At one time, hormone replacement therapy (HRT) was routinely prescribed to any woman reaching menopause and asking for it, in an effort to prevent fractures,osteoporosis, dementia and other chronic diseases.
That was fine but recent developments have advocated the reverse – only women with severe symptoms of menopause like flushing,headaches and excessive sweating are given a short course to relieve the symptoms. Otherwise, HRTs are now not advised at all.
What is the evidence for the change in stance? The US funded Women’s Health Initiative, known as WHI, was halted in 2002 when initial results showed women taking a combination of estrogen and progestin had a higher risk of breast cancer, heart disease and stroke than women who received a placebo( or ‘dud’ pill). This marked a drastic shift in opinion, so that now, these combination pills are no longer advocated. Indeed, even oestrogen-only pills are now taboo.
You can find more facts about HRT here:
For alternatives to hormone therapy, see here: http://www.nhlbi.nih.gov/health/women/pht_facts.pdf
The fact that the Mediterranean Diet has led to lower rates of heart disease, stroke and cancer has been known for decades; and the latest study highlighted over the media recently (see here) is on the back of several similar studies done over the years. I had written about one such study in an earlier blog posting in 2008 (see here).
So how many more studies do we need before the guidelines on healthy eating habits are changed by governments from the low-fat high carbohydrate that is so widely advocated? Even in those countries where a greater awareness of what constitutes healthy eating exists, the end-product may not be what the consumer paid for – olive oil is adulterated and/or filtered, garlic is taken as a pill than a freshly-crushed clove and even red wine is not aged and commercially processed so that it is lacking in polyphenols.
The Mediterranean Diet – low in saturated fat and high in fiber and monounsaturated fat - includes vegetables, whole grains, fish, legumes, fruit, and moderate red wine, if so inclined. The main cooking fat is olive oil – pure unfiltered virgin olive oil is preferable, although the quality varies quite a bit commercially.
It is interesting to note that this oil has been around since time immemorial and its benefits mentioned by most of the world’s major religions, whether its the Muslim Hadith (“Consume olive oil and anoint it upon your bodies since it is of the blessed tree”), the Catholic church (“Oil of the Sick”) or the Jewish Talmud which states that frequent consumption of olive oil is good for one’s memory.
But behind the benefits of this diet, a more stark message is revealed: that the typical ‘Western Diet’ is the antithesis, with processing, additives and chemical substitutes causing many of the lifestyle diseases it is supposed to prevent.
- Mediterranean diet proven to reduce risk of heart disease (newsfixnow.com)
A serial cheat and liar he may be after his confession on the Oprah Winfrey show, but there’s no denying he’s a cancer survivor. In this blog entry, I would like to elaborate on what he suffered from – cancer of the testes with spread to the brain and lungs – and the chances of survival in patients with this condition.
In October 1996, after delaying seeing a doctor and after his testes had swollen up to three times the normal size( he was also coughing up blood), he finally sought a medical consultation which confirmed that he had advanced stage three testicular cancer, of the subtype embryonal carcinoma. Worse, the cancer had already spread to the lungs and brain. Immediate surgery was done to remove the diseased testicle as well as the satellite tumors in the brain. Subsequently, chemotherapy, an essential part of the two-step treatment, was planned.
Here, instead of the standard chemotherapeutic regimen (the BEP regime), he opted for one (the VIP regime) which did not contain the drug bleomycin, which has toxic effects on the lungs and would probably have meant that his cycling career would have been finished. The course of chemotherapy finished in December 1996, and in February 1997, he was declared cancer-free, which he apparently remains to this day.
An interesting fact to note is that, prior to the surgery, he had already won two Tour de France titles. Following the cancer treatment, he was recruited by US Postals, resumed training, and was able to win the Tour de France every year from 1999 till 2005, when he officially retired.
Quite an amazing feat, even if it was tainted by the use of performance-enhancing substances. I would be hesitant to call them drugs, as the alleged substances involved (EPO, testosterone , human growth hormone, corticosteriods and blood transfusions) are all part of normal body constituents.
So, is what Armstrong the cancer survivor experiencing something out of the ordinary? Unknown to many, testicular cancer has one of the highest cure rates of all cancers - in excess of 90 percent overall; almost 100 percent if it has not spread elsewhere. Even if the cancer had spread widely, as in Armstrong’s case, the cure rate is over 80% following chemotherapy. Indeed, it is the most common form of cancer in males aged 20-39 years.
