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

Mar

2003

Men Need Testosterone For the Male Menopause

By Ray Schilling | Hormones, Men's Health

Introduction

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

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

The testosterone blood test

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

Replacement of missing testosterone

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

Testosterone For Male Menopause (Andropause)

Gonadotropins

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

Injections of testosterone

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

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

Additional information about effects of testosterone

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

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

Mar

2003

Hyperthermic Chemotherapy For Colon Cancer

By Ray Schilling | Cancer

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

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

Hyperthermic Chemotherapy For Colon Cancer

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

Last edited October 25, 2014

Mar

2003

Garlic Component Effective Against Head Lice

By Ray Schilling | Parasites, Prevention, Skin Disorders

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

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

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

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

Garlic Component Effective Against Head Lice

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

Last edited December 10, 2012

Mar

2003

Do Diet Drinks Make You More Hungry?

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

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

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

Diet Drinks Make You More Hungry

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

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

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

AS=Artificial sweetener group

SG=Sugar group

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

Last edited December 10, 2012

Mar

2003

The New Hot Asthma Treatment: Bronchial Thermoplasty

By Ray Schilling | Asthma, Lung Disease, Prevention

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

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

The New Hot Asthma Treatment Is Bronchial Thermoplasty

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

Last edited December 10, 2012

Feb

2003

Celiac Disease Frequency Examined In This US Study

By Ray Schilling | Gastrointestinal Disease, Prevention

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

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

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

Celiac Disease Frequency Examined In This US Study

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

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

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

Last edited October 25, 2014

Feb

2003

CYP46 Gene Marker Linked With Alzheimers Disease

By Ray Schilling | Alzheimer’s disease, Prevention

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

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

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

CYP46 Gene Marker Linked With Alzheimers Disease

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

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

Last edited December 10, 2012

Feb

2003

CRP Test Better Than Cholesterol Test

By Ray Schilling | Heart Disease, Hormones, obstetrics, Weight loss

At the 75th Annual Scientific sessions of the American Heart Association in Chicago several presentations centered around the use of the C-reactive protein test to evaluate risks for heart attacks, strokes and the risk of restenosing after doing a cardiac procedure to reopen stenosed coronary arteries.

I have previously reported about the use of the C-reactive protein (CRP) test in a review regarding Dr. Paul Ridker’s study in the New England Journal of Medicine.

This study is ongoing and is known under the name “Women’s Health Study”. He followed a large group of women and found that an increase of the CRP was closely associated with heart attacks. Other investigators found now that an increase of CRP is closely linked with obesity, with the metabolic syndrome (also known under “insulin resistance”) and hormone replacement therapy.

CRP Test Better Than Cholesterol Test

There appears to be a pivotal shift among cardiologists in that it is now clear that inflammation seems to be at the center of the process of hardening of the arteries, not just in a few cases, but in everybody who has heart disease. Below I summarized some of the features of CRP in a table.

C-reactive protein (CRP) and risk for heart disease
Facts:	Comments:
CRP is produced by the endothelial cells that line the arteries	CRP is intimately involved with arteriosclerosis. It has been identified as the culprit, which produces hardening of the arteries together with LDL cholesterol
CRP interferes with nitric oxide release from the endothelial cells, which is required for normal function	this leads to a dysfunction of the lining of the arteries, atheromatous plaque formation and it stimulates scavenger cells, called macrophages, to take up LDL. CRP also causes plaque destabilization and clotting
these factors elevate CRP:	obesity, the metabolic syndrome, hormone replacement in menopause with artificial hormones, but NOT with bio-identical hormones
these factors lower CRP:	low carbohydrate diet, exercise, statins, rosiglitazone (Avandia), lowering of insulin

There will be a lot of information coming out in the next few years. Two major trials have been started where patients with a normal cholesterol, but an abnormally high CRP, will be followed along.

The JUPITER trial will look at the effect of treating these patients with rosuvastatin (brand name: Crestor). About 15,000 patients will be enrolled in this trial and followed for about 4 years. The Canadian 4R trial (Risk Reduction with Ramipril in patients with high CRP) uses ramipril (brand name: Altace) for 12 weeks to see whether it reduces CRP levels. Much more research is needed, but the doctors already know enough about CRP to state that it is a major player when it comes to hardening of arteries. They also know that LDL cholesterol is not outdated, as both LDL cholesterol and CRP play important roles in this process.

Based on a cardiology update in the Medical Post, Dec. 31, 2002, page 17 to 19.

Comments on Dec. 10, 2012: The 4 R Canadian study showed a tendency towards a lowering of CRP with Ramipril, but it was statistically not significant due to numbers that were too low and the observation period was not long enough. The Jupiter trial had to be abandoned after two years as there was concern of diabetes being caused by Crestor and because the effect of prevention of heart attacks was not seen early enough (the number of treatments required before a beneficial effect could be seen was too high). Here is a review why rosuvastatin (brand name: Crestor) should be approached with caution.

Here are other links to related topics that won’t have serious side-effects:

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

Two things will lead to a normal weight (as you likely have heard before):

Proper nutrition…http://www.nethealthbook.com/articles/nutrition.php

…and proper exercise (fitness): http://www.nethealthbook.com/articles/fitness.php

Last edited December 10, 2012

Feb

2003

A Slipped Disc…Do Surgery

By Ray Schilling | Arthritis, Orthopedics

In the Dec.31, 2002 edition of the Medical Post a report of the recent North American Spine Society’s annual meeting in Montreal was entitled: “Aggressive approach to slipped discs needed”. A ground breaking study from England was presented that will change the attitude of many physicians about “slipped discs”.

