Medical Articles by Dr. Ray

Oct

2003

Flu Shot Cuts Death Rate Into Half

By Ray Schilling | Infectious Disease, Lung Disease, Prevention

An earlier publication in the New England Journal of Medicine in March 2003 has shown that the death rate of people 65 years or older who were vaccinated against the flu, dropped into half when they were exposed to the flu and were compared to non-vaccinated controls. On Oct. 9, 2003 Dr. Megan Wren, associate director of the internal medicine residency at Barnes-Jewish Hospital and Washington University School of Medicine, reminded physicians that with the upcoming flu season it is important to include everybody who is healthy at age 50 or older (as the CDC has suggested now for 3 years) with influenza vaccination . Many physicians are still not aware that the rules have been changed to incude younger persons.

Below are recommendations of who should get a vaccination (in table form).

Dr. Wren pointed out that the risk from a flu vaccination is minimal. Contrary to public belief the flu vaccine does not cause fever, unwellness or muscle aches. The only effect is a mildly sore arm at the site of injection.

Flu Shot Cuts Death Rate Into Half

This year the FDA has approved a live flu vaccine that is administered as a nasal spray. This is a live modified flu virus that has been “trained” to only multiply in the colder nasal cavity, but not in the warmer airways. Like with all live viral vaccines pregnant women are not allowed to take this.

Who should get the flu vaccine ?
Group of people:	Comments:
all people age 50 or over	the immune system weakens with age, that’s why complications of the flu are more common in this age group
women who will be in the 2nd or 3rd trimester of a pregnancy during November through to March	protects the fetus from the flu virus in the most vulnerable period of the development of the fetus
chronic heart disease or lung disease (including asthma)	the flu affects the lungs and the heart most readily
chronic kidney or liver disease	these chronic diseases weaken the immune system
people without a spleen and cancer patients	the immune system is weak in these patients
children and adults with any chronic disease including diabetes	chronic illnesses weaken the immune system in young and old
people on imunosuppressive medications	the immune system is weak in these patients
all close family members of any of the above people	the CDC hopes that this stops the spread of the flu into this vulnerable group of patients

Dr. Wren also mentioned that people with chronic illnesses, with immune deficiencies (e.g. AIDS and cancer patients) and healthy patients over the age of 50 cannot take this live vaccine. All others from age 5 to 49 can take it, but presently this is still very costly (one nasal mist application in 2003 is about 50.00$ US).

Last edited December 9, 2012

Oct

2003

Ozone And Pollution Linked To Asthma

By Ray Schilling | Lung Disease

Ozone and pollutants were the topics of two independent publications in October 2003, one in the New England Journal of Medicine (N Engl J Med) and the other in the Journal of the American Medical Association (JAMA).

Dr. Janneane F. Gent of Yale University School of Medicine in New Haven, Connecticut, and her team studied the effects of ozone and small pollutant particles on 271 cases of asthma in children less than 12 years of age (results published in the Oct. 8 ,2003 issue of JAMA). The researchers asked the question whether the air standards of the Environmental Protection Agency would be safe for asthmatic children. From spring 2001until now (about 2 years) exposure of air pollution was measured.

They found that in terms of particulate matter in the air the minimum standards were acceptable and no worsening of asthma took place because of flucutations in this component of air pollution (fine particulate matter of 2.5 micrometers or less). However, exposure to fluctuating ozone levels considered sofar to be safe were found to have profound effects in terms of worsening the asthma in the group of children being followed. For every 50 parts per billion (ppb) increase (in one hour ozone level) the wheezing of these astmatic children increased by 35% and chest tightness increased by 47%. At the time of the highest ozone exposure from a bad day of pollution, which was still “acceptable” to the standards of the Environmental Protection Agency, there was a 32% increase in shortness of breath and the children had to increase their medications by an average of 8% to cope with their asthma attacks (based on JAMA 2003;290:1859-1867,1915-1916).

Asthma made worse by pollution

A different facet of the asthma problem was dealt with in the Oct. 9, 2003 issue of the New England Journal of Medicine. Dr. Malcolm R. Sears from the McMaster University in Hamilton/Canada reported about a group of 613 children born in Dunedin/New Zealand in 1972 and 1973 who were followed with breathing tests and questionnaires until they reached the age of 26 years. This study showed that it does matter very much what lung irritants the very young asthmatic was exposed to and what lung irritants continue to affect the person later in life.

