More Dangers of BPA

Although there have been many studies showing possible adverse effects of BPA. BPA, or bisphenol-A is a plastic used in may cans and plastic bottles. Although some products are BPA free, there are many which have not yet changed their composition.

In a recent well designed study, researchers found that when adults drank from 2 BPA containing cans their blood pressure rose significantly as opposed to when they drank the same substances from glass bottles.

Clearly we need to stay away from BPA. I think it is another product that should no longer be used in our foods.

Baby Monitors, SIDS and Effectiveness

The "back to sleep" campaign, advising parents that babies should sleep on their back on firm mattresses, has decreased the incidence of SIDS, which was already rare, by over 50%.

But many babies seem to sleep better on their stomachs, leaving parents with a dilemma. This has created a niche for devices that have breathing alarms and claim to allow babies to sleep on their stomachs.

However, these devices are sold as consumer devices, NOT medical; and therefore are not subject to FDA regulation and approval. Their claims have not been proven or studied.

Here's what you need to know:

• These devices are not regulated by the FDA and may be marketed with the vague enticement of “keeping babies safe.”
• One device is a sock that measures heart rate and oxygen concentration. Other monitors provide various data; for example, an ankle monitor tracks heart rate and temperature.
• These devices do not have alarms; they are sold as consumer products rather than as medical devices.
• In addition to wearable monitors, smartphone applications are available for parents to monitor heart rate, oxygen concentration, and skin temperature.
• Although the product materials state that they are not intended to prevent SIDS, safety is being emphasized in the marketing materials. No published data are offered to support safety claims.
• Some devices are marketed at costs of US$200 to US$300.

Although they may be justified and effective in some cases, parents should not rely on these completely.

Money and Medicine - Device Approval and Herbal Smoking Remedies

In Europe, one of the most popular smoking cessation medications is actually a plant derived substance called cytisine. This inexpensive herb has been found, in a recent study, to be more 30% effective than nicotine patches or gum. Why is this product not used more in this country? Perhaps checking the profits and sales of the nicotine replacement therapy would be a clue.

You may have recently read that the FDA withdrew recommendations for a procedure known as morcellation which was a technique used to remove fibroids. It involved an expensive new machine. In its initial approval the FDA relied on a report from a physician on its panel who said the adverse effects were not as bad as reported. This doctor had received over $150,000 in speaker fees from the manufacturer.

Indeed, the Wall Street Journal reported that of 122 FDA advisers who evaluated cardiologic, orthopedic, and gynecologic devices from 2012–2014, one third had received compensation (e.g., money, research grants, food, or travel) from device companies, and nearly 10% overall had been compensated by companies whose device they were assessing. The FDA disclosed almost none of these relationships.

I rarely recommend new treatments or devices unless they are a dramatic improvement or have been in use for a significant time. I have seen too many of these adverse events being reported long after approval; perhaps this again is part of the reason.

Family Dinners and Bullying

Family Dinners - Important Psychological Effects

In today's fast moving and electronic society, we may have lost the tradition of a family dinner where everyone can talk about their day and obtain support our family.

Researchers studied cyber-bullying (Internet bullying) found a 30% or more decrease in mental health or substance abuse problems in those children who had at least four family dinners a week.

The psychological support of a teens family should not be forgotten!

IBS is Real

Irritable Bowel, or IBS, is characterized by constipation or diahrrea, often associated with cramps; as well as being associated with certain foods.

Physicians often prescribe anti-spasmotic drugs. The diagnosis is most often one of exclusion; where we rule out all other causes. But many in the medical community believe this is a psychological and not physical disease.

However, in a recent study, researchers found that, in patients with IBS, certain foods induced microscopic changes in the wall of te intestine, with increased permeability (leakiness) and migration of inflammatory cells.

We can expect this confocal laser endomicroscopy technique to become more common and help establish which foods IBS patients are actually sensitive to. This may also be useful in gluten intolerance (as compared with real antibody induced celiac disease).

Flu Vaccine Less Effective

The flu vaccine, which is generally very good at preventing disease, is formulated 6-12 month before flu season, and is based on the best guess of researchers and what viruses are circulating in the far East.

The flu virus is composed of several strands of RNA (like DNA), and there are up to about 12 different variations of each strand. Some combinations can result if a more severe strain (like Bird Flu), some in a more contagious but less dangerous variety. It is when all factors combine to make a potent virus which spreads more easily (as in 1918) that we have a dangerous epidemic.

This is one of the reasons we need an annual vaccine; to account for changes in the virus. This years "guess" by researchers was less accurate than usual. The virus that was predominating in September of this year was found to be different from the H3N2 strain used in the vaccine (created in February). The strain this year is a slightly different H3N2 variety; but is a potent variety that may be associated with more severe illness.

