Medical Articles by Dr. Ray

Apr

2003

Menopause And Perimenopause In Women

By Ray Schilling | Hormones, Women’s Diseases

In the February 19, 2003, issue of The Journal of the American Medical Association there was an extensive review of the topic of menopause and the time before and after menopause, called “perimenopause”.

The authors, Dr. Lori A. Bastian, from Duke University, and colleagues critically reviewed 1,246 articles on this topic and identified 16 studies that were accepted as being reliable regarding the review of this topic.

They were interested in finding menopause symptoms, signs and blood tests that would be reliable in terms of assessing whether a woman would be approaching menopause or would be in menopause. The result was that no single test or symptom was reliable, but that a number of tests and symptoms in combination were very helpful.

Menopause And Perimenopause In Women

They measured reliability by “likelihood ratios (LRs)”. What this means is that any value above 1.0 is significant, but the higher the number, the more reliable and important is this fact or sign. I summarized the findings in table form below.

Results of a Review Study on Menopause in Women

(modifed according to Feb.19, 2003, issue of The Journal of the American Medical Association)

Findings:

Likelihood ratio (LR):

Comments (by Dr. Ray Schilling):

self assessment of going through the transition

1.83

this is based on the effects of the changing hormones on the woman and how she feels it
is affecting her

symptoms of hot flashes

3.10

lack of estrogen from ovaries leads to a lability of the skin blood vessels with increased skin perfusion as well as stimulation of the sweat glands

night sweats

1.90

sleep pattern is changed and there is a loss of the day / night rhythm of skin perfusion

vaginal dryness

2.64

due to lack of estrogen

high follicle-stimulating
hormone levels

3.06

feedback from estrogen missing, which stimulates the hypothalamus of the brain to produce more
FSH hormone

low inhibin levels

2.05

this is a newer test, which is more specific than the FSH test and also has some importance in fertility work-ups

Self-assessment of perimenopausal status

0.25

this is not a reliable test as it is below 1.0. It was included to show how good the other tests are in comparison

The authors concluded that there is no need for blood tests for menopause diagnosis in a woman, if several points of the first 4 findings are positive (top part of the table).

Here is a link regarding menopause.

Last edited December 9, 2012

Apr

2003

Flu Shots Prevent Heart Disease, Lung Disease, Strokes And Deaths

By Ray Schilling | Heart Disease, Infectious Disease, Lung Disease, Prevention, Stroke

It has been known for some time that flu shots would be beneficial. But it was not known until now whether in larger field studies people who are 65 years or older would benefit significantly and to what degree from yearly influenza vaccinations (“flu shots”).

The April 3rd, 2003 issue of The New England Journal of Medicine published the answer to this question. Dr. Nichol from the University of Minnesota, Minneapolis, and his collegues have followed 140,055 patients of whom 55.5% were vaccinated against the flu in the 1998/1999 flu season.

They also followed 146,328 subjects during the 1999-2000 flu season of whom 59.7% were vaccinated against the flu. Below is a breakdown how they fared when compared to non-immunized controls (see table).

Flu Shots Prevent Heart Disease, Lung Disease, Strokes And Deaths

The examiners of this study concluded that high risk patients (asthma patients, patients with diabetes, cancer, elderly patients, arthritic patients and patients with high blood pressure) should have a yearly Flu vaccination.

Patients after Flu vaccinations. How did they do?

(based on 1998/99 and 1999/2000 flu seasons)

Complications:

Observation:

Comments:

Heart disease:

reduced 19%

this included heart failure and heart attacks

Hospitalization for stroke:

reduced 16% to 23%

often hospitalization for stroke patients can be weeks and months, often resulting in other complications due to bacterial superinfections, falls or clots

Pneumonia and
influenza rate:

reduced
29% to 32%

this can lead to heart attacks and deaths from bacteria in the blood

Death rates:

reduced 48% to 50%

all of the deadly complications from getting the Flu remarkably reduced by Flu shots!

