Medical Articles by Dr. Ray

Sep

2004

Stop That Heart Attack

By Ray Schilling | Diabetes, Heart Disease, High Blood Pressure

There is a window of opportunity for the patient who is rushed to hospital with a heart attack.

To be precise: if the patient is brought to hospital without delay, and there are changes in the ECG, which traces the heartbeat, and there are changes that point to the possibility of a heart attack, there is a chance to administer medication that prevents blood clots. If these “clot busters” are administered within one hour, as many as 25 % of heart attacks in the making can be aborted. This procedure is called “fibrinolysis”.

Dr. Paul Armstrong, professor of medicine at the University of Alberta, explains, that the aborted heart attack (or “aborted MI”) is a new term in cardiology. If treatment is received early, the patient will avoid heart muscle damage. Even if the treatment with the anti-clotting medication is given after only two hours, the patients still have a more favorable outcome. Patients with aborted heart attacks also have smaller infarcts than those who go on to have a full-blown MI (or heart attack). Dr. Armstrong points out that it is important to not only watch out for known high-risk factors (previous coronary artery bypass surgery, hypertension and diabetes), but also to pay close attention to treating the patient early.

Stop That Heart Attack

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

Reference: The Medical Post, July 27,2004, Vol.40, No. 29,pg.8

Last edited October 26, 2014

Sep

2004

Calcium Prevents Kidney Stones

By Ray Schilling | Health, Nutrition

Forget what your grandmother may have taught you about kidney stones. In the past there may have been a bias towards thinking that calcium may be one of the causes of kidney stones. But Dr. Curhan and collegues from the Channing Laboratory, Department of Medicine, Brigham and Womens’ Hospital, Boston, MA put this question to the test. Other food factors were also examined in this Nurses Health Study II, which was published recently in the Archives of Internal Medicine (in April of 2004) and reviewed by The Medical Post (Aug. 24, 2004 edition).

I have summarized the results in the bar graph below. What is shown is the cumulative risk for developing kidney stones in a population of 96,245 nurses aged 27 to 44 over eight years without a history of kidney stones in this prospective study. At the same time detailed records were kept regarding food and health habits. The risks between the highest and the lowest quintile regarding various food groups were computed, which is an accepted way to tease out the effects of the food group studied.

Calcium Prevents Kidney Stones

Dr. Curhan and his collegues found that calcium protects from getting kidney stones as does meat. Sugar is a risk for stone development. Fluid intake has a protective effect as uric acid and other stone forming substances are kept in solution preventing kidney stone formation. Phytates that are found in soybeans, beans and peas have a protective effect. The control value of the study was the average risk for the population, which was set at 1.0 meaning that there is no added risk to develop kidney stones.

Relative risk of developing kidney stones from exposure to different foods in younger nurses

Study shows Calcium To Prevent Kidney Stones

Conclusion: Contrary to popular belief calcium and meat as well as phytones have a protective effect against the development of kidney stones. Fluid intake is protective as well. On the other hand sugar is a risk factor for kidney stones, a fact that seems to not be generally known.

More info on kidney stones: http://nethealthbook.com/abdominal-pain/left-upper-abdomen/kidney-stone-renal-calculus/

Ref.: 1. Dr. G.C.Curhan et al., Arch Intern Med 2004 Apr 26; 164 (8), pp. 885-91 2. The Medical Post, Aug. 24, 2004, p.17

Last edited October 26, 2014

Aug

2004

Uric Acid Blood Test Predicts Future Health Problems

By Ray Schilling | Arthritis, Heart Disease, Stroke

A 12 year prospective, well controlled follow-up study from Finland determined that uric acid blood tests are not only useful in following patients with gout or kidney stones, but are also predictive for future health problems including death. Dr. Leo K. Niskanen from Kuopio University in Finland and colleagues followed 1,423 middle-aged Finnish men who at the beginning of the study were free from cancer, heart disease, strokes and diabetes. After about 12 years the researchers found that 157 men had died, 55 from heart disease or strokes. When men with elevated uric acid levels were classified into low, medium and high levels, an interesting observation was made when subclasses were compared with each other. Those men in the upper range of uric acid levels had a risk of more than 2.5-fold to die from a heart attack or stroke when compared to men with uric acid levels in the lower range. Also, men in the higher range were 1.7-fold more at risk to die from any cause than men in the lower range of uric acid levels.

