Category Archives: Opinion

Men's Health, Opinion, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS/CONDITIONS#10: MACULAR DEGENERATION

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Macular Degeneration is the most common cause of blindness in the western world.as you get older, it becomes increasingly common, and almost 20% of people older than 85 years have this disease.

It comes in 2 types, dry and wet. Mostly it starts as the milder dry type, which develops slowly and has no definite treatment. The dry type can develop into the more rapidly progressive wet variety, however, and is important to notice and report to your ophthalmologist.

The MACULA is the center of the visual field, and has by far the most photoreceptors. It yields the sharpest vision, and is essential for reading, and even recognizing faces.

LOSS OF VISION is the commonest symptom, but is hard to notice in a slowly developing condition. A neurologist friend of mine alerted me to the AMSLER GRID, which helps in picking up the subtle distortions of this sneaky problem.

Checking your vision every few days-it takes only a few seconds- is a good idea as you age. You might be healthy in every other way, but if you are blind, the quality of life in your final years will suffer. The mechanics of the wavy lines generated by macular degeneration are deposits beneath the macula, raising it up.

The deposits are fatty in the case of the dry, and fluid in the case of the wet macular degeneration; and fluid from the abnormal blood vessels in the wet MD can collect very rapidly indeed.

Even though the cause of MD is unknown, prevention is by the same old healthy habits tiresomely mentioned in all my other postings: DIET and EXERCISE. I’m sure that good sleep doesn’t hurt either, No cigarette smoking of course, and there are some vitamins and minerals mentioned, such as lutein, zeaxanthin, zinc, and copper.

The wet MD does have a treatment to slow down the disease. Since blood vessel growth is important in causation, antibodies to VEGF, vascular endothelial growth factor, are injected into the macular area. I’m sure that more help is on the way. Some treatments to support the protective pigmented layer of the retina are currently in progress.

–DR. C

Men's Health, Opinion, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #9: “Choking” (Food-Related)

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DYSPHAGIA covers a wide range of troubles, symptoms and diseases, as indicated from the excellent Infographic posted August 21, 2020. I have already discussed GERD, or trouble with the food coming back up after being swallowed.

This post will be on “choking”, or getting the food into the Airway instead of the Esophagus, or swallowing tube. In the future, I will develop a post in “swallowing difficulties”, or trouble getting the food to pass easily and freely down the esophagus into the stomach.

CHEWING the food properly is rare in our rushed, fast-food society, but it is very important, the first part of the digestion process. Mastication breaks the food into smaller particles that are easier to digest, and also EASIER TO SWALLOW. Saliva flows as you chew, and contains Ptyalin, an enzyme which breaks down starch into absorbable sugars.

Chewing also SLOWS down the rate of eating, improves enjoyment, and allows more time for the stomach to send Satiety signals to the brain. This leads to less overeating and weight gain. In children, chewing is said to aid in jaw development and to reduce dental crowding and need for Orthodontia.

Some people have trouble in Initiating the swallowing process. This can be caused by neurological problems like Parkinson’s Disease. It can also be Psychological, a reflection of fear of discomfort on swallowing.

I have the opposite problem, a tendency to swallow too eagerly and rapidly, causing me to choke on liquids, sometimes even on water. I went to an ENT specializing in swallowing problems. He checked the sensitivity of my throat to touch, and found it normal.

Apparently LESSENED sensitivity is the main concern, which would
lead to Aspiration of food. The only guidance he gave me was to eat and drink more slowly. I find that I am most likely to choke when I drink wine, or a tasty beverage which I tend to “slurp” so as to fan the aroma out broadly in my mouth. I am having a hard time breaking myself of that habit.

Sometimes I find that residual amounts of food builds up in the back of my throat, probably by my epiglottis. I worry about nuts especially. If I don’t drink some water to flush it away, I am likely to choke on it. I guess that is the reason people are told to offer some water to a person who is choking.

I seem to be choking more as I get older, which is reasonable. Swallowing requires an amazingly intricate coordination and motion in the throat area, especially in getting the epiglottis, the little door that closes off the windpipe, to close properly.

My other dexterities are fading, why should swallowing be an exception? Pill swallowing is getting more frequent and more problematic at the same time.