However, in my opinion anybody would benefit from regular Flu vaccinations as this boosts the immune system in general protecting against other infections and colds as well.

Here is a link to a chapter on the flu in Net Health Book.

Last edited October 25, 2014

Apr

2003

SARS (Severe Acute Respiratory Syndrome)

By Ray Schilling | Infectious Disease, Prevention

What is SARS? SARS is a new strain of an acute flu that leads to a high fever, a severe cough and an atypical pneumonia where the inflammation of the lung tissue caused by this new type of virus leads to a severe lung infiltration that can be detected with chest X-rays. Cases similar to SARS have been known to the medical profession for several decades under the name of “atypical viral pneumonia”.

Most viruses lead to a laryngotracheitis, affecting only the lining of the upper airways like the trachea and the voice box. However, SARS is not like this. It is a new strain of virus that goes right down into the lung tissue and leads to more severe breathing problems from secretions that plug the airsacs (alveoli) of the lungs. However, only about 3% to 4% of patients who get SARS actually die as explained in the links below (see CDC and WHO Internet sites). Here is a brief review explaining the evidence in the medical literature that is known at this time (April 2003). Since March 2003 it is known that SARS likely is transmitted by a small virus belonging into the same family of viruses like measles or mumps (the Paramyxoviridiae family of viruses). This WHO link explains this in more detail. However, Dr. Francis Allan Plummer from the National Microbiology Lab in Winnipeg/Canada has isolated a human metapneumo virus in six out of 8 specimens from high suspicion cases for SARS that were submitted to the Lab. It is at present not clear whether there are only one or perhaps two or three similar viruses that may work in concert in tricking the immune system not to mount an immune response in some susceptible persons whereas in the majority of patients the immune system produces enough antibodies to overcome the disease.

SARS (Severe Acute Respiratory Syndrome)

In a publication from the New England Journal of Medicine, which was released one month early on Apr.10,2003, the SARS working group noted that there has been a corona virus isolated from 18 SARS patients who died from this disease 10 to 14 days into it and that this was a new strain of virus, which likely originated from a single ill health care worker from the Guangdong Province in China. These researchers used genetic tests (reverse transcription- polymerized chain reaction), electron microscopic tests of cell cultures with throat swabs from infected SARS patients as well as immunological tests with group specific corona virus antibodies to pinpoint the cause of SARS.

The new name for this virus: Urbani SARS-associated coronavirus in honor of Dr. Carolo Urbani, a WHO investigator who died of SARS himself when he investigated the early epidemic in Asia.

There might be inborn (genetic) weaknesses in some patients. The National Institute of Health is developing a vaccine against the corona virus, which is thought to trigger SARS. At the present time the best therapy is isolation in a hospital for those who are very sick with a possible combination treatment with corticosteroids and antiviral antibiotics, which may be 70% effective in halting the disease. The most important point is prevention of further transmission by isolation procedures (quarantine). Hopefully there will be a vaccine available soon, which could possibly be incorporated into the Flu vaccine.

More information in Dr. Schilling’s Nethealthbook: http://nethealthbook.com/infectious-disease/infectious-disease-infections/severe-acute-respiratory-syndrome/

Here is a link to the official CDC site about SARS

This link brings you to the World Health Organization site (WHO) where SARS is discussed.

Last edited October 25, 2014

Mar

2003

Men Need Testosterone For the Male Menopause

By Ray Schilling | Hormones, Men's Health

Introduction

Men need testosterone for the male menopause as their testicles no longer produce enough of the male hormone. At a recent continuing education meeting at the University of Calgary in Alberta/Canada, which was reported in the Jan. 14, 2003 edition of the Medical Post, Dr. Norman Wong (professor of medicine, biochemistry and molecular biology) reviewed the symptoms, investigations and treatment modalities available for men who experience andropause (the male equivalent of menopause). They are as follows (my summary in table form).