The CDC recommends that anti-viral medications (such as Tamiflu) be used early in the diagnosis; even before confirmation cultures are back, especially in high risk individuals. If you fall into that group seek medical care as early as possible if you think you have the flu. You can check this web site to help you make that decision.

http://www.cdc.gov/flu/about/qa/testing.htm

Diet, Alcohol Health and Parenting

A couple of recent studies have emphasized how important parenting is to the health and habits of our children.

Many parents believe that introducing alcohol in a controlled manner can influence future responsible drinking. However studies do not support any change in the behavior of our children and their response to peer pressure. Teaching proper attitudes and not allowing underage drinking seems more appropriate.

In another interesting study, researchers examined the nutritive content of lunches sent from home and compared them to the current guidelines of the National School Lunch Program. They found that the home lunches had substantially more sodium, and less vegetables than recommended. Similar to our problems with fast food in this country we need to educate our society on better eating habits.

My daughter Jodi is a nutritionist, and we often comment on how difficult it is to obtain our daily balance of fresh fruits and vegetables.

Allergy Testing - Is Profit the Motivation?

I once knew a physician very well who would refer almost every patient with even minimal allergy symptoms for a $ 600 (almost all profit) panel of allergy tests. He would proudly show how this, and the subsequent allergy shots, was increasing his revenue. 

Like many doctors he (I hope) believed the sales pitch and was drawn to the increased profit; rather than paying attention to the actual facts.

We are all aware of allergy symptoms; for example a rash after eating shrimp, or nasal congestion and itchy eyes when exposed to ragweed. And physicians have developed many tests, including blood and skin testing for these allergens.

Unfortunately, the only certain way to detect allergies is to have an actual exposure. IgE blood tests are an expensive way to guess at allergies, and only correlates with real symptoms, whether food or otherwise, about 50% of the time. That means that 1/2 the test results are totally wrong; either you are allergic to something where the blood is negative , or not allergic to something that shows positive. Skin testing have a similar inaccuracy.

So why are these done? In certain cases, IF you show an allergy to something AND the skin or blood test CONFIRMS it then SOMETIMES allergy shots can desensitize you to this. But the testing should be restricted to ONLY those possible allergens you know you could be allergic to, AND only if the patient is willing to get allergy shots! Unfortunately, in many cases the motivation is profit.

The National Institute of Allergy and Infectious Disease has issued recommendations for food allergies based on these facts. To summarize:

• A high proportion of food allergy is caused by relatively few allergens (cow's milk, hen's egg, soy, wheat, peanuts, tree nuts, fish, shellfish).
• Evaluate patients with latex allergy for possible cross-reactivity to banana, avocado, kiwi, chestnut, potato, green pepper, and other fruits and nuts.
• For infants with family history of atopy or eczema , consider partially or extensively hydrolyzed infant formula to prevent rashes.
• Do not routinely recommend that patients with chronic hives avoid foods containing additives.
• Use prick tests and/or serum tests for specific blood testing (IgE) to diagnose food allergy; testing should be focused on suspected foods and test results alone should not be considered diagnostic.
• Do not routinely obtain total IgE levels to diagnose food allergy.
• Unproved tests (allergen-specific IgG measurement, cytotoxicity assays, applied kinesiology, provocation neutralization, hair analysis) should not be used to diagnose food allergy.
• Routine use of patch tests to diagnose food allergy is not recommended.
• Recommend a nutritionist consult for growing children, as elimination diets might affect growth. Be aware of nutritional consequences of elimination diets, including deficiencies of vitamins C and D.

In children with purported food allergies on "elimination" diets, 90% were able to re-introduce these foods without any problems.

Complications of Cosmetic Surgery

This type of surgery has become very popular as we try to maintain our beautiful youthful appearances. As was recently evident by the untimely death of Joan Rivers these procedures can be very risky.

Aside from death from anesthesia errors, not many studies have looked at actual complication rates.

The news is good. In a recent review of over 20,000 dermatologist cases there was less than a 1% rate of permanent complications such as scarring or pigmentation. There was, however an almost 25% rate of short term complications, such as bleeding or infection; most of which resolved without permanent damage.

If you decide to get that cosmetic procedure choose an experienced surgeon. If you need to be put to sleep do it in an outpatient surgical center; not in a physician's office unless there is a certified anesthetist and an up-to-date crash cart (meds and equipment on these need to be tested frequently) present.

Alcohol, Marijuana, and Moderation

In general, moderation is the key to a healthy lifestyle. This includes exercise, eating, alcohol and marijuana.

A recent study confirmed that heavy (daily) marijuana use is associated with decreased "gray matter" or brain tissue when compared with controls. Heavy alcohol use (more than 1 drink daily) causes liver disease as well as changes in the brain.

Our bodies are well adapted to small doses of many toxic substances, like alcohol, marijuana, saturated fats and cholesterol. It is only when we start overwhelming our normal detoxifying systems that we poison ourselves.

