All posts by doctorswithoutwaitingrooms

EMPOWERING PATIENTS THROUGH EDUCATION AND TELEMEDICINE

Cancer: High-Intensity Focused Ultrasound


Focal One® high-intensity focused ultrasound uses high-intensity sound waves to destroy a cancer tumor. It’s delivered through a rectal ultrasound probe. There are no incisions. Most patients need no pain medication after treatment. And there are fewer side effects than with radiation therapy or prostate removal.

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COVID-19: ARE VACCINE INCENTIVES PAYING OFF?

Across the country, states are shelling out incentives ranging from free beer to $1 million lotteries to encourage residents to get their Covid-19 shots. But is the effort to boost vaccination rates working? And is it worth the cost? Photo composite: Adam Falk/The Wall Street Journal

INFECTION: OPPORTUNISTIC INVASIVE FUNGI EXPLAINED

Fungi are in the outside air, the inside air, and even the air of isolation units In hospitals. The normal human respiratory tract is able to breathe these fungi in, have them deposited on the mucous membrane surfaces and have no problem. The normal respiratory membranes, with their associated cleansing cilia and normal mucus production are able to sweep the invaders out without sustaining any harm.

Problems arise when the respiratory tract is functionally or structurally abnormal, such as in cystic fibrosis, bronchiectasis and COPD. Immunocompromised conditions have been increasing in frequency with the improvement in medical care in recent years. Intravascular catheters and sensors can provide a resting place for pathogens including fungi, as can cavities, scars and other damage to the lung. The immune system may require suppression to accommodate an organ transplants or ameliorate autoimmune conditions.

Cancers, especially of the hematologic or lymphatic system, such as lymphomas, pose a definite problem. Severe burns and  malnutrition may weaken the immune system, as may Viral infections, especially AIDS, and more recently COVID-19. More subtle immune problems may arise with diabetes, Obesity, or even a lack of sleep and exercise.

These and other conditions give the fungal infections the OPPORTUNITY to invade the body, and a few dozen of the thousands of species of fungi proceed to do just that. Opportunistic fungi often have special features, depending upon the species. Most prefer the respiratory tract, and if they get in to the bloodstream can go to their favored spots.

Aspergillus, and coccidiomycosis , for instance, prefer the lung. Mucormycosis often involves the sinuses and eyes. Blastomycosis can involve bone. Sporothrix is often found infecting the skin.

Symptoms depend upon the area involved. Of course if it’s a respiratory tract, you have coughing, mucus production, sometimes shortness of breath. With the central nervous system you have headache and confusion. You can see the involvement in the skin.

The number of drugs available to fight fungal infection is fairly limited, and currently involves only three different classes. Many fungi are resistant to one or two of these classes, and can be problematic.
However, fungi do not as a rule spread through the air from person to person, and a true epidemic would be unlikely.

—Dr. C.

Dr. C’s Journal: What Is Huntington’s Disease?

Degenerative neurological diseases are particularly horrible. They affect the brain, the very essence of our humanity. Moreover, almost all of  these conditions have no satisfactory treatment. Alzheimer’s, Parkinson’s, and Huntington’s disease come to mind.

Much more is known about the genetics of Huntington’s  than any other aspect of the disease. The problem is due to CAG repeats, which either crowd out or distort the function of the Htt protein.

If a child of a Huntington family anticipates having children, intervention to prevent transmission, such as artificial insemination and eliminating any zygotes containing the Huntington Gene will prevent the children from inheriting the disease.

Huntington’s is considered to be inherited by a somatic dominant Gene. This gene codes for a number of CAG repeats in excess of the normal number, less than 35. However the number of CAG repeats tends to increase with each generation, and it is possible for parents with somewhat less than 35 repeats eventually to produce the disease in their offspring.

As in any degenerative brain disease, the focus of medical treatment is on neurotransmitters. This is because neurotransmitters can be studied and used as the basis of medical treatment that lessens the effects of the disease. In the case of Huntington’s, dopamine, glutamate and acetylcholine  have all been implicated, although transmitter balance is probably more important, and changes with time.

Neural malfunction, however, is where the true pathology lies, and all neurons, especially those of the Corpus stratum and Cerebral Cortex contain Htt and are eventually involved, Leaving a shrunken brain that loses much of its substance and function.

The symptoms begin as a movement disorder, and initially was called Huntington Chorea, because of the abnormal “Dance-like”  movements of affected individuals . Eventually, psychiatric, intellectual and other symptoms occur which  span all areas of the brain.

Today, after swimming, I encountered a man whose brother has Huntington’s disease. So far he has been spared. He is part of a study of Huntington’s Disease Families. He denies knowing anything about his genetics, and indeed does not want to know, Nor would I in his situation, since nothing can be done to affect the basic progress of the disease.

Please refer to the accompanying meal clinic article for more information about Huntington‘s disease.

—Dr. C.

Mayo Clinic Article

Telemedicine: Mayo Clinic Otolaryngology (Video)

The department of Otolaryngology offers telemedicine as a safe, secure and convenient way to consult with our care teams. Advanced planning, follow up visits and attending a consultation from a distant with a family member are beneficial ways to utilize telemedicine. See here for information on our clinic and specialty groups related to the department of Otolaryngology. https://www.mayoclinic.org/department…

Otorhinolaryngology is a surgical subspecialty within medicine that deals with the surgical and medical management of conditions of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, head and neck surgeons, or ENT surgeons or physicians.

DR. C’S JOURNAL: TIMING IN HEALTH AND MEDICINE

Timing is important in everything we do, and of course is important to health and how our bodies function.  It is a vast subject, and the only thing I can do here is to give you some ideas that might be helpful.

Your body will perform best for you if you have a daily routine; waking up at the same time every morning, and going to bed at the same time every evening keeps your circadian rhythm from getting confused. Of course, getting a good nights sleep is excessively important to your health. If you have trouble going to sleep at night or staying asleep, you can get all kinds of information over the Internet on “sleep hygiene”.

If you are an international traveler, jet lag is very important because the circadian rhythm is disrupted when you change time zones. The Internet is a rich source of information on how you might or rapidly get back into your routines. Timing of bright light and melatonin are involved.

Your metabolism also has a routine, and drugs work by targeting certain receptors, which cycle, depending on when their function is needed. “ Chronopharmacology” is a slowly developing science that will someday-if doctors, perhaps with electronic help, can ever get enough time to properly take care of the patients- be very important. As an example, certain cancer therapies vary significantly in their effects, depending upon the time of day they are given.

When I was a practicing Allergist, I took care of many Asthma patients. In the 60s and 70s there were few drugs to treat asthma, which is predominantly a nighttime disease. Giving medications, such as Theophylline, at the right time was therefore very important.

Finally, if you have any choice, you might arrange for your surgery during the first half of the day. Surgeons make less errors in the morning, when their minds are well rested.

—Dr. C.