Tablets are worse than capsules, maybe because they are not as slick. There is one size in particular that tends to get stuck in the back of my throat just above the uvula. I sometimes have to cough a lot and choke the offending object back up. One more reason to constantly try to cut down the number of pills.

There is one good thing about this problem, however. I now take the pills separately with a big swallow of water, improving my Hydration.

–Dr. C.

Dr. C's Journal, Medicine, Opinion

Dr. C’s Medicine Cabinet: Benefits Of “Nootkatone”

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INSECTS are mainly pests. Except for the very commercially valuable Pollinators, Honeybees, the other useful insects, like ladybugs, dragonflies and spiders are beneficial because they eat other insects. It is very exciting, then, to hear about a pleasantly-smelling insect repellent that is quite harmless to Humans.

NOOTKATONE, after you get used to its ugly spelling, has an aromatic, Grapefruit-like smell. It was discovered while researching the CEDAR family. We all know of the association between Cedar and storage. One of my prized possessions was a Cedar chest for storing our families ski clothes.

Whenever I hear of a non-toxic chemical that repels and sometimes kills mosquitos, ticks, bedbugs and fleas, and yet is so harmless as to be used in perfumes, I like to hear of a proposed MECHANISM OF ACTION.

Nootkatone is thought to work by stimulating octopamine receptors, which insects use to make their muscles work. The muscles just keep on contracting and the insects die. The only problem is that Nootkatone is mainly a repellant, and a weaker insecticide.

Another good quality of Nootkatone is that the effect lasts several hours, in contrast to citronella and the other plant oils. Interestingly, the substance was isolated from grapefruit some 25 years ago, while looking for a repellant for the tick of Lyme disease.

Anaplasmosis and Rocky mountain spotted fever are 2 other tick-transmitted diseases present in America. Nootkatone is particularly effective against ticks, and is now EPA-approved.

–Dr. C.

Dr. C "Comments", Men's Health, Opinion, Women's Health

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

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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

Dr. C's Journal, Men's Health, Opinion, SLEEP, Women's Health

Dr. C’s Journal: A Little Bit About “Energy & Fatigue”

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Sometimes I wake up in the morning with a feeling of RELAXED ENERGY. My mind is clear, I have no fatigue, and believe once more that the world is wonderful, and it’s great to be alive.

I St-re-tch, exercise my hands (I have Osteoarthritis, and they are stiff), take out my Nite guard ( I grind my teeth at night and would otherwise wear them away), take my beta blocker eye drops ( to lower my intraocular pressure) and wash down my Eliquis ( an anticoagulant to prevent stroke from my Atrial Fibrillation) with 16 oz. of water, while thinking about all of the delights awaiting me.

Yes, my body was in better shape 60 years ago; but I had much more responsibility then, and much less discretionary time. All things considered, I like to believe that I am happier now.

The KEY is to stay in GOOD HEALTH. GOOD SLEEP is critical, but it cannot be had by willpower alone. As I have discussed previously, you need a bedtime routine, good SLEEP HYGIENE.

You also need a…….. GOOD DIET. with lots of fruits, vegetables and whole grains. Fatty, spicy foods will stay in your stomach and bother you at night, particularly if you eat Late. I like to finish eating by 5 PM. Late dinner is also likely to produce GERD, and maybe Sleep Apnea.

GOOD EXERCISE is also critical. If you are not tired at the end of the day, it is hard to get good sleep. I always seem to sleep better on the day when I walk the hills for an hour, which is 3 days a week. Try not to exercise within 2 hours of bedtime. Assuming that you have a good base of SLEEP, DIET and EXERCISE, there are other mechanisms that can foul things up. INFLAMMATORY conditions often cause fatigue.

The most common inflammatory diseases are OBESITY, METABOLIC SYNDROME and DIABETES. OBESITY is the defining disease of our EXCESSIVE SOCIETY, where there is too much of everything, and excessive consumption is relentlessly advertised everywhere.

External correction is probably a pipe dream, since there is no will even to Tax Sugar-containing Beverages, the “low hanging fruit” of dietary excess. Internal correction is all that is left, and that takes WILL POWER, also in short supply.