- Editorial: Lance Armstrong, world-class liar (denverpost.com)
- Zero Worship: Did Surviving Cancer Make Armstrong a Hero? (psychologytoday.com)
Its the holiday season again, and many will be embarking to distant lands.. and with it comes the risk of exposure to new bugs (currently, the Norovirus virus outbreak is the vogue. Read more here.) Seasoned business travelers know that to reduce their chances of getting sick, its best to maximize the use of soap, water and hand sanitizer and minimize the number of times they touch their face.
Apart from that, what about other risks? Dehydration poses a greater risk, drying out the body’s natural defenses against germs. Avoid coffee and alcohol (no, its not a devious plan by airlines to reduce their beverage costs), which act as diuretics, and try to drink a cup of water an hour. Saline solutions can keep your nose and eyes moist, providing a barrier against germs. Dehydration makes the body’s defence mechanisms perform less efficiently and thus make the entry of germs easier.
While going around, preventing dehydration remains important, particularly in hot arid climates, where body water loss is not too obvious due to the absence of sweating.To avoid drinking contaminated water, watch out for recycled tap-water impersonating as bottled mineral water (look for a sealed cap). For that matter, possibly contaminated water could also be present in ice, uncooked salads and fruits that are eaten without peeling. These methods of reducing the odds of getting sick are important, as contaminated foods (due to agents causing infectious diseases) remain the number one killer of humans on earth.It is said that 80% of all infectious diseases are transmitted by direct or indirect human contact
Many air travellers claim they caught an infection from other passengers but, with the efficient air filtering systems of modern aircraft, where air is circulated 15-20 times per hour through efficient biofilters, chances of this happening is low unless the offending party is coughing and sneezing repeatedly within two rows of oneself.
At the hotel, I do recommend laying the bedspread aside, because it is washed rarely, and making sure the sheets are crisp and clean; if they are not, request another room. Check the mattress for bed bugs. Wipe down the telephone, night stand, remote control and bathroom with disinfectant. Disinfect the handle on the minibar fridge, and relax.
Indeed, various gadgets are available to make travelling safe – personal hand-sanitizers, personal air purifiers, UV scanners that destroy contaminants and the Silky Dreamsack, which “puts a layer between you and suspect bedding.”
All very exotic, but I would really recommend that the only cost-effective device that you will ever need is a bottle of hand-sanitiser..and refraining from touching your eyes,face or mouth. Not forgetting the ubiquitous mineral water bottle!
This being the end of another year, I thought it might be worthwhile to focus on the top game-changers in 2012, as far as the treatment of heart diseases are concerned. As a cardiologist, the rate of new advances in this field is bewildering and unless one were to update regularly, it is all too easy to fall behind..
The Polypill - the concept of a pill containing more than a single medication was first introduced in 2003, but the idea of adding several medications into one pill for people with multiple conditions have gained appeal in recent years. This year, it was shown at the American Heart Association meeting (the UMPIRE study) that a fixed-dose polypill that included aspirin, a statin (anti-cholesterol medication) and two blood pressure drugs, all rolled into one, were more efficient and improved compliance among people when compared to them taking 4 or more pills a day.
The Good Cholesterol - this year, more evidence were presented (the AIM-HIGH study)to say that increasing the good cholesterol (HDL-cholesterol) does not necessarily protect one better from a heart attack. However, it remains important to reduce the bad cholesterol (LDL-cholesterol) to reduce the risk for a heart attack.
Bypass vs BlowJob -if you’re diabetic and have multiple blockages in your heart arteries, then you’re better off going for a heart bypass surgery than subjecting yourself to multiple angioplasties.(the FREEDOM trial)
Bless the Generics -For years, clopidogrel (Plavix) , a blood-thinner pill used to prevent heart attacks and stroke among others, remained the second-most popular pill in the world..but at a premium: its high cost. Now, with the expiry of the patent, it is available at a quarter of its original cost.
