Posted by & filed under Viruses.

VaccineAs a result of vigorous drug company advertising and recommendations made by several health organizations, many patients have come to me asking if I advise getting  the shingles vaccine.

Shingles, also called herpes zoster, is a painful rash occurring on one side of the body only. It usually involves the chest or abdomen, but may affect any area, including the face. Direct involvement of the eye, though uncommon, is a medical emergency, since vision may be permanently impaired.

Shingles is due only to reactivation of the chickenpox virus that has been dormant in the body, usually for years.  It does not occur by transmission from other individuals. Factors that impair immune function, such as physical or emotional stress, nutritional deficiency or steroid use, may activate the virus from its location within nerve cells, where it resides.

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Posted by & filed under News.

Source: New York Times Health

A new study of acupuncture — the most rigorous and detailed analysis of the treatment to date — found that it can ease migraines and arthritis and other forms of chronic pain.

The findings provide strong scientific support for an age-old therapy used by an estimated three million Americans each year. Though acupuncture has been studied for decades, the body of medical research on it has been mixed and mired to some extent by small and poor-quality studies. Financed by the National Institutes of Health and carried out over about half a decade, the new research was a detailed analysis of earlier research that involved data on nearly 18,000 patients.

The researchers, who published their results in Archives of Internal Medicine, found that acupuncture outperformed sham treatments and standard care when used by people suffering from osteoarthritis, migraines and chronic back, neck and shoulder pain.

“This has been a controversial subject for a long time,” said Dr. Andrew J. Vickers, attending research methodologist at Memorial Sloan-Kettering Cancer Center in New York and the lead author of the study. “But when you try to answer the question the right way, as we did, you get very clear answers.

“We think there’s firm evidence supporting acupuncture for the treatment of chronic pain.”

Acupuncture, which involves inserting needles at various places on the body to stimulate so-called acupoints, is among the most widely practiced forms of alternative medicine in the country and is offered by many hospitals. Most commonly the treatment is sought by adults looking for relief from chronic pain, though it is also used with growing frequency in children. According to government estimates, about 150,000 children in the United States underwent acupuncture in 2007.

But for all its popularity, questions about its efficacy have long been commonplace. Are those who swear by it experiencing true relief or the psychological balm of the placebo effect? Read more »

Posted by & filed under IPM News.

Urgency Incontinence TreatmentUrinary urgency incontinence is leakage of urine due to inability to control the urge to urinate. Patients simply cannot get to the bathroom soon enough. It differs from stress incontinence, which is the spontaneous loss of urine occurring with activities that increase abdominal pressure, such as coughing or laughing. Urgency incontinence increases with age, is more common in women than in men, and often reflects a weakness in abdominal musculature.

Involuntary loss of urine is a very unpleasant problem, causing embarrassment, avoidance of social activities and therefore isolation, impaired sexual pleasure, anxiety and depression. Kegel exercises to strengthen abdominal muscles are helpful if correctly employed, but most people require instruction in performing these properly.

Medications that reduce bladder contractions are often beneficial, but have significant side effects, including dry mouth, constipation, blurred vision and confusion. They may also cause urinary retention with increased risk of infection, especially in men.

A new, non-drug therapy is available, providing at least a 50% improvement of symptoms in 60-80% of patients. It is simple and virtually painless.

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Posted by & filed under General.

Doctor and PatientA patient goes to a doctor’s office with the belief that the doctor knows something, or has the ability to do something, that will help the patient. It is the doctor’s obligation to have knowledge, or have access to knowledge, relevant to the patient’s situation, or the training to perform a procedure to evaluate or treat the patient.

It is therefore important for the doctor to be educated in what he purports to know, to offer recommendations based on a satisfactory knowledge base. It is also important that the basis of a physician’s recommendation is the well-being of the patient, not the physician’s self-interest.

These conditions are by no means straightforward. Many types of approaches are available for most conditions, while other conditions have few proven therapies. Still, patients will always look for answers, for some kind of help, because it is not in man’s make-up to sit and do nothing in the face of adversity.

The doctor must keep in mind that a given treatment may not help the patient, or may cause complications and make the patient worse, or that the real diagnosis lies elsewhere. The age, physical and mental status of the patient must also be considered in choosing a therapy. Cardiac bypass surgery may be a proper choice for a 50 year-old, hard-driving businessman, but excessively dangerous for an 85 year-old woman with severe arthritis and emphysema. Determining the best therapy may more involve the art than the science of medicine.

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Posted by & filed under Hormones, Weight Loss.

Healthy ManTestosterone deficiency is commonplace, and closely related to age. Levels decline 1% yearly after the age of 40. We also see declines in men under stress, either emotional or physical, and in men taking psychoactive agents such as antidepressants, sedatives, as well as alcohol and other drugs, particularly narcotics.

Testosterone is easily measured with a simple blood test. Deficiency is variously defined, but levels under 300 ng/dl are considered low. Treatment with testosterone by transdermal gel, injection or subcutaneous pellet will raise blood levels, and restore energy, libido, muscle mass, bone density, and sense of well-being.