INFECTIOUS DISEASES are a subset of inflammatory conditions. COVID 19 is the poster child of infection, and FATIGUE is one of the hallmarks of the disease. Interleukins, like TNF-alpha, IL-1, andIL-6 are some of the defense factors which cause the fatigue. AUTOIMMUNE Diseases like Rheumatoid Arthritis and Lupus are also associated with fatigue-producing interleukins.

Fatigue even has its own flagship disease, CHRONIC FATIGUE SYNDROME. Chronic viral disease has been suspected as the cause of this condition, and inflammatory cytokines may be elevated. This condition, and the similar GULF WAR SYNDROME are still poorly understood. Several CFS patients were sent to me when I was in practice, and I had some success in getting them to exercise regularly, which seemed to help. CANCER is another category of diseases where Fatigue is prominent.

Inflammation plays a role in these diseases, which also drain energy substrates from the Patients body; Cancer cells have a high metabolic requirement. MEDICATIONS, Cancer meds especially, but a variety of other Drugs are associated with FATIGUE. I went through MY MEDICATION LIST. Lo and behold, 3 of them are associated with fatigue.

Finasteride is a relic of my prostate operation, recommended to keep it from growing back. It causes fatigue, probably because of its ANTITESTOSTERONE effect. At least I can still pee, and am not bald. I take METFORMIN because of its fame in prolonging life. Its mechanism is that of interacting with the Sirtuin system, and increasing the inefficiency of mitochondria. Isn’t this surprising?

Like many other things in physiology, you place a stress on the body, and the body responds by improving its performance. If you are fatigued, you exercise. Respecting the body works with drugs as well. If you are drinking a ton of coffee and stop it, after a few weeks you will feel less fatigued.

And when you ARE FATIGUED, you drink a LITTLE coffee, and it wakes you right up. Caffeine works by displacing ADENOSINE, which causes Fatigue as it increases through the morning, peaking at SIESTA (or tea) time,at about 2 PM. OMEPRAZOLE, which I take to prevent HEARTBURN, also is related to fatigue especially if it blocks MAGNESIUM for long enough. DEPRESSION overlaps with fatigue, as does SLEEPINESS, to increase the complexity of the situation.

Many chronic LUNG, KIDNEY and LIVER diseases are associated with fatigue as a secondary concern. STAY HEALTHY!

–Dr. C

Men's Health, Opinion, Women's Health

DIETARY HEALTH: “SALT AND THE HUMAN CONDITION”

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Salt, so important to human health and disease, is also prominent in HUMAN HISTORY. Civilization has required it from earliest times. Cereal grains, the ‘Staff of life” is relatively low in SODIUM CHLORIDE, salt, making it a desirable food additive.

PRESERVATION of food before refrigeration required salt. Natron (Natrium is latin for salt, and Na is its chemical symbol) was the Egyptian city known for its salt. Salary was an income supplement to Roman Legionnaires for purchase of salt.

Salt, gold and slaves were prominent in north African trade, and salt was often as valuable, ounce for ounce, as gold. “Below the salt” in medieval times meant the “cheap seats” in Feasts; only the “high table” had salt.

SEA WATER was about 0.9% salt at the dawn of Life, and that is presently the salt concentration in EXTRACELLULAR FLUID.

TASTE BUDS are happy with salty foods, and one set is specialized to pick up salty favors. The 4 others are sweet, sour, bitter and umami. As you can see, these taste buds were pro-evolutionary in our paleolithic ancestors.

The extra salt, sugar, and fats that taste so good in our present modern, excessive society are over-generously supplied by capitalistic producers intent on enhancing sales. Portions keep getting ever larger to encourage us to eat more.

Salt supports BLOOD PRESSURE, and sometimes ER Patients in shock are given saline infusions. More commonly, HYPERTENSION is treated by salt restriction, as illustrated in the accompanying Infographic.

POTASSIUM is the most common cation in the INTRACELLULAR FLUID, just as Sodium is most common in the Extracellular fluid. Our bodies fastidiously defend narrow concentration limits of Sodium, Potassium and other electrolytes which are important constituents of the famous Milieu interieur.

It is interesting that the Sodium-Potassium ATP Pump requires a large percentage of the ENERGY used to keep us alive. This pump also keeps our cell membranes POLARIZED, so important in NERVE TRANSMISSION.

So eat a lot of NATURAL FOODS, high in potassium, and avoid the catsup, sauces and condiments that riddle our high sodium, