Ever since the much-publicised double mastectomy by the famous Hollywood star in May 2013, there has been quite a bit of confusion by women as to whether removing both breasts surgically is the only answer to avoid getting breast cancer. Even today, my colleagues are still being asked this question frequently.
Here are some facts regarding this:
- Most breast cancers (90%) are not inherited.
- The inherited form, due to alteration in the BRCA genes, account for 5-10% of cases.
- Routine screening by BRCA testing is not recommended. The blood test is expensive, costing anywhere between USD 1000-4000 and takes about three weeks before results are known.
- BRCA testing is usually done where there is a related history of breast cancer. Indeed, there are specific indications for doing this test, e.g for women with two first-degree relatives with breast cancer below 50. For a full list of indications, see here.
What happens if the BRCA test is positive? As such people have a very high chance of getting cancer of the ovaries and breasts, there are a few options available. It does not necessarily mean that double mastectomy is the only way out. Other options include taking medications, more intensive and regular breast cancer screening and having both ovaries removed before the age of 40. The right decision involves the patient being fully informed and playing an active role in the decision-making process.
Whatever the decision, its important to execute it immediately as procrastination is the worst enemy. Jolie’s case highlights the importance of knowing one’s family history and learning one’s cancer risks in order to address them proactively.
Around one in 10 British adults mistakenly think coffee causes cancer,so says a survey carried out by the World Cancer Research Fund (see here). Nothing can be further from the truth – repeat, drinking coffee does not cause cancer. In fact, the benefits of coffee have been largely understated. Among the benefits include:
2.Reducing the incidence of Parkinson’s Disease and Alzheimer’s. Read “A Cup of Coffee a Day will Keep Alzheimer’s Away”.
3.Protecting against diabetes. Moderate consumption may lower the risk of type 2 diabetes in younger and middle aged women.
4.Preventing liver disease and the formation of liver and kidney stones.
5. Promoting alertness, attentiveness, and wakefulness.
But its not all good and no bad. Drinking excessive amounts (more than four cups a day) has been shown to accelerate osteoporosis as well as increase blood pressure, palpitations and even increase the risk of hardening of the arteries (a process called atherosclerosis). In some, coffee can cause heartburn, or GERD(gastro -esophageal reflux disease).
An important point to note is that there seems to be a health hazard in drinking unfiltered coffee (as in Turkish coffee and kahawa) as it raises blood cholesterol. Filtered coffee, as in instant coffee, does not do so, as diterpenes, responsible for raising cholesterol, are removed by filtration.
What about heart disease? The verdict’s not in just yet..on one hand, diterpenes cause a rise in cholesterol and homocysteine but this seems balanced by the beneficial anti-oxidant properties. As of now, there is no convincing evidence that coffee leads to heart disease.
Bear in mind that this discussion is based on just pure plain coffee. The scenario changes quite a bit with additives like milk, cream and sugar. For one thing, a cup of latte at Starbucks can contribute about 260 calories (as opposed to 0 calories in plain coffee). This is not to mention the health risks of added fats (and cholesterol) and sugar.
- So, Is Coffee OK, Doc? (doctor2008.wordpress.com)
I was prompted to write about this when, in the last week or so, a couple of patients presented with upper back-pain in between the shoulder-blades and dismissed them off as ‘muscular aches’. In both cases, they turned out to be impending heart attacks. So what kind of symptoms are produced when the heart’s in trouble?
The reality is not all heart attacks happen suddenly and dramatically as in a TV drama where you clutch your chest in pain and fall to the ground. In many instances, the warning symptoms appear but are ignored because they appear in unusual parts of the body and may fade off after a while, only to reappear again especially when the heart is stressed.
The classical symptom is that of central chest-pain or pressure, not unlike someone standing on your chest. But sometimes, the pain can be in unusual locations include jaw or teeth pain, leading to a visit (wrongfully) to the dentist. An alert dental surgeon can recognise the differentiating features and refer the patient on to the cardiologist for urgent attention.
