Medical Articles by Dr. Ray - Collection of health news, health articles and useful medical information you can use in everyday life.

Aug

2006

New Screening For Cardiovascular Disease

By Ray Schilling | Health, Heart Disease, Nutrition

Checking out the patient’s heart disease risk factors used to be very basic. Lifestyle questions were one aspect: was the patient smoking? Did he have a lack of exercise? Did he have a risk of heart disease in the family? The patient’s diet was analyzed and the body weight was assessed. Cholesterol and triglyceride levels were the basic labs that provided more information. The risk factor assessment, as exemplified by criteria from the Framingham study, made a lot of sense.

In the meantime cardiologists are concerned that all these points are no longer sufficient in identifying individuals at risk for heart disease. Dr. Morteza Naghavi, president for the Association for the Eradication of Heart Attacks, is concerned that it is not only obesity and hypertension that bear the risk for heart attacks, but atherosclerosis. A lot of heart attacks occur in the low- and moderate risk groups. As far as he is concerned, every man aged 45-75 and every woman from 55-75 needs to be screened. We are better equipped to do something for people who have a high plaque burden (deposits in the blood vessels.) Statins are the medication of choice to help these patients.

Screening techniques have become less invasive, as imaging technology has made large progress in recent years. The condition of the carotid artery can be assessed by ultrasound (carotid intima-media thickness or CIMT). Coronary calcification score (CACS) can be measured by CT scanner. The tests are done in a few minutes, and the cost at the most is a few hundred dollars. A patient would only be screened every five years. Screening procedures work and save lives, as demonstrated in the screening for breast cancer. The SHAPE team (The Screening for Heart Attack Prevention and Education) has calculated that the screening cost is even better than breast cancer screening. There are other tests that improve the sensitivity of traditional criteria, like the blood test for C-reactive protein, but in assessing the patient’s risk, it does make sense to go to the source of disease. The striking color image that demonstrates the atherosclerotic burden will allow the patients to see the problem with their own eyes.

New Screening For Cardiovascular Disease

It may be a healing shock that has a beneficial effect on the compliance of patients. Test results of laboratory work are words, but here a picture is worth a thousand words when it comes to encourage the patient to actively work on prevention.

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

Reference: National Review Of Medicine, July 30, 2006, page 7

Last edited November 1, 2014

Aug

2006

New Aphrodisiac Nasal Spray

By Ray Schilling | Men's Health

Sildenafil and other phosophodiesterase-5 inhibitors(PDE-5 inhibitors) have taken the drug market by storm for erectile dysfunction. Viagra-just to name one of the drug names- has certainly enhanced the treatment possibilities for a male problem that was difficult to treat in the past. The market has had its heyday with splashy TV commercials, creating hype like seldom before. The truth remains, that any drug has also possible side effects that are not mentioned in the upbeat commercials, and patients with preexisting heart disease have experienced heart attacks. The medications for the treatment of erectile dysfunction are not recreational fun, but serious prescription drugs.
In the meantime these drugs are facing competition from a new class of erectile dysfunction drugs, the melanocortin agonists.
They claim to have remarkable properties due to the fact that they will not only help men but also women with a range of sexual disorders, including lack of desire. Contrary to the previous drugs they are not working through the vascular system but through the central nervous system. Through receptors in the brain area called hypothalamus, they stimulate areas of the brain associated with sexual arousal. Preliminary experiments have shown that they are increasing libido, but also help a man to get better erections.
The melanocortin agonist closest to the market is known as bremelanotide. Previously known as PT-141, the nasal spray has been tested in about 300 men up to phase II with promising results. A study on women has been too small in numbers to give detailed results, but significantly more women reported increased libido after bremelanotide treatment as opposed to placebo. The drug’s half-life is only two hours, but women have reported effects lasting 10 to 12 hours. They also reported that the quality of their sexual encounter had improved. The older group (women over 34) responded slightly better than their younger counterparts.

New Aphrodisiac Nasal Spray

Bremelanotide still has some way to go till it will be on the market, but it is getting some positive press in magazines as the “first equal-opportunity aphrodisiac”. Palatin Technologies, the manufacturer of the drug is more cautious and does not want bremelanotide to be perceived as a leisure drug, even more so as it has not seen its approval at this point.

