptoms and others would remain problem-free.
New research on patients’ medical history from the John Radcliffe Hospital, Department of Obstetrics and Gynecology in Oxford, Great Britain has been able to point out predisposing risks for pre-eclampsia in pregnant women.

Pre-eclampsia Is Predictable

A family history and history of previous eclampsia increases the risk, but also certain health problems make it more likely that pre-eclampsia will occur in the later stages of pregnancy: diabetes mellitus, kidney disease and high blood pressure are medical conditions that increase the risk. Beside these health conditions an increased body mass index at the start of pregnancy can be a predisposing factor, and a high maternal age-women over 40 years of age- are more likely to have the complication of pre-eclampsia. It is obvious that the risk gets higher, if several of these predisposing factors are present. The highest risk is found in women with a rare inherited variation of lupus, called anti-phospholipid syndrome, where blood clots are a problem and pre-eclampsia is a high risk with pregnancy.

Risk Factors For Pre-Eclampsia According To Meta Analysis (published
in the Brit.Med.Journal, March 12, 2005)

Pre-eclampsia Risks

Explanation of independent risk factors: A= Previous History Of Pre-eclampsia; B= In Women With Anti-Phospholipid Antibodies; C= Pre-existing Diabetes; D= Twin Pregnancy; E= First Child; F= Family History; G= High Blood Pressure; H= High Body Mass Index;
I= Maternal Age 40 or more

While it is absolutely imperative that regular pre-natal checks are part of proper health care, there are other consequences. There would be reason to be especially watchful with predisposing conditions. Last not least, prevention also has its place.

It is important that health concerns are already addressed as part of planning for a healthy pregnancy. Avoidance of alcohol and quit smoking are of extreme importance, followed by achieving a normal weight. Good eating habits are needed throughout the entire pregnancy. Opting for pregnancy after age 40 seems trendy in some celebrity circles, but with the knowledge of risk factors, it should be looked at with caution. Nature equipped the human species to have children in the age of 20 to 30, and even though a forty year old may have a youthful appearance, the genetic material is aged, and the biological clock cannot be fooled. Prevention also means that any health condition like preexisting diabetes should be well controlled before a pregnancy.
With a proactive and common-sense approach pre-eclampsia can be either avoided or recognized and treated early, resulting in healthy outcome for mother and baby.

More information about high risk pregnancies: http://nethealthbook.com/womens-health-gynecology-and-obstetrics/pregnancy-labor-delivery-2/%20High%20Risk%20Pregnancies/

References: British Medical Journal 2005;330:565(12 March)

Last edited October 28, 2014

Apr

2005

Hormone Replacement Worsens Incontinence

By Ray Schilling | Hormones, Prevention, Women’s Diseases

Once hailed as the miracle pill for the aging woman, hormone replacement therapy (HRT) is now being approached with caution. The infamous Women’s Health Initiative study, which first disproved benefits of hormone therapy, first pointed out an increase of breast cancer risk and risk of cardiovascular disease. On re-analysis of the data the Journal of the American Medical Association has published a study in its issue of February 23, 2005, which shows some more reason for caution with HRT. The previous notion that hormone replacement would improve the symptoms of urinary incontinence has turned out to be a fallacy. Dr. Susan Hendrix and her colleagues from Wayne State Untiversity School of Michigan in Detroit analyzed the data from 23,296 women with urinary incontinence. In randomized trials they received either estrogen alone, estrogen with progestin (Prempro) or the placebo effect (“fake pills”). Among those who were continent at the baseline, both, estrogens alone as well as the combination therapy were associated with an increased risk of incontinence at one year. Estrogen (Premarine) alone produced the most marked effect: stress incontinence increased by a factor of 2.15, the combination therapy increase stress incontinence by a factor of 1.87. In addition, women who were already suffering of incontinence, tended to report a worsening of their symptoms after beginning hormone therapy. The Women’s Health Initiative trials were stopped because the treatment risks appeared to outweigh its benefits. These new findings tilt the scales even further against hormone therapy, the authors say in their study.

