**Closure of my websites askdrray.com and nethealthbook.com**

These websites will be taken down on **April 30, 2025** and no further updates will be provided.
I hope you enjoyed the content of these websites. You can continue to read Dr. Schilling’s blogs which I publish daily on Quora

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Click on this: Under my image there is a heading “Profile”. Right underneath this you find a search box entitled “search content”. Type in any term you are interested in. You will get several answers I have written (I have written more than 15,000 answers).

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Thank you for your trust in the past. Ray Schilling, MD
**Closure of my websites askdrray.com and nethealthbook.com**

These websites will be taken down on **April 30, 2025** and no further updates will be provided.
I hope you enjoyed the content of these websites. You can continue to read Dr. Schilling’s blogs which I publish daily on Quora

My home page there is: ** https://www.quora.com/profile/Ray-Schilling**

Click on this: Under my image there is a heading “Profile”. Right underneath this you find a search box entitled “search content”. Type in any term you are interested in. You will get several answers I have written (I have written more than 15,000 answers).

On Quora you can also write comments that I will answer.

Thank you for your trust in the past. Ray Schilling, MD
Jan
01
2006

Combination Of Drugs Helps Rheumatoid Arthritis

By | Arthritis

Several treatment options have become available to patients suffering from rheumatoid arthritis, but side effects can be a problem. Corticosteroids are still needed, and methotrexate has been added. While anti-tumor-necrosis factor therapy (TNF alpha antibody) is a very beneficial form of treatment, there are patients who fail to respond or have toxicity to these therapy forms.
Dr. Stanley Cohen, a clinical professor of internal medicine at the University of Texas Southwestern Medical School in Dallas investigated 520 patients who had not adequately responded to methotrexate and anti-TNF therapy. The patients received the genetically engineered monoclonal antibody, rituximab (Rituxan), which so far has been used to treat Hodgkin’s lymphoma. It was found to be highly effective for active rheumatoid arthritis when given with methorexate in patients who experienced an inadequate response to anti-TNF therapies.
The patients were randomly selected and received either a single dose of 1000mg rituximab or placebo on days one and fifteen. All patients received a corticosteroid prior to the infusion. They also took a short course of oral corticosteroids between the two injections. For the patients on rituxmab, the medication proved beneficial. It was also well tolerated. Statistically 51% of the patients on rituximab had at least a 20% improvement on the swollen and painful joints and at least 20% improvement in 3 to 5 other criteria, like general well being, disability or laboratory tests of C-reactive protein.
Only 18% of the placebo group showed any improvement. It was also noted that the effects of this one-time treatment could last up to 15 months.
As good as the current medication is, there are treatment failures. Dr. David Karp, chief of Rheumatic diseases at the same university but not involved with this study finds the development very valuable.

Combination Of Drugs Helps Rheumatoid Arthritis

Combination Of Drugs Helps Rheumatoid Arthritis

He concludes that it becomes important in this area to personalize the treatment plan. The future is to look at the patients’ blood or gene makeup and prescribe specific therapies directed at their particular problem.

More information regarding treatment of rheumatoid arthritis: http://nethealthbook.com/arthritis/rheumatoid-arthritis/treatment-rheumatoid-arthritis/

Reference: The Medical Post, December 20, 2005, page 33

Last edited October 30, 2014

May
01
2005

Inflammation Connected To Sudden Heart Death

By | Diabetes, Heart Disease, Prevention

It is a well-known fact that certain diseases go together, for instance diabetes and heart disease. Every effort has to be made for this reason to control a disease in order to minimize the risk for other associated illnesses.
New research from rheumatologist Dr. Sherin Gabriel at the Mayo Clinic points to another health condition. Patients affected by rheumatoid arthritis have a higher risk of early death than others, and these deaths are mostly due to cardiovascular disease. The relationship between these two diseases is complex, reports Dr. Gabriel, and the common denominator between heart disease and rheumatoid arthritis seems to be systemic inflammation.

Research from the Mayo Clinic in Rochester, Minnesota, has been published in March, and it was found that inflammation documented by laboratory tests such as an erythrocyte sedimentation rate of over 60mm per hour increased the risk for heart disease by a factor of two. Rheumatoid arthritis vasculitis increased the risk to 2.4, and RA lung disease showed a risk increase of 2.3. Traditional risk factors for heart disease like smoking, alcohol, obesity and diabetes were accounted for, yet the more dramatic risk factor in the population with RA (rheumatoid arthritis) was the aspect of inflammation. The results of this research are based on data from the Rochester Epidemiology Project, in which 603 persons with rheumatoid arthritis were followed over 15 years. In this time span 364 of these patients died, and heart disease was the primary cause of death in 176 of them. The subjects of this group were three times as likely as an age-matched population to have been hospitalized for a heart attack and had five times the risk of having an unrecognized heart attack. This group is also more vulnerable, because patients with rheumatoid arthritis suffer of joint pains, receive painkillers, and often chest pain can be masked by pain medication and go unrecognized.

Inflammation Connected To Sudden Heart Death

Inflammation Connected To Sudden Heart Death

Co-author Dr. Hilal Maradit points out that rheumatoid arthritis remains a multifactor problem, and one factor alone does not explain the entire story, but in the meantime the link of inflammation in RA to cardiovascular disease is an important step closer to early recognition and successful control.

More info about:

Rheumatoid arthritis: http://nethealthbook.com/arthritis/rheumatoid-arthritis/

Gingivitis: http://nethealthbook.com/dentistry/gingivitis/

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

Reference: National Review Of Medicine, April 15, 2005, page 3

Last edited October 28, 2014

Feb
01
2003

Coffee — What’s The Scoop…

By | 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...

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