Another location for heart-attack pain can be the so-called interscapular area (the part between the shoulder-blades), even without chest-pain. Often, the pain can be excruciating with possible pain-free intervals, leading one to a false sense of security with disastrous consequences; because time is crucial in such circumstances : the well-known ‘golden hour‘, named because early treatment during an evolving heart attack can mean the difference between life and death.
Pain need not always be present as a heart attack develops. Especially in diabetics, breathlessness can be the only symptom. Of particular note is progressive deterioration of stamina, such as walking up a staircase.
Getting treatment within an hour of a heart attack cuts your risk of dying from it in half, so it is important to get to the nearest Emergency Department of a large hospital in double-quick time. Sometimes it may be better to rely on one’s own transport than to wait for an ambulance if that’s going to save time.
Are there any useful measures to do while waiting to receive medical attention? Anecdotally, several maneuvers have been promoted on the Internet, many without a proven basis. There’s certainly no place for home remedies! Sitting up and facilitating breathing (loosening tight clothing) and at the same time calming the patient does help as it is well-known that anxiety aggravates the heart. If aspirin is available (even the ones for headaches), putting a tablet under the tongue will help to thin out blood and prevent clots from developing.
Personally, I have encountered several instances where people hesitate to go to the hospital for fear of embarrassment in case it turns out to be a false alarm. Others deliberately neglect to call help, fearing the worst, but hoping their inner fears may be wrong. In any case, an important rule of thumb is that it is better to be proven wrong at the hospital than to miss a heart attack. No medical staff is going to chastise you, for sure, if you’re wrong.
- 20 Classic Heart Attack Signs Never To Ignore (positivelygood.net)
I wasn’t too surprised reading the other day that health-related matters take up 2% of all queries on internet search engines. In fact, I thought the figure would be higher, judging from day-to-day conversations with patients.
The big question of course is: how reliable are the facts dished out on the Internet? Obviously, its important that these websites are reliable and churn out accurate information. Even so, healthcare information is complicated by a few other factors not related to the reliability of these websites, as explained later.
How do you identify reliable websites? First of all, as a yardstick, websites sponsored by the governments, not-for-profit health or medical organizations, and university medical centers are the most reliable resources on the Internet. Sites supported by for-profit drug companies, for instance, who may be trying to sell you their products, are usually not your best option. Also note that medical info changes rapidly with time and a look at the dateline of the article is important. Here are a few such sites:
Medlineplus.gov – sponsored by the National Institutes of Health and managed by the U.S. National Library of Medicine, MedlinePlus provides information on more than 900 diseases and conditions in their “Health Topics” section, and links to other trusted resources.
WebMD provides a wealth of health information and tools for managing your health from an award-winning website, which is continuously reviewed for accuracy and timeliness.
MayoClinic.com – owned by the Mayo Foundation for Medical Education and Research, this site is produced by more than 3,300 physicians, scientists and researchers from Mayo Clinic, and provides in-depth, easy-to-understand information on hundreds of diseases and conditions, drugs and supplements, tests and procedures.
Sometimes,even with reliable trustworthy information, its rather difficult for the untrained public to give due weightage to the complex info that is being bombarded onto them. For instance, when reading the side-effects of a particular medication, it is difficult to appreciate that not all the listed side-effects will invariably occur when one consumes the drug.
This is why its better to consult a doctor to obtain clarification. It takes years of medical training to adequately decipher fully what’s found on web health-sites and to fully appreciate its implications.
In fact, the over-reliance of info on the internet has given rise to a new condition called cyberchondria (aka internet self-diagnosis) – this refers to the practice of leaping to dire conclusions while researching health matters online. If that severe headache haunting you in the morning led you to the Web search-engine and a search on ‘headaches’ led to ‘brain tumours’ or ‘meningitis’, people tend to look at the first few results in the search-engine which forms the basis for them to probe further till they are convinced that they have a brain tumour. The likely diagnosis is probably cyberchondria than anything else! The phenomenon has become so pervasive that Microsoft did its own study on the causes of cyberchondria way back in 2008.
Some readers of this blog asked what they can do to prevent a stroke from hitting them. Plenty!