Here is a link to the ADAM questionnaire regarding andropause by Dr. Morley, a geriatrician at the St. Louis University in Missouri. If you answer “yes” to question #1 and #7 (sexual dysfunction or lack of sex drive) or if you answer “yes” to any three of the other total of 10 questions, you should see your physician and ask for a testosterone blood test.

The testosterone blood test

What should you know about testosterone blood tests? What counts is the free testosterone or bioavailable testosterone. Dr. Ronald Swerdloff, professor of internal medicine and endocrinology at the UCLA School of Medicine in Torrance, California, stated at this conference that testosterone production decreases with aging, but is actually also one of the causes of aging. Testosterone levels decrease 1% to 2% every year from the age of 30 onwards. However, the sex hormone binding protein (SHBP) can buffer these changes for a certain period of time, if the SHBP is binding less testosterone thus keeping the free or biologically available testosterone relatively stable for a number of decades or years.

Replacement of missing testosterone

Often, however, the andropausal men who need testosterone replacement have high SHBP levels. Nobody knows why some men have problems earlier than others. So, if the free testosterone serum level is low (and the LH and FSH hormones are low or normal) this means that this man should have testosterone replacement therapy, if there are also clinical signs and symptoms of hormone deficiency.

Testosterone For Male Menopause (Andropause)

Gonadotropins

As can be seen from this link to menopause in women , the pituitary hormones LH and FSH, which are also known as gonadotropins, should be high to indicate that the feedback mechanism between the estrogen (or in the male the testosterone) no longer suppresses the production of these gonadotropins. The fact that this mechanism is lost in most older men shows that the hormone deficiency is likely much more profound than a simple deficiency, it may actually be indicative of the aging process of the hormone glands themselves. The good news though is that with a simple testosterone patch this can be fixed. Your doctor can discuss this further with you.

Injections of testosterone

Other possibilities are injections every 3 to 4 weeks with a Depo-testosterone hormone preparation or tablets. However, with the tablets the problem is that this will get metabolized in the liver and higher amounts of hormone are required to overcome the liver barrier. Liver cancer has been reported in a small percentage of men taking tablets for a long period of time. I think that testosterone tablets are not safe for this reason. Prostate cancer is the other worry and regular PSA tests and prostate exams should be done by your doctor. No clinical trials are available regarding the safety of long term testosterone replacement in andropausal men. Dr. Swerdloff recommended to replace only in the lower dose range to the point where the free testosterone serum values are just barely in the normal range and the clinical signs and symptoms disappear. Avoid overtreatment with testosterone.

Andropause symptoms (male menopause)
Symptoms:	Comments:
loss of sex drive (libido)	testosterone from the testicles, is responsible for a normal sex drive
erectile dysfunction (impotence)	inability to have sustained erections
loss of male characteristics	loss of male type hair distribution, deep voice, muscle mass etc.
fatigue and depression	brain hormones dysbalanced from low testosterone levels
decrease in muscle mass, increase in fat mass	lack of testosterone responsible for muscle loss and change in bone metabolism
oligospermia or azoospermia	too little sperm count or no sperm present

Additional information about effects of testosterone

Addendum Nov. 2, 2012: At the 19th Annual World Congress Anti-Aging and Aesthetic Medicine in Las Vegas (December 8-10, 2011) Dr. Abraham Morgentaler, a Harvard trained urologist explained that with bio-identical testosterone replacement there is no longer any concern about prostate or liver cancer with long-term use. It has been one of the “medical myths” that has been around. Dr. Morgentaler also noted that testosterone replacement is safe and actually prevents prostate cancer. He suggested replacement of testosterone with blood values being in the higher range of normal.

See also link to andropause/male menopause from the Net Health Book.

