Medical Articles by Dr. Ray

Feb

2005

News About The Flu

By Ray Schilling | Infectious Disease, Lung Disease, Prevention

Every couple of years new influenza strains seem to develop in Asia and spread thru the rest of the world. When summer comes, the flu season is forgotten and the cycle repeats itself in fall and winter.

Recently there were local outbreaks of two avian influenza strains that according to the name should only affect birds (the “asian bird flu”). Based on research from these two bird flu experiences there seems to be a new way of looking at the development of human influenzas. It appears that new strains of human influenza are born in the bird population of Asia where the virus mutates into new strains. From there it spreads into human care takers (bird-to-human spread) and their contacts. Eventually the virus adapts to the human host and effective human-to-human transmission is incorporated into the DNA of the virus. Now the time is ready for a flu epidemic. It is not clear yet how long this human-to-human transmission switch takes (how many months or years). Here are more details regarding the recent two local outbreaks of asian bird flus:

1. Recently Dr. Arnold Bosman published a study in Holland. He was the health officer in charge of investigating an outbreak of influenza A, type H7N7, affecting a number of chicken farms in Holland between March and May 2003. This was the time of the SARS epidemic that caught all of the media attention at that time. About 86 poultry workers had been infected with flu like illness that caused a viral conjunctivitis of the eyes. However, one veterinarian who was in close contact with the infected birds died from respiratory distress syndrome. Using very sensitive PCR facilitated DNA test they were able to show that these infected people had all the same bird flu with the influenza strain A (type H7N7). When contacts of these people were tested a surprisingly large number, about 1000 with an estimated total of about 2000, people were also positive for antibodies to this particular more harmless strain of bird influenza.

2. The second development is regarding the recent infection of a bird flu in Vietnam that has caused many deaths. This is a much more aggressive influenza A (H5N1), which is the other bird flu that is of concern for the rest of the world. In Vietnam this bird flu type has a mortality of 76%, in other words with this new type of flu 3 out of 4 people die who get it. It all started in December of 2003 and here are the latest details about this flu type.

News About The Flu

With the new study from Holland the concern among infection specialists is that there likely are a lot more healthy appearing people who become carriers of the disease (like the 2000 contacts in Holland). Experts feel that this type of flu presently might be in the stage of adapting to the human-to-human transmission mode (so far mostly bird-to-human transmission has taken place, which is still a barrier to mass transmission). When the virus has learnt to adapt to human-to-human transmission, there could be a flu pandemic with a new human strain of influenza A (type H5N1) that would rapidly sweep the world.

A Quebec/Canada company (ID Biomedical) is working on an influenza vaccine for the H5N1 virus, in preparation for a possible pandemic. The demand will be so great when a pandemic would happen, that the company is thinking of stockpiling this vaccine so that it would be available when bad news should strike.

In the meantime antiviral antibiotics such as Tamiflu (=oseltamivir) at a dose of 75 mg twice per day for 5 days started within the first two days of the flu aborts the flu effectively according to the experts. Unfortunately this antiviral antibiotic directed against the N1 component of the virus is expensive.

More background information about the flu (medically termed “influenza”): http://nethealthbook.com/infectious-disease/respiratory-infections/flu/

Reference: The Medical Post, Jan. 18, 2005, P. 2 and 56

Last edited October 27, 2014

Jan

2005

Relapse Of MS Reduced By New Drug

By Ray Schilling | Multiple sclerosis

The effects of MS have been devastating to people afflicted by the disease. New research has brought treatments to combat the progression of the illness, yet relapses after remission have remained perplexing and frustrating to physicians and patients alike. Interferon has been a tremendous help, but patients often experienced flu-like symptoms after receiving interferon. Treatment with steroids has been problematical as well.

The results with Natalizumab (Antegren) are showing impressive results: relapses of MS are reduced by two-thirds (compared to placebo) The drug mechanism works by inhibiting the migration of aggressive auto-immune cells into such tissues as the brain, where they would cause inflammation, which in turn would cause MS lesions. Dr. Paul O’Connor is the lead investigator of the trial and chief of the MS clinic at St. Michael’s Hospital in Toronto, and he reports that this new medication gives double the effect compared to previous drugs against MS. MRI scans also showed 90% less new lesions compared to patients who took placebo (ineffective “fake” medication). Compared to previous MS drugs the medication is safe and well tolerated. The administration of the drug has to be done intravenously, so the patient would need to make a trip to a clinic or hospital once a month.