National Review Of Medicine, July 30, 2006, page 11

Comment on Nov. 13, 2012: The FDA did not approve this drug due to reports of elevated blood pressure in a minority of test subjects. However, the drug has been synthetized by other pharmaceutical companies around the globe and is actively traded in Argentina, Armenia, Aruba, Australia, Austria, Azerbaijan, the Bahamas, the United Arab Emirates, United Kingdom and Uruguay.

Last edited December 6, 2012

Aug

2006

Autism Not Linked to MMR Vaccine

By Ray Schilling | Other neurological conditions

The fear that there could be a connection between the measles-mumps-rubella (MMR) vaccine and the development of autism (PDD or pervasive developmental disorder) has stopped many concerned parents to have their children vaccinated against these common childhood diseases.
Canadian research found out that a different picture emerged. Dr. Fombonne and his team from Montreal calculated that PDD prevalence increased by about 10 % every year. The MMR coverage decreased by about 4%. From these figures it is clear that the MMR-autism connection has been a myth. The consequences of the scare however, have been severe after the 1998 scare that came from an article in the Lancet. MMR vaccination has dropped from 95% to 85%, and the UK is currently experiencing its worst measles outbreak in 20 years. Measles is not a “harmless” disease that affects small kids. People have to remember that measles are a disease that kills, and not just in developing countries.
The next item was the hypothesis that mercury exposure from vaccines could pose a problem. Mercury exposure however has dropped to nil ever since a compound called thimerosal that was used as a preservative has been discontinued and eliminated from vaccines in 1996.
Autism (PDD) and its increase still keep researchers busy. The vaccination myth has been debunked as the culprit for autism.

Dr. Fombonne explains that there is increasing evidence for genetic factors giving rise to the disorder, but there could be contributing environmental factors.

Reference: National Review Of Medicine, July 30, 2006, page 3

Link to chapter on autism in my Net Health Book with more info about autism: http://www.nethealthbook.com/articles/autism.php

Last edited December 6, 2012

Aug

2006

Do Not Mix Migraine Medications With Antidepressants

By Ray Schilling | Mental Health, Other neurological conditions, Pain

Headache medications that are available over the counter in the local drugstore are ineffective when it comes to a migraine headache, and migraine sufferers have received great help from medications that are targeting a migraine attack. They are non-narcotic prescription drugs, some of which have to be injected. They are available under names like Amerge, Axert, Frova, Imitrex, Maxalt, Relpax or Zomic, and the medication group is known in pharmacists’ language as “triptans”.
The medications are generally well tolerated, but the FDA has issued a warning.
In combination with another medication group, life threatening side effects can occur.
Any patient who is receiving medication for the treatment of depression in the form of a Selective Serotonin Reuptake Inhibitor (SSRI’s) is strongly warned, not to take any of those listed triptans for migraine. The anti depressive drugs are Celexa, Fluvoxamin, Paxil, Prozac and Zoloft. Two other medications, namely Effexor and Cymbalta are Selective Serotonin/Norepinephrin Reuptake Inhibitors (SSNRI’s), and they carry the same risk when taken in combination with the triptans.
The combination of the two medications can lead to a dangerous condition known as Serotonin syndrome. It occurs when the body has too much serotonin, a chemical found in the nervous system. Serotonin syndrome symptoms may include restlessness, hallucinations, loss of coordination, fast heartbeat, and rapid changes in blood pressure, increased body temperature, overactive reflexes, nausea, vomiting, and diarrhea. Serotonin syndrome may be more likely to occur when starting or increasing the dose of a triptan, SSRI or SNRI.

Do Not Mix Migraine Medications With Antidepressants

It is up to the prescribing physician to carefully weigh the advantages against the serious side effects, and it can be a difficult choice, as both conditions, migraine as well as depression, need to be treated effectively. Any patient who has to take both medications has to be closely watched. The patient also has to be alert to any side effect.

