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

Sep

2018

Two Proteins Responsible For Getting Epilepsy

By Ray Schilling | epilepsy, neurological disease, seizure disorder

Epilepsy is sometimes difficult to control, but research has now identified two proteins responsible for getting epilepsy. According to the researchers this finding has the potential of turning our current knowledge about epilepsy upside down.

How the brain works and seizures originate

The brain is an accumulation of a myriad of nerve cells that are connected with an equal number of nerve fibers.

The communication from one end of the brain to the other end occurs via electrical signals. They have their origin in the nerve cells and travel through the nerve fibers at an astonishingly fast rate.

The nerve cells of the brain also have a connection to the muscles, organs and skin. This is achieved with the help of nerve fibers. They travel through the spinal cord and peripheral nerves to reach the end organs. Again the transmission of these communication signals are through electrical impulses. Usually these signals are perfectly balanced by inhibitory nerve cells, whose job it is in the spinal cord and throughout the brain to keep these electrical signals under control.

Unfortunately some people are not so lucky. They have a “low seizure threshold” and a fever or stress can trigger a seizure or epilepsy. This is a state of the brain where activated parts are overruling the inhibitory parts and an epileptic seizure or partial seizure results. In the case of a grand mal seizure the person may be unconscious for a brief period of time while the muscles have shaking spells. It may start with involuntary muscle twitching around the eyes, the patient becomes unconscious and may fall down onto the ground. The patient may bite the tongue, stop breathing, shake arms, then the trunk muscles and finally both legs. Around 1 in 100 people get epilepsy, and it is mostly children and people above the age of 65 who get it.

New research regarding two proteins responsible for getting epilepsy

Rochelle Hines led a team of neuroscientists from the University of Nevada, Las Vegas in this research. They investigated two proteins involved in inhibiting the central nervous system. In the past it was thought that an overstimulation of nerve cells would have caused electrical overstimulation of the central nervous system causing epilepsy. Now this new research showed that it is two proteins that are missing. Normally these proteins suppress the electrical nerve activity that leads to epilepsy.

First of all, gephyrin is a protein that regulates GABA receptors. GABA is a brain hormone that calms the brain. Another protein, called collybistin is a regulator of the localization of gephyrin.

Different approach to study epilepsy will find better medications

Rochelle Hines and her team found two key proteins, gephyrin and another protein, the alpha-2 subunit of the GABA receptor. They found that they have to interact with each other in order to calm the brain. If this does not occur, seizures (epilepsy) can occur. The emphasis of this research was on finding ways to stimulate the inhibition of the GABA receptor system. In the past the emphasis was to generally calm down the entire brain with medications. This caused a lot of side effects because the traditional anti-seizure medications do not target a specific area of the brain. Now scientists can work with the two key inhibitory proteins, gephyrin and the alpha-2 subunit of the GABA receptor. At this point a new medication is not yet available, but certainly when the development of it is complete, it will be more specific and have fewer side effects.

Some citations from the lead researcher, Rochelle Hines

“Regulating this ‘compartment’ of proteins in the brain that controls cell signalling may lead to better therapies for stopping or preventing seizures. If we can better understand the activity of the brain pattern, we can understand how it might go wrong in a disorder like epilepsy, where brain activity becomes uncontrolled. And if we can understand what is important for this control, we can come up with better strategies for treating and improving the quality of life for people with epileptic seizures and maybe other types of disorders as well, such as anxiety or sleep disorders.”

It is interesting to me that seizures and anxiety maybe the same process in the brain. While with anxiety the brain is irritated, it is still controlled. In contrast in the case of epilepsy the control of the GABA system is gone and the brain excitation is uncontrolled. Medication that will increase the proteins gephyrin and the alpha-2 subunit of the GABA receptor is badly needed.

Two Proteins Responsible For Getting Epilepsy

Conclusion

Epilepsy and seizure disorders appear to now be due to a lack of inhibition in the central nervous system. Two proteins that work on the inhibitory GABA receptors hold the key. They are gephyrin and the alpha-2 subunit of the GABA receptor. There are mouse strains that are deficient for these proteins, and they come down with epilepsy. The human brain has the same proteins that are necessary to inhibit the brain. In anxiety disorders it seems like there is a mild loss of these inhibitory proteins. In contrast with epilepsy the deficiency of these hormones is more severe. Researchers are now concentrating on developing new drugs or modifying existing drugs to stimulate the production of these inhibitory proteins. The hope is that these medications will have fewer side effects, because they will be more receptor specific.

Sep

2018

Cell Phones Can Cause Cancer After All

By Ray Schilling | Cancer, leukemia

Re-investigation of whether or not cell phones can cause cancer revealed that cell phones can cause cancer after all. This publication comes from the Journal “The Guardian”. It turned out that for 25 years the cell phone industry managed to suppress scientific evidence of cancer. In many experiments scientists found brain cancer and adrenal gland cancer in rats from exposure to electromagnetic fields. Regulatory authorities based their statements on fake experiments that showed no apparent effect of EMF (electro-magnetic fields) on animals. There were never any human trials. But 25 years ago cell phones received a “clear signal” though in retrospect that was wrong. Now it turns out that this is one of the biggest human mass experiments.

Human cancer statistics

Exposure to radiation from an atom bomb can indeed bring on brain tumors. This Australian study investigated brain cancer rates in the 1980’s and in the early 2000’s. The conclusion was that cell phone exposure was about the same in the 1980’s and the early 2000’s. Brain tumors were also the same. But at the bottom of this review the authors show some interesting statistics about Hiroshima. Brain cancers are shown as bar graphs in people who suffered exposure to the radiation of Hiroshima. The bar graphs compared brain cancer statistics between 31 years after Hiroshima and 41 to 50 years after Hiroshima. There still was a clear increase of brain tumors in the population 41 to 50 years after Hiroshima.

Long lag time

This is because brain cancer has a long lag time between radiation exposure and actual brain cancer occurrence. The prominent Sydney neurosurgeon, Dr. Charlie Teo said that there can be a long lag period of 10 to 20 years for electromagnetic frequencies (EMF) to cause brain cancer. EMF also has the name EMR (electromagnetic radiation). If one takes into account that EMF is much weaker than radiation from an atom bomb, the lag period of causing brain cancer could be much longer than what Dr. Teo assumed.

An international study found that gliomas were 40% more common in high cell phone users than in low cell phone users. For meningiomas the high cell phone users had 15% more meningiomas than low cell phone users. A previous British study assuming a lag period of 10 years found no gliomas in children and young persons as I reported 12 years ago. But this data might change with a lag period of 20 or 30 years or longer.

Political manoeuvres

The cigarette industry did not want to admit that cigarette smoke was causing lung cancer. In a similar vein the cell phone producers attempted to suppress any negative information about their products. They have been suppressing information that found any biological effect of EMF on tissues. And they funded studies that showed no effect by EMF.