Relapse Of MS Reduced By New Drug (Approved, Then Not Approved, Now Approved Again)

On the strength of the excellent results the approval process of the drug is carried out only after one year of the study. A second study involving approximately 1,200 patients is ongoing, and the manufacturers of natazulinab (Elan Corp. and Biogen Idec Inc.) are anticipating regulatory approval in the United States. They are also seeking the approval of the drug with Health Canada.

Addendum: This drug was withdrawn from the market due to unacceptable side-effects as can be seen from this link. Here is a review of multiple sclerosis treatments that offers an alternative approach.

Reference: The Medical Post, November 30, 2004, page 49

Last edited October 27, 2014

Jan

2005

Bone Loss Non Reversible After Provera

By Ray Schilling | Women’s Diseases

Depo-Provera has been used as an injectable form of contraception, but the manufacturer (Pfizer Canada Inc.) has sent out warnings to physicians about some quite serious side effects. New data have shown that after two years of use significant bone density loss can be seen.

What is more alarming is the fact, that this loss does not seem to be fully reversible, even if the medication is stopped. The effect is bad enough for adults, but it becomes even more alarming should adolescents receive the product: at a time when they should build their bone density, they would be experiencing the problem of bone density loss!

The amounts of bone mineral density is not insignificant: a controlled clinical study showed that women, who received the medication for 5 years showed a decrease of bone density in the spine and hip of 5 to 6 %. If the drug was stopped, there was a partial recovery of the loss, but the longer the drug was used, the less favorable was the recovery of bone density.

There has been some awareness in the past, that loss of bone density could be a risk in the use of Depo-Provera, but there was the thought that all would be well after discontinuing the medication.

Bone Loss Non Reversible After Provera

This however is not the case after the new research data, and it should caution women to stay away from this form of birth control, if they are interested in maintaining good bone health.

More information about osteoporosis: http://nethealthbook.com/arthritis/osteoporosis/

Reference: The Medical Post, December 7, 2004, page4

Comment on Dec. 7, 2012: Depot Provera belongs into the progestin type hormone equivalents of progesterone (= the natural ovarian hormone). A young female who has normally functioning ovaries has strong bones as both estrogen and progesterone stimulate bone formation by stimulating receptors on the osteoblasts, cells that make new bone. Artificial hormone products like the progestins do not stimulate these receptors, they may even block them. So, women should stay away from Depot-Provera and other Big Pharma contraceptives, as they will contribute to osteoporosis. On the other hand when a woman enters the menopause, she requires full replacement with bio-identical estrogen/progesterone creams to stimulate bone formation and to prevent osteoporosis. There is still a lot of misinformation around in the public, often because of misinforming “infomercials” from Big Pharma.

Last edited October 27, 2014

Jan

2005

Doctor Recommended Diet Against Obesity

By Ray Schilling | Diabetes, Health, Heart Disease, Nutrition, Weight loss

After overindulging over the holidays, new years resolutions often have diets and life style choices high on the list.
These concerns are not something new. Doctors have had concerns about heart disease, diabetes, bulging waistlines and elevated cholesterol. For over three decades there have been concerns that elevated insulin levels may be associated with heart disease, and the constellation of symptoms was called “syndrome X” and later the “insulin resistance syndrome”.

Most recently the evils that are associated with body fat have been called the “metabolic syndrome”.The problem has assumed epidemic proportions: by 2001, 30% of US adults were considered obese with a body mass index of over 30, and 50% were overweight with a body mass index over 25. The form of type 2 diabetes (the adult onset of the disease) is predicted to double in the next 20 years. Physicians are reporting that they are seeing increasing numbers of children who are obese and suffer of type 2 diabetes. The major concern with an accumulation of body fat is the area of the abdomen (think of the “apple shape” with fat around the abdomen). This visceral fat tissue is not just innocently sitting there stopping you from closing buttons and zippers. It is very metabolically active and the substances it releases are a threat to your health. These fat cells secret pro-inflammatory substances called “cytokines.”