About half of the study population had at least one wheezing attack during the 26 years of observation. Contrary to popular belief asthma is not something “you grow out of” with age as 26.9% either had wheezing that persisited all the time (14.5%) or where the wheezing came back in adult life(12.4%). Allergies to house dust were associated with a risk of more than double and general airway hypersensitivity was associated with a triple risk of causing wheezing persistence or causing a return to wheezing. Other factors that were contributing to risk were female gender (1.7-fold risk) and exposure to cigarette smoke (1.8-fold risk). Those who started smoking young had the highest risk of asthma persistence and severity.

The more wheezing attacks there were and the more persistent the asthma was, the more permanently abnormal the lung function tests remained. The authors concluded that intervention against factors that lead to asthma must be initiated at a very young age. It is crucial to not allow environmental factors (ozone, pollution, allergens, cigarette smoke etc.) to interact with the asthma gene as this will lead to the more severe and chronic forms of asthma with permently abnormal lung function.

These two studies would reconfirm what the recent Swedish family lifestyle study had found as well. All of these studies point to the importance of the air quality and how the environment affects not only those with asthma, but affects everybody. Asthmatics simply are the tip of the iceberg due to a genetic weakness with which they were born. This makes asthmatics particularly vulnerable to pollution and to other environmental factors.

Link to a chapter on asthma from Dr. Schilling’s Net Health Book.

Last edited October 26, 2014

Oct

2003

Schizophrenia Gene Discovered

By Ray Schilling | Mental Health

In the not too distant future new tests and new anti-psychotic drugs (“designer drugs” rather than “trial and error drugs”) for schizophrenia will likely be developed in the US because of the following new findings.

At the 19th International Congress of Genetics in Melbourne/Australia (July 2003) the Nobel Prize laureate Dr. Susumu Tonegawa, who had won the 1987 Nobel Prize for Medicine, reported about his new discovery of a gene that controls schizophrenia. This has already been studied extensively in mice by the research team that he is heading (from the Howard Hughes Medical Institute of Technology (MIT) in Cambridge/Mass).

Together with other colleagues from other Centers (Duke University, Rockefeller University and Columbia University College of Physicians and Surgeons) they have developed an animal model, a “schizophrenic mouse”, that is defective for the schizophrenia gene. Researchers had found that an enzyme called “calcineurin” was missing in schizophrenic families where genetic defects could be located in one particular gene. Subsequently this type of gene was also shown to be important for the normal brain metabolism in mice. The detection of a mouse model for schizophrenia has made it much easier to do ground-breaking research in the field of schizophrenia. Dr. Tonegawa said that the existing drugs for schizophrenia were developed by trial and error. In some patients these drugs do not work, in many others they have serious side-effects. He stated further that in future there will be a new class of anti-psychotic drugs with minimal side-effects as they will specifically normalize the calcineurin production.

Anti-psychotic designer drugs

This in turn will normalize the derailed brain metabolism. In schizophrenics it is in this area where the psychotic behavior originates due to a lack of normal calcineurin production. This enzyme is found not only in brain tissue, but also in immune cells such as the T lymphocytes throughout the body. Because of this connection a future modern treatment for schizophrenia will likely normalize the brain metabolism, but also have beneficial effects on the entire immune system.

Here is a link to a review of schizophrenic disorders

Last edited October 26, 2014

Oct

2003

Heart Scan Saves Lives In Diabetics

By Ray Schilling | Diabetes, Heart Disease, Prevention

A simple new nuclear perfusion study of the heart when applied to healthy appearing diabetics (adult onset or “type 2 diabetics”) showed silent hardening of the coronary arteries in 21.6%. This large study of an American medical team was recently presented at the 18th Congress of the International Diabetes Federation in Paris/France. Dr. F. Wackers, professor of medicine from Yale University school of medicine and one of the lead investigators, explained that 1,124 patients with diabetes in the age range of 55 to 75 years who were all thought to not have any heart blood vessel disease, either had nuclear perfusion studies performed and a control group did not.

