#MayoClinicMinute: #Flu during #COVID19 pandemic. "It's very hard — almost impossible — to distinguish the two just based on symptoms … So really, the only way to know for sure when you have a respiratory illness is to get tested," says @PSampathkumarMD. https://t.co/1Dpx6VNIcp pic.twitter.com/YWjrbzptO1
— Mayo Clinic (@MayoClinic) October 12, 2021
Category Archives: Medicine
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #58: SPINAL STENOSIS
Spinal stenosis is a narrowing in the spinal canal. Constriction of the spinal nerves can produce pain that goes down one or both of the arms or legs, depending on the location of the stenosis. Malfunction of the nerves can cause numbness In the arms or legs, or weakness in muscles served by the affected spinal nerves.
Your doctor can confirm the diagnosis with imaging techniques such as MRI or CT scan.
The interesting part of this condition to me is the tremendous advances in surgical techniques that have taken place in the past decade. Many surgeries are now done through an endoscope, which limits the surgical disruption in the area. There is even a needle guided procedure to remove part of the ligament that is causing compression of the nerve.
Depending on the exact problem, small amounts of bone or other tissues can be removed, especially if the exact site of compression has been identified. If the extent of compression is more extensive, increasing amounts of bone is removed from the lamina (bony arches), facets , or nerve outlets (foramina) to give the nerves more room.
If there is slippage of the vertebra, a fusion is sometimes done. My understanding is that fusion is becoming less common. That being said, the Cloward procedure in the neck, with its approach from the front, is still sometimes used with neck pain.
Pain in the neck or back without any associated nerve malfunction is often best treated with physical therapy, steroid injections, or other conservative methods.
In my opinion spinal surgery is best done by trained neurosurgeons, who are familiar with minimally invasive surgery.
—Dr. C.
DOCTORS PODCAST: MEDICAL & TELEHEALTH NEWS (OCT 9)
A weekly podcast on the latest medical, science and telehealth news.
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #57: SCOLIOSIS
Scoliosis is a curvature of the spine most commonly starting in childhood or adolescence. The cause can be a muscle imbalance from cerebral palsy or other muscle problems, a birth defect, an injury, or sometimes there is scoliosis that runs in the family and is hereditary. Occasionally it is caused by a difference in the length of the two legs.
The curvature is sometimes accompanied by a rotation of the spine, and will produce an asymmetry of the back. Perhaps one shoulder blade is higher than the other or one shoulder is lower than the other. Differences in the leg length can be seen by differences in height of the pelvis.
The problem can be silent, if mild. However it can affect the way the child walks, or even interfere with breathing if severe. If untreated and progressive, it can cause chronic back pain in adulthood. Treatment is accomplished by braces, or occasionally by screws placed in the side of the vertebra that can be adjusted.
I had a friend that was 70 years old whose back pain eventually forced surgery. Scoliosis should definitely be supervised by a Doctor who will use physical therapy, braces, or some other conservative treatment to avoid later difficulties.
Please refer to the Mayo clinic article for more information.
—Dr. C.
Podcast: Treating And Preventing Liver Cancer
The National Cancer Institute estimates that more than 42,000 new cases of liver cancer will be diagnosed in 2021, representing 2.2% of all new cancer cases in the U.S. The most common type of primary liver cancer is hepatocellular carcinoma.
Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common. “The vast majority of liver cancers — over 90% — occur in patients who have a chronic liver disease,” says Dr. Ilyas. “Cirrhosis, or advanced scarring of the liver, is the strongest risk factor for hepatocellular carcinoma.” Chronic infection with the hepatitis B or hepatitis C viruses also increases your risk of liver cancer.A wide range of treatment options for primary liver cancer are available. Which treatment is used depends on the stage of the disease. On the Mayo Clinic Q&A podcast, Dr. Ilyas discusses liver cancer diagnoses and treatment options, and the importance of prevention.
TREATING DEPRESSION: DEEP BRAIN STIMULATION (UCSF)
UCSF Health physicians have successfully treated a patient with severe depression by tapping into the specific brain circuit involved in depressive brain patterns and resetting them using the equivalent of a pacemaker for the brain.
COMMENTARY:
UCSF is my medical alma mater, and I am proud to comment on their info graphic about need-driven deep brain stimulation (DBS). This is not only a good idea, it should spearhead a personalized wave of the future.