Replacing a Heart Valve Without Open-Heart Surgery - replacing a diseased aortic valve in the heart via a tube inserted into the femoral artery (in much the same way as an angiogram) using an FDA-approved device offers hope for those who cannot undergo an open-heart surgery for various reasons. Transcatheter Aortic Valve Replacement (TAVR) is now an approved treatment.
New Side-Effects of Statins - many on these cholesterol-lowering drugs are familiar with the possible side-effects of muscle damage and impotence, but the FDA has issued a warning that it can increase both blood glucose and blood HBA1C levels (read: cause or worsen diabetes).
New Blood Thinners -for years, people have depended on warfarin although it is notorious for being difficult to give the correct dosage continually and requiring frequent blood tests. New blood-thinners like dabigatran and rivaroxaban are more efficient and do not need regular blood tests.
For the very first time, a supreme court has ruled that using mobile or cordless phones is directly linked to causing brain tumors, affirming what many scientists have been saying for years now about the dangers of cell phone radiation. The U.K.’s Telegraph reports that 60-year-old Innocente Marcolini, who developed a tumor in his trigeminal nerve, was ruled to have suffered this fate as a result of using his mobile handset for up to six hours every day for 12 years.
Italy’s Supreme Court in Rome, ruled that there is a “causal link” between Marcolini’s mobile phone use and the non-cancerous tumor that caused the entire left side of his face to become paralyzed. Experts provided evidence at a recent trial showing that the electromagnetic radiation emitted from mobile and cordless phones damages cells.
Though Marcolini’s brain tumor is non-cancerous, it still reportedly threatened to kill him because it had been encroaching on his carotid artery, which is the major blood vessel responsible for transporting blood to the brain. The tumor also developed directly next to where Marcolini typically held his phone next to his ear, illustrating how significantly mobile phone radiation can disrupt proper brain cell function.
In the face of repeated studies that there was no direct causative effect, this landmark ruling takes a new perspective on the possible dangers of prolonged mobile phone usage. To add fuel to the debate, last year the WHO ( World Health Organisation) urged limits on mobile use, calling them a Class B carcinogen.
International radiation biology expert Michael Repacholi said: “Studies show no evidence of cancer”. But he quickly adds : “If you are worried, use a headset, hands-free or loudspeaker.”
- Mobiles can give you a tumour, court rules (thesun.co.uk)
Some friends asked me how can they know when someone has a stroke and what they should do about it. Its summarised quite well on this chart.
A few words about the last point - stroke is a medical emergency. If given through the veins within three hours of the start of symptoms, a clot-busting drug called tissue plasminogen activator (tPA) can reduce long-term disability for the most common type of stroke, by dissolving the clot that caused the blockage. In some cases, the stroke may be completely cured. As this drug can only be given in hospital, its important to transport a person suspected of a stroke to the Emergency Department as soon as possible.
- Earlier Treatment with Clot-Busters Boosts Survival in Stroke (everydayhealth.com)
- Emergency Medicine: Recognize the Signs of Stroke (omtimes.com)
- Stroke Treatment – Why Every Second Counts (everydayhealth.com)
What happens when an internationally renowned child specialist working in one of the world’s best children’s hospitals is found guilty of sexually abusing young boys? The news barely made it into most of the world’s mass media 2 weeks ago..read on.
Prof Philipp Bonhoeffer, former head of cardiology at the Great Ormond Street Hospital for Children, London until 2010, was found guilty by a panel of the Medical Practitioners Tribunal Service on 21st September 2012 of sexually molesting young boys in France and Kenya. Read the full details here.
In a subseqent meeting of the Panel a few days later, it ruled that Prof Bonhoeffer’s fitness to practise was impaired by reason of misconduct and decided to erase him from the General Medical Council register, thereby barring him from practising as a doctor in the UK.
The punishment appears appropriate but some isuues need to be highlighted:
-Why did it take so long for the Panel to formalise the charges when the first reported abuse was as early as 1995?
-Was there any element of cover-up by peers or the hospital in an attempt to save face?
-Being struck off the GMC Register in the UK merely means being barred from working in that country. He is still able to practise in Belgium (where he hails from) as well as the Continent.
This case highlights once again that professionals, being placed in a privileged position as a member of the medical profession, are entrusted with certain reponsibilities for which they are beholden to uphold. When this trust is abused, mechanisms must be in place to protect this trust. The question is, are these mechanisms adequate?