The Guardian states: “The key strategic insight animating corporate propaganda campaigns is that a given industry doesn’t have to win the scientific argument about safety to prevail – it only has to keep the argument going. Keeping the argument going amounts to a win for industry, because the apparent lack of certainty helps to reassure customers, fend off government regulations and deter lawsuits that might pinch profits.” By pursuing this strategy over 30 years the industry has been very successful to undermine any scientist who found that cancer of the brain and cancer of the adrenal glands can occur after prolonged exposure to EMF.

What is the truth about EMF?

The National Cancer Institute

The findings of the National Cancer Institute review are that there is no evidence that the exposure rate or intensity of EMF is strong enough to pose any risks to children or adults. It did acknowledge that exposure to living within 1 kilometer of high voltage power lines could cause leukemia in children. But EMF exposure is not comparable to EMF from these high power lines. The problem with the attitude of the National Cancer institute is that they don’t mention how the lag period can delay the occurrence of cancer by several decades. In other words, their observation time was cut short, and they simply concluded prematurely that EMF could not cause cancer.

World Health Organization

The WHO has done a thorough review of the world literature on the topic of EMF and possible effects on humans. It did acknowledge that the top 10% of heavy cell phone users are at a higher risk of gliomas and meningiomas as mentioned above. EMF exposure has to last for at least 10 years for this to occur. But the vast majority of cell phone users show no effect on the brain or elsewhere. The WHO makes the point that brain cancers may be more common, if EMF exposure to a person is 10 years or longer. The International Agency for Research on Cancer has classified EMF as “possibly carcinogenic to humans”. It means that more exposure, longer duration of exposure, and closer tissue contact with EMF could cause cancer.

Cancer literature supports that cell phones can cause cancer after all

In a website by Prof. Keith Scott-Mumby several factors come up that support the notion that EMG is capable of causing DNA damage to cells given the right circumstances.

Children are much more vulnerable in their brains than adults to get brain cancer. As a result, when children play with cell phones and other gadgets that emit EMF they will be more likely to develop brain cancer later in life.
Acoustic neuromas in the auditory nerve are 5-fold more likely to develop in children than in adults.
Swedish researcher, Prof. Lennart Hardell presented a talk at a cancer conference, which stated the following: People who started to use cell phones before the age of 20 had a 5-fold risk to get gliomas, which is a brain cancer type.
Other research showed that exposure of children to EMF from cordless phones in a household caused a 4-fold higher risk of developing gliomas later in life than controls who did not have EMF exposure.
Keith Scott-Mumby also stated that brain tissue of children absorbed EMF twice as much as adults do, and similarly, bone marrow of children absorbed EMF 10 times as much as adults do.
An Indian study in 2005 was comparing people who had no EMF exposure with people who used a cell phone for 1 to 15 hours per day. DNA damage was measured from buccal scrapings (the lining inside the cheek). The controls had only 4% of DNA damage. The frequent cell phone users had DNA damage in 39.75% of their buccal scrapings. We know from other literature that the first step to developing cancer is a mutation of the DNA. After a certain lag period cancer can develop in tissue with mutated DNA.

Cell Phones Can Cause Cancer After All

Conclusion

EMF, the low-grade radiation of electronic gadgets like i-phones, cell phones in general and cordless phones, has an effect on our body cells. We are not aware of this effect. But the body knows on a cellular level that part of our DNA has been damaged. Fortunately, we do have protective mechanisms in place that safe us from most of these damages. But children who are not fully developed yet are at a disadvantage. Their bone marrow and brains are much more prone to develop various types of leukemia and brain cancers. This is why it makes sense to limit their exposure to EMF emitting devices.

At this point the government institutions have not developed recommendations what to do about this problem. The industry has no interest in providing guidelines, as they want to sell more gadgets and increase their market share.

Add to this that even the wiring in a house is sending out weak signals of EMF, which is added to all of the other effects of EMF from cell phones, TV and computer use. We need to rethink our exposure to EMF and balance our lifestyle with other activities where we are not subject to this exposure.

We also need to eat an anti-cancer diet, like a Mediterranean diet. This diet has shown to be an anti-inflammatory and antioxidant diet preventing cancer. All of this can balance our exposure to EMF and offer us preventative measures to stay healthy.

Aug

2018

The Downside Of Living To 100

By Ray Schilling | Alzheimer’s disease, Arthritis, back pain, Cancer, Cardiovascular disease, chronic pain, Dementia, depression, Diabetes, diet, Drugs, exercise, Fitness, fractures, heart attack, High Blood Pressure, Infectious Disease, mitochondria, Mortality, Obesity, osteoarthritis, Osteoporosis

A review article has examined longevity and reviewed the downside of living to 100. In their 80’s about 10% of the population live in nursing homes, but among centenarians 55% are residing in nursing homes. They are often very lonely, as their social circles have shrunk as they aged.

Common diseases of older people

Osteoarthritis makes it difficult for people to get around, it causes chronic pain and it can also be the reason for falls. In 1990 there were 213.4 cases of osteoarthritis per 100,000. 26 years later, in 2016 there were 232.1 cases of osteoarthritis per 100,000 people.

Chronic obstructive pulmonary disease (COPD) has been falling, because less people smoke cigarettes now. Statistics show 1667 cases of COPD per 100,000 in 1990, but only 945 cases of COPD per 100,000 in 2016.

Diarrhea and common infections have dropped sharply from 8951 per 100,000 in 1990 to 3276 per 100,000 in 2016.

What other common diseases do older people get?

There are a number of common diseases that affect the elderly.

Osteoarthritis

Osteoarthritis of the hips and the knees are common, but it can affect every joint in the body. In the end stage knee replacements or hip replacements may be necessary. But before a total knee replacement or total hip replacement can even come into consideration, the person’s heart needs a thorough checkup to ensure that it is safe for the patient to undergo surgery under a general anesthetic.

Heart disease

Older people often have heart disease.

When coronary arteries are narrowed, heart attacks occur. Cardiologists can place stents, so that previously narrowed coronary arteries receive normal blood flow. Following such a procedure the patient may live for another 10 to 15 years.

There are also heart valve calcifications. The aortic valve is particularly endangered. A heart surgeon may be able to replace a diseased aortic valve by a porcine valve.

The nervous system of the heart transmits electrical signals from the sinus node to the muscle fibers, which can get diseased. Heart rhythm problems may necessitate the insertion of a pacemaker.

Finally, the heart may enlarge, but pump less blood than before. This condition is congestive heart failure. The 5-year survival for this condition is only 50.4%. Unfortunately there is very little the doctor can do for patients like this.

Cancer

The older we get, the more DNA mutations we accumulate. At one point cancer develops. If the diagnosis happens at an early stage there is a good chance that surgery can remove a cancerous growth, and the patient survives. But there are cancers that are notoriously difficult to recognize in the early stages. These are: cancer of the pancreas, kidney cancer, stomach cancer and certain types of leukemias.