Reference: FDA/Center for Drug Evaluation and Research, July 19, 2006

Link to chapter on migraines in Net Health Book: http://nethealthbook.com/neurology-neurological-disease/common-causes-headaches/migraine-headache/

Last edited Nov. 1, 2014

Jul

2006

Better Blood Pressure Control With New Drug

By Ray Schilling | Heart Disease, High Blood Pressure, Prevention, Stroke

Numerous medications for blood pressure control are in circulation. Treatment of high blood pressure patients is crucial in the prevention of strokes, but despite the multitude of drugs that are on the market, the treatment has its challenges. Some of the drugs have side effects, like an irritating cough, and a suitable medication has to be tried out first. Even, when all is well and there are no unpleasant side effects, many patients have a problem with compliance. Pills that have to be taken several times per day are forgotten. As a result, the patient will have poor blood pressure control.
Blood pressures must be controlled on an ongoing basis. Ideally there are no big fluctuations, whether it is day or night. For this purpose, a medication has to stay in the system of the patient long enough. This time stretch is called the half-life of a drug.
The first drug in a new class of agents for the treatment of high blood pressure does exactly that: it has a long half-life, so blood pressure control is smooth and continuous, day or night. The oral direct renin inhibitor aliskiren has the potential to protect the heart and other organs with a once-daily dosage of 150 mg or 300 mg. The drug is being developed by Novartis, and clinical trials are on their way.
The medication in combination with a diuretic provides significant additional blood pressure reduction. The agent at work is a renin inhibitor (also known medically as “renin antagonist” as it blocks the effects of renin). In the past, renin inhibitors for treatment of hypertension (high blood pressure) could only be used as intravenous solution and this was only effective for a short time.

Better Blood Pressure Control With New Drug

The new development is a breakthrough, as the medication is taken by mouth and it continues to work even when the drug is gone from the blood stream. It is ideal for daily dosing, and there is no apparent buildup in the body.

More information about hypertension (high blood pressure): http://nethealthbook.com/cardiovascular-disease/high-blood-pressure-hypertension/

Reference: The Medical Post, June 13, 2006, page 38

Comment on Nov. 13, 2012: Aliskiren (brand name “Tekturna”) was approved by the FDA in March of 2007. However, as all drugs, it does have some side-effects like headaches, cough, angioedema, skin rash, elevated uric acid with gout etc. (see this Wikipedia link).

Last edited Nov. 1, 2014

Jul

2006

Benefits Of Arthritis Drug Outweigh Cancer Risk

By Ray Schilling | Arthritis

Any medication that is very effective in one area may also have side effects.
An analysis of randomized trial has confirmed, that rheumatoid arthritis patients who are treated with anti- tumor necrosis (TNF) antibodies, are at an increased risk for cancer. A study from the Mayo Clinic and other studies from institutions in the U.K. showed that patients who are treated with the monoclonal antibodies infliximab (Remicade) and adalimumab (Humira) are at a higher risk for serious infections.
This may sound like a blow to any patient with rheumatoid arthritis. Treatment with Monoclonal antibodies and anti-Tumor necrosis antibodies has revolutionized the care of these patients. The medications are highly effective and have made a difference for many affected with rheumatoid arthritis.
Dr. Eric Matteson, a study co-author and professor of medicine in the division of rheumatology at the Mayo Clinic points out, that the concerns about infection and malignancy are not new. They are already mentioned in the drug labeling. The risk for cancer was statistically significant only in the high-dose groups. It was also impossible to draw any conclusions about whether any type of malignancy occurred more often than another. He also emphasized, that doctors and patients have to be alert to signs of infection, and age-appropriate cancer screening is of great importance for the patient who takes these particular medications.
Dr. John Esdaile from the University of British Columbia mentions some additional points. These medications are not handed out freely to any patient with R.A. The treatment cost of about $18,000 per year does not make this a standard medication for anybody with R.A. Patients with severe disease who have failed to get relief from any conventional medications would be the ones who are considered for this treatment. Most patients would likely be receiving doses in the lower range of the spectrum, and patients usually know within 3 months, whether the medication is helping them. The medications do not work in everyone, but for 50% of the patients the effect is dramatically positive. The patient, whose joints were being destroyed by rheumatoid arthritis, can go from a state of terrible pain and disability to being able to return to a good quality of life.

Benefits Of Arthritis Drug Outweigh Cancer Risk

The key is close screening of patients regarding the suitability of the therapy. The possible increased risk for malignancies and infection must be discussed with candidates for anti-TNF therapy. Finally close monitoring for infection and cancer screening is necessary.

More information about rheumatoid arthritis: http://nethealthbook.com/arthritis/rheumatoid-arthritis/

Reference: The Medical Post, June 2, 2006, page 1 and 7.

