Category Archives: Dr. C “Comments”

Blood Pressure: What Is Hypertension? (Video)

Learning about hypertension can be intimidating. Leslie Thomas M.D., a nephrologist at Mayo Clinic, walks you through the facts, the questions, and the answers to help you better understand this condition.

Video timeline: 0:00 Introduction 0:39 What is hypertension? 1:13 Who gets hypertension? / Risk factors 2:18 Symptoms of hypertension 2:36 How is hypertension diagnosed? 3:14 Treatment options 3:51 Coping methods/ What now? 4:05 Ending

COMMENTARY:

Hypertension is an elevation of the blood pressure in the arteries. It is measured conventionally by blood pressure cuffs, although a catheter in the artery is more accurate. I’ve had my blood pressure taken countless numbers of times by nurses and doctors who sometimes put the cuff on my arm through a piece of clothing, making it less accurate. Sometimes it is taken by an automatic blood pressure cuff even in the doctors office. The automated cuff can be purchased for $20 or less for you to use it at home, but it’s accuracy is questionable when you have an irregular heartbeat with atrial fibrillation such as I do.

The blood pressure reading which is considered to be normal Is dropping. In the present video, following 2017 guidelines , they state that a systolic reading of more than 120 mmHg is elevated, and anything more than 130 is hypertension. It may be true that studies have been done to show that these slight elevations cause problems, but so can the drugs that are used to lower blood pressure; a cough can be caused by ACE inhibitors. Fatigue and fainting can be caused by an excessive dosage of any blood pressure medication.

Healthy diet, especially avoiding extra salt, Regular exercise and good sleep will go a long way towards keeping your blood pressure at 120 or below on the high reading (systolic), and 80 on the low reading (diastolic).

My systolic blood pressure varies between 120 and 140 systolic, and is usually around 60 diastolic. For a long time I thought the relatively low (diastolic) blood pressure was more important, since diastole is of greater duration than systole, but it has now been determined that the systolic blood pressure reading is the one to worry about. Calcification and lack of elasticities in the arteries as you get older can lead to higher systolic blood pressure.

It used to be thought that the normal systolic blood pressure was 100+ your age in years. Those days are gone, however, and greater life expectancy and health Is one result of carefully monitoring your blood pressure, and working hard to keep it down.

Please refer to the Mayo Clinic article to give you (much) more information.

—Dr. C.

Medical Conditions: Signs And Treatment Of Sepsis

Sepsis occurs when the body’s response to an infection damages its own tissues. When these infection-fighting processes turn on the body, they cause organs to function poorly and abnormally.

As sepsis worsens, blood flow to vital organs, such as your brain, heart and kidneys, becomes impaired. Sepsis may cause abnormal blood clotting that results in small clots or burst blood vessels that damage or destroy tissues. If sepsis progresses to septic shock, blood pressure drops dramatically, which can lead to death.

Nearly 270,000 people in the U.S. die each year as a result of sepsis, and one-third of people who die in a hospital have sepsis, according to the Centers for Disease Control and Prevention.

Signs of sepsis

To be diagnosed with sepsis, you must have a probable or confirmed infection, and all of these signs:

  • Change in mental status.
  • Systolic blood pressure — the top number in a blood pressure reading — less than or equal to 100 millimeters of mercury, or mm Hg.
  • Respiratory rate higher than or equal to 22 breaths per minute.

Signs of progression to septic shock include:

  • The need for medication to maintain systolic blood pressure greater than or equal to 65 mm Hg.
  • High levels of lactic acid in your blood, which means that your cells aren’t using oxygen properly.

Treatment

Early, aggressive treatment increases the likelihood of recovery.

A number of medications are used to treat sepsis and septic shock, including antibiotics, corticosteroids, painkillers and sedatives. Supportive care, including oxygen and dialysis, and surgery to remove the source of the infection, also may be needed.