Hormone Replacement Worsens Incontinence

Reference: National Review of Medicine, Canada, March 15, 2005, page 28

Comments on Nov. 8, 2012: We have to keep these observations in perspective. The authors of that study were using the “regular” Big Pharma manufactured hormone substitutes that the body cannot read. There are no Premarin or Provera receptors in the tissue, only testosterone receptors, estrogen receptors and progesterone receptors. These artificial hormones cannot be metabolized in the woman’s body into testosterone as bio-identical estrogen and progesterone would, because they are structurally different from the bio-identical hormones. The sad truth is that an anti-aging physician could have treated these poor women with incontinence safely by prescribing small amounts of testosterone cream that would have had to be applied to the urethral opening. From there the body would have sent it to the bladder, the bladder sphincter and the testosterone receptors that control these tissues and would have taken care of the incontinence problem. You do not need a clinical trial. This type of treatment has been used in Europe for decades and has been used in the US for maybe 10 to 15 years as well by some open minded urologists and anti-aging physicians. The heading for this post is only applicable for HRT in the conventional sense (using Big Pharma drugs), but none of this applies to bio-identical hormone replacement for menopause.

More info on bio-identical hormone replacement in menopause: http://nethealthbook.com/hormones/hypogonadism/secondary-hypogonadism/menopause/

Last edited October 28, 2014

Apr

2005

One Shot For Better Blood Sugar Control

By Ray Schilling | Diabetes

People with permanent health conditions face the need for lifelong medications, and patients with type 2 diabetes see insulin shots as part of an everyday routine. There are different types of insulin, which helps in tailoring the medication to the needs of the patient.
It is old news that a new type of insulin under the name insulin glargin can be used for the treatment of type 1 diabetes. The news of a study just published in February is, that also patients with type 2 diabetes benefit from insulin glargin. Often the standard treatment with diabetes drugs does not provide optimal control of blood sugar levels.
371 type 2 diabetes patients with inadequate diabetes control who were not supplemented with insulin were part of a 24-week clinical trial in Bremen, Germany, headed by Dr. Hans U. Janka.

The patients received an antidiabetic combo consisting of sulfonylurea and metformin. These patients were randomly picked, and they received a morning dose of glargine insulin injection along with the antidiabetic medication. Others did not receive the oral medication, but were administered twice-daily injections of NPH insulin. Patients were monitored for the level of glycosylated hemoglobin (= HbA1c), which is the best indicator for diabetes control. The improvements in laboratory tests were more pronounced in the group that received the combination between an oral antidiabetic and glargine injection. In addition 46% reached HbA1c levels of 7% or less, which is excellent long-term blood sugar control, as compared to only 29% of the NPH insulin group. Fasting blood sugar levels also showed improvement. There is a risk of patients becoming hypoglycemic. Again, the risk was significantly lower in those who were on the glargin combination, than those who were on the NPH insulin.

One Shot For Better Blood Sugar Control

These results show that one single injection, which is added to the oral medication, can help type 2 diabetes patients, whose condition has been poorly controlled. Glargine insulin has been approved in Canada already in 2002, but due to supply problems it is only now expected to be on the pharmacy shelves soon.

More information on treatment of diabetes with insulin: http://nethealthbook.com/hormones/diabetes/treatment-diabetes-insulin/

Reference: National Review Of Medicine, March 15,2005,page22

Last edited October 28, 2014

Apr

2005

Rapid HIV Tests – Not At Home

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

Consumers beware: a company from Montreal is advertising do-it-yourself home diagnostic tests, and the US regulatory body (FDA 2005 safety alerts) has issued a warning, after consumers complained about the accuracy of the tests. The tests are not approved for sale in Canada, and a company that specializes in marketing and web design is marketing them. Even though some people feel more comfortable doing an HIV home test anonymously in the privacy of their home, they do well checking first, which tests are reliable, by looking up approved test kits on sites like Health Canada’s web page.The test kits in question are as follows:
-Rapid HIV test kit
-Rapid syphilis test kit
-One step cassette-style cocaine test
-One step cassette-style marijuana (THC) test
-One step cassette-style amphetamine test
-Rapid Dengue fever test
-One step midstream style HCG urine test
-Home pregnancy test.

Rapid HIV Tests – Not At Home

Globus Media website has been down since the FDA advisory, and no one from the company has been available for comment.

