Monthly Archives: August 2020

Dr. C "Comments", Men's Health, Prevention, Women's Health

HEALTH: “COMPRESSION THERAPY” REDUCES CHRONIC CELLULITIS & LEG EDEMA

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New England Journal of Medicine (Aug 13, 2020) – In this small, single-center, nonblinded trial involving patients with chronic edema of the leg and cellulitis, compression therapy resulted in a lower incidence of recurrence of cellulitis than conservative treatment.

The researchers have conducted a single-center, randomized, nonblinded trial that aimed to find out an association between the compression therapy and controlled incidents of chronic edema of the leg and people with cellulitis that can be defined as an infection of the skin that involves subcutaneous tissues or the innermost layer of the skin. Cellulitis can be caused by trauma or scratching of other lesions due to animal or human bites that result in fever, extreme pain, and redness of the skin.

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COMMENTARY

I have been using compression stockings for decades, since the discovery of the difference in color of my feet. An evaluation by a vascular surgeon revealed incompetence in the valve of my left popliteal vein. It wasn’t long before I developed small varicose veins.

Comfortable with PREVENTATIVE MEDICINE after a career in ALLERGY, I started wearing Jobst compression stockings, with 30-40 mm of constrictive force. After a decade or so of daily wearing, my big toes started to overlap my second toes, and I began using toe-spreaders; scissor-toe and hammer-toe were my worry, and I wanted to prevent this discomfort.

After a while, I began to notice that the Jobst stockings tended to bunch my toes together. Also, with the developing arthritis in my fingers, it was increasingly hard to get the 30-40mm stockings on without straining my arthritic hands. I now wear OPEN-TOE 15-20mm compression Medi stockings, which are easier to get on, and don’t bunch up my toes.

I still use the visco-elastic toe spreaders. Now, back to the compression stockings for treatment of cellulitis complicating ankle swelling. Of course it works. Beta Hemolytic Streptococci and Staph aureus like nothing better to feed on than a warm pool of interstitial fluid, which is the juice that comprises the ankle swelling.

And BLOOD CLOTS tend to form in the stagnant pools of blood which aggregates in varicose veins, particularly when you are sitting for a long time, such as during a long airline trip. By all means, use compression stockings if you have ankle edema, or even a condition predisposing to ankle edema like varicose veins. Don’t wait for the complication to develop. Be PROACTIVE, and STAY HEALTHY.

–DR. C

Dr. C's Journal, Men's Health, Opinion, SLEEP, Women's Health

Dr. C’s Journal: A Little Bit About “Energy & Fatigue”

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Sometimes I wake up in the morning with a feeling of RELAXED ENERGY. My mind is clear, I have no fatigue, and believe once more that the world is wonderful, and it’s great to be alive.

I St-re-tch, exercise my hands (I have Osteoarthritis, and they are stiff), take out my Nite guard ( I grind my teeth at night and would otherwise wear them away), take my beta blocker eye drops ( to lower my intraocular pressure) and wash down my Eliquis ( an anticoagulant to prevent stroke from my Atrial Fibrillation) with 16 oz. of water, while thinking about all of the delights awaiting me.

Yes, my body was in better shape 60 years ago; but I had much more responsibility then, and much less discretionary time. All things considered, I like to believe that I am happier now.

The KEY is to stay in GOOD HEALTH. GOOD SLEEP is critical, but it cannot be had by willpower alone. As I have discussed previously, you need a bedtime routine, good SLEEP HYGIENE.

You also need a…….. GOOD DIET. with lots of fruits, vegetables and whole grains. Fatty, spicy foods will stay in your stomach and bother you at night, particularly if you eat Late. I like to finish eating by 5 PM. Late dinner is also likely to produce GERD, and maybe Sleep Apnea.

GOOD EXERCISE is also critical. If you are not tired at the end of the day, it is hard to get good sleep. I always seem to sleep better on the day when I walk the hills for an hour, which is 3 days a week. Try not to exercise within 2 hours of bedtime. Assuming that you have a good base of SLEEP, DIET and EXERCISE, there are other mechanisms that can foul things up. INFLAMMATORY conditions often cause fatigue.