People who have sepsis require close monitoring and treatment in a hospital ICU. Lifesaving measures may be needed to stabilize breathing and heart function.

Read more at Mayo Clinic

COMMENTS:

The hospital is a dangerous places to be, and the most common cause of death there is sepsis. Sepsis is an underappreciated killer, and it’s getting more common because people are aging, devices are more commonly implanted into the body, immunosuppressive treatment is being used more commonly, and hospital acquired infections are increasingly resistant to treatment.

Sepsis can be caused by an overwhelming infection with bacteria, but can also be caused by viruses, fungi, and severe trauma. Low blood pressure is a common  problem, and is associated with change in mental status, and increased breathing rate in raising a red flag for sepsis. Endotoxins play an important, if confusing, role. Endotoxins derive from Gram negative bacteria, but the most common bacterium causing sepsis is the gram positive staphylococcus aureus. With sepsis, though,the gastrointestinal tract may become more leaky, and Gram negative organisms may thereby gain  access to the blood stream.

A ccmmon test to detect sepsis is the serum lactate, which becomes elevated if oxygen utilization is diminished, such as in sepsis. There is also a direct test for endotoxin in the bloodstream, performed by using LAL, or Limulus amebocyte lysate. This substance, derived from the cells of the blood of the horseshoe crab, is very sensitive to endotoxins, and coagulates in its presence. This test is also used to detect endotoxins in Biological products and devices, making horseshoe crab is quite valuable.

Maintaining general health, keeping up on your immunizations, wishing your hands, keeping cuts and burns free from infection, ovoid smoking, controlling diabetes and avoiding hospitals whenever possible are useful preventative techniques.

—Dr. C.

Prostate Cancer: Its Signs And Advanced Symptoms

Prostate cancer is one of the most common types of cancer. Many prostate cancers grow slowly and are confined to the prostate gland, where they may not cause serious harm. 

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However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.

Prostate cancer that’s detected early — when it’s still confined to the prostate gland — has the best chance for successful treatment.

Prostate cancer may cause no signs or symptoms in its early stages. When it’s more advanced may cause signs and symptoms such as:

  • Trouble urinating
  • Decreased force in the stream of urine
  • Blood in the urine
  • Blood in the semen
  • Bone pain
  • Losing weight without trying
  • Erectile dysfunction

Read more

COMMENTARY:

PSA screening will pick up prostate cancer very efficiently. However, it will also pick up slow growing cancer that might never be require treatment, and responding to the positive test could cause problems ranging from pain and convenience to erectile dysfunction and incontinence.

It takes 1000 men screened to produce one life-saving treatment for prostate cancer.

Risk reward analysis means that the younger you are, the more reasonable is a test, since you have many more years of potential life. The older you are, conversely, the less you have to gain. The problem is that most cancers are slow growing, and might never cause a problem, especially if you have only a few years left to live.

Most experts recommend a test when a man reaches the age of 45, but reserve annual testing for those who are at high risk, such as having a brother or father with aggressive prostate cancer.

When a man reaches the age of 70, most experts would decline to test.

Sometimes, emotional considerations present themselves; worry is very much a disease. For instance, the best man at my wedding stopped getting his PSA test about three years before he was diagnosed with fatal metastatic prostate cancer. I am inclined to continue getting my annual prostate test, and would worry if I didn’t.

A recent study in the journal Cancer reported that more than half of a group of men 75 years and older had PSA tests and biopsies.

As an interesting aside, the PSA test is the only test I have ever had rejected by Medicare, presumably because of this expert opinion factoring in the cost benefit analysis of using the test.

—Dr. C.

Covid-19: China Approves The First Inhaled Vaccine

The vaccine, called Convidecia Air, changes the liquid form of the vaccine into an aerosol using a nebuilzer. The vaccine can then be inhaled through the mouth using the nebulizer machine. The needle-free vaccine “can effectively induce comprehensive immune protection in response to SARS-CoV-2 after just one breath,” Cansino said in a statement.