A very recent research study just released in the British Medical Journal by 4 authors, one of whom is a Malaysian classmate who now works in the UK, reveals 4 things that people can do to reduce the chances of getting a stroke by half.
The study, conducted in England involving 20,000 people over 11 years, showed that they could reduce the chances of getting stroke by 50% if they did all the following life-style measures:
- not smoking
- being physically active
- limiting their alcohol intake to not more than 14 units a week
- fruit and vegetable intake of at least five servings a day.
Apart from the above, it is well-known that the presence of the following risk-factors also predispose to stroke: high blood pressure, diabetes, high cholesterol, atrial fibrillation (irregular heart-beats), heart disease and certain blood diseases which cause clotting.
One does need to realise, however, that some risk-factors cannot be changed or eliminated. Try changing your age (the chance of having a stroke approximately doubles for each decade of life after age 55), sex (more common in men), your relatives( your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke) or the fact that you have had a previous stroke or transient ischemic attack (TIA, or warning strokes)!
The whole idea of getting away from stroke is to eliminate as many of the above risk-factors as possible and to lead a healthy lifestyle.
See my related article “Mending A Stroke In Time”.
Last month, it was reported that an American, Michael Boatwright was discovered unconscious in a Motel 6 room in California , but when he awoke could not remember anything about himself, recognize even his own reflection, nor how to speak English.
Even though his driver’s license says he was born in Florida and served in the U.S. Navy from 1971 to 1973, Boatwright has no memory of his life to date and now answers only to Johan and converses in Swedish to doctors with the help of an interpreter.
This brings to mind several similar cases in the past where apparently normal strangers have been seen to be aimlessly walking around in total amnesia, with no recollection at all on their name or background.
As in this case, the cause has been attributable to a medical condition called transient global amnesia – a sudden, temporary episode of short-term memory loss that cannot be attributed to conditions like epilepsy or stroke (which are known causes of temporary amnesia).
What causes this condition? Basically, any sudden stress to the brain, whether in the form of sudden immersion in cold water, physical strain, mental stress, head injury or even sexual intercourse. They tend to occur in those over 50 and who suffer from migraine. It is thought that in all of the above conditions, there is a temporary constriction of the blood vessels going to the brain, causing temporary brain malfunction.
The good news is that the condition is temporary and usually resolves within 24 hours. No treatment is required and the condition seldom recurs.
Back to Michael Boatwright. It turns out that the American had lived in Sweden in the 1980s where he learnt to speak good Swedish and was known as Johan Ek. He was identified by members of the Swedish branch of the Society for Creative Anachronism, where he was a keen participant of the group’s jousting team. So, mystery solved..
Its all very well for big pharmaceutical companies (pharmas) to release a new medication with a big bang , what with the enormous money invested in its research, development and production . However, not often enough, such new launches become unstuck when unexpected side-effects appear after a few months on the market, despite the most strenuous prelaunch testing and extensive marketing as a blockbuster-to-be.
Unexpected side-effects aside, what’s potentially more serious is when clinical trials (designed to prove a drug’s efficacy before its official launch) are falsified, thereby giving end-users erroneous data proclaiming (falsely) the drug’s efficacy. Such appears to be the case with regards to the Kyoto Heart Study.
What was the significance of this study? This study by Japanese scientists was greeted with great fanfare in 2009 and centres around the ability of a medication ,already extensively used for the treatment of high blood pressure, to reduce the possibility of getting stroke by 50% when used in high-risk patients. This was a milestone in drug treatment for hypertension and enabled the maker, Novartis , to make it one of the best-selling drugs in the world.
The drug itself, valsartan, which is marketed as Diovan has been on the market since around 2001 for the treatment of hypertension and belongs to the new group of ARBs (angiotensin-receptor blockers). In fact, its patent expired in 2012, thereby enabling any pharma to produce its own version, so-called generic drug.
And now the bombshell: Last Friday, Japan’s minister of health, Norihisa Tamura, as well as university officials at Kyoto Prefectural University announced that the Kyoto Heart Study data were “very likely” fabricated, Apparently, incomplete data was used and some of the scientific investigators were in fact employees of Novartis.
