Category Archives: Dr. C “Comments”

CDC INFOGRAPHICS: ‘HEAT STROKE & HEAT EXHAUSTION’

COMMENTARY:

THERMOREGULATION, preservation of the normal body temperature, is well developed in humans, and monitoring the body temperature has been useful since the development of thermometers.

Indirect measurement by Infrared detectors is being widely used today to detect FEVER as a sign of Covid in gatherings such as schools. Reactive increase of body temperature in a cool environment is a body defense mechanism that I have discussed earlier. Contrary to general practice, Fever, in my opinion, should be left untreated unless excessive, such as above 103 degrees F., or even 104 degrees.

Excessive environmental temperature, such as in a closed car, Jacuzzi, or heat wave can defeat the body’s ability to defend the normal temperature. Children, with their high body surface to mass ratio, are particularly at risk, as periodic newspaper articles testify. HEAT STROKE is the most serious of heat-related illnesses, leading to high and increasing body temperature, mental symptoms, even convulsions, and is a MEDICAL EMERGENCY.

The treatment is to call 911, and to lower the body temperature by removing insulating clothing, and immersing in cold water. There are a variety of other conditions based on excessive exertion, water or salt loss.

These include HEAT EXHAUSTION. Older Workers are particularly susceptible, and medical clinic attention may be needed for fluid and electrolyte replacement. MUSCLE CRAMPS and even damage( Rhabdomyolysis), FAINTING (this has been discussed before) and Heat Rash can result from too hot an environment. Furry Animals Pant instinctively to get their highly vascular Tongue to “air condition” their bodies. Humans should dress and exercise appropriately when the environment requires it.

–Dr. C.

VIDEOS: DIAGNOSING AND TREATING COVID-19 (MAYO)

Dr. Stacey Rizza, an Mayo Clinic infectious diseases specialist, discusses the various ways COVID-19 is diagnosed and treated.

COVID-19 can be diagnosed several ways when looking for active infection.

“The most common way that testing is done is with a swab into the nose or into the nasal pharyngeal area,” says Dr. Stacey Rizza, a Mayo Clinic infectious diseases expert.

“This polymerase chain reaction (PCR) test is essentially a test looking for the genetic material of the virus.” If it’s positive, it means that person is infected with SARS-CoV-2, the coronavirus that causes COVID-19.

COMMENTARY:

Dr. Stacey Rizza from Mayo Clinic gave the standard Academic recommendations for Covid Testing and treatment. I will comment on how this differs from the testing recommendations of Dr. Michael Mina from the Chan school at Harvard and the actual treatment given to Donald Trump as we speak.

I agree with the latter recommendations, and route that I would opt for, were I to catch Covid 19. TESTING, if it is to be Epidemiologically effective should offer results that are rapidly available so as to reduce spreading of the virus and treatment delay. One trouble with PCR- based tests is that they are slow. Another trouble, according to Dr. Mina, is that if they run for 40 cycles for maximum sensitivity, they may pick up viral shedding that is too minor to be infective, and may cause unnecessary precautions, such as quarantining. If they run for 35 or even 30 cycles to show only infective, actionable cases, they take several days, and even then labs do not usually report the number of cycles run, but only yes or no, positive or negative.

The RAPID TESTS detect viral protein are available within hours. They are less sensitive, but in Dr. Mina’s view, this can be a virtue, since only definitely infected patients are identified. They are cheaper, and can even be done on site. Frequent testing more than makes up for decreased sensitivity. Most tests currently available use only specimens from nasal swabs, which are uncomfortable.

SALIVA is almost as sensitive, and has one additional virtue, when it comes to testing school children. If school children are organized into learning “pods”, They can all spit into a common collector, and the pod tested preemptively, at least twice weekly. If positive The entire pod is individually tested to find who is positive. Of course if a full 20 kids are in a pod, The sensitivity of the protein test may be insufficient for positive to survive a 20-fold dilution, but this can be empirically worked out. Twice weekly testing vs. every other week is much better for reducing the number of the pod members infected at time of discovery, as the NYT has illustrated.

TREATMENT given to Donald Trump has so far consisted of more than Remdesivir. He is also receiving Corticosteroids, plus an experimental double antibody mixture, derived from both Covid Convalescent serum, and monoclonal antibodies from a “humanized” murine source. The antibodies should theoretically be given early. The corticosteroids are generally not given until a bit later, but with the reported drop in O2 sats, he may be later in the disease than we are led to believe. To my knowledge, he is not receiving his tweeted Hydroxychloroquine- azithromycin combination.

If I were infected, at age 88, I would also like the antibody treatment, but most likely would not be allowed to get it.

–Dr. C.

NUTRITION INFOGRAPHIC: “GOOD AND BAD FATS”

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COMMENTARY:

Water, the miracle molecule, proteins and fats are the very essence of life. Water does not dissolve fat, allowing for the cell membranes, and the compartmentalization of metabolic activity that allows life to happen.