The issue with alcohol, tobacco, cocaine, and narcotics is the addiction potential that creates a craving and essentially prevents moderate use!

Nicotine and E-Cigarettes - Still Bad news

No one will argue that smoking is bad for you. However new electronic cigarettes, which produce just nicotine and none of the other toxic tobacco chemicals have argued that they are safer and that they help people quit smoking. This, unfortunately, is not the case.

Nicotine is highly addictive, and is the actual chemical that makes cigarettes addictive. So no, the electronically pure is as habit forming and possibly worse.

As well, electronic cigarettes were used at least once by 12% of high school students and 3% of middle school students, with almost 25% of high school students admitting to regular smoking (regular or electronic). In another study researchers found that adolescents who smoked either kind were more than five times more likely to move on to more serious drugs, such as oxycontin and heroine (but not marijuana). So nicotine has become a gateway drug.

We need to continue to monitor and discourage our teens from any kind of smoking; including marijuana since, as I have mentioned in previous blogs, it can cause serious damage to the growing brain.

Unsafe at older age

As we age our bodies change, and we become more susceptible to complications or medications and supplements. In most other countries, where there is universal health care, it is relatively easy to do large population studies and examine complications and effects of drugs and medications. The government databases contain records of deaths, illnesses, and medications.

In several studies, researchers have discovered that drugs which were considered safe may have complications in those with underlying illnesses. These include some common antibiotics.

UNSAFE ANTIOTICS

BIAXIN, ZITHROMAX, LEVAQUIN and its relatives all have very rare cardiac side effects. These do not seem to be an issue in younger and healthy individuals, but in older patients, and those with heart issues, there is a small but significant increased risk of complications and death. If possible we should try and avoid the use of these medications; however when indicated they are usually safe. As well, SEPTRA has been found to be potentially dangerous in those who are taking certain blood pressure drugs called ACE or ARBs.

USELESS VITAMINS

In a related study, Dutch researchers addressed the concept that elevated homocysteine levels were related to Alzheimer's and could be treated with B vitamins. Although the association may be valid, and B vitamins do decrease homocysteine levels, unfortunately there is no affect on Alzheimer or heart disease.

DANGEROUS BLOOD PRESSURE TREATMENT

Blood pressure treatment is important in older patients, but in a recent study it was found that the prevalence of orthostatic hypotension (drop in pressure when standing up) increased by a level of 5 from 4% to 20% between the ages of 60 and 80. This is associated with more frequent falls and fainting.

It is important for doctors to understand that those patients should not be as aggressively treated; there needs to be a balance between treatment and over-treatment. If you or someone you know is getting the symptoms of fainting or dizziness when standing and they are on medications that can cause this discuss it with your doctor!

Laser and Robotic Surgery

Lately there has been a lot of hype concerning Laser and Robotic surgery. But what is it and is it really better? Most of the time it is not.

Robotic surgery is not R2D2 doing surgery. It is more like a remote control hobby device; the surgeon is working from a remote control device while the machine follows his instructions. He (or she) is usually watching on a TV screen; but sometimes live. Recent advances may involve a 3D virtual reality; allowing remote operations by tele-medicine.

The advantages of robotics include a finer control of movement with less slipping of the knife likely. As well, surgery is possible in very confined locations. Disadvantages include the lack of direct visualization and two-dimensional pictures. A major issue is the lack of sensory feedback; most robotics do not allow that. The surgeon does not know when the tissue has a different feel or density.

So for most surgeries an experienced surgeon doing it manually is far better than robotics. Indeed in a recent study of benign ovarian lesions on 87,000 women researchers found there were 50% more complications in robotic cases.

Lasers are being used in surgery as special knives or scalpels. They burn a very fine line through tissue, and have minimal bleeding due to the cauterization. However, like robotics, there is no feedback from the tissue; and there effects of small surgical errors by the operator are magnified.

There are several tissue specific colored lasers but these also can damage normal tissue. I had three cases of patients who had green laser prostate surgery by an inexperienced laser surgeon. All three had severe complications and required additional surgeries and long term incontinence.

Much of the hype about laser and robotic surgeries has been promulgated by the manufacturers of this very expensive equipment whose surgeries are far more expensive than standard procedures. Like new drugs we need to be cautious; they are rarely major advances.

I review a surgeon's experience and complication rates. I much prefer an experienced surgeon using standard instruments. Never be afraid of asking how many of these procedures the surgeon has performed; if the physician gets insulted I would strongly recommend you go somewhere else.

Broccoli and Autism

Broccoli and Autism

In recent studies, researchers have discovered that a chemical found in broccoli, sulforaphane, seemed to result in a mild improvement of symptoms of autism in 80% of children (as judged by their parents).

This is too preliminary to use as a treatment, but since it is believed that the changes that result in autism may begin before birth, it would be prudent for pregnant women to eat adequate vegetables and broccoli!

Sofas are for Adults not Babies!