In July, Chinese scientists published a pre-print study showing that people who received one booster dose of Cansino’s inhaled vaccine after two doses of the inactivated jab from Chinese maker Sinovac developed more antibodies than people who received three Sinovac shots. Four weeks after receiving the inhaled booster, 92.5% of people had developed neutralizing antibodies for Omicron.

Those who got three doses on Sinovac’s jab did not demonstrate any neutralizing antibodies for Omicron, either four weeks or six months after getting a booster.

Read more

COMMENTS:

Spray vaccines will be our best chance to stop Covid.

However, there are two big problems that have to be solved.

The first problem is keeping up with the blitzkrieg mutation capacity that Covid has. Our best chance to do that is with the mRNA technology, which permits vaccine generation with minimal delay. However, mRNA vaccines are too fragile to be suitable for a nasal or oral spray. The particles would be destroyed before they could activate the mucosal immune system.

But it is still possible, using laboratory technology to convert this mRNA into peptides and proteins suitable for use as a spray. Using AI to generate three dimensional shapes, surely a  stable molecule of suitable configuration and stability could be eventually generated.

The second appears to have been partially solved by the Chinese, according to the Fortune  article, namely getting an injectable vaccine into a suitable form and dose to survive the bodies mucosal clearance mechanisms and enzymes, designed to keep foreign sprays and mists out of the body, in enough concentration to stimulate the mucosal immune system.

Our bodies have developed a parallel Defense system using a unique immunoglobulin, IGA, and  special support cells. When stimulated, immunity bristles as a first line of defense to deny incoming viruses entrance to the body. This is what is needed to prevent infection from occurring in the first place, so extremely important for a highly infectious and potentially lethal virus such as Covid.

The Chinese, with their autocratic system,  have a better chance of making everybody take this vaccine, even though it requires a cumbersome liquid nebulizer to generate the mist.

Better would be a handheld inhaler, and, hopefully, this is what some dozen pharmaceutical corporations, working on a nasal or inhaled vaccine , are aiming for.

—Dr. C.

Insulin Resistance: Risk Factors And Treatment

Learning about insulin resistance, or prediabetes, can be intimidating. Eleanna De Filippis, M.D., Ph.D., an endocrinologist at Mayo Clinic, walks you through the facts, the questions, and the answers to help you better understand this condition.

Video timeline: 0:00 Introduction 0:41 What is insulin resistance? 1:32 Who gets insulin resistance? / Risk factors 2:38 Symptoms of insulin resistance 4:04 How is insulin resistance diagnosed? 4:34 Treatment options 5:21 Coping methods/ What now? 5:41 Ending

COMMENTARY:

The (developed) world just has too much food. Food producers race with each other to make It tastier, to advertise it widely, and make it available on demand. As a consequence of their success, at least 1/2 of the developed world is overweight and has decreased insulin sensitivity, prediabetes or diabetes. This leads to severe health consequences in the form of hypertension, arteriosclerosis, heart disease, brain disease, liver disease, and a variety of back and joint problems.

Mankind did not evolve in an environment of chronic nutritional oversupply, but rather it’s reverse. Mankind did not develop in a sedentary environment, but rather it’s reverse.

Insulin resistance is caused by overfilled energy stores (excess fat), increased inflammation from distended, dying fat cells, excess fatty acids and stresses to some of the important micro structures in our cells, such as mitochondria and endoplasmic reticulum, not to mention metabolic pathways such as the mTOR and Sirtuin systems.

Eating is a pleasure, and turning down food takes self-discipline, which is a pain, and is becoming increasingly unpopular. “Maybe a pill will come along to get rid of fat and prevent its accumulation”. but don’t count on it. The main hope for avoiding the danger of overnutrition is being discriminating about what and how much you eat.

Exercise is inconvenient and uncomfortable, but is the second necessity for a healthy life. Two of its many benefits is to increase adiponectin, which increases burning of the fatty acids which are so toxic to the body, and to increase insulin sensitivity, counteracting type two diabetes.