Dr. Niskanen said that uric acid simply seems to be another good marker for spotting troubles in health. The mechanism of this connection is not known at this point in time, but the test is easy to do and is very useful in screening a middle aged population.

Risk of Developing a Heart Attack or Stroke with Elevated Uric Acid Blood Test

Uric Acid Blood Test Predicts Future Health Problems

Other investigators in the past have also observed a similar association, but this seems to be the first longterm and prospective study.

More info on:

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

2. strokes: http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/

3. Gout: https://nethealthbook.com/gout/

Reference: Arch Intern Med 2004;164:1546-1551

Last edited October 26, 2014

Aug

2004

Birth Control Pill Increases Strokes And Heart Attacks

By Ray Schilling | Heart Disease, Hormones, Stroke, Women’s Diseases

At the recent 86th Annual Meeting of the Endocrine Society in New Orleans/Louisiana a Canadian delegation presented data from a meta-analysis of 14 trials regarding side effects of the birth control pill (BCP) when taken on a prolonged basis. The researchers were interested to know the risk of heart attacks or strokes that would be associated with the prolonged use of the low dose estrogen BCP. All of the studies between 1980 and October of 2002 were examined and 14 independent studies qualified for the meta-analysis. The strength of such a meta-analysis lies in the pooling of data and the fact that the data is derived from a much larger patient population, which generally makes the results more reliable. Dr. J. Baillargeon from the Centre Hospitalier Universitaire in Sherbrooke, Quebec/Canada, stated that they found a 1.85-fold risk for developing heart attacks with longterm use of the BCP and at the same time there was a risk of 2.54-fold of hemorrhagic strokes with longterm use of the low-dose BCP.

I have depicted these findings below in graph form where the risk is readily seen when compared to women who did not use any birth control pills. In discussions following this presentation the authors explained that with short-term use of the BCP using the modern low dose formulations heart attacks and strokes would likely not be noticeable.

Birth Control Pill Increases Strokes And Heart Attacks

But women should know that long-term use does have this risk. These decisions of whether to take the BCP and for how long needs to be discussed with the treating physician also in the view that other risks such as high blood pressure, diabetes or the metabolic syndrome would be added risks where heart attacks and strokes can occur more frequently. In these conditions the BCP likely should be avoided.

Risk of Developing Heart Attack or Stroke after Longterm Use of The Birth Control Pill

Birth Control Pill Increases Strokes And Heart Attacks1

Dr. Ricardo Azziz, chairman of obstetrics and gynecology at the Cedars-Sinai Medical Centre in Los Angeles, California, stated that these findings from this meta-analysis would be very important because it was based on such a large data base and was measuring the effect of the BCP over a long period of time. He stressed that the benefits of any medication must always be weighed against the risks by the treating physician. In diabetic patients on the BCP, for instance, the benefits likely outweigh the risks as the metabolism is stabilized through an improved insulin sensitivity, improved managability of the diabetes and avoidance of the high risk pregnancies in diabetics.

More info on:

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

Strokes: http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/

Reference: The Medical Post, Vol.40, July 20, 2004, page 20

Comments on Nov. 6, 2012: What was not discussed by these experts is the fact that the BCP contains a mix of two artificial hormones (estrogen and progesterone equivalents) that the body’s estrogen and progesterone hormone receptors cannot recognize. Bio-identical estrogen and progesterone creams on the other hand would be recognized by these receptors, but nobody has researched their use for BCP purposes, only for post-menopausal hormone replacement.