Respiratory diseases

Those who smoked earlier in life may develop chronic obstructive pulmonary disease (COPD). It is a chronically disabling lung disorder. Often these individuals have to carry an oxygen tank with them wherever they go. The 5-year survival rate for people with COPD is 40 to 70%.

Osteoporosis

Osteoporosis is a disease where the bone is brittle. Spontaneous bone fractures can occur at the wrists, the upper thigh bone (femoral fractures) or in the vertebral bones. Women in menopause are hormone deficient and this contributes to calcium depletion of the bones. Lately research has shown that vitamin K2 and vitamin D3 are necessary for a normal calcium metabolism. Briefly, 200 micrograms of vitamin K2 and 5000 IU of vitamin D3 every day are the necessary dosage that the body can absorb calcium from the gut, eliminate it from the blood vessels and deposit it into the bone. Calcium is present in milk products and milk. If a person does not consume enough milk products a supplement of 1000 mg of calcium daily does make sense.

Alzheimer’s

The older we get, the more likely it is an onset of Alzheimer’s or dementia. Between the ages of 90 to 94 there is a yearly increase of Alzheimer’s of 12.7% per year. The group from age 95 to 99 years has a yearly increase of Alzheimer’s of 21.2% per year. Persons aged 100 years and older have an increase of Alzheimer’s by 40.7% per year. What this means is that essentially there is a doubling of Alzheimer’s every 5.5 years. We do not have all of the answers why this is happening and why Alzheimer’s develops. But we do know that diabetics are more likely to develop Alzheimer’s. High blood sugar levels and high insulin levels seem to lead to the precipitation of the tau protein in the brain, which causes Alzheimer’s.

Diabetes

When diabetes is not well controlled, there is accelerated hardening of the arteries. This can cause heart attacks and strokes. Longstanding diabetes can affect the kidneys (diabetic nephropathy, kidney damage) and can lead to hardening of the leg arteries. Often the only treatment left is a below knee amputation. Blindness from uncontrolled diabetes is common and pain from diabetic neuropathy as well.

Diabetics have an average life expectancy of 77 to 81 years. However, if they pay attention to their blood sugars and manage their diabetes closely they can live past the age of 85.

Falls and balance problems

As people age, their balance organ is not functioning as well. Also, people with high blood pressure medication may have postural hypotensive episodes that can lead to falls.

There may be a lack of cognitive functioning and misjudging of steps, ledges and irregularities in the floor. When a person has brittle bones from osteoporosis and they fall, a hip fracture is very common. At a higher age surgery for a hip fracture is dangerous. It can have a mortality of 50%.

Obesity

A person with obesity has a life expectancy that is 10 years less than a person without obesity. The reason for this is that with obesity This is so, because the risk of heart attacks, strokes, cancer, arthritis and diabetes is increased.

Depression

Older people often get depressed. It even has its own name: involutional depression. People can get into a state of mind, where they think negatively. Depressed people feel that they have nothing to live for. They lost friends; they are shut in because they can’t drive a car any more. This type of depression needs treatment by a psychologist or psychiatrist. The danger of leaving depression untreated is that the person may get suicidal. In older people depression is often precipitated by physical health problems.

Oral health

When teeth are not looked after, gingivitis and periodontitis can develop. Infected gums can shed bacteria into the blood and this can affect the heart valves. Endocarditis, the infection of heart valves, is a cardiological emergency. Prolonged antibiotic therapy is necessary to overcome this condition.

Poverty

Poverty has real consequences. The aging person may not have access to the optimal medical care facility because of a lack of funds. But even at a younger age there is evidence that people are healthier when they are wealthier.

Shingles

Older people often get shingles, even if they had chickenpox or shingles as a child. This is evidence that the immune system is getting weaker. Shingles in an older person should alarm the treating physician that there could be an underlying cancer. Due to that knowledge a cancer-screening tests should be part of the medical exam. In addition, a varicella vaccine should be offered to the patient to build up immunity.

The Downside Of Living To 100

Conclusion

Living to 100 is often glorified in the press. Maybe you have seen a 90-year old jogger completing a marathon, or you saw an 85-year old couple ballroom dancing. But what they don’t show you is what I summarized here, the less glamorous things about living to 100. You may get a heart attack or a stroke. Osteoarthritis may affect you how you walk. Congestive heart failure may make you get short of breath when you walk upstairs. Then there are various cancer types that are difficult to diagnose early.

If you have smoked in the past, you may suffer from chronic obstructive pulmonary disease (COPD), which leaves you breathless.

Other illnesses

Osteoporosis can lead to spontaneous fractures. Because the bone has a lack of calcium, this is difficult to treat and takes a long time to heal.

Alzheimer’s is ever so much more common when you approach the year 100. There are other medical conditions you can get: obesity, diabetes and depression. When you get shingles for the second time, it may mean that your immune system is getting weak and a cancer-screening test should be done.

There are some downsides when you approach the age of 100.

Know your risks and be vigilant

You may keep your physician busy checking out various age-related illnesses, but more importantly, get regular check-ups and tests. Any condition is easier to treat with an earlier diagnosis! The message for anybody reading this is very simple. Prevention through healthy living is something you can actively pursue. Keep your body and your mind busy. Enjoy time with friends and family instead of living a solitary existence. See the glass that is half full instead of viewing it as half empty. Stick to a healthy diet. Knowing all the risks is not a scare but a call to being vigilant. Knowledge is powerful and will help you to enjoy your golden years feeling well and happy.

Aug

2018

Poor Diet Habits Can Cause Alzheimer’s

By Ray Schilling | Alzheimer’s disease, Dementia, diet, exercise, food, Heart Disease, High Blood Pressure, Inflammation, Nutrition, Obesity, Smoking

A new study from the Brock University in St. Catharine’s, Ont. showed that poor diet habits can cause Alzheimer’s. Specifically the risk for Alzheimer’s was a combination of high saturated fats in the diet in combination with too much sugar.

The third triggering factor was the normal aging process that also contributed to the development of Alzheimer’s.

The study showing that poor diet habits can cause Alzheimer’s

Master student Bradley Baranowski and PhD student Kirsten Bott conducted the experiments under the supervision of Assistant Professor of Health Sciences Rebecca MacPherson. The experimental group consisted of middle-aged mice that were observed for 13 weeks. They received a high-fat/high-sugar diet. The control group received a normal diet.

The experimental group with the high fat/high sugar diet was aging prematurely. They also showed elevated inflammatory markers, elevated insulin levels and cellular stress. Dr.MacPherson mentioned that the middle-aged mice would be comparable to humans aged 40 to 60. “[We’re] trying to see what the initiating signals are that can lead to progression of Alzheimer’s disease,” MacPherson said.