They also form substances that influence blood-clotting, factors that increase insulin resistance, substances like angiotensin, which are signing responsible for high blood pressure as well. Among the host of damaging substances is also the C-reactive protein, which is recognized as a risk factor for heart disease.

Doctor Recommended Diet Against Obesity

There is only one solution: to reduce the risk, excessive weight has to be shed. A sensible diet to achieve that goal has to contain less saturated fat, more fiber, and low glycemic index carbohydrates. Proper dietary habits are only one part. The other as important measure is life style intervention, which includes 2.5 to 3 hours of moderate exercise per week.
Many of the current diets promise weight loss without compromising health. All of them promote weight loss, provided they are strictly adhered to.
The high protein diets (Atkins, Protein Power Plan) are useful for rapid initial weight loss, however due to the overload of protein long term use is highly questionable. Kidney dysfunction as a consequence is a threat to health and no benefit at all!
Moderate carbohydrate diets, moderate fat, as well as moderate protein will remain the answer for long-term life style changes. It is also of significance that the glycemic index of carbohydrates plays a major role. Food intake, which favors carbohydrates with a low glycemic index, is associated with less heart disease. It has also been documented that insulin levels are more stable. Low glycemic carbohydrates include most vegetables, beans, lentils, as well as fruit like apples, pears and oranges. In contrast, high glycemic carbohydrates result in a fast insulin release, which ultimately leads to insulin resistance. Among these items are potatoes, crackers and other flour products, rice, puffed or flaked breakfast cereals, and tropical fruit (papayas, pineapple, melons).

For short-term dieters, it is an option to embark on any of the current diets without deleterious effects, no matter whether they are high-carb or low-carb. But at this point only the diets with moderate carbohydrates have shown to have some benefits on heart health.
Ultimately the wiser choice is to consume foods with a low to moderate glycemic index, by increasing the intake of vegetable proteins and oils and by choosing increased servings of vegetables and fruit instead of highly processed items. So, when you next walk through your supermarket, remember that most of the good stuff is in the periphery, namely the area where all the fresh, unprocessed or minimally processed foods are found.

More info about Mediterranean diet: http://nethealthbook.com/news/mediterranean-diet-benefits-us-workers/

Reference: Metabolic Syndrome Rounds, Oct. 2004, Vol. 2, Issues 8, St. Michael’s Hospital, University of Toronto/On/Canada

Last edited October 27, 2014

Jan

2005

Vaccine To Eradicate Cervical Cancer

By Ray Schilling | Cancer, Health, Prevention, Women’s Diseases

Dr. Diane M. Harper, a lead researcher from Dartmouth Medical School in New Hampshire has called the results of a vaccination trial against the Human Papilloma Virus (HPV) “extremely exciting and encouraging”. A simple vaccination against this virus, which is the cause for cancer of the cervix, has the potential to eradicate the vast majority of cervical cancers worldwide.
The injection in the study was tested on 1,113 women between the ages 15 and 25 over an 18-month period. One hundred percent of the patients of the vaccinated group escaped persistent infection.

The protection against initial HPV- infection was at 92 %.
At this point a much larger trial is set to begin, before the vaccination can be licensed for general use. It will very likely soon be a routine vaccination for young women. If it is successful, it will be a powerful tool for prevention and will save thousands of lives that otherwise would be lost to cervical cancer. Even for those patients who dread shots, a needle prick will be a small price to pay.

Vaccine To Eradicate Cervical Cancer

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

Comment on Nov. 7, 2012: In the meantime the vaccine has been introduced into the school vaccination program of many countries around the world, but mostly concentrating on the female population. In Australia the vaccine is given to boys aged 9 to 15 and girls. The two main brand names are Gardasil and Cervarix. Here is a detailed medical review from Great Britain.

Last edited October 27, 2014

Jan

2005

PSA Screening For Prostate Cancer Not Obsolete

By Ray Schilling | Cancer, Men's Health, Prevention

Like with any test there are false positive results, and the blood test called PSA (short for Prostate Specific Antigen) has received some criticism as a result. Negative comments likening it to “Shooting flies with a bazooka” have been voiced, and yet, statistics on the mortality due to prostate cancer tell a different story.

