Annual low-dose CT scans are now recommended for smokers with 20 pack years, who are over 50 years of age and have stopped smoking within the past 15 years.
The screening test is progressively becoming more advisable because of improvements in technology, such as endoscopic biopsy, and improved criteria to prevent overtreating false positives.
The advantage of the test is that cancer can often be caught early, at which time 60% is curable, compared to only 7% five-year survival if the disease has spread.
It’s startling to realize how a few people take advantage of this test, currently averaging only 6%. Family practitioners have been slow to embrace this valuable preventative screening, and the American Lung association has increased It’s outreach to doctors and patients alike.
Lung cancer is still the nations top cancer threat, killing upwards of 127,000 people in the United States each year, although the toll has lessened recently thanks to the declining smoking rates and new treatments.
Without an immune system, we wouldn’t be here. Even the simplest creature, like bacteria, have types of defensive systems.
However, as we learned with Covid, the immune system can become mistimed, and be a detriment. Covid retards the innate immune system, and unleashes it later on when it no longer serves a useful purpose and actually damages tissue. In certain illnesses, like the common cold, most of the symptoms are actually CAUSED by the immune system.
in the case of allergies, symptoms are caused by the operation of our th2 immune system against a harmless entity, like pollen. With organ transplantation, our immune system recognizes the transplant as foreign; it has no reasoning capacity to realize that the transplanted tissue is necessary for us to live, and to proceeds to reject the transplant.
In the case of the previous post, hydrocortisone, the prototypical shotgun that tamps down the immune system, benefited severe pneumonia.
With public health, immunizations, and a clean environment, infection is no longer the big killer is once was. Our immune system, designed to defend against a much more infectious world, is currently a real source of danger and disease.
Just like our coagulation system, once critical to stop the more frequent blood flowing in a violent world, Is now a bigger danger than ever because of our development of atherosclerotic blood vessel disease as we live longer.
Anticoagulants and anti-immunity treatments, some of them very expensive, are finding increased utility.
Please press the magnifying glass on the green field, and type in “immune system”. There are a number of previous posts of a more specific and detailed nature.
TB has been a gradually diminishing presence in the United States for decades, and currently there are only 2.4 cases per hundred thousand people in our country.
When I was in medical school, TB was still a big problem, and we learned about the fever, night sweats, weight loss and coughing up blood from active tuberculosis. With any of these symptoms, you should, of course, check with a physician.
These severe infections still happen but, currently, tuberculosis occurs primarily in immigrants from other countries, homeless people, prison inmates, people with Immune deficiency, such as cancel therapy and HIV infection.
TB is also more common in Asians, Native Americans and Eskimos, and Hispanics.
The Ordinary middle class American citizen these days is unlikely to catch tuberculosis, unless they are exposed to somebody that has an active, open case, more likely in people described above.
On first contact, the Tubercle bacillus is almost always controlled by the immune system. Most of these primary cases are without symptoms, and after a few weeks could be picked up by an immune blood test, called the T-spot.TB, or the skin tuberculin test. The chest x-ray can also show a spot on the lung with primary tuberculosis. it is with reactivation that the severe symptoms of secondary TB, described above, can occur.
My own inclination would be to get tested with exposure to any of the groups mentioned above, especially if they have a cough.
Incidentally, there was a dip in tuberculosis incidence during the contagion versus COVID-19 pandemic, showing one more advantage in avoiding big, inside groups.
Catching tuberculosis at the earliest possible moment still continues to be important, especially since long drawn out disease in individuals who have defective immune systems has led to the development of drug resistant organisms.
Can you imagine having breast cancer in the mid 1800s before the germ theory was developed? 50% of all surgeries died of severe infection at that time. Before the development of anesthesia, of course, cancer removal was extremely painful as well. Even if the patient escaped dying from infection, the one size fits all often meant removal of some chest wall muscles, leading a gaping wound.
Today, prophylactic breast imaging (mammography) often discovers the cancer at a very early and treatable stage.
Searching the cancer cells for rogue genes and surface markers often shows the way to better treatment; no longer does one size fit all.
Sometimes the breast lump is removed with minimal surgery and radiation is used, often yielding better results than the old time radical mastectomy.