Lifestyle choices matter

“People often view Alzheimer’s disease as a genetic disease when in fact, genetic mutations leading to Alzheimer’s accounts for less than five per cent of cases,” Baranowski said in the press release. “This study highlights that our lifestyle choices matter and can potentially put us at risk of developing or progressing neurodegenerative diseases such as Alzheimer’s.”

Other studies that support the concept that lifestyles matter

Over the years many other researchers have analyzed what factors contribute to getting Alzheimer’s. It probably is a combination of several factors.

Age

Age is one of the major risk factors. Most Alzheimer’s patients are above the age of 65. Above 65 the risk doubles every 5 years. By the time we are 85 our risk is 1/3 to get it.

Family history

If you have a parent, brother or sister who came down with Alzheimer’s, you have a higher risk of getting it.

Environmental factors

Often environmental factors like eating too much sugar or too much saturated fat are confused with family history factors. Nutritional habits in a family can be like a tradition. It may appear as if this is a family history of Alzheimer’s when in reality poor eating habits were passed on from generation to generation. A lot more research is necessary in this area.

History of Head injury

A history of a closed head injury carries with it a higher risk of Alzheimer’s later in life. We need to use seat belts in cars and helmets when bicycling. Avoid risky sports activities where you would sustain a traumatic brain injury.

Heart disease

There is a link between heart disease, diabetes, stroke, high blood pressure, high cholesterol and Alzheimer’s. When brain arteries get clogged, the brain deposits more beta-amyloid protein as plaques. This is a sign of early Alzheimer’s disease.

Older Latinos and older African Americans

Older Latinos have a 1 ½-times higher risk than older whites to get Alzheimer’s and dementia. On the other hand older African-Americans are 2-times more likely than older whites to come down with Alzheimer’s. The reason for this is not entirely clear. But a big factor likely is the cardiovascular risk that is higher in Latinos and African Americans. This translates into a higher risk for Alzheimer’s.

Prevention of Alzheimer’s disease

There are more publications that point out that Alzheimer’s disease is largely preventable by cutting out those factors that contribute to its development.

Here is a list of steps to follow in order to prevent Alzheimer’s disease.

First of all treat diabetes, high blood pressure and obesity aggressively. This eliminates cardiovascular risk factors, which keeps the brain vessels open.
Furthermore quit smoking. By preserving the cardiovascular system the brain stabilizes.
Another important factor is physical activity: exercise daily! This maintains cardiopulmonary fitness. It also keeps your brain vessels open.
Also, take care of your diet: eat balanced meals and avoid junk food. A Mediterranean diet or the MIND diet are examples of diets that help prevent Alzheimer’s. Note that these are low sugar and low saturated fat diets. This fits the initial observation that you read in the beginning of this blog. Mice on a high fat/high sugar diet showed premature aging and developed Alzheimer’s. Knowing this, it is good to do the opposite: cut out excessive saturated fats and sugar. Sugar increase LDL cholesterol and triglycerides, which leads to hardening of arteries.
Mental stimulation is another important factor for preventing Alzheimer’s. With lifelong bilingualism there was a delay of about 4.5 years in onset of dementia. The ACTIVE study is in the link above. It showed that mental stimulation could indeed delay the onset of Alzheimer’s over a 10-year period.

Poor Diet Habits Can Cause Alzheimer’s

Conclusion

Above all, I cannot emphasize enough how important a healthy diet is for a healthy mind. The combination of an overabundance of saturated fats and refined sugar was found to be the cause of premature aging in mice. But likewise, we know from human trials that this also causes premature aging in humans and higher incidence of Alzheimer’s. As a result, it is logical to recommend a lower intake of saturated fat and to reduce sugar intake. It will prevent hardening of the arteries and slow down the development of Alzheimer’s.

But there are many other recommendations to avoid getting Alzheimer’s: quit smoking. Stay physically active by exercising daily. Use a Mediterranean diet or the MIND diet to prevent Alzheimer’s. Clinical trials with these diets have shown them to be effective. Treat diabetes, high blood pressure and obesity aggressively as this will stabilize your metabolism. As a result it also prevents Alzheimer’s. Finally, stimulate your brain every day by doing various activities. This forms new synaptic connections inside your brain and postpones Alzheimer’s from setting in as you age.

Aug

2018

HPV Testing For Cervical Cancer

By Ray Schilling | Cancer, cervical cancer, Prevention, Women’s Diseases

HPV testing for cervical cancer is more sensitive than the traditional Pap test. For years physicians recommended the traditional Pap test once a year to prevent cancer of the cervix. But a few years ago a new cervical cancer screening test, namely the HPV test made the news. It stems from the observation that cancer of the cervix develops in 99.7% of women who test positive for the HPV virus. There are many types of HPV, here we are interested in the few subtypes that produce cancer (carcinogenic HPV virus).

Transmission of the HPV virus between men and women

The human papilloma virus transmits from males to females through bisexual contact. The problem starts when he develops HPV lesions on his penis. Without him wearing a condom, the contact with her cervix during sex can transmit HPV to her cervix. Both partners are not aware of the transmission of that virus, as it does not cause any symptoms. HPV invades the superficial skin layer of the cervix in the woman. In the man HPV will invade the skin of the glans of the penis. After certain incubation time it causes transformation into cervical cancer in the woman. Strangely enough it does not cause cancer in the male. However, in both sexes HPV virus is in the mucous membranes and can contaminate the other sex’s genital.

A recent study comes from UBC Vancouver, British Columbia, which compared the Pap test with HPV testing.

Details of the Vancouver study on HPV testing for cervical cancer

On July 3, 2018 this study appeared in the medical journal JAMA.

19,009 women were part of this randomized clinical trial. With HPV testing only 2.3 cases per 1000 women of early cervical cancers were present four years later. Using the traditional Pap test this figure was 5.5 cases per 1000 women after 4 years. 224 clinicians participated in this study. Women were recruited for this study from January 2008 to May 2012. Follow-up took place till Dec. 2016. The participating women in this study were 25 to 65 years of age.

In 2017 in the US there were still 12,820 women in the United States who got cancer of the cervix. Approximately 4210 are dying from this disease every year. Many women do not like to take the Pap test or the HPV testing. There are compliance problems with either one of these tests.

Significance of this trial regarding HPV testing for cervical cancer

The newer HPV testing was superior to the regular Pap test. The HPV test was more sensitive and resulted in much lower cancer rates after 4 years of follow-up. Every woman would have an HPV test every 4 years. In this case we likely would see cervical cancer go to the bottom of cancers that kill women. The reason for that is that HPV testing and colposcopy pick up cancers much earlier. This leads to a more effective treatment of cervical cancer. After 4 years much less cancer of the cervix was found when the researchers tested again using HPV testing.

Implications of HPV testing for cervical cancer

In third world countries

Many 3^rd world countries do only the HPV testing. At the time when this decision was made, it was unknown that they had actually chosen the better method to test for cancer of the cervix. Now this trial reassures all the health care providers in 3^rd world countries that they should continue with the program, and they only have to do the test every 4 years, not every 2 years, which makes it even more cost effective.