The most common inflammatory diseases are OBESITY, METABOLIC SYNDROME and DIABETES. OBESITY is the defining disease of our EXCESSIVE SOCIETY, where there is too much of everything, and excessive consumption is relentlessly advertised everywhere.

External correction is probably a pipe dream, since there is no will even to Tax Sugar-containing Beverages, the “low hanging fruit” of dietary excess. Internal correction is all that is left, and that takes WILL POWER, also in short supply.

INFECTIOUS DISEASES are a subset of inflammatory conditions. COVID 19 is the poster child of infection, and FATIGUE is one of the hallmarks of the disease. Interleukins, like TNF-alpha, IL-1, andIL-6 are some of the defense factors which cause the fatigue. AUTOIMMUNE Diseases like Rheumatoid Arthritis and Lupus are also associated with fatigue-producing interleukins.

Fatigue even has its own flagship disease, CHRONIC FATIGUE SYNDROME. Chronic viral disease has been suspected as the cause of this condition, and inflammatory cytokines may be elevated. This condition, and the similar GULF WAR SYNDROME are still poorly understood. Several CFS patients were sent to me when I was in practice, and I had some success in getting them to exercise regularly, which seemed to help. CANCER is another category of diseases where Fatigue is prominent.

Inflammation plays a role in these diseases, which also drain energy substrates from the Patients body; Cancer cells have a high metabolic requirement. MEDICATIONS, Cancer meds especially, but a variety of other Drugs are associated with FATIGUE. I went through MY MEDICATION LIST. Lo and behold, 3 of them are associated with fatigue.

Finasteride is a relic of my prostate operation, recommended to keep it from growing back. It causes fatigue, probably because of its ANTITESTOSTERONE effect. At least I can still pee, and am not bald. I take METFORMIN because of its fame in prolonging life. Its mechanism is that of interacting with the Sirtuin system, and increasing the inefficiency of mitochondria. Isn’t this surprising?

Like many other things in physiology, you place a stress on the body, and the body responds by improving its performance. If you are fatigued, you exercise. Respecting the body works with drugs as well. If you are drinking a ton of coffee and stop it, after a few weeks you will feel less fatigued.

And when you ARE FATIGUED, you drink a LITTLE coffee, and it wakes you right up. Caffeine works by displacing ADENOSINE, which causes Fatigue as it increases through the morning, peaking at SIESTA (or tea) time,at about 2 PM. OMEPRAZOLE, which I take to prevent HEARTBURN, also is related to fatigue especially if it blocks MAGNESIUM for long enough. DEPRESSION overlaps with fatigue, as does SLEEPINESS, to increase the complexity of the situation.

Many chronic LUNG, KIDNEY and LIVER diseases are associated with fatigue as a secondary concern. STAY HEALTHY!

–Dr. C

Medicine, Men's Health, Women's Health

MEDICINE: LUNG CANCER DEATHS DROP AS TARGETED THERAPIES IMPROVE (NEJM)

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NEJM (Aug 13, 2020) – Population-level mortality from NSCLC in the United States fell sharply from 2013 to 2016, and survival after diagnosis improved substantially. Our analysis suggests that a reduction in incidence along with treatment advances — particularly approvals for and use of targeted therapies — is likely to explain the reduction in mortality observed during this period.

“The survival benefit for patients with non-small cell lung cancer treated with targeted therapies has been demonstrated in clinical trials, but this study highlights the impact of these treatments at the population level,” said Nadia Howlader, Ph.D., of NCI’s Division of Cancer Control and Population Sciences, who led the study. “We can now see the impact of advances in lung cancer treatment on survival.”