A recent study reveals a further benefit with weight reduction and lower waist circumference. These improvements were progressive over 5 years, not limited to a few months after starting therapy.

The study, reported at the annual Endocrine Society meeting, involved 255 men averaging 61 years of age. All were obese or overweight. Testosterone levels normalized with long-acting intramuscular injections. Mean body weight dropped 16 kg (35 lbs) over 5 years. Waist circumference dropped an average of 8.8 cm (3 ½ inches).

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Posted by & filed under Cancer.

The US Preventive Services Task Force has recommended against routine PSA screening in men for prostate cancer. The recommendation was based on the conclusion that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” Large studies had revealed either no or very small increases in survival from screening in patients followed for over ten years. In a European study, results showed that in men aged 55-69, screening prevented only 7 deaths per 10,000 men followed over 9 years. In older men, screening is even less useful. Moreover, screening often leads to prostate biopsy with negative results, with complications of pain, infection and bleeding. Subsequent elevated PSA readings lead to additional biopsies with further complications. I have seen patients who had three prostate biopsies performed, all negative for cancer.

The incidence of cancer within the prostate is high, and increases with age. A 50 year-old man has about a 50% chance of having cancer in the prostate, while an 80 year-old man has an 80% chance. Many of these cancers, however, are indolent, do not metastasize, and will not cause death if untreated. Unfortunately, we have no easy way of determining early which individuals have aggressive cancer.

How will this recommendation translate into action in the real world? Will patients not want to have a PSA test? Will doctors recommend against it? Will insurance companies refuse to pay for it? Will lawsuits occur when patients who were not screened develop invasive cancer and die? I think it is unlikely that PSA screening will drop into obscurity, especially when it is compared to the ritualistic frequency of mammography screening, which the Task Force has recommended not be initiated until the age of 50, then performed every two years until the age of 75, and discontinued.

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Posted by & filed under Cardiovascular.

Aortic stenosis is a narrowing of the aortic valve by calcification, usually occurring in older people or those with congenital defects in aortic valve formation. When the valve gets too narrow, the heart has to pump extra hard to force blood into the aorta and into the rest of the body. Eventually heart failure, chest pain or passing out will occur, ultimately leading to death unless the valve is surgically replaced.

Until now, older people who were too ill to undergo open heart surgery to replace the valve would die. A new procedure has arrived, allowing for valve replacement without opening the chest and putting the patient on a heart-lung machine. A special catheter is threaded up the aorta from entry in the groin artery. An artificial valve at the end of the catheter is placed carefully and exactly within the orifice of the aortic valve, then expanded by inflation of a balloon. The calcified natural valve is pushed against the sides of the aorta, and the new valve is fixed in place, allowing for a larger passage. Read more »

Posted by & filed under General.

DoctorsWhether it is alternative or allopathic (conventional), bad medicine is just bad medicine. We have patients who take no prescription or over-the-counter medication at any time. We see others who are taking 10-12 medications at once, who are interested in getting off as many of them as possible. They know that prescription drugs can be and often are toxic, and they experience those adverse effects. Certainly we deplore situations where patients enter the hospital with chest pain and are discharged with eight new medications, with no detailed advice on beneficial life-style changes, and told not to eat vegetables because they are on Coumadin.

There are times, however, that prescription drugs are useful and even life-saving. There are times when surgery can save a life, as in the evacuation of a subdural hematoma, and times when it is massively destructive, as in prefrontal lobotomy for psychiatric disorders.

I have seen physical therapy employed when the cause of pain was obvious but undiagnosed malignancy, herbs employed for critical aortic stenosis that needed surgery, congestive heart failure treated with acupuncture. The list goes on, and indeed every practitioner in every field of medicine has failed at some point to make the right diagnosis, or has offered the wrong therapy, or failed to offer the right therapy. Conventional practitioners are for the most part untrained in alternative therapies, and often demean them, while alternative practitioners have limited training in conventional diagnosis and treatment. Read more »

Posted by & filed under Cancer, Nutrition.

Vitamin C DripIntravenous vitamin C has a storied past. Not at the time identified as the active therapeutic component, vitamin C in citrus fruits was demonstrated by James Lind in 1747 to prevent scurvy in sailors. Citrus fruit therapy had been inconsistently utilized for 500 years for the same purpose, but was not officially acknowledged and promoted by the British admiralty until 1785, 50 years after Lind’s great experiment. During that interval multitudes of nutritionally deprived seamen suffered and died from a preventable disease Scurvy caused gastrointestinal, skin and mucous membrane bleeding, skin rashes, loss of teeth, fatigue, depression, and poor wound healing. Oranges and limes, high in vitamin C, were the answer.

Linus Pauling, a world famous chemist and beneficiary of two Nobel prizes, began studying vitamin C in 1966, after discussions with Irwin Stone, another researcher. From his work came the recommendation of vitamin C for the common cold, an idea repudiated out of hand by the medical community. He later studied intravenous vitamin C as a treatment for lung cancer, with survival rates months longer than for patients who did not receive vitamin C. Read more »