Category Archives: Men’s Health

COVID-19: MOLNUPIRAVIR – MERCK’S ANTIVIRAL DRUG

Molnupiravir (MK-4482, EIDD-2801) is an investigational oral antiviral medicine that significantly reduced the risk of hospitalization or death at a planned interim analysis of the Phase 3 MOVe-OUT trial in at risk, non-hospitalized adult patients with mild-to-moderate COVID-19. At the interim analysis, molnupiravir reduced the risk of hospitalization or death by approximately 50%; 7.3% of patients who received molnupiravir were either hospitalized or died through Day 29 following randomization (28/385), compared with 14.1% of placebo-treated patients (53/377); p=0.0012. Through Day 29, no deaths were reported in patients who received molnupiravir, as compared to 8 deaths in patients who received placebo.

DR. C’S JOURNAL: SIGNS AND SYMPTOMS OF APPENDICITIS

The appendix is a finger like projections at the origin of the colon in the right lower part of your abdomen. It may become inflamed, especially if there is a blockage. Appendicitis is best considered a medical emergency, since it may rupture and infect the entire abdominal cavity.

When I was a practicing pediatrician, appendicitis was one of the two conditions I refused to allow myself to overlook; the other one was meningitis, which is now mostly prevented by immunization.

Pain in the abdomen is almost invariably present as the main symptom of appendicitis. This pain often begins around the belly button and then migrates to the right lower part of the abdomen. The patient should try to notice whether jarring the abdomen by walking makes the pain worse; if so, this finding would favor an inflammatory condition like appendicitis.

A similar condition, diverticulitis, may cause similar symptoms in the left lower part of the abdomen, and other conditions may cause confusion. The doctor checks to see if it is more painful in the right lower belly area, and she may pull her hand away suddenly. If the pain intensifies, there may be inflammation around the appendix. Sometimes a vaginal examination or rectal examination will be needed to help with the diagnosis; the appendix is close to these areas.

Other symptoms and signs may be a low-grade fever, vomiting, add an elevated white blood cell count. In the modern medical era, ultrasound, CT scans, and MRIs are sometimes used to visualize the appendix to evaluate its size and possible inflammation.

Treatment used to consist only of surgery, but with imaging techniques available to prevent disaster, the condition can be treated with antibiotics. 30 to 50% of those so treated will still eventually require surgery. Removal of the appendix is now sometimes performed through a fiberoptic scope, leading to more rapid recovery.

A dilemma is present for individuals who go to the south pole to live for several months, and where weather may prevent them from getting proper medical help. Such  people may have their appendix removed as a preventative. Of course they also can take antibiotics if appendicitis develops, but it’s really scary to use medical treatment only, without the aid of modern imaging techniques.

Please consult the following Mayo clinic article for more information.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #60: ADHD

Trouble with impulsivity and inadequate ability to pay attention characterizes most of the human race. It is particularly characteristic of childhood; while developing, all children are hyperactive and inattentive, compared with an adult standard.

Children and adults inflicted with extremes of these two neurodevelopmental problems have a particular difficulty in our complex, organized, and demanding society, and consequently“ excessive“ hyperactivity and inattention are presently considered a disease, with specific diagnostic criteria, and medicinal, psychiatric, and sometimes instrumental treatments.

ADHD is divided into predominantly inattentive, predominantly hyperactive/impulsive, and combined. I will concentrate on certain features of the attentive aspect.

I encourage you to read the excellent Mayo clinic article which covers most bases, including advice for parents and relatives who have to deal with these sometimes difficult individuals.

ADHD most commonly involves children. It leads to difficulty at school, and often suboptimal interpersonal relations. Drugs such as amphetamines and Ritalin are most commonly given, and seem to work; it is always amazing to see a stimulant quieting down an overactive child. Struggling college students often consume these same medications, since they seem to give a short term boost In concentration, ability to learn, and performance in tests.

Caffeine is the poor man’s drug and also sometimes helps. 60 years ago I worked in the UCLA clinic where we checked problem children for “split dominance”, where the children may throw with the right hand and kick with the left foot. There is no mention of this in the literature now, and indeed FADS have characterized the whole area.