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Medicine, Men's Health, Technology, TELEMEDICINE, Videos, Women's Health

NEW MEDICAL TECHNOLOGY: UC DAVIS SCIENTISTS INVENT WORLD’S FIRST TOTAL-BODY PET SCANNER (VIDEO)

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UC Davis Health scientists Simon Cherry and Ramsey Badawi spent 15 years developing the world’s first total-body PET scanner, called EXPLORER. This imaging machine scans a patient’s entire body at one time, delivering breathtaking image quality that improves patient diagnoses and disease research.

UC Davis Cultivating Health blog: https://health.ucdavis.edu/cultivatin…

Dr. C "Comments", Medicine, Men's Health, Resources, Women's Health

INFOGRAPHIC: PROLONGED COVID-19 SYMPTOMS – “A MULTI-SYSTEM DISEASE” (BMJ)

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COMMENTARY

COVID 19 is a nasty disease, in case you hadn’t noticed. It is SNEAKY: you can catch it from a person who has no symptoms.

It is UNPREDICTABLE: you may develop no symptoms or Die from it. It can affect any part of your body, including HEART and BRAIN.

And now we hear that it can DRAG ON. The outstanding infographic, “a multi-systems disease, which is intended for PRIMARY CARE PROVIDERS, has a lot to offer patients, who can do a lot to Care for themselves:

  • –They can get a THERMOMETER and a PULSE OXIMETER to watch their own temperatures and oxygen saturations
  • –They can monitor their own COMORBIDITIES, like Diabetes and HYPERTENSION, which are common with severe Covid. In patients who get very ill .
  • –They can watch their GENERAL HEALTH, including SLEEP and DIET (the exercise part is relegated to DOCTORS recommendations).

You should also RESTRICT Alcohol, Caffeine and it goes without saying CIGARETTE SMOKING. Of course PREVENTION, with DISTANCING, MASKING and being Outside, coupled with SLEEP, DIET and EXERCISE is always best.

–Dr. C.

Men's Health, Opinion, Women's Health

DIETARY HEALTH: “SALT AND THE HUMAN CONDITION”

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Salt, so important to human health and disease, is also prominent in HUMAN HISTORY. Civilization has required it from earliest times. Cereal grains, the ‘Staff of life” is relatively low in SODIUM CHLORIDE, salt, making it a desirable food additive.

PRESERVATION of food before refrigeration required salt. Natron (Natrium is latin for salt, and Na is its chemical symbol) was the Egyptian city known for its salt. Salary was an income supplement to Roman Legionnaires for purchase of salt.

Salt, gold and slaves were prominent in north African trade, and salt was often as valuable, ounce for ounce, as gold. “Below the salt” in medieval times meant the “cheap seats” in Feasts; only the “high table” had salt.

SEA WATER was about 0.9% salt at the dawn of Life, and that is presently the salt concentration in EXTRACELLULAR FLUID.

TASTE BUDS are happy with salty foods, and one set is specialized to pick up salty favors. The 4 others are sweet, sour, bitter and umami. As you can see, these taste buds were pro-evolutionary in our paleolithic ancestors.

The extra salt, sugar, and fats that taste so good in our present modern, excessive society are over-generously supplied by capitalistic producers intent on enhancing sales. Portions keep getting ever larger to encourage us to eat more.

Salt supports BLOOD PRESSURE, and sometimes ER Patients in shock are given saline infusions. More commonly, HYPERTENSION is treated by salt restriction, as illustrated in the accompanying Infographic.

POTASSIUM is the most common cation in the INTRACELLULAR FLUID, just as Sodium is most common in the Extracellular fluid. Our bodies fastidiously defend narrow concentration limits of Sodium, Potassium and other electrolytes which are important constituents of the famous Milieu interieur.

It is interesting that the Sodium-Potassium ATP Pump requires a large percentage of the ENERGY used to keep us alive. This pump also keeps our cell membranes POLARIZED, so important in NERVE TRANSMISSION.

So eat a lot of NATURAL FOODS, high in potassium, and avoid the catsup, sauces and condiments that riddle our high sodium, Fast food, modern diets.

–Dr. C.