Last edited Oct. 26, 2014

Aug

2004

Too Much Fat Fuels Metabolic Syndrome

By Ray Schilling | Heart Disease, High Blood Pressure, Hormones, Nutrition, Obesity

In a review article for physicians from the St. Michael’s Hospital of the University of Toronto (see reference below) Dr. Monge outlined some of the newer human research where links were found between the lining of the blood vessels and the hormones produced by fat cells that lead to the complications of the metabolic syndrome. In obese people there is a cluster of conditions such as high blood pressure, high blood sugar, high cholesterol, lipid abnormalities and high insulin levels, which is known as “metabolic syndrome”. Another name that was used for this condition in the 1990’s was “syndrome of insulin resistance”.

Dr. Monge pointed out that blood vessel health depends on the fine balance between two opposing forces. On the one hand there is a system that leads to blood vessel spasm, blood clotting, growth promoting, inflammation causing and oxidizing. On the other hand there is a system that is responsible for blood vessel relaxation, growth inhibition, blood clot dissolving, inhibiting inflammation and antioxidant activity. Complex changes occur in our metabolism when we put on pounds and accumulate too much fat. It is important to realize that fat is not just sitting there, but is composed of highly active fat cells that respond to insulin and growth factors and in turn produce a number of hormones and factors that affect the cells that are lining the blood vessels. Inflammatory cytokines are produced by fat cells that attack the blood vessels by producing atheromatous plaques, causing them to accumulate fat again and help in the processes that lead to rupture of the plaques.

Too Much Fat Fuels Metabolic Syndrome

The end result is that the deadly interplay between the fat cells and the endothelial cells lining the blood vessels tips the balance between the two systems mentioned above to the point where heart attacks and strokes suddenly occur.

There are two complex pathways that are involved in this process and that are linked to what was stated above. One crucial aspect of this involves nitric oxide, a small molecule that is normally produced by the endothelial lining cells and that is needed for normal circulation of the heart muscle, skeletal muscles and internal organs. This protective system is where much of the derangement of normal metabolism occurs with regard to the metabolic syndrome.

Dr. Monge pointed out that with these newer insights into the complex metabolic changes associated with the metabolic syndrome in obese people, there will be very practical results in the near future. Anti-inflammatory medications are already being utilized and some of the anti-diabetic medications have been shown to reduce the risk of heart attacks. It is hoped that sensitive tests will be developed to measure the hidden endothelial dysfunction at a time when preventative steps are still effective or early intervention can be done.

More info on the metabolic syndrome: http://nethealthbook.com/hormones/metabolic-syndrome/

Reference: Metabolic Syndrome Rounds (April 2004): J.C. Monge “Endothelial Dysfunction and the metabolic syndrome”

Last edited Oct. 26, 2014

Aug

2004

Citrus Fruit Peel Lowering Cholesterol

By Ray Schilling | Anti-aging medicine, Heart Disease, Nutrition

New research from London/Ontario in cooperation with the U.S. Department of Agriculature has shown that in hamsters cholesterol can be reduced by about 35% through a diet that contains compounds derived from orange peel.

A development company (KGH Syndergize, London/Ont.) under the lead researcher, Dr. Elzbieta Kurowska (PhD), has identified the active compounds in the peels of oranges or tangerines that are having cholesterol lowering properties. They are a group of substances known under the name of “polymethoxylated flavones” (PMFs) and have the advantage that they have no side-effects. They are naturally occuring and have been part of the food chain that our bodies are used to.

The research results were recently published in the Journal of Agricultural and Food Chemistry, which is a peer-reviewed journal of the American Chemical Society.

The animal and cell line experiments showed that the liver cell metabolism of cholesterol is changed so that bad cholesterol (LDL cholesterol) is lowered, but the good cholesterol (HDL cholesterol) is unaffected. When hamsters were fed a diet with 1% PMFs their LDL blood levels were lowered by 32% to 40%.