Implications for the US

In the US so far the recommendation was to do both the regular Pap test and the HPV test simultaneously. This trial, however, says that this is not necessary. It would be better to use the more sensitive HPV test and abandon the more expensive and less sensitive PAP test. In 2012 a taskforce recommended to do the Pap smear in women age 21 to 65 every 3 years. The taskforce further recommended to women age 30 to 65 that they screen with a combo of cytology and HPV testing every 5 years. The lead investigator, Dr. Ogilvie said: “Offering women HPV [testing] for cervical cancer screening detects more precancerous lesions earlier, and also a negative HPV test offers more assurance that women will not develop precancerous conditions in the next four years,” she said. “This can mean that women may need less frequent screening but have more accurate results.”

What other doctors are saying about HPV testing for cervical cancer

Comments by Dr. Kathleen Schmeler

Dr. Kathleen Schmeler said that the study was “well-designed” and provided a much-needed comparison of Pap versus HPV testing. She is a gynecologic oncologist and at The University of Texas MD Anderson Cancer Center. She was part of the new research. Dr. Schmeler added: “The bottom line is that this could really potentially simplify how we screen women and have it be more effective and not quite as complicated and burdensome — and opens the door for doing just HPV testing, which is actually what’s currently recommended by the World Health Organization for countries that don’t have Pap testing capabilities,”

Comments by Dr. Stewart Massad

Dr. L. Stewart Massad Jr. is a professor of obstetrics and gynecology in the division of gynecologic oncology at Washington University School of Medicine. He wrote an editorial to the study in the JAMA. He wrote: “What will replace the Pap test? In 2012, the American Cancer Society endorsed co-testing with cervical cytology testing and HPV testing at 5-year intervals as the preferred strategy for screening women 30 to 65 years of age because this approach combines the sensitivity of HPV testing with the familiarity of traditional Pap testing,” He then went on to say: “However, the addition of cervical cytology testing adds little to the accuracy of HPV testing while increasing cost and false-positive results. In 2018, organizations that develop cancer screening guidelines are wrestling with whether to recommend replacing co-testing with primary HPV testing as the optimal screening strategy.”

Future dilemma

In view of all those comments the regulatory agents will have to come up with solutions for what is in the best interest of women for testing for cervical cancer.

HPV Testing For Cervical Cancer

Conclusion

A large randomized clinical trial in Vancouver, BC, Canada has compared screening methods for cancer of the cervix in women. Half of the subjects underwent screening by the newer HPV tests that checks for the presence of HPV virus. The other half received conventional screening by the Pap test (a cytological screening test.) The result was that the HPV test was more sensitive and resulted in less early cancer tests 4 years down the road. With the conventional Pap test there were more than double the amount of abnormal cells present 4 years down the road, which makes the Pap test less safe compared to the HPV test.

It appears from this trial that the Pap test is no longer a choice, except for colposcopy procedures that take care of early cervical cancers. But for screening in general HPV testing every 4 years is all what every women needs for her protection.

Phage Therapy Against Superbugs

By Ray Schilling | Infectious Disease

Introduction

Phage therapy against superbugs is the latest concept in treating infections. Antibiotic resistance has developed into a huge clinical problem. Every year in the US about 2 million people have infections from antibiotic resistant bacteria, and 23,000 people die as result of it. Certainly, there is a desperate need to find alternative treatment options to treat antibiotic resistant infections. One such option is to use phages, a specific form of viruses to treat antibiotic resistant bacteria. Here is a scientific overview regarding the use of phages for the treatment of antibiotic resistant infections.

History of phages

The observation of phages attacking bacteria goes back more than 100 years. The French Canadian microbiologist, Félix Hubert d’Herelle (1873–1949) described in 1917 what bacteriophages are. He also coined the term of “phage therapy” for the treatment of bacteria with phages. Dr. d’Herelle recognized phages to be virus-like organisms that attacked bacteria and could kill them. When Fleming detected antibiotics, phage research came to a halt. Drug companies invented more and more antibiotics, as it was easier to kill bacteria this way. But now with emerging resistances of bacteria to antibiotics, there is a sudden revival of the 100-year old research on phages. The problem is that there has not been much clinical experience with phage therapy against super bugs until lately. In 1923 Dr. d’Herelle co-founded the Eliava Institute in what is now Tbilisi, Georgia. This institute has the world’s most comprehensive database on phage therapy in man.

Two clinical examples of phage therapy against superbugs

Chronic prostatitis due to superbug

Pranav Johri, a Canadian of Indian descent was suffering of a chronic prostate infection. Physicians had used five different antibiotics, but all to no avail. His doctor told him that he had a chronic prostatitis problem for which there was no cure. But Pranav saw another specialist who determined that Pranav had a prostatitis due to a superbug, which was resistant against all the common antibiotics. Pranav traveled to the Eliava Institute in Tbilisi, Georgia. He paid 6000.00 CAD and had three treatments. After the first treatment his temperature became normal for the first time in months, and his chronic pain subsided. He and his wife were so excited that they felt like celebrating. They did sightseeing, went out to restaurants and enjoyed their travels, all things he was unable to do for months. Pranav had finally received a cure with phage therapy to his chronic prostate infection.

Enteric infection due to superbug

Tom Patterson who had visited Egypt in 2015 together with his wife fell ill on the last night of his holiday. Eventually he went into a hospital in his hometown, San Diego. The doctors told him that he would likely die. He had acquired a multi-antibiotic resistant infection. He was slipping in and out of consciousness. His wife, Steffanie Strathdee, an infectious disease epidemiologist, remembered having heard about phage therapy during a virology class during her training in Toronto. Tom received two separate phage cocktails that two separate research teams in the US had prepared for his condition. He received the first dosage into his abdomen.

Intravenous phage therapy

The second administration was intravenously. There are only a handful of patients who had received treatment with phage therapy in the US; he is probably the first one who received phage therapy intravenously. A few days later he woke up. He had to relearn basic life skills like swallowing and speaking. But he made a full recovery from a serious disease with multi-antibiotic resistant bacteria. The University of California San Diego School of Medicine had helped Tom to recover from his illness. They announced at the end of June 2018 that they would be opening the Center for Innovative Phage Applications and Therapeutics in San Diego.

Modern phage technology

Basically phages are viruses that specialize in killing bacteria. They exist in nature wherever bacteria grow and help that they do not over-proliferate. But they can be useful in fighting difficult to treat bacterial infections as well, like pseudomonas ear infections, Clostridium difficile gut infections or Methicillin-resistant Staphylococcus aureus infections in skin wounds. In the former Soviet Union and in the Eliava Institute in Tbilisi, Georgia, extensive phage research has accumulated valuable data over decades. In the West physicians relied on the power of antibiotics, and phages stayed on the back-burner of the research lab.