Discs in the lower back do not really “slip”. The disc can bulge, protrude or herniate. In the center of the disc is a more liquid part (nucleus pulposus), which can leak out when the fibrotic shell of the disc tears.

This occurs commonly with aging and also with obesity. Dr. Keith Greenfield from the University of Bristol presented data together with the Walton Neurosurgery Centre in Liverpool showing that the borderline cases (“bulging discs”)that previously were treated without surgery do much better when early surgery is done (discectomy). This is a shift for many European countries and Commonwealth countries including Canada. In the US back surgeons always had a higher surgical rate as MRI scans have been used much earlier as the standard and the hidden minor disc protrusions and bulging discs are visualized earlier. Dr. Greenfield’s study involves 88 patients who belong into the group of patients who are borderline cases between those who definitely need surgery because of a sciatic nerve compression and those who do not need surgery (normal MRI scan). Clinically the “slipped disc” group (with disc bulges) has moderate back pain and some pain that radiates into the leg.

A Slipped Disc…Do Surgery

They have moderate disabilities with problems of walking, sitting, travelling and standing. The investigators treated half of the patients with microdiscectomy and the other half with conservative treatment (physiotherapy etc.). One year after the surgery a large percentage of them had returned to work and are feeling fine. The control group is quite the opposite: a large percentage of them has slipped into total disability that makes it impossible for them to return to work. Many have entered into chronic pain syndromes that might keep them disabled for a long time. The study is ongoing and the group will report about the two year follow-up point in Vancouver/B.C./Canada in May 2003 at a conference of the International Society for the Study of the Lumbar Spine. For now it seems that microdiscectomy is the treatment of choice in the bordrline cases of disc bulges and mild disc protrusions.

Comments: The rate of back surgery in the US has been 10 times that in England. Perhaps it is time that back surgery is being standardized and MRI scans are done routinely in every more significant back case to find out what’s going on earlier in the course of back pain. The direction medicine is going is that back pain that persists for more than 1 month likely should be MRI scanned. In case of a positive finding (bulge, protrusion or disc herniation), this study suggests that doing a microdiscectomy would be the new standard of therapy. Early mobilisation is the other key, which sports medicine physicians have been aware of and used for the last decade. If it’s good for athletes, it is likely good for the public at large.

Coffee — What’s The Scoop…

By Ray Schilling | Health, Nutrition, Prevention, Women’s Diseases

In a recent issue of The Medical Post, a weekly news magazine for Canadian Physicians (The Medical Post, Jan. 28, 2003), Dr. Suzan Biali has revisited what is medically known about the effects of coffee on health.

This doctor is a family physician in Vancouver/B.C., but also has a degree in dietetics. Here is a summary in table form of what this medical review found.

Dr. Biali also mentioned the recent publication in the November issue of the Lancet by the Dutch investigators that coffee consumption of more than 7 cups per day would cut diabetes in half.

Summary: It would appear that coffee consumption is better than previously thought of. Most people can benefit from it. But this is a personal preference issue. Some groups of patients should refrain from coffee consumption entirely such as patients with rheumatoid arthritis.

Coffee — What’s The Scoop…

Others such as women in early pregnancy (particularly the first 3 to 4 months) should refrain from it. When infertility is a problem it is wiser to refrain completely from coffee as well. Patients with a tendency to ulcers likely should refrain or cut down the coffee consumption. The majority of the population likely could enjoy a cup of coffee and prevent degenerative neurological diseases (Alzheimers and Parkinsons disease). Some patients with psychiatric illnesses (phobias, anxiety disorders) likely should stay away from coffee as should patients with high blood pressure or heart rhythm irregularities.

Coffee — what’s the scoop?
Effects of coffee on:	Comments:
first trimester pregnancy	5 or more cups a day can cause miscarriages
infertility	women who drink 250 mg of caffeine per day (5 to 6 cups) experience infertility
no hip fractures	a large Minnesota study showed in 2001 that there were NO hip fractures with coffee consumption
calcium in bones	despite the rumors otherwise, there is NO link of coffee consumption to calcium loss
rheumatoid arthritis (RA)	This is the patient group where osteoporosis has been found to be present with coffee consumption; a Finland study found a 2-fold risk with more than 4 cups per day, and a 15-fold risk with more than 11 cups per day (in RA patients only)
Alzheimers and Parkinsons	the cells in the basal ganglia that produce dopamine get stimulated by coffee; this is also the seat of the addiction (though mild) to coffee and the cause for headaches when coffee is suddenly withdrawn. This effect prevents Alzheimers and Parkinsons, both bad degenerative neurological disorders.
stomach problems	anybody with a tendency for stomach ulcers or duodenal ulcers tends to get worse with coffee. Arabian type coffee is less acidy than South American coffee. Coffee does not cause ulcers, but may stimulate existing acid production and in higher doses may stimulate H.pylori growth.
panic attacks and insomnia	more sensitive people tend to feel anxious with a single cup of coffee per day, others can tolerate many cups. When a patient complains about panic attacks or insomnia the physician will likely inquire about how much coffee the person drinks.
high blood pressure	long term coffee users show almost no effect on blood pressure, it does not cause high blood pressure. Those with high blood pressure or a history of a stroke still should refrain from drinking coffee

Last edited December 10, 2012

Introduction

The testosterone blood test

Replacement of missing testosterone

Gonadotropins

Injections of testosterone

Additional information about effects of testosterone

Coffee — what’s the scoop?

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