FAT IS ESSENTIAL TO LIFE. Alas, all fats are not equally beneficial to nutrition, as the article stresses. Trans-fats, partially hydrogenated fatty acids produced mainly by industry, are the worst, acting to stimulate cholesterol synthesis, produce inflammation and damage the endoplasmic reticulum.

Their use has been banned in most countries. Saturated fat has been widely condemned, is not as good as the mono- and polyunsaturated fats, but not as bad as trans-fats. Some of life’s most delicious foods, such as cheeses, contain saturated fats, but it is best to keep down their consumption.

Remember that the first bite of something savory tastes the best; prevent habit from shoveling it down. Unsaturated fats are found in oily fish, which should be part of your diet.

Vegetables such as nuts, seeds, olives, and avocados are sources of “good fat” and should comprise 10-15% of your calories. Fats, compared to carbohydrates, contribute almost twice as many calories to your diet on a weight basis, and it’s easy to get carried away.

Total calories must be kept under control. STAY HEALTHY!

–Dr. C

STUDIES: “INSOMNIA / SHORT SLEEP DURATION” IS A TYPE 2 DIABETES “RISK FACTOR”

Diabetologia  (Sept 8, 2020) – Insomnia with objective short sleep duration has been associated with an increased risk of type 2 diabetes in observational studies [2728]. The present MR study found strong and suggestive evidence of a causal association of insomnia and short sleep duration, respectively, with increased risk of type 2 diabetes.

Conclusions/interpretation

The present study verified several previously reported risk factors and identified novel potential risk factors for type 2 diabetes. Prevention strategies for type 2 diabetes should be considered from multiple perspectives on obesity, mental health, sleep quality, education level, birthweight and smoking.

Read full study

COMMENTARY

This was a laborious and apparently objective study.

The discovery of insomnia as a unique risk factor is no surprise, and reinforces the restorative IMPORTANCE of SLEEP.

I was surprised to see docosohexanoic and Eicosapentanoic acids in the risk column and LDL in the good column. However they were studying type 2 diabetes, and not vascular health. I will continue to take my fish oil, and enjoy my HDL, which is in the good column.

—Dr. C.

STANFORD: RESEARCHERS FIND WAY TO “REGROW” NEW CARTILAGE IN JOINTS

The Stanford researchers figured out how to regrow articular cartilage by first causing slight injury to the joint tissue, then using chemical signals to steer the growth of skeletal stem cells as the injuries heal. The work was published Aug. 17 in the journal Nature Medicine.

“Cartilage has practically zero regenerative potential in adulthood, so once it’s injured or gone, what we can do for patients has been very limited,” said assistant professor of surgery Charles K.F. Chan, PhD. “It’s extremely gratifying to find a way to help the body regrow this important tissue.”

STANFORD MEDICINE (Aug 17, 2020): Researchers at the Stanford University School of Medicine have discovered a way to regenerate, in mice and human tissue, the cushion of cartilage found in joints.

Loss of this slippery and shock-absorbing tissue layer, called articular cartilage, is responsible for many cases of joint pain and arthritis, which afflicts more than 55 million Americans. Nearly 1 in 4 adult Americans suffer from arthritis, and far more are burdened by joint pain and inflammation generally.

Read full article

COMMENTARY

Stanford has come up with a Promising new approach to the surgical treatment of osteoarthritis. Unfortunately for the suffering public, this approach is still in the rodent experimental stage.

The pain of osteoarthritis is caused by the LOSS of the CARTILAGE which insulates the bone of the joints. The wonderful cartilage coating prevents the pain which would result from the rubbing of bone on bone. The best solution in osteoarthritis would be to replace the cartilage, and I have no doubt that this will be possible some day.

STEM CELLS is the theoretical method most commonly imagined when it comes to replacing lost tissue.. Brain cells, cardiac muscle cells, and pancreatic islet cells are some of the research areas. The development of stem cells from the cells of the Patient herself (iSCs) obviates the need for immunosuppression, which plagues allographs ( stem cells or organs from other humans).

Recently, in situ transformation of neighboring cells has been described, which sidesteps the need to introduce any cells. For instance the transformation of astrocytes (a type of brain cell) into neuronal stem cells of the dopamine lineage would be a great boon to Parkinson’s disease.

The Stanford method somewhat resembles this last-mentioned technique. An injury is created where the cartilage is desired. Like any injury, bleeding, clotting, and cell infiltration follows, destined to form a scar. However, the researchers added BMP-2, which in this milieu causes the pro-fibroblasts to head toward the bone (osteoblast) lineage. Since cartilage forms first in a tissue destined to be bone, they then added a VEGF antagonist, which interrupts the transformation in the desired cartilage stage. Both BMP-2 and anti-VEGF have already been approved for use, facilitating the development of this attractive therapy.