Citrus Fruit Peel Lowering Cholesterol

The experiments were so successful that there is now a human trial on the way where the longterm effects of PMFs on LDL levels is being followed. Dr. Kurowska cautioned that drinking orange or tangerine juice would be having many beneficial health effects. But in order to get the cholesterol lowering effect that you can achieve with the citrus peel PMF supplement you would have to consume about 20 cups of orange or tangerine juice every day.

Reference: The Medical Post, Vpl. 40 (June 22, 2004): page 18

Last edited December 8, 2012

Aug

2004

Electronic Nose Smells Sickness

By Ray Schilling | Health, Lung Disease, Prevention

Sniffing out disease has become a reality with a new device called Cyranose 320.
This electronic “nose” is able to recognize bacteria by sampling a patient’s breath.
The device has been tested and found to be quite accurate, as it was able to successfully diagnose 92 % of pneumonia cases in 25 patients.

This hand-held little invention costs about $8,000, and has been fitted by researchers at the University of Pennsylvania with a smart chip, which is capable of learning chemical “smellprints” of different bacteria. A further study showed that the Cyranose was also able to diagnose sinusitis- the most common respiratory complaint in US outpatient clinics.
This electronic nose will show its value for early detection of pneumonia in the intensive care unit, where patients on ventilators can be safely and quickly tested. About 25 % of these patients on the average develop pneumonia, and the lead researcher of the first study, Dr. William Hanson III, emphasizes that early recognition of pneumonia and avoiding wrong diagnoses is crucial for the swift treatment of pneumonia, which can be life saving.

Electronic Nose Smells Sickness

Reference: National Review of Medicine (Canada), June 30, 2004, page 5

Last edited December 8, 2012

Jul

2004

Gene Therapy Can Repair Blood Vessels

By Ray Schilling | Heart Disease

When the first attempt of gene therapy were made, a concoction of LDL- receptor genes was infused into the portal vein of patients with a family trait of high cholesterol levels. This was back in 1989, and the results at that point were not encouraging.
In the meantime advances have been made in genetic research. Dr. Duncan Stewart of the cardiology department of St. Michael’s Hospital in Toronto who is considered by many as the guru of cardiac gene therapy, reports that we are now “at a crucial stage of the field”. He cautions, that having the gene on hand is only part of the answer. For good results it is also important to understand how the delivery system to the diseased organ works.

Gene therapy stands out from other treatment options, because instead of drugs, DNA is provided. DNA itself is not the therapeutic agent. It penetrates the cells where it sets up shop and produces proteins, which are needed for therapy. In the case of heart disease, where heart vessels are blocked or have been damaged, the idea is to send specific DNA sequences to the heart cells and stimulate the production of growth factors. These growth factors would trigger new heart vessels to grow and take over for damaged or blocked vessels. This is not just a dream of a research team: a gene therapy trial – the only one of its kind in Canada – is on its way under the leadership of Dr. Stewart. This ambitious project was launched in 2002. In seven sites across Canada 110 patients with heart disease are receiving the vascular endothelial growth factor gene (VEGF for short). The gene is being directly injected into the areas of the heart where blood vessels have become diseased or blocked. The placement is measured with a mapping system known as NOGA. At the end of the year the study enrolment will be finished. Patients will be followed up for results 6 months later. This therapy promises long lasting effects, but it still has a long way to go.

Gene Therapy Can Repair Blood Vessels

Dr. Robert Hegele from the Blackburn Cardiovascular Genetic Laboratory at the University of Western Ontario is credited with uncovering eight genes for human disease (four of them are related to cardiovascular illness) and 80 mutations in other genes that are contributing to premature heart disease and diabetes. Dr. Hegel’s interest is to discover the villains that predispose people to illness, but at the same time he cautions that genes are not everything. Being genetically susceptible does not necessarily foretell one’s destiny when it comes to developing heart disease. Dr. Hegele emphasizes that the longer he works in the genetic field, the more he respects environment and lifestyle and finds that most people can even overturn genetic susceptibility and he leaves us with the final remark: “Tell your patients to stay away from tobacco, eat wisely and get that needed exercise.”