Mar

2003

Hyperthermic Chemotherapy For Colon Cancer

By Ray Schilling | Cancer

When colon cancer comes back (Duke stage D cancer) there often are seedlings of cancer cells in the peritoneal cavity, which in the past made surgery impossible. However, at Montreal’s Maisonneuve-Rosemont Hospital the surgical oncologist, Dr. Pierre Dubé, is using a brand new technique that allows to do surgery even in these difficult cases. It has been known for some time that cancer cells are heat sensitive.

At the time of the surgery all of the visible cancer is removed, like with ovarian cancer, using a cytoreductive surgery approach. At the end all invisible cancer cells are treated with a combination chemotherapy fluid that is introduced into the abdominal cavity and that is heated in a controlled manner. Heat probes measure the temperature and make sure the fluid is heated to 44°C (111°F). Other experiments have shown that at this temperature chemotherapeutic agents enter into the cancer cells faster, as they had been rendered more fragile by the heat. The end result is an increase in survival by 2 to 2 1/2 years. This is a breakthrough because in the past conventional combination chemotherapy for this group of advanced colorectal cancer patients achieved a remission (meaning “response rate”) of 0%. Now with this new technique there is a remission rate of 30% to 50%. Hyperthermic chemotherapy for colon cancer was pioneered at the Gustave Roussy Institute in Paris where Dr.Dubé was introduced to this technique. This was reported in the Jan. 14, 2003 edition of The Medical Post (page 7). According to Dr.Dubé about 10% of all colorectal cancer patients will need this type of surgical approach and about up to 25% of patients who develop cancer spread into the abdominal cavity (peritoneal carcinomatosis) would be potential candidates for this treatment modality.

Hyperthermic Chemotherapy For Colon Cancer

Comments: Recently there has been a paper intitled “Factors predicting survival after intraperitoneal hyperthermic chemotherapy with mitomycin C after cytoreductive surgery for patients with peritoneal carcinomatosis” by P.Shen et al. (Arch Surg – 01-JAN-2003; 138(1): 26-33). 109 patients with carcinomatosis of the abdominal cavity with different cancers were treated with cytoreductive surgery and hyperthermic chemotherapeutic solutions. With this procedure, after complete removal of gross cancerous disease, the 3-year survival rate achieved 68% versus 21% of those where gross cancer removal was not entirely possible.

Last edited October 25, 2014

Mar

2003

Garlic Component Effective Against Head Lice

By Ray Schilling | Parasites, Prevention, Skin Disorders

The Jan. 21, 2003 edition of the Medical Post published an article about some Argentine research involving the active ingredient of garlic, allicin.

Dr. Juan Barboza and his collegues from the University of Cuyo in Mendoza started their research first with plant lice, as they had been approached by farmers to help them find a natural way to fight lice infestation of their crop .

Of the various chemical compounds in garlic it was the allicin compounds that were most effective in asphyxiating common pests, particularly plant lice. Subsequently they were experimenting with head lice formulations. Shortly after there was a severe outbreak of headlice infestation at the day care center of the university.

This was an opportunity for the researchers to test the efficiency of the new formulation of a mixture of allicin with a mint-scented cream. With only one application of this formulation there was a 96% reduction of the number of head lice within only 1 week!

Garlic Component Effective Against Head Lice

Here is a link to other useful hints about head lice.

Last edited December 10, 2012

Mar

2003

Do Diet Drinks Make You More Hungry?

By Ray Schilling | High Blood Pressure, Nutrition, Prevention, Weight loss

There were some articles recently that stated that diet drinks would make you hungry. However, they lacked proper controls. For this reason the gastroenterologist, Dr. Khursheed Jeejeebhoy, from the University of Toronto/Ontario designed a well controlled 10 week trial where several parameters were measured while patients were either snacking on diet drinks or on sugar containing soft drinks on top of their regular food intake, which was also closely monitored. The only requirement in the beginning of the study was that the subjects had to be overweight (body mass index of 27 to 28). Participants of the study were then divided randomly into subjects drinking soft drinks with either sugar or sugar substitutes. The drinks were blindly given, but meticulous records were kept of what was consumed. In addition the subjects were allowed to eat as many snacks as they liked with either sugar in it or sugar substitutes. Below is a tabular summary of the findings.