Surgery itself is often aided by tissue biopsy, and now, with “intelligent” knives, gases from the surgical cut, using mass spectrophotometry, can tell the surgeon whether the tissue being cut is cancerous or normal.
Immunization methods are in development which will help your immune system to conquer any residual cancer, and “smart” T cells can be used to attack cancer cells directly.
Breast cancer Is still the most common cause of cancer deaths in women, even with all of the modern developments. Early detection is very beneficial, as with Breast self-examination and regular mammograms as prescribed by your doctor.
Extra care should be taken in families with certain genetic markers like like the BRCA gene.
Vitamin D Blood levels are seldom ordered by doctors, or demanded by patients, in spite of the fact that it is the “vitamin of the decade”.
Vitamin D is the sunshine vitamin, since the UVB light normally converts skin cholesterol into vitamin D. The white skin of peoples who migrated into temperate zones such as Europe was very likely a survival factor due to the low amount of sunlight in northern climates compared to the African tropics, and white skin permits increased vitamin D production.
Vitamin D is most famous as the factor that prevents the childhood bone disease “rickets”. The industrial revolution resulted in kids being in factories, getting insufficient sun exposure, and having an epidemic of rickets.
The Covid pandemic resulted in orders of magnitude more deaths among the elderly, especially those in sunless retirement homes. Eventually, vitamin D became implicated in immune deficiency, and the ability to survive Covid.
Vitamin D Is suspected as a factor in multiple sclerosis, tuberculosis, and even seasonal affective disorder, where there is a great increase in depression during the dark months of winter in extreme northern climates.
The NFL, ever striving to keep their players in top physical condition and accelerate recovery from injury, now supplements their players, and, I hear, requires blood levels of 60 ng./ml and above, more when they are injured. Vitamin D thought to improve muscle strength, and the rate of repair in muscle injury.
A lot of studies have failed to show the benefits claimed for vitamin D, but a recent large study from Harvard showed that the beneficial effects of vitamin D occur only among thinner individuals with a BMI of less than 25, which is a shrinking percentage of our population. It seems that already healthy people who are not overweight are the only recipients that can benefit from vitamin D, a fat soluble vitamin, which may be tightly held by the excess fat of overweight people.
Although I am waiting for more and better studies, I obtain yearly vitamin D blood levels. in fact, I was rather worried recently that my 5000 i.u./day supplementation might be excessive. Not so; it came back as 51 ng/mL The normal level is now considered to be above 30 ng/mL. This was determined in part by finding that the parathyroid hormone blood level was elevated with lower levels of vitamin D, and reached normal only at 30 ng.
How much is too much? It has been documented that most lifeguards in the summer have levels above 100.ng/ mL and there has never been Vitamin D toxicity based on with sun exposure as the sole source of elevation in vitamin D level. “
Getting your vitamin D by sun exposure can lead to skin cancers in later life, however, and my opinion is that VITAMIN D BY ORAL SUPPLEMENTATION IS SAFER.
Checking your blood vitamin D level should be done at least twice. Once to check the baseline, and, since most people in our mostly inside, sunscreen-using population will not have an adequate level, a second test to be sure that you are adequately and not excessively, supplemented.
Tuberculosis is an ancient killer, and is one of the few diseases that has been traced back to Ancient Egypt and beyond. TB has ravaged humanity for millennia, and was commonly called consumption due to its tendency to produce weight loss.
Once thought to be under control, TB has received a new lease on life with the emergence of AIDS. All countries except North America, western Europe, and Australia have a problem with tuberculosis, which kills more than 1 million people each year.
The tuberculosis germ is unusual in that It has a cell wall high in the lipid, mycolic acid. This protects the germ when it is engulfed by first responders such as macrophages. The infected cell Is surrounded by other macrophages, lymphocytes and Fibroblasts to form a granuloma. This creates a standoff, where the tuberculosis germ is still alive, but walled off, and becomes an inactive or “latent” case of tuberculosis, a small percentage of which become active each year.
Active tuberculosis produces the usual infectious symptoms of fever, chills, and cough, often productive with blood. The tuberculosis germ multipliesu much more slowly than most other bacteria and the symptoms are long and drawn out; a cough lasting for more than a month, especially if accompanied by weight loss, should raise the suspicion of TB.