In recent years the mortality rate in North America is down by 25%, and part of it is due to PSA. Currently there is no more effective testing in place, so the alternative is not attractive. It is like going back to the bad old times, where men where diagnosed only, once the prostate cancer was advanced, had formed metastases, and hopes for a cure were remote. There are promising new tests under development which at one point in time will replace the PSA, but for now it’s still the best test available. The only other way to find prostate cancer is by doing a biopsy.

PSA Screening For Prostate Cancer Not Obsolete

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

Reference: National Review Of Medicine, December 15, 2004, page 22

Last edited October 27, 2014

Dec

2004

Nuts To Bust Gallstones Says Harvard

By Ray Schilling | Gastrointestinal Disease, Nutrition, Prevention

Gallbladder problems rank fairly high among health problems in Canada: nearly 20% of women and 10% of men harbor gallstones. According to the Canadian Liver Foundation certain racial groups have an even higher incidence: in the aboriginal population between 70 and 80% are affected. Statistics in the US would be similar.
Leaders in gallstone research at Harvard Medical School came up with new studies recently from the large scale Health Professional Follow-up and the Nurses Health study with respect to how eating habits influence the formation of gallstones.

Dr. Chung-Jyi Tsai and colleagues examined the relationship between nut consumption and the risk of gallstone disease. Men who consumed about 5 oz of nuts per week had a significant decrease in gallstone development than those who ate less than 1 oz per month. Women fared similarly. The 20-year study involving 80,718 female nurses found that women who consumed at least 5 oz of nuts per week had a 25% lower risk of developing gallstones requiring gall bladder surgery than those who rarely ate nuts or nut butter. It turned out that not all nuts have equal benefits. Peanuts decreased the risk only by 19%, peanut butter consumption decreased the risk by 15%, whereas other nuts lowered the risk for gallstones by 35%. Nuts offer this prevention due to a combination of fiber, unsaturated fatty acids, as well as magnesium and beneficial plant chemicals. Fats as “the good guys” in gallstone prevention may sound like a novel idea, but there are differences in fats: it is the monounsaturated fats and the polyunsaturated fats that are the winners. They are the ones that are found in nuts or vegetables, but not in meat.

Nuts To Bust Gallstones Says Harvard

The coauthor of the Harvard study, Dr. Edward Giovanucci, points out, that a diet that is high in saturated fat (the fat which prevails in meat products) and high in refined carbohydrates (bakery products, pasta, sugar) increases the risk of gallstones. It also depends on the dosage: those who consumed a diet high in insoluble fiber decreased the risk by 17%. So, what is the reason? Insoluble fiber acts like a broom that sweeps waste out of the intestinal tract faster than a diet that lacks fiber. It also reduces the bile acid secretion, increases insulin sensitivity and lowers triglycerides (harmful blood fat levels). The good news is, that you can get it all at a local supermarket. Nuts, tomatoes, squash, cucumbers, whole grains like cracked wheat (as opposed to flour), beans, apples, berries and pears are all good and inexpensive sources.

For more info on gallstones: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/gallbladder-disease/cholelithiasis/

Reference: National Review Of Medicine, November 30,2004, page 13

Last edited October 27, 2014

Dec

2004

New Drug Zaps the Avian Flu

By Ray Schilling | Infectious Disease, Lung Disease, Prevention

Introduction

Flu shots are considered the most useful precaution to control influenza, but a new drug zaps the avian flu, Tamiflu. The avian influenza virus threatens commercial chicken flocks. This influenza type has the ability to infect humans as well; it has been a threat in Asian countries. Current influenza vaccinations do not provide immunity against the avian flu. The annual vaccination programs cannot possibly target all of the various types of influenza viruses.

Tamiflu effective against influenza A, B and avian flu viruses

British researchers have found that the neuraminidase inhibitor, which is effective against all subtypes of influenza A and B viruses, is also effective against avian influenza viruses. Senior scientist Shobana Balasingam from Queen Mary School of Medicine in London states that there is no current vaccine available should a pandemic influenza of the avian flu subtype H5N1 emerge.