As indicated above to the surprise of the investigators 113 patients of 522 (=21.6%) had positive heart scans showing perfusion difficulties of the heart muscle. Further testing with other methods revealed that 73% indeed had perfusion defects and 27% had other heart disease, electrocardiogram abnormalities and other heart dysfunctions. Conventional assessment tools such as a smoking history, determination of degree of obesity, blood pressure,kidney disease , high blood lipid levels, high C-reactive protein levels, the diabetes test hemoglobin A1C or homocysteine levels in the blood were also assessed. However, these conventional tests did not help in predicting that these patients would have developed perfusion defects in their heart muscle. This was due to hidden narrowing of the heart blood vessels (=coronary arteries) and this affected the supply of nutrients and oxygen to the heart even though these patients were completely symptom free at the beginning of the trial.

Heart vessels and nuclear scan

Dr. Vivian Fonsega, a professor of medicine and pharmacology at Tulane University in New Orleans and co-researcher of the team, added that after a follow-up of 1 year those who had normal initial nuclear perfusion studies of the heart only 1% developed serious heart disease. These control patients who have now been followed for 3 years overall remained very healthy. In other words a normal (called “negative”) nuclear perfusion test in diabetics predicts a better longterm outcome than a positive perfusion test.

With this heart scan the cardiologist can identfy the high risk group among diabetics and can subsequently concetrate on doing something actively about the identified diseased heart blood vessel(=”coronary artery”) disease. Identified narrowing in the coronary arteries (“stenotic arterial lesions”) can be overcome by prying them open and placing heart stents across the affected section utilizing catheters (angiography). In other cases heart bypass surgery can be done by the heart surgeon to improve the perfusion of the heart muscle. The researchers stressed that those diabetics at risk can be identified with this test and the life expectancy of this high risk group of patients can be significantly prolonged. The study will continue for several more years so that the longterm results of any intervention can be measured when compared to controls.

Based on The Medical Post (Sept. 23, 2003 ): p. 55.

Here is a link to a chapter on diabetes and here is a link to heart attacks.

Last edited December 9, 2012

Oct

2003

Better Recovery From Strokes Through Early CT Scans

By Ray Schilling | Other neurological conditions, Stroke

Introduction

You can have a better recovery from strokes through early CT scans. This was published in the September 2001 issue of the American Journal of Neuroradiology (Am J Neuroradiol – 01-SEP-2001; 22(8): 1534-42). A group of clinicians from the Foothills Hospital in Calgary/Alberta published an article with a scoring system for CT scans. These scans were done on every patient with a stroke. By utilizing early CT scans and this scoring system an ischemic stroke (due to a blood vessel that closed off in the brain) could be rapidly assessed.

Early CT scan helps to decide whether clot-busting drugs help the patient

Within 3 hours of the beginning of the stroke the treating physician would know whether the patient would benefit from clot-busting drugs (TPA or tissue plasminogen activator) or not. Dr. Pexman and co-workers had noted that patients with an Alberta Stroke Program Early CT Score (ASPECTS) of less than 7 had a poor survival rate or an outcome with high dependency on caregivers. Patients with a score of 7 to 10 had a much better survival chance and were ideal candidates for the clot-busting therapy. The radiologist who reads the CT scan of the brain of the stroke patient divides th CT scan into 10 regions. Researchers evaluate the findings systematically and obtain an ASPECTS score.

Ischemic strokes treated early

Dr. Michael Hill, an assistant professor at the University of Calgary, and one of the co-workers of this initial study has now completed a further follow-up study together with Dr. A.Buchan, director of the Calgary Stroke Program. The authors published the results of the study in the August 2003 issue of the medical journal “Stroke”. They found that ischemic strokes (from clots in the middle cerebral artery) have the best outcome when detected by CT scan early (within 3 hours of the beginning of the stroke) and if thrombolysis therapy with TPA, the clot-busting drug, is done before 6 hours after the beginning of the stroke.

Better Recovery From Strokes Through Early CAT Scans

CT Scan of Ischemic Stroke

Stroke in the middle cerebral artery diagnosed early

The lack of blood circulation from a stroke, which closed the middle cerebral artery, is shown in this link. What does that mean in practical terms? Let us assume a patient is suddenly losing all of the strength and movement in one arm and losing speech as well. In this case the physician orders an emergency CT scan right away. This helps to determine that the patient had a stroke in the middle cerebral artery region. Let us say that the ASPECTS score was between 7 and 10. This patient’s physicians would likely treat the stroke with the clot-busting medicine mentioned being confident that there likely will be a good outcome.