Since the introduction of he back to sleep campaign (infants sleeping on their backs) there has been a more than a 50% decrease in Sudden Infant Death Syndrome (SIDS). However, accidental suffocation has not changed.

In an analysis of infant deaths, researchers found that there was a significantly higher risk in infants sleeping on sofas. Some of the causes probably include the baby rolling into the corner, and the softness of the pillows.

One of the theories of SIDS is that when a baby is on their stomach, especially on a softer surface, their nose and face forms a small indentation. When we breath we breath out carbon dioxide; this gas is heavier than air. With a baby, who moves much less and has a less powerful breath, the carbon dioxide gas may remain around their face. Their reflexes and motion can then lead to suffocation.

So don't let your babies sleep on the couch! Leave that for Grandpa!

Milk in Adults - Too Much is Risky!

There have been some questions about the use of cows milk in adults. Many state that cows milk is for calves, not humans, but the protein, vitamins and calcium in milk do have a high nutritive value.

However there are some compounds in milk that could produce adverse effects. D-galactose, found in milk, has been shown to induce oxidative stress damage and chronic inflammation in animals, and such changes have been associated with cardiovascular disease, cancer, bone loss, and sarcopenia in humans.

Researchers in Sweden followed almost 100,000 patients for almost 20 years. They found that in the higher consumption groups (3 glasses per day) had almost double the risk of cardiovascular disease, as well as an increased risk of fractures as compared to those that drank less than one glass a day.

As usual, moderation is the key!

Eczema, Children and Moisturizers

Eczema in children is treated by use of moisturizing creams to help restore the normal skin barrier. But can the use of these creams actually prevent the development of this rash?

In a study in Great Britain parents were randomized to using one of three creams (sunflower oil, Cetaphil cream, or Aquaphor Healing Ointment, their choice) daily even the absence of a rash in infants. They started at 6 weeks and were evaluated after 6 months. The group was higher risk; having a first degree relative with atopic dermatitis.

The study discovered a 50% reduction in eczema. This is significant.

My daughter uses coconut oil on her baby; this child has had beautiful skin and no diaper rash! I would recommend it to everyone.

Supplement Makers Ignore the FDA and Health Risks!

I recently reported that many dietary supplements included dangerous and unapproved compounds, in varying and sometimes dangerous concentrations. 

These included anabolic steroids, Prozac and Viagra. Some have been associated with fatal liver disease.

In response to the earlier report the FDA recalled many of the supplements.

In this follow up study, researchers found that 27 products recalled between 2009 and 2012 still contained the substances that were banned by the FDA. And 20% of these products contained an additional banned product.

The FDA needs more teeth to enforce their rules. And all of us have to continue to be more careful about using supplements. As you know I am against virtually all of these.

Green Coffee Beans for Greenback Dollars!

As many of you have probably heard, the study that purportedly showed the use of green coffee beans causing weight loss was false. The "researcher" changed weight numbers and results intentionally in order to show its efficacy.

Then the manufacturers paid Dr Oz for his endorsement, and undoubtedly made millions of dollars. We need to be more careful with these "fringe" treatments before accepting them.

Incidentally, in most coffee plantations the beans are picked both green and red. The red ones go to premium coffee, and the green to regular brands.

Stem Cells - Cures for Diabetes?

Diabetes is caused by either inadequate production or no production of insulin. This is related to either a decrease (Type 2), or total destruction (type 1) of Beta cells. These cells in the pancreas respond to high levels of glucose (sugar) in the blood by releasing appropriate amounts of insulin.

Now a team from the Harvard Stem Cell Institute have developed a technique to convert stem cells (which are now relatively easy to find) into working Beta cells. If these can be re-introduced into diabetic it may be a way to cure them.

The caveat, of course, especially in Type 1 diabetics is the initial cause of the loss of the beta cells. If it was an autoimmune process it is possible these new cells will also be destroyed. However we may be able to suppress this reaction.

We hope for a time that this treatment will really cure diabetes. Of course I wonder what the multi-billion dollar diabetic drug industry would do if this became close to being a reality!

Ebola News

Some good news has finally appeared in this terrifying epidemic. It seems that no one else has developed the disease from Mr Duncan in Texas; and Nigeria announced that they have had no cases in the past 21 days; meaning it is likely gone form that country. As well, some evidence has arisen that intensive re-hydration may decrease the mortality by a significant factor.

In terms of treatment, the experimental antibodies ZMapp seems to be very effective in monkeys. Unfortunately these are grown in modified tobacco plants and take several months to produce. They work by decreasing the total virus count and allowing the body to fight the infection.

People who have been cured develop antibodies which can last 10 years (hence the transfusions of their serum into sick patients). The NIH was close to finding an effective vaccine in 2001 when funding to this (and many other medical projects) was drastically cut in order for us to pay lower taxes. I'm sure Mr Duncan would have been happy to pay a few extra dollars.