New Drug Zaps the Avian Flu

Tamiflu works best, if the patient takes it 24 to 48 hours after influenza symptoms start. In two placebo-controlled, double-blind clinical trials 849 adult patients experienced a reduction of flu symptoms of 1.3 days. They started Tamiflu 40 hours after the beginning of flu symptoms. Patients took 75mg for 5 consecutive days. When another group started Tamiflu 24 hours after the onset of flu symptoms, the treatment outcome improved significantly. However, a higher dose of Tamiflu (150 mg twice per day) did not improve the treatment.

Prevention of influenza with Tamiflu

A clinical trial with 1559 non immunized adults showed an overall protection rate of 74% for all groups. There were some locations in Virginia where the infection rate was higher than in the rest of the US. Tamiflu achieved a protection rate of 82%. In cases where no vaccine is available against a new flu type, Tamiflu is a good alternative to protect the population against a new epidemic.

Reference

The Medical Post, November 23, 2004, page 14

Dec

2004

Forget Glucosamine For Arthritis

By Ray Schilling | Arthritis, Prevention, Vitamins and supplements

Glucosamine has been touted as an effective supplement for osteoarthritis, and the Arthritis Research Centre of Canada under the rheumatologist Dr. Jolanda Cibere at the University of British Columbia led a study to get solid data.

Patients from the ages of 44 to 88 years from all over Canada who had used the supplement for an average of two years and stated that they had at least moderate improvent from knee joint pain were entered into a maintenance study. They received either a placebo (“fake” pills without glucosamine) or glucosamine for six months. During this time they were monitored for arthritic flare-ups including pain and reduced physical activity.

The results were the following: 42% of the patients who were taking the placebo reported flare-ups of the arthritis problems, and 45% of the glucosamine users had flare-ups. The difference was not statistically different. The severity of arthritis had been the same in both the control group and the group that took glucosamine.
This leads to the conclusion that continued use of glucosamine is of no benefit to a patient who hopes to improve knee osteoarthritis.

Glucosamine And Fake Pills (Placebo) Equally Ineffective Against Arthritis As Shown By Study

Forget Glucosamine For Arthritis

There is the question about the possibility of initial benefits, but it seems to be anecdotal rather than solid evidence, and there may be a placebo effect. Unfortunately the data did not support the notion that glucosamine supplements would give pain relief. It is really up to each individual to decide, whether to give glucosamine a try. Looking at the lack of results in long-term use it seems not warranted spending amounts of $15 to $50 per month for such an ineffective supplement.

More info about osteoarthritis treatment: http://nethealthbook.com/arthritis/osteoarthritis/treatment-osteoarthritis/

Comment: There are other studies that disagree with this study pointing out that glucosamine combined with chondroitin does help for osteoarthritis pain.

Reference: The Medical Post, November 16, 2004, page 5

Last edited October 27, 2014

Dec

2004

Alzheimers Now Detected Early

By Ray Schilling | Alzheimer’s disease, Health, Mental Health, Prevention

A combined American and Swedish Research team has described the compound “Pittsburgh compound-C” (for short PIB), that glues itself onto amyloid plaques in the brains of Alzheimer’ patients. This gluey substance is responsible for the symptoms of dementia that plague the patients. These plaques can be detected by positron emission tomography, a test that is known as PET scan.
This may sound very high tech, but the significance of this is great: it allows researchers to look how Alzheimers begins, shows the progression and also demonstrates how effective drugs are at slowing down or reversing the disease. Dr. Klunk and his colleagues who share the research, note that it is possible to identify patients at high risk of early onset as much as ten years before symptoms of the disease show up. This is now even more critical as several new treatments for Alzheimers are being tested. Also as future medicines become available that work by preventing amyloid deposition, these early testing methods will be of utmost importance.

Reference: National Review Of Medicine, November 15,2004, page 15

Alzheimers Now Detected Early

See also the following links regarding Alzheimers:

1. Diagnosis of Alzheimer’s: http://nethealthbook.com/neurology-neurological-disease/alzheimers-dementia-and-delirium/alzheimers-disease-diagnosis/

2. Link About the Pittsburgh compound and PET scanning

Last edited October 27, 2014

Introduction

Tamiflu effective against influenza A, B and avian flu viruses

Prevention of influenza with Tamiflu

Reference

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