The surprising findings were that the sugar group had an increased appetite and wanted to eat more and more. Sugar also raised the blood pressure significantly.

Diet Drinks Make You More Hungry

The result was a significant weight gain during the 10 weeks of the trial while the other group (AS) had lost a significant amount of weight without any hunger pangs. The researchers also measured body fat versus muscle mass and found that the sugar group (SG) had gained fat mass without changing the muscle mass. On the other hand the atrtificail sweetener group (AG) had lost only fat mass, not muscle mass.

Dr. Jeejeebhoy concluded according to the article in The Medical Post (Jan.14, 2003 edition, page 27) that sugar in snacks and drinks should be kept to a minimum to prevent obesity from developing or getting worse. Patients with high blood pressure should avoid sugar as much as possible and stick to a low glycemic-index diet. Drinks should be diet drinks or fluids without sugar content. Do diet drinks make you more hungry? The answer is: “NO!”

Artificial Sweeteners And Weight Loss(10-Week Study)
Findings:	Comments:
Additional Calories from drinks per day:	AS: 250 Cal.	SG: 870 Cal.
total caloric intake over the 10 weeks:	AS:decreasing steadily	SG:increasing steadily
appetite sensation:	AS:no appetite complaints	SG:sugar stimulated appetite
weight gain or loss:	AS:significant weight loss	SG:significant weight gain
activity level(exercise)	no change in either groups (AS or SG)
blood pressure	AS:no change	SG:sugar increased blood pressure significantly

AS=Artificial sweetener group

SG=Sugar group

Comment: Not every diet drink is medically safe. Aspartame and Sodium cyclamate are brain excitotoxins. One of the safest alternatives to sugar is Stevia. Read this review about sugar alternatives.

Last edited December 10, 2012

Mar

2003

The New Hot Asthma Treatment: Bronchial Thermoplasty

By Ray Schilling | Asthma, Lung Disease, Prevention

There is a new concept in the treatment of asthma, a mechanical solution rather than the familiar pharmacological solution. As is outlined in the lung disease chapter of my nethealthbook.com, the treatment of asthma is usually a combination of inhaled and oral medications that have as a target the smooth muscular envelope of the bronchial tubes, which is depicted in this link. In addition to the spasm of the bronchial tubes some anti-inflammatory steroid inhalers are also needed to control the swelling of the lining of the bronchial tubes, which can obstruct the air flow from inside.

Dr. John Miller has done research with the Alair catheter system at Broncus Technologies Inc. in Mountain View, CA (San Francisco Bay Area). Dr. Miller helped to develop this bronchoscopic instrument with a concealed expandable wire basket that can be heated. In cooperation with Dr. Gerard Cox from the Respiratory Division of McMaster University in Hamilton/Ontario/Canada they tested this procedure on a small group of 14 mild to moderately severe asthma patients. The procedure consisted of a 30 minute bronchoscopy during which several heat cuts were made through the muscle layer of the bronchial tubes using this instrument (the heat used is only as hot as a cup of coffee). The smooth muscle layer of the bronchial tubes remains relaxed after this. A total of four such treatments were given, 3 weeks apart. The result was surprising in that the breathing performance doubled, which would have been considered to be a good drug effect, if this result had been achieved with the help of medication. However, this effect is permanent and medication can still be used on top of this, if necessary.

The New Hot Asthma Treatment Is Bronchial Thermoplasty

The researchers will now start a larger multinational trial including a total of 110 moderate to severe asthma patients from Canada, England and Scotland, Germany and Denmark. Results of this study are expected to be published in 2004. (Based on The Medical Post, Feb.11, 2003, page 37).