Your body’s metabolism is a great balancing act, and needs to be kept on an even keel, to maintain the stability of your internal environment. What is “good” at one time may be deleterious at another.
Good illustrations of this are insulin and thyroid hormone. Both too little and too much is deleterious.
Likewise, the need for DBS varies.. This was recognized by the designers of feedback-driven DBS. The amygdala is overactive when the depressive wave is greatest, triggering the deep brain stimulation. As the depressive wave lightens, the stimulation diminishes or stops.
Engineers are quite attentive to this idea. A similar feedback mechanism is used by implanted heart stimulators, or “ defibrillators“. if the heart slows down excessively, there is stimulation of the atrium to restore the proper rate. If the ventricle is ineffective, and fibrillates, it is given a shock which acts like rebooting your computer.
Chronotherapy, the administration of medication depending upon the time of day, is a kindred idea, illustrated by asthma. Wheezing attacks peak at night, when adrenaline and cortisol ebb, and so should the blood levels of the anti-asthmatic medication, theophylline.
Another illustration is the medication omeprazole, a proton pump inhibitor that reduces stomach acid. Reflux of this acid into the esophagus increases when you are recumbent and sleeping.. The need for the antacid is therefore greatest at night.
It is estimated that the effects of at least 50% of all medications would benefit by attending to the diurnal cycles. If your symptoms cycle with the sun, ask your doctor about your medications.
—Dr. C.
DOCTORS PODCAST: MEDICAL & TELEHEALTH NEWS (OCT 3)
A weekly podcast on the latest medical, science and telehealth news.
Medicine: Is Metformin A Wonder Drug? (Harvard)
MONOCLONAL ANTIBODIES: HOW THEY ARE SAVING LIVES
Doctors are increasingly turning to monoclonal-antibody drugs to treat high-risk patients who get sick with Covid-19. WSJ takes a look at how the therapies work and why they’re important for saving lives. Illustration: Jacob Reynolds/WSJ
DR. C’S JOURNAL: WOMEN AND AUTOIMMUNE DISEASE
Almost 80% of autoimmune diseases occur in women. Why should this be?
From the evolutionarily standpoint, perhaps up regulation of immunity conferred a survival advantage. Women spent a much greater percentage of the time pregnant in Hunter gatherer days than they do at the present time, and an active immune system may have been an advantage in getting both you and your child’s genes through the many ancient environmental hurdles.
Women differ from men in the prominence of the X chromosome, the female sex hormones, estrogen and progesterone, and, surprisingly, in their microbiome. All three areas may play a role in autoimmunity.
The X chromosome contains many genes directly tied to Autoimmune diseases. One of these is a gene for TLR-7, which is important in the innate immune response, and is linked to disorders such as lupus and scleroderma. Another Gene, TASL, increases the production of interferon, a common inflammatory factor.
Many autoimmune diseases are driven by estrogen. For instance, estrogen attaches to, and turns on the gene that codes for interferon gamma. It activates B cells which produce antibodies. Progesterone, another female hormone is elevated in pregnancy, and tends to switch on the TH-2 response, which produces more antibodies. AIRE, the immune regulator itself, is partially influenced by the sex hormones.
A severe asthmatic I was treating became pregnant, and her asthma marvelously improved. I had always thought that pregnancy turned OFF her asthma-linked TH-2 response, going against one of the observations above.
At the present stage of knowledge, individuals may respond in perplexing ways to interleukins, treatments and pregnancy. Cellular interactions are complex indeed.
The microbiome in the male tends to increase testosterone, which tends to down regulate the immune system. The reverse is true for the female microbiome.
The fact that identical twins may be discordant with autoimmune disease favors environmental factors, such as the microbiome and other extrinsics such as smoking, diet, stress and chemicals. Some of the males who get autoimmune diseases tend to be feminized, such as in the Klinefelter syndrome, which has an extra extra X chromosome, and an XXY genotype.
The use of the estrogen or progesterone in the form of contraceptives tends to increase the likelihood of autoimmune diseases. The observation that women are more susceptible to autoimmune diseases goes along with many of these genetic, hormonal, and environmental observations.
Please consult for Scientific American, September, 2021, P 40 for more information.
Doctors Without Waiting Rooms 