Last edited Nov. 1, 2014

Jul

2006

Avian Flu Threat Exaggerated

By Ray Schilling | Health, Infectious Disease, Lung Disease, Prevention

Disconcerting headlines about avian influenza has caused widespread concern. Warnings have been issued to brace for an onslaught of a pandemic that could paralyze and decimate entire nations. Countries that showed cases of avian flu were scrutinized closely. Travel stopped to areas where poultry was affected. Despite reassurance to the consumer, buyers felt unsure about choosing chicken for dinner. It has been stated before, that at this point the virus of the avian flu has not made a mutation, and it is not passed from human to human. It can be transmitted from diseased fowl to human who are in close contact with the diseased animal.
The word pandemic seems to trigger a response of fear, but it has to be mentioned that a pandemic is not new. It is universally accepted that there have been 3 pandemics in the 20-th century. Pandemics are defined by an increased number of influenza deaths. One influenza wave hit in 1968, prior to this the year 1957 showed a similar picture. Pandemics are not all equal. The outbreak of influenza in 1918/19 was severe, and young and old were affected alike. Death was in many cases due to the primary viral infection.
In the meantime flu preparedness is much more common than in previous years. Flu shots are available, antibiotics can help treat secondary infection, laboratories are working on vaccines for new influenza strains, and lately antiviral medications have come into the picture.
While the work of scientists is invaluable, in some cases the statements are too simplistic. The avian flu virus H5N1 could mutate. Looking at the facts, the virus has been around since 1997, and it has not mutated. Reporters write stories about possible future pandemics, and there is worry in the population. They need to know the truth! The truth is that we should plan. The truth is also, that a pandemic is not more imminent today than it has been since 1918. In fact it is not more imminent than a multitude of other emergencies. The outbreak of SARS has shown that it is the front-line public health and hospital staff that handles the virus most of all. The production of vaccines and a strong vaccination program is being worked on. This does not leave the rest of the population with nothing what they can do.

Avian Flu Threat Exaggerated

Good hygienic measures have to be followed. The most important one (and often neglected one) is hand washing. It does not stop a pandemic like the one in 1918/19, but it certainly makes a difference to annual influenza rates. The annual vaccination against influenza is a highly effective weapon against the influenza outbreak that happens every year, and improved vaccines will make a difference between wellness and the opposite!

More information about:

The flu: http://nethealthbook.com/infectious-disease/respiratory-infections/flu/

The swine flu: http://nethealthbook.com/infectious-disease/respiratory-infections/swine-flu/

Reference: The Medical Post, June 20, 2006, page 47

Last edited Nov. 1, 2014

Jul

2006

Exercise Can Reverse Risk Of Heart Disease

By Ray Schilling | Fitness, Heart Disease, Prevention

A growing health concern is cardiovascular illness. As a rule the risk increases with unhealthy life style choices. The most common neglect is the lack of physical activity, and a couch-potato existence is a sure recipe for poor health. Often juvenile “couch potatoes” lay the groundwork for health problems in their middle age years.
Jennifer Robbins of Duke University in Durham, N.C. led a follow-up study on a group of participants. The objective was to examine, how much impact an exercise program would have on the overall condition of the participants. Fitness parameters included weight, waist circumference, visceral and subcutaneous fat, cholesterol levels and metabolic score.
In a control group 61 subjects were instructed not to change their dietary habits or exercise habits for 6 months. Researchers expected that the general health condition of these people would stay the same. What was observed, however, was a deterioration of all the fitness parameters. The sedentary group actually got worse! At the end of the study, all the 61 were offered to participate in one of the exercise programs offered to the other groups. 53 participants decided to take part, and they were enrolled in a low- intensity, medium-intensity and high- intensity exercise program. The two lower groups managed to reverse the detrimental effects of inactivity on cardio-vascular risk in a half-year exercise program. The researchers noted also that the ones who had deteriorated the most during the sedentary period achieved the most improvement from the exercise program.

Exercise Can Reverse Risk Of Heart Disease

Exercise Physiologist Jennifer Robbins and her team concluded, that the study result gives encouragement to those who don’t exercise and feel bad about it, as they will reap the most benefits. The results also give doctors more incentive to make physical exercise part of a prescription regimen. With a word of recommendation from the physician patients are more likely to enrol in an exercise program and stick with it.