Genetic engineering of phages and toxins produced by phages

Combining phage research and genetic engineering research we are entering a new era of manufacturing biological compounds that can kill bacteria similar to antibiotics. Here is a review article of this new exciting field. I only include this link to show that researchers are now getting a handle on phages. They can be genetically modified to specifically attack one kind of bacterium. The DNA of the phage can be isolated and injected into bacteria. I do not expect you to understand all of what is discussed in this link.

Phage Therapy Against Superbugs

Conclusion

As a result phages are more and more in use to treat difficult chronic infections where bacteria have become resistant to multiple antibiotics. It requires a team of experts who are familiar with phage cocktails. The cocktail is a careful combination of various phages that will fight the antibiotic resistant infection.The composition of it has to be according to the bacteria present in the patient’s bacterial flora. As shown with two clinical examples very sick patients can recover relatively quickly from their chronic infections. After this breakthrough more and more centers for phage therapy will open and this should help reduce the death rate from antibiotic-resistant infections.

Jul

2018

Modified Poliovirus Effective Against Brain Cancer

By Ray Schilling | Cancer, immune system

A clinical trial found modified poliovirus effective against brain cancer. 61 patients with glioblastoma, the most deadly brain cancer there is, have been enrolled in this trial since 2012.

Glioblastoma treatment with genetically modified poliovirus

Dr. Gromeier, one of the lead cancer researchers at Duke University, Durham, North Carolina has done animal experiments. Unlike poliovirus, he found that genetically modified poliovirus was harmless for the central nervous system and yet he found modified poliovirus effective against brain cancer. This genetically modified poliovirus was attacking glioblastoma cells in cell cultures and in human brains. Dr. Annick Desjardins, a co-author of the study explained that the researchers had to take a piece of RNA away from the poliovirus and replace it with a neutral piece of RNA. This way it is still attracted to the numerous poliovirus receptors, which are expressed on many human cancers. The genetic sequence that allows poliovirus to reproduce in normal cells was taken out with the genetic modification. An inert RNA piece from the rhinovirus, the cause of the common cold was replacing this.

Effect of the genetically modified poliovirus

This way the modified poliovirus is no longer destroying nervous tissue. But the virus can still multiply in the glioblastoma cells, release toxins and kill these cancer cells.

Dr. Bryan Choi is a fellow in the Cellular Immunotherapy Program at Massachusetts General Hospital Cancer Center. He also works at the Department of Neurosurgery at Harvard Medical School. Although he was not part of this study he stated that this study was a giant step forward. “Perhaps the most promising aspect is the ability for this genetically modified virus to not only directly kill brain cancer cells, but to release tumor antigens,” Choi said. Antigens are toxic substances that stimulate the immune system to mount an immune response against the cancer. This immunotherapeutic effect is an important aspect of this new treatment modality.

Some human statistics of the pilot study showing modified poliovirus effective against brain cancer

Here are the highlights.

21% of the poliovirus patients are still alive three years after treatment; this compares to just 4% of the control patients who only received chemotherapy.
The average survival time for the 61 patients who have received the genetically modified poliovirus therapy was 12.5 months. This compares with 11.3 months for a control group of matched patients. These had received standard treatment (chemotherapy).
Some patients were much better responders than others. A 20-year old man a 60-year-old man survived 69 months (nearly 6 years). They are still alive today. This was unthinkable of in the past for patients with glioblastoma.

Repeat modified poliovirus therapy for glioblastoma recurrence

Dr. Darell D. Bigner, a co-author of the study, a professor of pathology and emeritus director observed the following. Some patients experienced initial reduction of the glioblastoma, and when the cancer came back they received repeat modified poliovirus treatments. To the surprise of the investigators the tumors shrank again and again. This was never the case with conventional chemotherapy. Once a glioblastoma is chemotherapy-resistant, chemotherapy will not work again.

Experience with modified poliovirus therapy

In this trial treatment for glioblastoma started with implanting a catheter right into the center of the glioblastoma. An infusion of the engineered poliovirus followed, a process that could take up to 6.5 hours. Removal of the catheter was next.
In the beginning researchers used higher doses of the genetically engineered poliovirus. Some people developed severe inflammation causing seizures, which needed treatment. Confusion and language difficulties were also side effects. Others developed pronounced nausea. The researchers decided to lower the dosage of the genetically engineered poliovirus, and the patients still had good clinical results.
“We are presently enrolling in a phase 2 trial combining the genetically modified poliovirus with one dose of chemotherapy,” Desjardins said. “We are also enrolling in a trial for pediatric brain tumor patients.” In addition studies using genetically engineered poliovirus against breast cancer and against skin cancer are also in the planning stage.
There are other new approaches where there the doctor injects the photosensitizer indocyanine into breast cancer tissue. Next the doctor points a laser beam near the infrared frequency of light to the cancer area. You find details about this procedure here.

Modified Poliovirus Effective Against Brain Cancer

Conclusion

A new approach to treating glioblastoma, one of the deadliest brain cancers, has shown promising results. A genetically engineered poliovirus is no longer making the person sick with polio, but instead destroys glioblastoma cells and prolongs patients’ lives. Some patients lived up to 6 years while controls lived less than one year. The effect of this new treatment occurs from the release of toxins within the glioblastoma cancer. This leads to cancer cell death and the release of these toxins. The immune system receives stimulation to recognize and destroy the remaining glioblastoma cells. At this point the basic steps of this new therapy are in place.

Future direction of research

But the same method will one day likely be in use for other cancers. There are plans for new clinical trials to examine this further. The researchers also want to test cure rates of a combination of chemotherapy and genetically engineered poliovirus therapy. This will answer the question whether the combination treatment will be better than genetically engineered poliovirus therapy alone.

Jul

2018

Frequent Flying Can Increase Cancer Rates

By Ray Schilling | breast cancer, Cancer, cervical cancer, Circadian rhythm, immune system, lung cancer, prostate cancer

A review article from June 25, 2018 discusses that frequent flying can increase cancer rates. A study showed that cancer of the breast, cervix, skin, thyroid and uterus are about twice as common in female stewardesses than in women at large. Also, gastrointestinal system cancers including cancer of the colon, stomach, esophagus, liver and pancreatic cancers are more common. This observation was true in both male and female flying personnel who engage in frequent flying. This publication comes from a scientific paper published on June 26, 2018.

Study of flight attendants

Patients from the National Health and Nutrition Examination Survey (NHANES) served as a control for flight attendants. This control group consisted of 2729 patients; they were of a similar socioeconomic status as the flight attendants. In contrast there were 5366 flight attendants with much higher cancer rates than normally expected. Specifically breast cancer had a 1.51-fold higher frequency than the control group. Melanoma had a frequency of 2.27-fold in comparison to controls, and non-melanoma cancers had a cancer rate of 4.09-fold when compared to controls. Non-melanoma cancer cases include basal cell and squamous cell carcinomas.