Less permanent palsies with early intervention

Before this therapy was available, many of these patients ended up with a permanent arm palsy without much function. They likely also sustained a permanent speech deficit as well. After the clot-busting therapy many of these patients have a much better outlook. Now they have a considerably better return of function in their arm and regain their speech as well. Unfortunately, the opposite is true as well.

Those with an ASPECTS score below 7 do poorly with their stroke

Those with a poor ASPECTS score below 7 will not be candidates for the clot-busting therapy. They tend to do poorly. Several countries use this scoring system of early CT scans already to investigate the severity of strokes (ASPECTS). Among those are Canada, the US, Australia and Europe. Dr. A.Buchan said: “Early detection and intervention in stroke is critical to achieve a positive outcome”. He is the director of the Calgary Stroke Program. In addition, he is also a professor in the department of clinical neurosciences of the University of Calgary/Alberta. Here is a link for more background on strokes.

Sep

2003

West Nile Virus (WNV) Vaccine Being Tested In Humans

By Ray Schilling | Infectious Disease, Prevention

According to Dr. Tom Monath, the scientific officer of the Acambis pharmaceutical company, human trials on a new vaccine for West Nile virus (WNV) can begin as soon as the FDA will give the green light (likely in October of 2003).

At the 2003 World Vaccine Conference in Montreal/Canada this summer Dr. Monath explained that Acambis has been doing research for a new vaccine against WNV since 1999 when this virus arrived in New York. The virus belongs into the same group of flaviviruses as dengue fever, yellow fever and Japanese encephalitis.

Yellow fever has been successfully prevented by vaccination with a live vaccine that has been modified considerably (called 17D attenuated vaccine). This strain is basically a harmless virus, which will induce a strong immune response in 100% of vaccinated people. If this is repeated every 10 years, a vaccinated person would be safe to travel in yellow fever infested areas. Based on this knowledge the researchers of Acambis have created a chimera virus where the yellow fever vaccine (attenuated virus 17D) is used as a vehicle in the center while the surface has been modified by incorporating parts of the WNV into its envelope. As this new vaccine virus has qualities of both the yellow fever vaccine virus and the WNV, it is called a chimera virus. The same technology has already been successfully applied to two other flavivirus vaccines, namely the dengue fever vaccine and the Japanese encephalitis vaccine.

West Nile Virus (WNV) Vaccine Being Tested In Humans

The new WNV vaccine has been tested extensively in mice and monkeys and has been found sofar to be very safe and it is mounting a very good immune response. It is timely that human trials are being done now starting this fall as WNV seems to be expanding rapidly throughout the United States and Canada. The vaccine would be needed particularly for older people as in them the WNV disease presents much more violently with a higher death rate. However, visitors from Europe to the US and Canada will likely want to protect themselves as well before they travel.

Comment in July 2012: A vaccine for humans is still not available, for horses it is.

Last edited December 9, 2012

Sep

2003

Stillbirth Associated With High Coffee Consumption In Pregnancy

By Ray Schilling | Nutrition, Women’s Diseases

A study entitled “Maternal consumption of coffee during pregnancy and stillbirth and infant death in first year of life” by Dr. K. Wisborg et al. was published recently in the British Medical Journal (BMJ 2003; 326: 420-423).

The pregnancy outcome of 18,478 women who completed a questionnaire at their first prenatal visit was studied. They were asked about coffee consumption and the following 4 groups were identified: group 1 consisted of the 43% of women who drank no coffee. Group 2 (34%) drank 1-3 cups per day, group 3 drank 4-7 cups per day (18%). Group 4 drank 8 or more cups per day (5%).

Below are the results in tabular form.

The surprising result was that a small amount of coffee (1-3 cups per day) was actually reducing the risk of stillbirth by 30% when compared to women who drank no coffee at all. However, from 4 cups of coffee per day or more there was a sharp increase of stillbirths within the first year (=sum of stillbirths and deaths within the first year of life).

Stillbith Associated with High Coffee Consumption in Pregnancy

The authors suggest that physicians should advise their pregnant patients to limit coffee consumption in pregnancy to 1 or 2 cups of coffee or the equivalent of caffeinated drinks per day as a precautionary measure.