In any case, researchers are now close to being able to create an effective vaccine. Accelerated animal testing has been successful and we should hopefully have a working vaccine within a year.

Marijuana and Your Brain - Reefer Madness!

Most people think that marijuana is very safe. It does have some medical uses as well; but as a recreational drug it usually produces a relaxed state associated with a slightly increased appetite and enhanced sense of humor.

However, more studies have emerged showing that, in developing brains (as opposed to adults), smoking weed can have long term permanent adverse effects.

Researchers followed moderate users of marijuana from teen years up until age 30, and compared them with a group of controls who were similar in social and psychological factors.

They discovered a dose–response relationship between use frequency and dropout from high school, failure to get a college degree, marijuana dependence, use of illicit drugs, and suicide attempts.

Like the US drinking age, Marijuana should not be used before age 21. After that, under controlled conditions, and in Washington and Colorado states, you can feel free to get high.

When is the time to stop Treatments

Many doctors are extremely aggressive in the use of medications and interventions, even in those who should not get treated. I already discussed the over use of osteoporosis medications.

In general, medications whose benefits do not exceed the person's predicted life span; or do not improve quality of life, are unnecessary and wasteful aside form possible side effects.

A good example are patients with advanced dementia or Alzheimer's. In a recent study, researchers found that among 5400 patients with severe dementia (mini-mental status result of 5) at average age 85, more than half of these patients were taking medications that were of questionable value. These included Alzheimer's drugs (which are not effective at all in severe cases), and cholesterol medications (whose benefit would be long after the patients would pass). About 1/3 of the medication cost was related to "questionable" drugs.

I always try to get my older patients off of medications, especially those of no benefit. Anyone who takes care of the elderly should pay close attention to the medications and their value.

Fat Kids and Heart Issues

Overweight children often become fat and unhealthy adults. A recent study showed that these children are also more likely to develop left ventricular hypertrophy; a enlargement of the heart often associated with high blood pressure and premature death.

Researchers in Belgium followed over 1000 patients for 28 years.

We know that fast foods and processed foods are very rich in calories and closely related to obesity. Keep your children away from sugary snacks and fast foods!

Gluten intolerence and Introduction of Gluten in Children

Gluten intolerance, and in its severe form Celiac Disease are digestive illnesses where the intestines cannot digest gluten, a substance found in most wheat products and breads. These patients often develop diarrhea and can get severe inflammation associated with anemia and weight loss. Many believe that gluten itself is an inflammatory promoter and can lead to other diseases such as arthritis.

Although there are some tests for the most severe cases, now a days there are so many gluten free foods a relatively simple elimination diet can help make the diagnosis.

There have been some who believed that the early (or late) introduction of gluten into a child's diet could affect their sensitivity. A recent study suggests that this is false.

In two studies of about 1000 children each, introducing gluten at 6 months versus 12 months made absolutely no difference. Neither did breast feeding. Evidently this is a genetic related disease with at least these environmental factors unrelated.

Are ER doctors creating addicts?

Emergency room physicians are generally well trained and competent to handle life threatening illnesses. However they can become flippant with what they consider minor illnesses.

In Texas, I cannot excuse the physician who saw that Ebola patient and did not take a proper history. It was his job to ask about travel history! I still remember one of my professors (I guess McGill was a better school) saying that history was 90% of medicine; and MD stood for Medical Detective!

I often see patients who have come from the ER or an orthopedist on very potent and addictive narcotic drugs for pain that could be controlled better with non-narcotics. Without proper follow up these physicians do not realize how many patients can become drug seekers.

In a recent survey of US emergency rooms, researchers discovered that narcotic drugs were prescribed for headaches 35% of the time in 2010, as opposed to 21% in 2001. In addition, most recommendations would have that number at 10% or less.

When I had hernia surgery in the 80's I received a bottle of 30 percocets - I used 3. When I had knee surgery in the 90's I received prescriptions for 90 narcotic pills; which I never ended up using. Without my medical knowledge I might have taken them thinking they were important in recovery.

This kind of activity needs to stop, and if you are given narcotics please use them sparingly

How to Lose Weight!

Many popular diets claim almost magical properties which help you lose faster and without any effort. I've always said that losing weight is a simple but difficult formula - eat less than you burn! This is very difficult because your body does not want to do that!

In a recent study researchers looked at 48 different diets in over 7,000 obese individuals. To no ones surprise the diets lowest in calories such as the Atkins low carb diet and the Ornish low fat diet were most effective. Every diet worked as long as it was followed.

My recommendation is a sensible low carb diet with regular exercise

Supplements and Your Liver - Can be Fatal!

Unlike most drugs and foods, there is very little regulation in the supplement industry. Furthermore, the claims they make range from outrageous to magical; without any real evidence. Just like you should not believe everything you read in the Internet (did I just destroy my credibility?) without researching it properly (that's better), don't believe everything the supplement industry tells you.