The researchers have even identified an excellent potential Patient Population: Osteoarthritis patients scheduled for surgical removal of the first metacarpal articulation with the wrist. They could do their procedure on this area, and if there is no benefit, They could just go ahead with the original plan of removal. The thumb happens to be one of my most painful arthritic areas.

I will most interestedly follow their research.

–Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #8: GOUT (GOUTY ARTHRITIS)

If you develop severe big toe pain in the middle of the night, and it is so tender that you can’t even stand the pressure of the sheet on it, you may have GOUT, an increasingly common form of ARTHRITIS.

And you would be in famous company: King Henry Vlll, Isaac Newton, and Benjamin Franklin all had Gout. There is even a famous dialogue between Franklin and his Tormentor.

Gout is caused by a buildup of URIC ACID in the bloodstream. This buildup can be caused by eating too much nucleic-acid-containing foods, like meats, “sweetbreads” and shellfish, and drinking too much alcohol, especially beer.

Reduced Clearance of Uric acid in the kidneys may contribute, and may be responsible for some of the familial tendencies of gout. The uric excess acid in the blood stream gets into joint tissues, most famously the big toe, although ankles, knees and other joints may be involved.

When deposited in joint tissues, the uric acid crystals attract inflammatory cells, which secrete their Interleukins and produce all of the symptoms of painful, red and swollen joints.

Risk factors include Obesity, diabetes, and the usual suite of problems of the METABOLIC SYNDROME. Just look at a picture of Henry Vlll with a mug of beer in one hand, and a leg of mutton in the other, and your big toe will start to hurt.

Dietary regulation is one of the best ways of reducing PURINE AND PYRIMIDINE intake and consequently the metabolic BYPRODUCT, Uric Acid, in the circulation.

There are DRUGS, called uricosurics, which will cause the kidneys to Clear more Uric acid, and other drugs, such as thiazide diuretics, which will reduce clearance and excretion of gout’s causative agent.

Yes, UNHEALTHFUL EATING CAN BE PAINFUL.

–DR. C

TOP NEW BOOKS ON AGING: “EXERCISED” BY DANIEL E. LIEBERMAN – “EXTENDING LONGEVITY” (HARVARD)

HARVARD MAGAZINE (SEPT – OCT 2020): From the book EXERCISED: Why Something We Never Evolved to Do Is Healthy and Rewarding by Daniel E. Lieberman, to be published on September 8, 2020 by Pantheon Books:

‘….many of the mechanisms that slow aging and extend life are turned on by physical activity, especially as we get older. Human health and longevity are thus extended both by and for physical activity.’

What Happens When We Exercise?
The graph breaks total energy expenditure (TEE) into two parts: active energy expenditure, and resting metabolism. Resting metabolism remains elevated for hours even after exercise ceases, burning additional calories in a phase known as excess post-exercise oxygen consumption (EPOC).

Exercise is like scrubbing the kitchen floor so well after a spill that the whole floor ends up being cleaner. The modest stresses caused by exercise trigger a reparative response yielding a general benefit.

In order to elucidate the links between exercise and aging, I propose a corollary to the Grandmother Hypothesis, which I call the Active Grandparent Hypothesis. According to this idea, human longevity was not only selected for but was also made possible by having to work hard during old age to help as many children, grandchildren, and other younger relatives as possible survive and thrive. That is, while there may have been selection for genes (as yet unidentified) that help humans live past the age of 50, there was also selection for genes that repair and maintain our bodies when we are physically active.

Daniel E. Lieberman is a paleoanthropologist at Harvard University, where he is the Edwin M Lerner II Professor of Biological Sciences, and Professor in the Department of Human Evolutionary Biology. He is best known for his research on the evolution of the human head and the evolution of the human body.

Read full excerpt from article

COMMENTARY

Daniel Lieberman, a Cultural Anthropologist from Harvard, makes the case that paleolithic hunter-gatherers Grandparents were helpful, in fact necessary to their families, and evolved to be active into old age. They did not evolve to sit in front of the TV, and modern men pay a penalty if they do.

INACTIVITY at ANY AGE is bad. If you put 20 year olds to bed, both weight and blood pressure go up. The book addresses a conundrum. Free radicals are bad. Exercise runs O2 through the mitochondria, which produces free radicals.

But EXERCISE REDUCES FREE RADICALS. A metaphor is introduced: you spill some tomato juice on the floor. But you clean it up, and the floor becomes cleaner than it was before. You exercise, the muscles suffer some microtears and injury. The REPAIR RESTORES the muscles to better than before, maybe with some extra mitochondria.

The Bodies MECHANISMS are MEANT TO BE USED. DIET is meant to supply the body energy and units for repair, EXERCISE is meant to use that energy, and keep the mechanism lubricated, and SLEEP is meant to allow for time to accomplish repair.

Sleep, Diet and Exercise can all be reconciled by recourse to Paleolithic man, whose activities imprinted our modern bodies.

–Dr. C.

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

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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Read NEJM Study

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

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.