TB can spread to infect bones, kidneys, liver, and brain, but prefers the lung.
A spot on the Lung, confirmed by a Tuberculin test, or a blood test called a T-spot, will confirm the diagnosis.
The slow multipication of the tuberculosis Germ requires much longer treatment, and the combination with AIDS has caused a rapid development of resistant organisms. Fortunately, there are several drugs available.
Only one immunization is currently available, namely BCG. This has been used a lot in Europe and other countries . BCG produces a weekly positive tuberculin test.
A large number of conditions which reduce immunity, such as cigarette smoking, drug use, and immunosuppressive treatments associated with organ transplants and cancer will predispose a person to catching tuberculosis. TV is transmitted in the tiny droplets from sneezing, coughing, or talking such as we were accustomed to thinking about during Covid. The same preventative measures, such as masks and avoiding close contact with infected individuals should be practiced to prevent spread from an infected person.
If you follow a healthy lifestyle and are careful when traveling, you will most likely have no trouble with this nasty infection. Please check with the following reference or more complete information.
HHT is a rare hereditary condition with abnormal connections between the arteries and the veins. it’s most obvious sign is little spidery blood vessels, which increase with age, most apparently on the lips, but more importantly in the nose, where they lead to the most common problematic symptom, recurrent nosebleeds.
The abnormal connections between arteries and veins, called arteriovenous malformations, most commonly affect the nose, lungs, brain, and liver.
The AVMs in the lung can short-circuit the blood circulation and lead to shortness of breath, as can iron deficiency anemia caused by the frequent nosebleeds, and bleeding from the G.I. tract. Liver nodules, detected by imaging techniques such as CT and ultrasound, can be helpful in confirming the presence of the disease.
The AVMs in the brain can cause headaches and seizures.
The diagnosis is often delayed, unless it is known to run in the family. HHT is often called the great masquerader because of the variety of problems it can cause.
Children of proven HHT should have genetic testing, since the symptoms and telangiectasia are often not present in childhood. There are also other genetic abnormalities linked to HHT that can produce such disparate things as colonic polyps.
If I had this problem, I would invest in a device to monitor my hemoglobin level so as not to slip silently into debilitating anemia. I might also invest 15 or $20 In a fingertip oximeter. If I were short of breath, and not anemic, I might have a pulmonary AVM which bypasses the lung and produces a decrease in the Oxygen saturation.
With respect to Nose bleeds, it is important to maintain an adequate hemoglobin, preferably above 12g, using oral iron on a daily basis, and if necessary supplemented by intravenous iron. It is also important to avoid medication and foods which cause increased bleeding. This includes the NSAIDs, fish oil, ginkgo, and St. John’s wort. News to me is the possible contribution to nosebleeds of blueberries, red wine, dark chocolate, spicy fruit and spicy foods. It may well be advisable to keep a food diary that that also records when nosebleeds occur. Perhaps you are eating something that affects coagulation that is not on the common lists. Take it with you to your doctor visit.
This is a rare condition, and should be evaluated in a medical center specialized to treat HHT.
CureHHT has some interesting information. My alma mater, UCSF, specializes in this condition.
Mayo clinic and the Cleveland clinic, as well as Wikipedia, have broader, more organized articles on HHT. A link to the former will be attached, and the latter is the most detailed.
Not too long ago, US government required pharmaceutical manufacturers to place an expiration date on their medications. The drug manufacturers embraced this requirement, since it added to their bottom line.
There are three cogent questions that should be asked:
Can outdated medications cause direct harm?
Do medications become ineffective after their expiration date?
How do you dispose of unwanted medication?
Most sites mention only two medications that can become dangerous as they age, tetracycline, and diclofenac. Neither finding is for certain, but its best not to take these medication‘s if outdated.
Everything degrades with time, and medications are no exception. Those that are compressed into tablets and kept in the dark and dry tend retain potency longer than those in liquid form. Certain medications, such as nitroglycerin and epinephrine are quite prone to oxidation; epiPen, In ready-to-inject needles, in particular should be fresh; Biologics in general should be current. Drugs that are exposed to water, warm or humid conditions, or that are crumbly or have an odor should obviously be discarded. Liquid medication’s of all types, such as eyedrops, should be carefully stored and within their expiration date. One of my eye medications, latanoprost, requires refrigeration, a sure sign of instability.