Stillbirth coffee study
Groups with varying amounts of coffee consumption:	Risk increase of stillbirth compared to group 1 as control:
group 2 (1- 3 cups per day)	-30%
group 3 (4 – 7 cups per day)	80%
group 4 (8 or more cups per day)	300%

Last edited December 9, 2012

Sep

2003

Asthma And Wheezing Influenced By Family Lifestyle (Swedish Study)

By Ray Schilling | Asthma, Prevention

A new study from Sweden was published by Dr. Magnus Wickman and colleagues,from the Karolinska Hospital in Stockholm, in the medical journal Allergy 2003;58:730-731,742-747. The authors of this study were analyzing data of a prospective birth cohort study of 4089 children who were born in Sweden between 1994 and 1996.

The families were given health questionaires at the age of 2 months to assess whether the family was adhering to the allergy prevention guidelines (see below). Questionaires were again given at the age of 1 year and 2 years of these children. Specific questions were asked regarding environmental conditions in the house where the children lived. In the mid 1990’s allergy prevention guidelines were strongly recommended to the public in Sweden regarding the value of breast feeding, the avoidance of smoking inside the house in the presence of children, also that a house should be kept well ventilated and without dampness. All of these factors, as was stressed by the allergists in Sweden who organized the campaign, would protect the immune system from allergies against molds, dust mites as well as cigarette smoke and should reduce the rates of asthma.
Here are the results in tabular form.

Asthma And Wheezing Influenced By Family Lifestyle (Swedish Study)

As can be seen from this table, which is based on families without allergic parents, a two-fold drop of asthma and wheezing occured when the allergy prevention guidelines were followed in the house. With allergic parents the children had an even greater benefit as the reduction of asthma and wheezing was three-fold when compared to controls who did not follow the guidelines. This is one of the few studies, which shows conclusively that allergy prevention works!

Link to asthma chapter of Dr. Schilling’s Net Health Book: http://nethealthbook.com/lung-disease/asthma-introduction/

Swedish Family Lifestyle Study
Agreement with allergy guidelines	% of asthma and wheezing at ages 1 and 2 of child:
Agreement with allergy guidelines	1 year	2 years
Yes (all three measures followed)	6.8%	12.6%
No (one or none of measures followed)	17.9%	24.1%

Last edited October 26, 2014

Sep

2003

SARS Due To SARS-Associated Coronavirus (SARS-CoV)

By Ray Schilling | Infectious Disease, Lung Disease

A comprehensive paper was recently published online July 22, 2003 (Lancet 2003; 362: 263-70) regarding the causative microorganism of SARS.

Several investigators have collaborated in this study from viral laboratories of Rotterdam/The Netherlands, Hong Kong Special Administrative Region/China , Singapore, London/UK, Hamburg/Germany, Paris/France and Geneva/Switzerland.

This study involved isolation of the SARS-associated coronavirus (SARS-CoV) from SARS patients who died from the disease, propagation of the virus in an experimental animal model (cynomolgus macaques) and causing SARS again with an injection of the isolated virus back into a healthy experimental animal.

This, according to the authors (Dr. Thijs Kuiken et al.), fulfils the Koch’s postulates, which is one of the fundamental laws in microbiology that has to be fulfilled in order to claim a new infective organism. Dr. Robert Koch was a German physician who had detected the causative organisms of anthrax, tuberculosis and cholera and won the Nobel price for physiology and medicine in 1905. He developed the four original Koch’s postulates that were subsequently modified to a total of six. Here is a run down of the postulates and how it relates to SARS:

SARS Due To SARS-Associated Coronavirus (SARS-CoV)

1. The specific organism should be present in all cases of animals suffering from a specific disease, but should not be found in healthy animals.

For SARS this was fulfilled as this study, which was based on a thorough analysis of 436 patients in six countries, showed. 75% of the suspected cases were found in postmortem studies to contain the SARS-associated coronavirus (SARS-CoV). In some patients other infectious agents could also be isolated, but the primary causative agent was SARS-CoV.

2. The specific organism should be isolated from a diseased animal and grown in pure culture on artificial laboratory media.

Using an experimental animal model, the virus was able to be isolated from a diseased person and injected into a healthy animal that turned sick with SARS. From this animal the virus could be isolated again from cells of the infected airways and grown in tissue culture.

3. This freshly isolated microorganism, when inoculated into a healthy laboratory animal, should cause the same disease as in the original animal.

As already explained under point 2 above, this has been shown with SARS.

4. The microorganism should be able to be isolated again in pure culture from the experimental infection.

This was proven in this paper regarding SARS. It was even done with genetic markers that were still present after passage from postmortem human tissue into an experimental animal and from the final respiratory tissue isolate of this newly infected animal.