More info about:

Heart disease: http://nethealthbook.com/cardiovascular-disease/heart-disease/

Fitness and exercise: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

Reference: The Medical Post, June 20, 2006, page 47

Last edited Nov. 1, 2014

Jul

2006

Coffee Protects Against Liver Cirrhosis

By Ray Schilling | Gastrointestinal Disease, Nutrition, Prevention

Coffee has been used as a stimulant for centuries, and more recent research has shown that moderate use of coffee can be beneficial.
The flavorful brew has been used as a wake-up drink, especially after a bad night’s sleep. Those suffering of a hangover after too much alcohol have also brewed it and felt better afterwards.
A new study in the June 12 Archives of Internal Medicine found that there was more benefit than just headache relief for those who drank too much booze. Heavy alcohol drinkers who also drank coffee reduced their risk for liver cirrhosis. (Liver cirrhosis is one of the severe side effects of too much alcohol use.)
Researchers examined the data of 125,580 subjects between the 1978 and 1985. Nearly 200 of these people developed alcoholic cirrhosis by 2001. The researchers found that for each coffee drink per day, there was a 22% drop in the risk of alcohol induced liver cirrhosis.

Coffee Protects Against Liver Cirrhosis

Generally tea is considered a beneficial beverage due to the bioflavonoids content. This large study also examined whether tea consumption would decrease liver cirrhosis risk, but no similar benefits were found for tea drinkers.

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

Reference: National Review of Medicine June 30, 2006

Last edited Nov. 1, 2014

Jun

2006

Screening Colonoscopy Highly Effective

By Ray Schilling | Cancer, Gastrointestinal Disease, Prevention

The proverbial “ounce of prevention” can be very crucial when it comes to cancer screening methods. Cancer screening has been in the forefront for some time. Early disease detection is not only crucial for successful treatment; it can be a lifesaver!
Effective screening methods are available for some forms of cancer. Mammography screening for breast cancer and rectal examination and PSA tests for prostate cancer are methods that have received attention in the media.
Screening the large intestine for colon cancer by performing a colonoscopy has not made inroads, but new statistics point out the benefits. A colonoscopy will examine the colon for irregularities, namely the formation of polyps. Polyps are initially harmless and non-cancerous, however over time, some polyps have the potential to turn cancerous. In a colonoscopy examination, small polyps can be removed immediately, and this “weeding out” process is a highly effective preventative method against colon cancer. Research has shown, that one colonoscopy that is performed in a middle-aged patient (in his 50’s or 60’s) decreases the risk of developing colon cancer quite significantly. If no polyps are found in the initial screening, it is safe to assume that no colon cancer will present itself for 10 years.

Dr. Harminder Singh and associates from Cancer Care Manitoba and the University of Manitoba, in Winnipeg Manitoba/Canada, analyzed data of the Manitoba Health’s physicians’ database where 35,975 patients had undergone a colonoscopy, but were negative for colon cancer.These colonoscopies took place between April 1, 1989, and December 31, 2003 and follow-up was for 10 years. The end point was death or diagnosis of colon cancer.

One Screening Colonoscopy Guarantees Low Colon Cancer Risk for 10 Years (modified JAMA. 2006; 295: p.2366-2373)

This retrospective study showed the following results depicted in the modified graph bar. Patients who were negative in the beginning of the study had a reduction of colon cancer rates of 72% at the 10-year point when compared to those who had no colonoscopy. This is quite an astounding finding. Even at the 5-year point there was a reduction of colon cancer risk by 45% from a single colonoscopy. This would indicate that a person should have a colonoscopy at about the age of 50 to establish freedom of colon cancer. This could be repeated only every 10 years to ensure that no colon polyps and colon cancer develop in the meantime. This should be definitely done in patients who have a family history where colon cancer occurred in a first relative such as mother, father, brother or sister, where specialists say screening should be done every 3 years. In this familial form of colon cancer they should also have a colonoscopy done earlier (at age 40 or earlier). However, this data would indicate that in everybody such colonoscopy screening would be beneficial as it is one of the most common cancers in men and women and other tests are not reliable at this time.

More information about colon cancer: http://nethealthbook.com/cancer-overview/colon-cancer/

Reference: JAMA. 2006;295: page 2366-2373

Last edited Nov. 1, 2014

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