Cancer rates in pilots

In a meta-analysis of various studies it became obvious that pilots had 20% more prostate cancer than a non-pilot control group. However their mortality was not higher than controls.

In an interesting study spanning over 60 years Icelandic airline pilots underwent an analysis for cancer development.

83 cancers were registered. The general population (non-pilots) served as controls. There was an increase of 2.42-fold for all cancers compared to controls. Prostate cancer was higher in these pilots by 2.57-fold. Malignant melanoma had a 9.88-fold increase in pilots in comparison to controls. The basal cell carcinomas in these pilots were 3.61-fold more common than the rates in the controls. With regard to basal cell carcinomas of the trunk there were 6.65-fold more of them in comparison to controls.

The difference between the pilots and the general population was likely due to the higher exposure to cosmic radiation. This is what the authors concluded.

How does cancer develop?

There are several ways cancer can develop. One of the known cancer causations is ionizing radiation. We know a lot about this from the atom bombs of WWII in Japan. There were many more thyroid cancers in children than were normal following the dropping of the atom bombs.

But diagnostic CT scans and X-rays are not without risk of cancer development either. There is a lag period of 10 to 20 years and even longer. But after this time the higher cancer rate becomes measurable. A person who had a CT scan done as a diagnostic test in childhood will still have a 25% higher cancer rate 15 years later. This is how powerful radiation of the DNA of our cells is despite inherent repair mechanisms that fight back to keep things normal.

Single cancers versus multiple cancers

It is interesting that female stewardesses and male pilots came down with a mix of various cancers. There were skin cancers, breast cancers, cancers of the prostate and many gastrointestinal cancers. The numbers were not big enough to show statistical significance for leukemia also being a likely cause of cancer from cosmic radiation.

If cosmic radiation was going through the body randomly hitting various DNA strands in all cell types, which could explain why a random number of cancers develop in those cells that got the highest exposure. The ones who got above average cancer were stewardesses and pilots who were longest on their jobs. A variety of cancers would develop from various tissues. This is exactly what the studies have shown. Radiation exposure following the Fukushima disaster led to thousands of thyroid cancers.

There are frequent flyers like business travelers and vacation seeking retirees who will also be at a higher risk of developing cancer. The more they fly, the higher the risk.

Other causes of cancer

Cosmic radiation is only one cause of cancer. There are many other causes of cancer. If you smoke heavily or abuse alcohol this can cause genetic mutations of cells that can develop into cancer. There is a pathway to cancer, which consists of initiation, promotion and progression. After those initial hurdles the cancer cell will multiply and start metastasizing into other areas of the body.

Carcinogens can damage the DNA of cells. In the case of pollution carcinogens enter the body through the air. But consuming processed meat and red meat has a proven link to cancer development as well, namely colon cancer.

Diverse factors all can cause cancer

Chronic inflammation from chronic infections is also carcinogenic. Chronic gastritis is caused by H. pylori. After years of infection with this pathogen stomach cancer can develop. Hepatitis viruses that are chronically present in liver cells can be the cause of liver cancer. Human papilloma virus (HPV) is the cause for the development of cancer of the cervix. The majority of cancer is caused from the environment or by poor life styles. Only 5 to 10% of cancers are inherited.

Tumor suppressor genes are important in terms of resisting the development of cancer. The TP53 gene produces a protein that interferes with the multiplication of cancer cells. Cancer cells in turn can produce a protein that interferes with TP53 function. The end result is that it will interfere with the body’s immune system to produce killer T cells. This way the cancer has the upper hand. There are some herbs that have shown anti-cancer effects, such as curcumin. https://www.askdrray.com/curcumin-and-cancer/. As I explain in this blog, there are absorption problems with curcumin presently. It is not yet primetime for curcumin, but it could be once the absorption problems are overcome. Nevertheless the research surrounding curcumin is interesting.

Frequent Flying Can Increase Cancer Rates

Conclusion

Several interesting studies have shown that stewardesses, pilots and frequent airplane travellers have a higher risk of developing cancer. Research groups have been careful to control these studies for lifestyle factors and other causes of cancer. Exposure to cosmic radiation is the common culprit that is behind this cancer causation. There was a multitude of cancers rather than one single type of cancer in pilots and stewardesses. This makes it more plausible that it is indeed cosmic radiation that caused the cancer increase. But cancer development is complex, and I have summarized this briefly here. It is important to be aware of all the possible causes of cancer. This allows you to minimize your exposure to carcinogens. We all get exposure to carcinogens from pollution. In addition we get exposure to cosmic radiation according to how much time we spend flying to holiday destinations or on business trips. Be safe and be informed!

Jul

2018

Less Chemotherapy For Breast Cancer Patients

By Ray Schilling | breast cancer, Cancer, Hormones

A new clinical trial suggests that less chemotherapy for breast cancer patients is necessary than what is the custom today.

70% of the common form of breast cancer, which is estrogen positive, but HER2 negative (more info below) has received treatment with surgery and subsequent chemotherapy. However, there was no scientific basis for this and this is what this large clinical trial was all about. The trial is discussed under this link. It has its origin in a medical research paper in the New England Journal of Medicine.

Estrogen positive, HER-2 negative breast cancer

The majority of breast cancers belong into this category. They have no signs of metastases and the Oncotype DX Breast Recurrence Score test has a score between 0 and 10. A woman with breast cancer like this does not need to undergo chemotherapy, because her long-term survival will not be any better on chemotherapy, and she can save all of the complications of chemotherapy.

The Oncotype DX Breast Recurrence Score

With this relatively new test 21 genes are tested in breast tissue from biopsies and surgical specimens. Dr. Otis Brawley, chief medical and scientific officer for the American Cancer Society, who was not part of the study explained: “What that test does is look at 21 different genes to see if each is turned on or off and then if it is over-expressed or not. So we have two yes-no answers for each gene. It looks at all 21 of those answers and gives that cancer a recurrent score between 0 and 100.” This number based on genetic cancer markers determines how likely the breast cancer is to reoccur in the next 10 years.

Relevance of genetic score test

A low score of between 0 and 10 on this test is indicative of good long-term survival. These patients will not need any chemotherapy. A medium score of 11 to 25 also has good survival as in this trial. However, scores of over 25 have an association with poor outcomes, when the patient receives only hormone therapy. In these cases the researchers say chemotherapy is also necessary in addition to hormone therapy.

Clinical trial regarding whether or not chemotherapy is necessary in the intermediate risk breast cancer patient

10,273 women were part of this trial between April 7, 2006, and October 6, 2010. 6,711 had test scores between 11 and 25, which placed them in the intermediate risk. Half of them received hormone therapy and chemotherapy. The other half received hormone therapy only. After an average of 9 years 83.3% of those on hormone therapy alone did not develop a recurrence of breast cancer. They also did not develop a second cancer. For the other group on both hormone and chemotherapy the rate was 84.3%. The difference between the two was not statistically significant. This established that the intermediate risk breast cancer patient does NOT require chemotherapy.