Last edited December 10, 2012

Feb

2003

Celiac Disease Frequency Examined In This US Study

By Ray Schilling | Gastrointestinal Disease, Prevention

There has not been a large study in the US looking at the natural frequency of Celiac disease (CD) in the population. Celiac disease is an inborn hypersensitivity to gluten, to be more precise, a hypersensitivity to the sub-fraction of gluten, called “gliadin”, which leads to an atrophy of the villi in the small intestine.

Dr. Alessio Fasano, from the University of Maryland in Baltimore, and colleagues have examined a total of 13,145 subjects in their study to look for specific antibodies in the blood and by doing as many bowel biopsies to see how many cases of CD would be found. There were 4 groups of patients that could be identified: 4,508 first-degree relatives of CD proven patients; 1,275 second-degree relatives; 3,236 symptomatic patients who either had gastrointestinal (GI) symptoms or who had a disorder associated with CD; 4,126 patients not considered at risk and who could serve as a control group. Below are the results of the study in tabular form.

The blood tests that were performed were the anti-endomysial antibodies (EMA). In all positive tests two more specific CD blood tests were done as well.

Celiac Disease Frequency Examined In This US Study

The results in the table showed that the first degree relatives of CD patients are at a higher risk of developing he disease, even if they have no bowel symptoms (they may be incubating the disease before they even get CD). Second degree relative had about half the risk from first degree relatives. A surprisingly high number of patients with gastrointestinal symptoms do have CD (1 in 56 patients). The normal control group finding of 1 CD patient among 133 people was very similar to the European studies that had been published in the past.

Celiac disease US study findings
Patient group:	Statistics: Frequency of CD in group
first degree relatives	1 in 22
second degree relatives	1 in 39
patients with gastrointestinal symptoms	1 in 56
normal control group	1 in 133

Details about CD under this link: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/celiac-disease/

Last edited October 25, 2014

Feb

2003

CYP46 Gene Marker Linked With Alzheimers Disease

By Ray Schilling | Alzheimer’s disease, Prevention

Dr. Andreas Papassotiropoulos and his group from the University of Zurich in Switzerland have published an interesting paper in the January issue of archives of Neurology (Arch Neurol 2003;60:29-35). These researchers found when they compared a certain genetic area of 201 patients with Alzheimer’s disease with that of 248 control subjects, that there were important differences in the socalled CYP46 genotype.

A modified form of this genetic region (CYP46*TT genotype) was much more common in the late onset Alzheimers patients than in normal controls. When this test was found to be positive in a patient, this was associated with a 2.16-fold risk of Alzheimers. However, if another known genetic Alzheimers marker (apolipoprotein E epsilon-4) was present also at the same time, the risk of that person having Alzheimers was 9.6-fold when compared to normal controls. With another group of patients who had died from Alzheimers disease, autopsies were done and the brain tissues and cerebrospinal fluids was examined. It was found that the brain tissues and cerebrospinal fluids were loaded with beta-amyloid, which is the glue-like substance typical for Alzheimers.

The Swiss authors concluded from their study that CYP46 is a novel susceptibility gene, which allows to test for Alzheimer’s disease. From other studies it was known that the CYP46 gene encodes the cholesterol 24-hydroxylase, an enzyme that breaks down cholesterol in the brain.

CYP46 Gene Marker Linked With Alzheimers Disease

It was also known that the beta-amyloid is a by-product of this changed cholesterol metabolism in brains of Alzheimers patients. There are now new possibilities of prevention, if perhaps changes in diet would prevent the accumulation of cholesterol in the brain. Also, medications could be developed that help reducing the cholesterol load of Alzheimers brains to prevent the devastating memory loss.

Related link regarding Alzheimers and dementias: http://www.nethealthbook.com/articles/neurologicaldiseases_alzheimersandothers.php

Last edited December 10, 2012

Introduction

The testosterone blood test

Replacement of missing testosterone

Gonadotropins

Injections of testosterone

Additional information about effects of testosterone

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