The reaction to this has been deafening. the respected European Heart Journal retracted the study from its 2009 issue. There has been widespread condemnation among medical circles, resulting in the resignation of the principal Japanese investigator from the Kyoto University, Dr Matsubara.
This episode puts into perspective the over-reliance of the efficacy of new medications on so-called landmark scientific studies, whose integrity may be subject to the temptations of big bucks and commercialism. Often, the losers are the consumers themselves.
Face-masks come in many shapes and sizes. One normally associates them with surgical masks, which is meant to prevent germs from the wearer contaminating the environment. However, the haze which is affecting Southeast Asia is another story..
The Southeast Asian haze event is caused by continued uncontrolled burning from “slash and burn” cultivation in Indonesia, and affects several countries in the Southeast Asian region because the prevailing southwesterly winds carry the pollutants across the water – see below.
What are haze particles composed of? Haze particles are predominantly made up of fine particles that are 2.5 micrometers or smaller. This means using an ordinary facemask, whether single-ply, 2 ply or 3 ply, hardly protects the wearer effectively from the haze particles Its designed to keep the germs in and should be worn by those having viral illnesses like flu. Nevertheless, ordinary surgical masks will reduce the inhalation of haze particles but NOT eliminate them completely.
To eliminate haze particles completely, one needs to wear a N95 mask (so-called because these masks eliminate 95% of particles as small as 0.1 micrometers (or microns). It must be tight-fitting and is rather uncomfortable to wear over long periods as extra effort is sometimes needed to inhale.
For this reason, the N95 mask is a must for those with lung problems, those with reduced immunity and those who have to be in the open for prolonged periods (like traffic cops).
For those who are otherwise healthy and stay indoors most of the time, ordinary surgical masks may be adequate. In all cases, adequate hydration is important mainly to facilitate the removal of the haze particles which have lodged in the lungs.
- Singapore’s Great Haze exposes limits of e-commerce (sgentrepreneurs.com)
If the latest manual in psychiatry is anything to shout about, ladies and gentlemen, we have quite a number of new mental illnesses to worry about. And maybe throw out a couple of outdated ones out of the window..
The Diagnostic and Statistical Manual of Mental Disorders, or DSM for short, lists these changes. The American Psychiatric Association released its revised fifth edition of the manual recently, which serves as the official authority on mental health diagnoses (and related insurance claims).
Among the new entries are:
Compulsive Hoarding– a pattern of behavior that is characterized by the excessive acquisition of and inability or unwillingness to discard large quantities of objects that cover the living areas of the home. Read more here.
Excoriation (Skin-Picking) Disorder– Under the group of obsessive-compulsive disorders, this condition is characterized by chronic picking and scratching of the skin that can cause wounds and scabs. The condition can be associated with other disorders involving compulsive eating, buying and stealing. The problem is often treated with antidepressants, anti-anxiety drugs or other medications.
Caffeine Withdrawal– People who are grumpy before they’ve had their morning coffee may welcome caffeine withdrawal to the manual as a legitimate mental affliction. A controversial addition, the new diagnosis directly reflects our increasing dependence on caffeine, from the proliferation of Starbucks outlets to the growing array of non-coffee energy drinks and caffeine-injected alcoholic beverages.
Social (Pragmatic) Communication Disorder- With this addition to the manual, psychiatrists can now more precisely diagnose speech and written language problems that are unrelated to autism. Indeed, while symptoms of this disorder, which must date back to childhood, include “inappropriate responses in conversation” and difficulty communicating, the diagnosis can only be made after autism spectrum disorders have been ruled out. These problems often hamper people’s social lives, academic careers and job performance.
A few entries in previous editions have been taken out. “Sexual aversion disorder,” for example, has been retracted from legitimate diagnoses because of “rare use and lack of supporting research,” according to the APA. By the way, as an illustration of changing times and how time changes society’s values, until the 1970s, the manual listed homosexuality as a disorder.
2000 calories..that’s what an average-sized man requires in one day. I found this interesting video and it helps explain why there is so much obesity around.