Tag Archives: health

If You Must Mask, Mask Correctly

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..

facemask2

Facemasks come in different shapes and sizes..see if you can spot the two wearing the N95.

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.

haze map

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.

N95_Mask

A properly fitting N95 mask/respirator is effective in keeping out haze particles

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.

 

It’s a Mad, Mad World – 15 New Mental Illnesses

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 And maybe throw out a couple of outdated ones out of the window..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.

Compulsive hoarding – a form of obsessive-compulsive behaviour?


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.

Skin-picking disorder – a manifestation of anxiety and depression, say the psychiatrists.

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.

FourLoko – The drink packs the same punch as two cups of coffee and a six pack of beer.

social disorder

Communication disorders start in childhood and may persist to adult life.

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.

Say No to HRT

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.

menopause

Hot flushes are a common symptom on reaching menopause, not always needing treatment

osteoporosis-(1)

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:

http://www.nhlbi.nih.gov/health/women/index.htm

For alternatives to hormone therapy, see here:  http://www.nhlbi.nih.gov/health/women/pht_facts.pdf

So What Is the Mediterranean Diet?

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).

Mediterranean food pyramid

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.

olive oil

There are many grades of olive oil – extra virgin being the best

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.

 

New Drugs – How To Assess If They’re Effective

Reading the media, many are fascinated as to the plethora of new drugs claiming to provide a ‘cure’ against diseases which hitherto were considered incurable. Why, new drugs have even pervaded the social media – pharma companies have started posting widgets on Facebook in a bid to attract readers. Recently, FDA cautioned the drug company Novartis for overstating the benefits of a drug without pointing out the ill-effects (see here).

Social Media as a Marketing Tool – even Big Pharmas Use It

 

 

This rampant form of advertising naturally may confuse the public about the efficacy of new medications. In fact, its sometimes difficult to know the validity of claims made in the media.

Here are  some tips on how to evaluate the validity of medical news items that you may come across..

  • It is a fact that competition is intense among medical journals, research bodies and medical journals to attract media attention. Media themselves compete with each other to come out with the latest. Try to read the same news from several sources. Obviously, if the item is reported in just one obscure source, it should carry less weight.
  • Look for key-words like suggestive or may (as opposed to will) as this does not always indicate a cause and effect meaning. Many people make hard-core assumptions based on such words.
  • It is the nature of scientific studies that, for a given topic, several would say one thing and a few would say the complete opposite. It is for the trained professional and their peer-groups to make an informed decision to advise consumers. Bear in mind that space is a premium with the mass media and such reports usually omit vital details which will affect accuracy.
  • Separate the wheat from the chaff..make sure the website you’re looking at is a reliable one!
  • Personally, I feel reports originating from researchers and pharma companies should not appear in the mass media without vetting by an appropriate professional body so as to convey the proper perspective to the audience at large. So if a news report originates from a known professional body, this should carry a lot of weight; as opposed to a solitary item in a nondescript health magazine.

Lance Armstrong – Cheat, Liar & Cancer Survivor

armstrong1

Confession on TV..the body language speaks volumes

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.

armstrong2

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 testeshighest 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.

 

Travelling? Keep the Germs at Bay.

holiday traveller

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.

Abdominal pain,nausea,vomiting and diarrhoea -symptoms of Norovirus infection

Abdominal pain,nausea,vomiting and diarrhoea -symptoms of Norovirus infection

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.

The Silky Dreamsack..a bed bug barrier

The Silky Dreamsack..a bed bug barrier

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!

Have a great 2013!2013

Taking Better Care Of Your Heart..

 

game-changerThis 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 polypill2003, 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.

A box of Plavix

A box of Plavix (Photo credit: Wikipedia)

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.

tavr

TAVR – replacing the aortic valve without open-heart surgery

 

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.

 

 

 

 

Court Ruling: Mobile Phones Cause Brain Tumor

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.

WHO classified mobile phones as Class B carcinogens last year.

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.”

 

 

Stroke..A Timely Reminder

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.

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