The third necessity is getting enough sleep.

Replay the old record. Diet, exercise and sleep, sleep  diet and exercise.

Please excuse me, it’s time for my evening exercise.

—Dr. C.

For more reading visit: https://mayocl.in/3waShVV.

Infographic: Diagnosis & Treatment Of Psoriasis

Psoriasis is a skin disease that causes a rash with itchy, scaly patches, most commonly on the knees, elbows, trunk and scalp.

Psoriasis is a common, long-term (chronic) disease with no cure. It can be painful, interfere with sleep and make it hard to concentrate. The condition tends to go through cycles, flaring for a few weeks or months, then subsiding for a while. Common triggers in people with a genetic predisposition to psoriasis include infections, cuts or burns, and certain medications.

Treatments are available to help you manage symptoms. And you can try lifestyle habits and coping strategies to help you live better with psoriasis.

Website

COMMENTS ON ‘PSORATIC ARTHRITIS’:

My practice was restricted to allergy, but I saw many patients with psoriasis. The red scaly patches made them think they had allergic dermatitis, eczema. Psoriasis on the arm is usually located on the elbow, and atopic dermatitis on the opposite side, in the flexural area. Thick, pitted fingernails are also common in psoriasis. It’s combination with arthritis is worrisome.

Psoriasis will usually develop first, and the psoriatic arthritis will follow years later, but 10% of the time the arthritis Is the first problem. This form of arthritis can be very painful, and cause deformities. It is often worse than rheumatoid arthritis, although does not affect as many joints, and is often asymmetrical. It inflames the area where tendons attach to the bone, which is one of the reasons that it can be more painful than rheumatoid arthritis.

Psoriasis is an autoimmune problem and can involve practically any organ in the body.

It is often associated with metabolic syndrome and diabetes.

Psoriatic arthritis does not have the rheumatoid serum markers that can help diagnose rheumatoid arthritis, and unless psoriasis is also present on the skin, it can be hard to diagnose.

Symptomatic treatment with NSAIDs, physical therapy, phototherapy and topical treatments can be helpful, but very expensive biologics are sometimes needed to help out methotrexate and other first line DMARDs (Disease modifying antirheumatic drugs).

This condition can be  progressive.  If you develop scaly red patches on your skin, be sure to check with the doctor about the possibility of psoriasis.

—Dr. C.

Diet: Benefits Of Eating Blueberries (Mayo Clinic)

Blueberries might be the best example of how good things come in small packages. Dietitian Anya Miller says that includes protection for your heart, thanks to something called an anthocyanin – a compound in these berries that gives them their deep blue hue. Studies have shown eating foods high in these anthocyanins can help lower your risk of developing coronary heart disease. Besides the heart-healthy perk, that serving of blueberries will get you some vitamin C, dietary fiber and natural sweetness. That makes them blueberries a boost for physical and mental health.

COMMENTARY;

Anthocyanins are a member of the flavonoid plant-chemical family and are responsible for the red and purple colors of many fruits and vegetables. They are pleiotropic (Multi faceted )In their health benefits, and are good for diabetes and metabolic syndrome, obesity, cardiovascular disease,  inflammation, dementia and cancer. If this sounds almost too good to be true, the OPTIMAL AMOUNT of anthocyanins has not yet been determined. let’s hope that you cannot ingest too much of these marvelous substances, and that they don’t follow the path of vitamin C, an excess of which can prove detrimental to inflammatory defenses..

On the optimistic side, it’s been stated multiple times in the literature that antioxidant and free radical effects are just part of the benefits conferred by anthocyanins, and that the mechanism of benefit remains to be discovered.

Anthocyanins are present in blueberries, blackberries, bilberries, cherries, red cabbage and so many other fruits and vegetables. The benefits of a fruit and vegetable-based diet have been extolled for a long time, and I am buying into this narrative.