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

Reference: National Review of Medicine, Canada, March 15, 2005, page 5

Last edited October 28, 2014

Apr

2005

Sweet Alcohol Has Bitter Consequences

By Ray Schilling | Gastrointestinal Disease, Prevention, Substance abuse

Aggressive marketing of sugar/alcohol, called “girlie drinks” or “alcopops”, are luring young girls into alcohol consumption. Colorful commercials convey the image of fun and sexy drinks, and as a result, the percentage of girls who drink is more on the rise than boys. The American Medical Association has conducted two teen surveys, and discovered some troublesome facts:
-Approximately one third of teen girls have tried the aggressively marketed alcopops.
-About one in six were sexually active after drinking.
-One quarter has driven after drinking or ridden in a car with a driver who had been drinking.
-The average age of the first alcoholic drink is now 13.
It is obvious from the marketing content, that alcoholic beverage marketers go after young teens, reported Dr. Bob Mann PhD, senior scientist at the Center for Addiction and Mental Health in Toronto.

This advertising is highly effective, as it was observed in a study, which was conducted several years ago. Young males were questioned two months after a brewery launched an advertising campaign for a high-alcohol beer that was geared towards young males. 66% of underage drinkers were consuming the product.

Sweet Alcohol Has Bitter Consequences

In Canada federal and provincial governments are out of the regulation of alcohol advertising. It is essential that parents, educators and family physicians point out the hazards of excessive alcohol use long before the first drink is sampled. An American Medical Association poster shows a young girl taking a swallow from a bottle. The headline warns: “Girlie Drinks…women’s diseases”, and the list of diseases are shown: brain damage, STD’s, heart problems, liver disease, and menstrual disorders.

More information about alcoholism and the effects of alcohol on the body: http://nethealthbook.com/drug-addiction/alcoholism/

Reference: Medical Post, March 1, 2005, page 23

Last edited October 27, 2014

Mar

2005

Liver Cirrhosis Threatens Overweight Children

By Ray Schilling | Gastrointestinal Disease, Nutrition, Obesity

Generally the condition of liver cirrhosis has been associated with excessive alcohol intake, and the victims have been adults.
A similar condition is the fatty infiltration of the liver, where the function becomes impaired through the growth of fatty tissue, which replaces healthy tissue. In its worst form this non-alcoholic fatty liver disease can advance to cirrhosis and end-stage liver disease. So far this devastating course of illness has been seen in adults, but it is not confined to the adult population. The most important risk factor for this disease is obesity, and with one in three children in Canada now overweight, the previous adult-only disease is now affecting kids. Non-alcoholic fatty liver disease is now the most common cause of abnormal liver tests.

Dr. Ariel Feldstein, a pediatric gastroenterologist from the Mayo Clinic in Rochester reports that the average age of children with these symptoms is about 12, which is an alarmingly low age for this picture. There is also a warning, that children do not even have to sport a sky-high body-mass index (BMI). The risk is already significant with a high BMI.The most direct approach to prevent type 2 diabetes and fatty-liver disease in children has to start within the family. Instead of singling out the child it is important to work together as a family to become healthier. The terms”fat”, “chubby”, “exercise” and “diet” are less conducive to improvement than “physical activity” and “better nutrition”. Consistent minor changes are also more important than crash diets that come and go.

Liver Cirrhosis Threatens Overweight Children

Eating more vegetables and fruit, not eating and snacking mindlessly in front of the TV, eating together as a family and preparing healthy snacks instead of tossing a cookie bar or a bag of chips into the lunch bag are all ways that benefit the entire family.
A study from Dr. Robert Berkowitz at the Children’s’ Hospital of Philadelphia affirms even more, that prevention has to start with the parents: children born to overweight mothers have a higher risk of following the pattern of having a high body mass index than those whose parents were normal weight.

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

Reference: The Medical Post, February 15, 2005, page 21

Last edited October 27, 2014

Risk Factors For Pre-Eclampsia According To Meta Analysis (published in the Brit.Med.Journal, March 12, 2005)

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Risk Factors For Pre-Eclampsia According To Meta Analysis (published
in the Brit.Med.Journal, March 12, 2005)