Results of clinical trial a surprise

This was a big surprise. Oncologists always included chemotherapy in the routine treatment schedule for these patients. But the trial clearly showed that hormone therapy alone was good enough! This allows thousands of breast cancer patients to avoid the devastating side effects of chemotherapy. Why would a woman undergo unnecessary chemotherapy, loose her hair, vomit and get stomach upsets? She may also suffer osteoporosis and undergo bone marrow suppression, which makes her more prone to serious infections.

Premenopausal women and those younger than 50

There is a group of women where breast cancer is more aggressive. Research followed this subgroup of women (premenopausal women and women below the age of 50) separately in the trial. More deaths occurred in the group that received hormone therapy alone. But death rates were much lower with a combination of hormone therapy and chemotherapy. If the score in these women was 16 or higher these women should receive the regular treatment consisting of surgery and hormonal measure). But they should also receive chemotherapy at the same time to reduce complications from their breast cancers. It has been known for many years that breast cancer in this particular patient group has a more aggressive growing habit. This trial showed that survival was a lot better in the group that did receive chemotherapy as well.

Surface markers of breast cancer

1. BRCA1 and BRCA 2

BRCA1 and BRCA 2 are rare mutations in some women who get early breast cancer, often on both breasts and often ovarian cancer as well. These are women who benefit from bilateral mastectomies, even when there is no cancer present yet.

2. HER2

HER2 is a protein that is expressed on the cell surface of some breast cancers. It leads to faster cell proliferation. Only about 30% of all breast cancers are HER2 positive. They respond to Herceptin and other medications listed in this link. In the past the prognosis for HER2 breast cancer was poor, now with better medication against this condition it has one of the more favorable outcomes.

3. ER and PR surface receptors

Estrogen receptor (ER) positive cancer cells will lead to faster tumor growth, when the patient receives estrogen. It also grows faster under the influence of estrogen or progesterone. About 65% of all breast cancers are hormone receptor positive (ER or PR). They will respond to drugs like Tamoxifen and others.(See this link)

Less Chemotherapy For Breast Cancer Patients

Conclusion

Breast cancer diagnosis and treatment is rapidly changing. A clinical trial from the New England Journal of Medicine with over 10,000 women with breast cancer showed the following:

It is safe to treat women with an intermediate risk of breast cancer with surgery of the primary cancer and follow this up with hormone therapy. In the past these women were undergoing chemotherapy in addition, which has not shown better survival rates. On the other hand, premenopausal women or women below the age of 50 should receive treatment with chemotherapy to improve their long-term survival. Other factors to consider are the hormone receptors (ER and PR) and the HER2 marker. The Oncotype DX Breast Recurrence Score test has added a completely new dimension to breast cancer treatment as the New England Journal of Medicine article has shown. Overall breast cancer treatment has improved, which is good news for women.

Jul

2018

Asthma In Adults

By Ray Schilling | Allergies, Asthma, Drugs, Inflammation

On April 6, 2018 CNN published an article about asthma in adults. It was called “Developing Severe Asthma in Adulthood”.

Asthma in adults occurs with a frequency of about 2.3 per 1000 people per year. This publication also noted that women suffer from this condition more often than men. For both sexes the occurrence of asthma in adults peaks at 35 years of age.

Symptoms of asthma

The triggering factors for asthma can be infections, allergies, or the condition can come on spontaneously. Coughing is one of the main symptoms. You may be breathless when walking stairs. You may feel weak or tired when exercising. After exercise you may be wheezing or coughing. If you measure your breathing capacity with a peak flow meter, the values are lower than normal. Cold air or irritants like cigarette smoke may trigger coughing or wheezing. In industrial workers the trigger for asthma can be noxious fumes.

Diagnosis of asthma

Spirometry

Your doctor likely will order a test, called spirometry. You are breathing into a tube with a connection to a spirometer. A technician will instruct you to breathe out to the max (maximal exhalation). Next you will have to breathe in as quickly as you can. These breathing activities translate into a breathing curve on the read-out of the spirometer. With asthma there is a certain degree of restriction of airflow due to spasms in the smaller bronchial tubes, called bronchioles. This will be obvious from the breathing pattern of the spirometry read-out.

Methacholine challenge test

When the spirometry test is normal or near normal, a Methacholine challenge test can be another diagnostic tool. If this produces an asthma attack, it is clear that the person does indeed have asthma.

Measuring nitric oxide in your breath

Our bodies normally produce nitric oxide, and a small amount of it appears in your breath. But if there is a large amount of it present in your breath, it indicates chronic inflammation in your airways, which can be one of the causes of asthma.

Other tests to rule out other related diseases

Your doctor may want to order sinus x-rays to rule out sinusitis or a chest X-ray to rule out pneumonia. If he suspects allergies a referral to an allergist sill be next. The specialist will do skin prick tests to see what you are reacting to.

Differential diagnosis of asthma and other diseases

When the physician is thinking about an asthma diagnosis, it will be necessary to exclude other diseases first. It is important to exclude a bronchial or lung infection as well as the presence of emphysema or chronic obstructive pulmonary disease (COPD). Clots in the pulmonary vasculature (pulmonary emboli) have to be ruled out. When there is a history of gastroesophageal reflux, tests should exclude that there is aspirated gastric contents into the lung. Another condition that could bring on wheezing is chronic congestive heart failure, where the heart fails to pump enough blood, and shortness of breath is a consequence. Tests are available to exclude all of these conditions.

Treatment of asthma in adults

Anti-inflammatory medication

As all patients with asthma have inflammation in the airways, it is important to use corticosteroid inhalers that will control this. These inhalers will control the swelling and mucous production in the lining of the bronchial tubes. With the daily use of these inhalers the airflow improves, the airways become less sensitive and the patient experiences fewer asthma episodes.

Bronchodilators

Bronchodilators are inhalers that will relax the muscle bands around the bronchial tubes. This allows the patient to breather easier. The mucous flows more freely and can be coughed up easier. There are short-acting and long-acting forms of bronchodilators. Your physician will instruct you which one to use.

Asthma In Adults

Conclusion

Adult onset asthma is separate from asthma of childhood. Often the triggers are allergies or irritants, including industrial irritants. With a proper diagnosis and treatment adult asthmatics have a normal life expectancy. It is important to control the inflammation of the airways with anti-inflammatory corticosteroid inhalers. For acute asthma attacks a bronchodilator must be used right away to ensure normal airflow is restored. The patient learns how to modify the asthma therapy. As a result there are very few occasions where the patient would need treatment in a hospital. Most patients can treat an asthma attack quickly and they respond very well to the treatment. As a result adult asthmatics can lead active lives and have no physical limitations.