5. The infective agent can be filtered and the filtrate contains the infective agent.

This was proven for SARS and the exact classification of the virus was possible because of the advanced genetic knowledge that is now available.

6. When the virus enters the body or the experimental animal, there are signs of the immune system attempting to rid the body of the infectious organism.

Sophisticated immune tests were performed that showed in more than one way that the immune system attempted to rid the body of SARS, but was eventually overwhelmed in the cases that did not survive.

Summary: This paper has conclusively proven that SARS is caused by a new type of coronavirus, SARS-associated coronavirus (SARS-CoV). In about 12% of cases there was another virus type present, such as human metapneumovirus. This occasionally was also present in lethal SARS cases as a secondary virus. Some other flu-type viruses were also found in the non-SARS cases. However, this paper has shown that SARS-associated coronavirus (SARS-CoV) is what causes SARS.

Link to SARS chapter of Dr. Schilling’s Net Health Book: http://nethealthbook.com/infectious-disease/infectious-disease-infections/severe-acute-respiratory-syndrome/

Last edited October 26, 2014

Sep

2003

Poor Lungs And Heart Attacks Related To Leptin Levels

By Ray Schilling | Heart Disease, Lung Disease

It is known from the medical literature that poor lung function can often lead to heart attacks making it one of the important causes of premature death for patients with poor lungs (due to emphysema, chronic bronchitis, COPD etc.).

A research team led by Dr. Don Sin from the University of Alberta, Edmonton, Canada, asked the question recently whether there may be a circulating factor that would be responsible for this association of poor lung function and increased cardiovascular disease.

They studied serum leptin and a variety of other inflammatory markers such as C reactive protein, leukocytes, and fibrinogen in 2808 participants in the Third National Health, Nutrition, and Examination Survey. Apart from blood tests they also measured lung function by spirometry (forced expiratory volume in 1 second, called FEV1). The leptin levels found in these patients were then divided into 5 groups from low to high levels. They also carefully adjusted the data for body mass index, sex, age and other factors. They compared the group with the lowest leptin concentration (lowest quintile) with the highest group of leptin concentration (highest quintile) and looked for any significant differences in any of the markers.

Results: The highest quintile group (high leptin in blood samples) had also the highest other inflammatory markers in their blood (C-reactive protein, leukocytes and fibrinogen). This group was the one that was associated with advanced lung diseases as well as heart disease. The authors of this study, which was recently published in a medical journal (Thorax 2003;58:695-698), concluded that leptin plays an important role, if not the major role, in the development of both chronic lung disease and cardiovascular complications.

Poor Lungs And Heart Attacks Related To Leptin Levels

Links to lung disease: http://www.nethealthbook.com/articles/chronicobstructivepulmonarydisease.php
Links to heart attacks:

http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Last edited December 9, 2012

Who should get the flu vaccine ?

Group of people:

Comments:

Introduction

Early CT scan helps to decide whether clot-busting drugs help the patient

Ischemic strokes treated early

Stroke in the middle cerebral artery diagnosed early

A Survivor’s Guide to Successful Aging

Prostate Cancer Unmasked

Healing Gone Wrong – Healing Done Right

Medical Question Answered

Social Media Links

askdrray.com Insider

Recent Posts

Navigation Menu

Tags

A Survivor’s Guide to Successful Aging

Prostate Cancer Unmasked

Healing Gone Wrong – Healing Done Right

Medical Question Answered

Social Media Links

askdrray.com Insider

Recent Posts

Tags

A Survivor’s Guide to Successful Aging

Prostate Cancer Unmasked

Healing Gone Wrong – Healing Done Right

Medical Question Answered

Social Media Links

askdrray.com Insider

Recent Posts

Tags

A Survivor’s Guide to Successful Aging

Prostate Cancer Unmasked

Healing Gone Wrong – Healing Done Right

Medical Question Answered

Social Media Links

askdrray.com Insider

Recent Posts

Tags

A Survivor’s Guide to Successful Aging

Prostate Cancer Unmasked

Healing Gone Wrong – Healing Done Right

Medical Question Answered

Social Media Links

askdrray.com Insider

Recent Posts

Tags

A Survivor’s Guide to Successful Aging

Prostate Cancer Unmasked

Healing Gone Wrong – Healing Done Right

Medical Question Answered

Social Media Links

Certificates