More info on arteriosclerosis (hardening of the arteries): http://nethealthbook.com/cardiovascular-disease/heart-disease/atherosclerosis-the-missing-link-between-strokes-and-heart-attacks/

Reference: The Medical Post June 29, 2004 (Vol. 40, No.26): page 35

Comment (July 9, 2012): Note that this trial failed to show effectiveness as indicated in the paper below. So, eat wisely, exercise and don’t smoke.

VEGF gene therapy fails to improve perfusion of ischemic myocardium in patients with advanced coronary disease: results of the NORTHERN trial. Stewart DJ, Kutryk MJ, Fitchett D, Freeman M, Camack N, Su Y, Della Siega A, Bilodeau L, Burton JR, Proulx G, Radhakrishnan S; NORTHERN Trial Investigators. Mol Ther. 2009 Jun;17(6):1109-15. Epub 2009 Apr 7.

Last edited Oct. 26, 2014

Jul

2004

Beer A Red Flag For Gout

By Ray Schilling | Arthritis, Nutrition

This article focuses on “beer a red flag for gout”. For centuries gout has been known as the affliction of the affluent. The Greek physician Hippocrates first described it as “the disease of the kings”. In the meantime the illness has jumped social boundaries. The reason is that the over consumption of meats and alcohol will occur in all population groups.

A British publication said: beer a red flag for gout

In its April 17 issue the British medical paper”The Lancet” mentioned a link between alcohol and gout. Dr. Hyon Choi of the rheumatology unit of the Massachusetts General Hospital, Harvard Medical School, headed a study. It showed that moderate amounts of wine did not pose a risk for gout. It was the beer drinkers who had a problem. Those who drank more than two 350 ml cans or bottles of beer per day had a 2.5 times higher risk of developing gout than nondrinkers. People who had 2 shots of liquor a day ran a risk that was 1.6 times higher than those who did not drink. Moderate wine drinkers had the same risk of developing gout as nondrinkers, as long as they did not overindulge: 1 to 2 glasses of wine per day were the limit! It is not clear at this point, which would be the noxious substance in beer and spirits that is responsible for attacks of gout, and moderation is still in order for all wine lovers!

Beer A Red Flag For Gout

Reference: National Review Of Medicine, May 15,2004, pg.10

Last edited Oct. 26, 2014

Jul

2004

New Asthma Drug Works Slowly But Surely

By Ray Schilling | Asthma, Lung Disease

Patients with severe asthma will have a new treatment option. A new medication under the name omalizumab has been studied in clinical trials by Dr. Jean Bousquet of Arnaud de Villeneuve Hospital in Montpellier, France.

In the study it was also determined which patients would benefit most of the new drug. The results are very encouraging: those patients who had the least success with other asthma medications had the best response. However, it is not an instant response. 67 % of the patients showed a good response after 4 weeks of treatment. 87 % of patients showed a response only after having been on the medication for 12 weeks. As a result of this trial it was determined, that patients with asthma should be treated with omalizumab for at least 12 weeks. FDA approval for difficult to manage cases of allergic asthma came in June of 2003 (trade name Xolair, manufacturer: Genentech, Inc). On the other hand, patience is also of essence: if the medication is only administered for a month, a lot of patients with difficult to treat asthma will miss out on the beneficial effects, as opposed to those who persist and reap significant improvement after 12 weeks. One of the downsides of the medicine is the possibility of anaphylactic reactions.

Reference: National Review of Medicine, May 15, 2004, pg. 27

New Asthma Drug Works Slowly But Surely

More information about asthma: http://nethealthbook.com/lung-disease/asthma-introduction/

Here is a NEJM article (case study involving omalizumab)

Last edited Oct. 26, 2014

A British publication said: beer a red flag for gout

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