The large amount of fiber present in fruits and vegetables is an independent benefit, not to mention taking up space in the stomach that could displace red meat, saturated fat, and that great enemy of modern civilization, sugar.

Be sure to eat your fruits and vegetables as such, and not in the form of juices, which have the habit of being sweetened, or in the case of tomatoes, loaded with salt.

With fall coming on, also remember that anthocyanins form the basis for much of the brilliant reds and oranges present in the fall leaves; They nourish the eyesight along with the rest of the body.

—Dr. C.

Infographic: Acute Heart Failure (Nature Reviews)

Acute heart failure (AHF) is a syndrome defined as the new onset (de novo heart failure (HF)) or worsening (acutely decompensated heart failure (ADHF)) of symptoms and signs of HF, mostly related to systemic congestion. In the presence of an underlying structural or functional cardiac dysfunction (whether chronic in ADHF or undiagnosed in de novo HF), one or more precipitating factors can induce AHF, although sometimes de novo HF can result directly from the onset of a new cardiac dysfunction, most frequently an acute coronary syndrome.

Despite leading to similar clinical presentations, the underlying cardiac disease and precipitating factors may vary greatly and, therefore, the pathophysiology of AHF is highly heterogeneous. Left ventricular diastolic or systolic dysfunction results in increased preload and afterload, which in turn lead to pulmonary congestion. Fluid retention and redistribution result in systemic congestion, eventually causing organ dysfunction due to hypoperfusion. Current treatment of AHF is mostly symptomatic, centred on decongestive drugs, at best tailored according to the initial haemodynamic status with little regard to the underlying pathophysiological particularities.

As a consequence, AHF is still associated with high mortality and hospital readmission rates. There is an unmet need for increased individualization of in-hospital management, including treatments targeting the causative factors, and continuation of treatment after hospital discharge to improve long-term outcomes.

COMMENTARY:

High frequency sound (ultrasound) bounces off of tissues, like an echo,  and allows an electronic look at the heart. Doppler echocardiography is the doctors method of choice for evaluating a heart failure. One of the most important numbers determined by this method is the EJECTION FRACTION, which is a measure of heart efficiency. If the ejection fraction is low, let’s say below 45%, the heart is pumping out only 45% of its volume with each stroke, which means it must work harder to produce the same amount of circulation. The normal is about 60%.

This is the basis of SYSTOLIC Heart failure.

The test can also tell about blood coming into the heart; the early part of the blood entering is usually 80% of the total. If it drops, let’s say below 50%, it means the heart is stiff and resists blood coming in, which is the basis of DIASTOLIC heart failure.

FACES Is an acronym-mnemonic for the symptoms of heart failure. F is for FATIGUE.

A is for ACTIVITY LIMITATION. C is for CONGESTION in the lungs.  E is for EDEMA, or swelling, usually of the ankles and legs. S is for SHORTNESS of BREATH.

If you want to remember a bit about heart failure, think about echoes and faces. If your Doctor orders an ultrasound with Doppler, be sure to ask about your ejection fraction and percent of blood that enters early, before the “atrial kick”. Being informed is always a good thing.

To be honest, I have never encountered a person who was given a Doppler echocardiogram and could tell me what his ejection fraction was, but I am eternally hopeful.

—Dr. C.

Skin Cancers: ABCDE’s Of Melanoma (Mayo Clinic)

Moles are a common skin growth, and most are harmless. But changes in moles and other pigmented patches may be the sign of skin cancer, particularly melanoma.

When it comes to early detection, just remember the ABCDEs.

“A” is for asymmetry.

“You want moles to be perfectly symmetrical, such that you could put a mirror right down the middle of it and the image would look the same,” says Dr. Catherine Degesys, a Mayo Clinic dermatologist.

“B” stands for border.

“You want a nice crisp edge to these pigmented lesions and no scalloped edges or indistinct edges,” says Dr. Degesys.