That being said, the US Army found that 90% of 100 medication‘s were still effective 5 to 20 years after their expiration date. Another study found that some retain their efficacy even after 10 to 40 years.
Another factor to consider is the danger of the disease that is being treated. If you have such things as heart disease, or a severe infection, You should exert greater care.
If you plan to get rid of medication, look around for an organization willing to accept them; Developing countries are looking for such medication.
Avoid flushing medication down the toilet, since it may enter the environment and be harmful to the ecosystem. Ideally it should be packaged in a container that is difficult to get into, so that children and other individuals may not have access; almost all medications are dangerous if taken in large amounts.
A lot of information is available on the Internet, with a variable amount of suggested precautions, depending upon the site.
I am a physician, and have taken many outdated medications In a pinch, but if I plan taking them for an extended time I usually get a new prescription.
You should get your flu shot this year. Not only has he influenza Genie been kept in its bottle by Covid precautions, and overdue for a bad year, but the H3N2 serotype circulating around is a good match for today’s vaccine; you may have been disappointed by the lack of protection in the past, due to the vaccine poorly matching the prevalent infecting serotype, caused by the rapid change of the virus and slow changes in the vaccine.
With RSV already making a comeback, influenza likely to be bad, and Covid likely a big problem also, You would be well advised to start going back to your masks, keeping your distance, avoiding large groups, and making sure your inside exposures are well ventilated, not to mention getting the most recent covalent Covid shot, which contains BA.1 and BA.2.
The common cold with running nose, sneezing, and nasal congestion, is usually caused by rhinoviruses, of which there are several hundred serotypes, although can be caused by any of the respiratory viruses. Whenever I traveled, I often came back with a cold because my immunity at home was based on the common rhinoviruses at home, and when I traveled, I encountered different types, to which I was not immune. Many other viral types can also cause the common cold including influenza, para influenza, and even coronavirus. In asthmatic children, the rhinovirus also produces an asthmatic response, often severe.
Croup in children is often produced by parainfluenza type one virus.
Bronchiolitis in children is usually caused by RSV. There is currently no vaccine for RSV.
Influenza, the “flu”, starts out with chills and fever, often settles into the lung. The influenza virus is usually the initiating culprit, but bacterial infection often follows. Coronavirus infection may start as “the flu” with the respiratory symptoms, such as runny nose, sore throat, and cough following.
Pneumonia is often produced by coronavirus, Especially the early strains. The more recent epidemic strains such as BA .1, Seem to have traded increased transmissibility for less lung affinity.
Avian influenza, H5N1 Is highly lethal with pneumonia, but you catch it from birds rather than people at the present time. Watch out if it ever starts spreading from human to human.
Most respiratory infections begin as a viral infection, which are not affected by antibiotics. Bacterial complications, such as otitis media, sinusitis, and pneumonia may follow, facilitated by the viruses, which lower immune resistance.
There are a number of antiviral agents, especially for coronavirus and Influenza. RSV may have effective treatments, which are needed particularly in babies.
The Achilles tendon, or “heel cord”, connects your calf muscle to the heel. Overuse can inflame the tendon, or even tear or rupture it, causing a lot of pain.
Sudden increases in intensity of exercise can be a cause. It is more common in men, and as you get older. Running a lot in the soft sand of the beach has caused problems in many of my friends. Achilles tendinitis can be caused by certain antibiotics, such as fluoroquinolones.
Varying your type of exercise, or cross training, distributes the strain you put on your body and decreases the likelihood of Achilles tendinitis. Swimming comes to mind with any disturbance of your lower extremities. The pool in which I swim three days a week is disparagingly called the “injured reserve pool” in my community Stretching before exercising is always a good idea. Pick a routine and stick with it, particularly as you get older. If you have flat feet, getting a slight lift for the heel may help to take tension off the Heel cord, and orthotics may help. Getting expert advice is always advisable.
Prevention is always far better than treatment.
If a short period of rest doesn’t get rid of the pain, check with your Doctor, who might examine the tendon, take x-rays, or order ultrasounds to check the extent of the difficulty.