Several years ago in my practice I had a patient who developed severe liver failure and required a transplant. The only thing we could tie this to was a diet tea from Brazil.

In a recent study researchers found that liver injury related to herbal and dietary supplements has more than doubled in the past 10 years, (according to an analysis of data from a U.S. liver injury network published in Hepatology).

They found that liver damage from non-bodybuilding-related supplements required liver transplantation more often than injury from conventional drugs (13% vs. 3%); there were no cases of liver transplantation associated with bodybuilding supplements.

If you read my posts and blogs you know that I do not believe there is any evidence that supplements help anything. I still stand by that!

More on testosterone

I had previously reported that the epidemic of low testosterone is, in my belief, a product of aggressive drug company marketing. And testosterone is a dangerous drug associated with cancer and heart disease.

This apparently has not stopped many from using it, so, in an unusual turn of events, an FDA advisory panel voted on Wednesday to limit the use of testosterone replacement therapies to men with medically related low testosterone — for example, due to a genetic condition or malignancy.

If the FDA adopts this recommendation, then any other use would be "off-label" making the physician liable for any side effects. Of course this could simply be a way for big Pharma to insulate itself by saying they don't recommend off label use (even when they do!).

In any case, more negative publicity may help deter the over use.

Hair and Nails

Although I try to comment on controversial issues or important breakthroughs, there are many of us out there who suffer from two conditions which are not really dangerous but irritating.

These are toenail fungus, which, even with treatment recurs over 70% of the time; and of coarse hair loss with aging.

Toenail fungus was only effectively treated with oral medication, which had liver side effects and had a very high recurrence rate. Now some new reports show that certain new (and very expensive) topical creams have high cure rates. These prices will surely come down in 10 or so years. As well, there are some centers that offer laser therapy for this disorder. And it seems to work, with 50% cure and 90% having some response. But does it come back - maybe.

Hair loss is a big business, from Rogaine and Propecia; which work marginally, to hair transplants. Now researchers may be one step closer to a real treatment. I did not call it a cure, since hair loss is a normal aging process! 

Researchers have discovered, that dormant hair follicles can actually start growing hair again. They did this by exposing the "old" follicles to young skin. They found that there are agents which diffuse form this young tissue to rejuvenate the old hair cells. Unfortunately this experiment was in mice and is very preliminary. But if they find away to get these rejuvenating chemicals into bald men; well maybe you won't recognize me!!

Raw Milk - Dangerous and Stupid

Many people believe that raw milk (unprocessed and unpasteurized) is healthier for you than pasteurized milk. No matter what you read, this is absolutely untrue and potentially dangerous.

Louis Pasteur helped develop this technique which prevented many dangerous and fatal techniques. It involves heating milk to a temperature that kills most of the dangerous bacteria; so their levels are safe. This technique does not kill all the bacteria, so milk can spoil if left out of the refrigerator.

How about some perspective. If you believe we should be drinking raw cow's milk, rather than processing it to remove unhealthy bacteria, then, using that same logic we should only eat raw meat. And raw chicken. And raw fish (all the time, not just with sushi). Raw snails! The list goes on. Indeed, "logically" when man evolved 5-10,000 years ago we did eat raw meat when fire was not invented. Of course we did get parasitic and bacterial diseases; but again, with the raw milk logic... On the other hand cow's milk (goat milk, etc) was NOT a natural part of our diet until until goats and cattle were domesticated. So why drink milk at all?

Pasteurized milk has the same nutritive value as "raw" milk. If you want the extra fat and particles in milk buy non-homogenized milk.

Fresh milk, within minutes of milking the cow, may be safe, but there is no reason to drink it. Remember also, cow's milk is made for baby cows.

Listerosis is a serious bacterial disease, especially in pregnancy where it frequently leads to fetal death, even in the absence of maternal symptoms. Raw milk used to be the main source before pasteurization.

Raw milk is milk from cows, sheep, or goats that has not been pasteurized to kill harmful bacteria. This raw, unpasteurized milk can carry dangerous bacteria such as Salmonella, E. coli, and Listeria, which are responsible for causing numerous foodborne illnesses.
These harmful bacteria can seriously affect the health of anyone who drinks raw milk, or eats foods made from raw milk. However, the bacteria in raw milk can be especially dangerous to people with weakened immune systems, older adults, pregnant women, and children. In fact, the CDC analysis found that foodborne illness from raw milk especially affected children and teenagers.

Pasteurization is a process that kills harmful bacteria by heating milk to a specific temperature for a set period of time. First developed by Louis Pasteur in 1864, pasteurization kills harmful organisms responsible for such diseases as listeriosis, typhoid fever, tuberculosis, diphtheria, and brucellosis.