My middle son had difficulty in school and was hard to get along with. I tried him on some amphetamine, but he wisely spit it out. He turned out to have dyslexia (poor reading ability), studied engineering in college,  and is running his own company; Entrepreneurs are often dyslexic.

Be very careful before labeling a child with the stigma of ADHD. Try loving and working with her more. If the situation is clear cut, make sure the least five of the nine criteria are present before agreeing to try drugs.

One of my grandchildren was very slow in learning, and was distracted easily. His mother persisted in sending him to a Montessori preschool, and when he went into his growth spurt (I like to think he myelinated his neural pathways), a miraculous change took place; He now seems very interested in many things and does excellent work at school.

You cannot lavish too much attention on developing children. ADHD thought present in somewhat less than 10% of children, particularly boys. It is also being increasingly recognized in adults, where it interferes with their personal, home, and occupational lives. Anxiety, depression, and other psychiatric problems may follow.

I wonder if inattention also afflicts some of my elderly friends; if they don’t pay attention to what they’re doing, they may well FALL, and curtail their lives. We could all pay better attention to what we are doing.

TOO MUCH ability to pay attention, however, could grade into obsessive compulsive disorder. In more extreme forms, ADHD is certainly real, and failure to intervene can result in distressing secondary problems. However, it is almost too convenient a category for assigning children. Haste in categorization may result in missing other problems.

When normal, our brains are amazingly fine tuned instruments. The best thing to do is keep them exercised, stimulated, and well nourished.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #59: Lyme Disease

Lyme disease is high on every hard-to-diagnose disease list, because it is relatively uncommon, and can produce a variety of disturbing symptoms often classified as psychosomatic.

It is caused by a deer tick bacterial injection of the Borrelia genus, which can progress to cause widespread problems. Not every tick bite will inject the bacterium, and ticks that have been attached for less than 12 to 24 hours are unlikely to have done so.

Risk factors include living in a wooded area, particularly on the east coast. With people fleeing the cities in the wake of Covid, exposure is more common.

The NYT columnist, Ross Douthat wrote a book about his travails: “patient heal thyself“. In this day and age of overworked  doctors, and with the huge variety of medical information available online, more and more people are going on a “medical odyssey”.

A painless red swelling, followed by an expanding area of red(erythema migrants), is often the best medical clue. Flu-like symptoms and enlargement of the lymph glands can accompany the “rash”. Tests are not positive for several weeks, and may be negative if and when the late symptoms of Lyme disease develop.

The earlier you get treated with a 10-day course antibiotics, the better. The problem is that not all tick bites produce infection, and so overtreatment is a real possibility.

Late symptoms can include fatigue, mental symptoms arthritis, liver problems and a variety of other symptoms. Like another bacterial disease, syphilis, lyme disease can be the great mimic.

Prevention is paramount. People living in endemic areas should wear long sleeves and pants when they go out into the woods, use insect repellent , and make sure their animals are kept tick-free.

A DWWR article on Nootkatone may be worth your time to read, since DEET and many other insecticides are toxic and have to be used with care.

Please refer to the following article by the Mayo clinic for more organized information.

-Dr. C.

Medicine: CT Scans & Radiation Exposure

Health: Distinguishing Between Flu & Covid-19

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.

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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.

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Brain Study: REM Sleep Behavior Disorder Linked To Neurodegeneration

REM sleep behavior disorder is linked to Parkinson’s disease, a movement disorder; dementia with Lewy bodies, which causes cognitive decline; and multiple system atrophy, in which the ability to regulate involuntary functions, such as blood pressure, breathing, and bladder and bowel function, deteriorates.

ROCHESTER, Minn. — People with rapid eye movement (REM) sleep behavior disorder act out their dreams. While sleeping safely in bed, for example, they might throw up their arms to catch an imaginary ball or try to run from an illusory assailant. Such actions are more than just a nuisance. People with the disorder have a 50% to 80% chance of developing a serious neurodegenerative disease within a decade of diagnosis.

Read more at Mayo Clinic