“C” is for color.

“In general, you want moles to be a homogenous color and not have multiple different pigmented areas,” Dr. Degesys adds.

“D” represents the mole’s diameter. Pigmented lesions being greater than 6 millimeters potentially need further evaluation.

“E” is probably the most important, and that corresponds with evolution, says Dr. Degesys.

“Any pigmented lesion or any moles that are changing are something that really needs to be evaluated by a dermatologist.”

COMMENTARY:

Melanoma is a devastating disease, and must be picked up early to give you any chance.

The memnomic A-B-C-D-E is a reminder of the things you must watch in a dark freckle, or nevus, in order to suspect melanoma. Symmetry, border, color, diameter, and evolution reminds you of things that will alert you.

A-B-C is also a good mnemonic when it comes to evaluating an unconscious person, in order to address the order in which to proceed. Here, it is Airway, Breathing and Circulation. If the airway is blocked, it doesn’t matter whether or not the person is breathing, or the heart is beating, because if you’re not able to move air in and out of the lungs, the breathing attempts and heartbeat will do no good. Secondly, if you’re not breathing, the heart pumping will do no good. Another memnomic is A-B-CPR.

The third memnomic has to do with psychology. Here, it is Affect, Behavior and Cognition. Most activities of the brain can be put into one of these three different areas.

I’m sure there must be more memnomics in a world such as ours, and if you know of any, I would appreciate knowing about them.

—Dr. C.

Stroke Care: Deep Brain Stimulation ‘Pacemaker’ Restores Hand Movement

Deep brain stimulation for patients who experience a stroke.

Deep brain stimulation is a surgical procedure that involves implanting electrodes in the brain, which deliver electrical impulses that block or change the abnormal activity that cause symptoms. (Courtesy: Cleveland Clinic)

“He had limited use of his hand. It really wasn’t functioning,” explains Andre Machado, MD, PhD, who is Chairman of the Cleveland Clinic Neurological Institute. “He couldn’t do as much manual work, with both hands, and that was a limitation for his quality of life.”

For the study, Joe first underwent two surgical procedures — one to insert the DBS device under the skin of his chest, just below the collarbone, and the other, to implant the DBS electrode in a part of the cerebellum called the dentate nucleus. Once activated, the device, called an implantable pulse generator, serves as a specially-calibrated pacemaker for the brain, stimulating it to try and enhance motor rehabilitation.

COMMENTARY:

Many times in science, application precedes understanding. Deep brain stimulation, either by electrical or magnetic pulses is a good example.

It is not at all understood how the brain really works, much less how electrical and magnetic stimulation in the brain works. It may stimulate or slow down neural impulses, or interrupt the incoming signals or the outgoing messages. Are there any other possibilities?

At least it does work, Apparently.

One thing for certain is that deep brain stimulation is preferable to previous treatments, which produced small, destructive, irreversible lesions in the brain. At least these stimulations can be stopped if they don’t work.

I enjoyed this posting, since it reignited my interest in the cerebellum. This amazing Organ has more neurons than the rest of the brain combined, represented by innumerable small granule cells. I wasn’t even aware of the dentate nucleus, which is an island of cerebral cortex-like neurons in the white matter of the cerebellum. Apparently the action of the cerebellum is orchestrated through this and a couple of other islands of neurons. All of the coordination, movement, and thought processing accomplished in the cerebellum takes place through these nuclei.

It was also fascinating to learn of a patient who has complete lack of a cerebellum, and suffers only some mild incoordination and speech problems. Apparently, absent the cerebellum, the rest of the brain is largely capable of taking over the function of the missing cerebellum. Once the brain is formed, However, and dependent upon the cerebellum, damage to this organ causes a great deal of coordination, movement, and balance problems.

I’ll put another plug-in for sleep, diet and exercise, as well as being careful with your body. Prevention is far better than treatment.

—Dr. C.

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