• Pasteurizing milk DOES NOT cause lactose intolerance and allergic reactions. Both raw milk and pasteurized milk can cause allergic reactions in people sensitive to milk proteins.
• Raw milk DOES NOT kill dangerous pathogens by itself.
• Pasteurization DOES NOT reduce milk's nutritional value.
• Pasteurization DOES NOT mean that it is safe to leave milk out of the refrigerator for extended time, particularly after it has been opened.
• Pasteurization DOES kill harmful bacteria.
• Pasteurization DOES save lives.

The Dangers of Listeria and Pregnancy
Pregnant women run a serious risk of becoming ill from the bacteria Listeria which can cause miscarriage, fetal death or illness or death of a newborn. If you are pregnant, consuming raw milk - or foods made from raw milk, such as Mexican-style cheese like Queso Blanco or Queso Fresco - can harm your baby even if you don't feel sick.

Okay to Eat
• Pasteurized milk or cream
• Hard cheeses such as cheddar, and extra hard grating cheeses such as Parmesan
• Soft cheeses, such as Brie, Camembert, blue-veined cheeses, and Mexican-style soft cheeses such as Queso Fresco, Panela, Asadero, and Queso Blanco made from pasteurized milk
• Processed cheeses
• Cream, cottage, and Ricotta cheese made from pasteurized milk
• Yogurt made from pasteurized milk
• Pudding made from pasteurized milk
• Ice cream or frozen yogurt made from pasteurized milk

Unsafe to Eat
• Unpasteurized milk or cream
• Soft cheeses, such as Brie and Camembert, and Mexican-style soft cheeses such as Queso Fresco, Panela, Asadero, and Queso Blanco made from unpasteurized milk
• Yogurt made from unpasteurized milk
• Pudding made from unpasteurized milk
• Ice cream or frozen yogurt made from unpasteurized milk

Osteoperosis, Drugs and Loss of Teeth!

In a recent study reserachers discovered that 1 in 200 users of osteoperosis drugs like Foasamax (Aldentronate) develop osteonecrosis of the jaw; a condition where your jaw bone melts away and your teeth fall out. I know several dentists who will not do implants on any patient taking this drug; and I have a cousin who lost all his teeth when he apparently was needlessly prescribed these medicines.

Thinning of the bones, or osteoperosis, is a big watch word these days. One of the major reasons is the marketing by big drug companies.

Read how Merck created a market for this drug and, in my opinion, induced its over use. This article is worth reading and can apply to many new drugs:

http://www.npr.org/2009/12/21/121609815/how-a-bone-disease-grew-to-fit-the-prescription

It is true, that in elderly individuals, especially those who have trouble getting around, a hip fracture can result in an extended hospital stay and even premature death from other conditions. But that does not mean all of us need treatment.

The actual recommendations are based on many factors including history and bone density, There is an on-line tool that you can use (if you understand it)

http://www.shef.ac.uk/FRAX/tool.aspx?country=9

It calculated the risk of a fracture over the next 10 years and gives the recommendations for treatment> For example in a 60 year old female treat at about a 4% risk and in an 80 year old at a 15% risk. However, the intense marketing campaign has resulted in many people being over-treated! And losing their teeth!!

The loss of teeth is actually much worse than the minimal risk. Be sure that your physician is not treating borderline osteoperosis without doing the proper assessment. 

Family Dinners and Mental Health

Family dinners often get lost these busy days as we often are running around and on our mobile devices. However in some homes this is an important daily event.

Now an interesting study shows that these get-togethers seem to moderate much of the negative mental health effects of cyber-bullying.

About 19,000 teens completed a survey of cyber-bullying. Those who were exposed to this type of bullying were up to five times more likely to develop substance abuse and mental problems. However having family dinners four times a week made it seven times less likely that those children who were bullyed would have these effects.

An editorialist concluded: "The relatively simple parenting behavior of regularly eating dinner together ... may provide more opportunities for youth disclosure of bullying events."

Regardless of the way this helps, clearly a strong family bond is an important factor in mental stability. At our house, fortunately, my wife was always insistent that we eat dinner together without distraction. Another example of "Mother Knows Best"

Obesity and Cancer

Many articles have been written about ways to prevent cancer. If we tried everything we would be afraid of eating or doing anything.

Simple changes, such as smoking cessation, are very obvious. Not so clear is the effect of weight, or body mass index, on risk of cancer.

In a recent study, British researchers looked at 160,000 cancers in over 5 million people. After separating out smoking (the highest risk) they found a 40% increase risk in uterine cancer and 10% in other cancers in patients who were overweight or obese.

Once again, proper diet, exercise and appropriate weight are the best ways to live!

Can Neck Manipulation Cause a Stroke?

Probably

There is a condition know and arterial dissection, which, when it affects the arteries in the neck (carotid) can lead to a stroke even in a young person. This is fortunately very uncommon.

However, when it starts the first symptom is often neck pain. A good medical history and exam will usually point a physician in the right direction, but there have been many cases of patients going first to chiropractors.  Although there are many trained to look for this, there are also many who go ahead and perform neck manipulation without proper evaluation. This has been associate with many strokes as the maneuver often makes the dissection worse very abruptly. 

In some other cases, not associated with the typical pain of early dissection, younger patients have had strokes very soon after neck manipulation. Not the best way to diagnose this type of illness.

Before consulting a chiropractor for neck pain I would recommend you get properly evaluated. Patients with sudden onset of severe neck pain should be investigated for dissection before undergoing neck manipulation; a good chiropractor should be aware of this. 

Do You Really Get Sick on and Airplane?

I have always held out that an airplane is not a flying petri dish and you are not more likely to get infections. Traveling, especially to new places, does expose you to different viruses and bacteria than you might have adapted to; which is why many people do get sick on these vacations. But it is probably not related to the air travel. Check out this article:

Article in Wired

MRI Mammogram - The New Standard?

One of the concerns about routine mammography is that there are many false positives that lead to unnecessary biopsies and issues. This occurs to ensure we catch all cancers, but has led to some recommendations of decreased screening when looking at a risk/benefit profile.

I recently mentioned the improved accuracy of the 3-D mammogram. More accurate and specific, as many of you know, is the MRI of the breast. However, until now this took 30-45 minutes and was very expensive. Most insurance companies require complex pre-approval processes.
Now a group in Germany have developed a 3 minute breast MRI which is more accurate and produces much less false positive results than standard mammograms. Presumably the cost will be closer to existing mammograms. If this is the case, there is the potential that the rapid breast MRI will replace current mammograms!

Chicken Pox Vaccine

Chicken pox is a relatively innocuous disease in children. Yet we now require vaccination. Many have wondered why this is?

In a recent study, researchers reviewed the incidences of complications of chicken pox since the vaccine use has become widespread. Although rare, there were cases of brain inflammation (encephalitis) and seizures with resulting permanent neurological damage with the disease; these do not seem to occur with the vaccine. As well, especially in adults, there were severe and often life threatening complications such as blood infections (sepsis), pneumonia, joint and bone infections and bleeding.

Furthermore, in people whose immunity is suppressed, chicken pox can be fatal. This includes HIV patients as well as many people undergoing treatment for cancer.

Based on our current knowledge, the vaccine for chicken pox (also known as varicella) is safer than getting the disease and spreading it.

Fasting for Lipid tests - Not that important?

Do Lipid Blood Tests need to be Fasting?

Most physicians recommend that you fast for 12 hours or so before checking your cholesterol or lipids. But is this absolutely necessary?

Researchers compared the LDL and HDL cholesterol levels as well as the predictive values of these in patients fasting and non-fasting and found there was little difference. We know that triglyceride levels are very sensitive to eating, but it seems that triglyceride lowering and levels are not useful in predicting or preventing heart disease.

Because certain foods can lead to high non-fasting sugar and triglyceride levels which can lead to repeat testing, you should try to avoid eating for at least 4 hours before a blood test, and avoid fatty foods the day prior.

A New Sleeping Pill - Not That Different

New drug for Insomnia - Is It Really different?

A new drug has been recently approved for insomnia. Suvorexant tablets (marketed as Belsomra), works on a different pathway than traditional sedatives and you will likely see a blast of TV advertisements.

But is it really so different? Yes and no - it does work on different pathways so may be effective in people in whom previous drugs did not work well. However it has many of the similar issues of existing medications.

It may lead to dependence so that you cannot fall asleep without it. In addition, it carries a risk for behaviors such as driving, eating, having sex, and making phone calls while not fully awake.

It may be marketed as "a new approach", which it is, but it really is not that different.

Fist Pumps and Howie Mandel - Preventing Infection?

Many of us have seen Howie Mandel shake hands with a fist pump; he has a phobia about germs and thinks that is a more hygenic way to say hello.
So researchers decided to test that out. And it is true! One of them (probably a medical student!) dipped his hand in a bacterial broth, then fist pumped, high fived or shook the hand of another who was wearing a latex glove. Then the glove was analyzed for bacteria.

A high five reduced transmission by 50% and fist pump by 90%.

I still shake hands; but wash frequently!

Fruits and Veggies Love us in Many Ways

I have often waxed poetic on the benefits of daily fruits and vegetables. And so researchers continue to publish studies showing how they benefit us!

In the latest study they found that the more fruits and vegetables people consumed each day (up to five total servings), the lower the risk for death for any reason.

In particular, for consumption of five servings versus no servings daily,patients had a 25% lower risk of death.

Two servings of fruit and three of vegetables appeared to provide the most benefits. Interestingly this was mostly related to cardiovascular death rates; there was no difference in cancer rates in this study (although there has been in others)

So perhaps Pink Floyd should change their song to "you can't have your pudding if you don't eat your fruits and vegetables!"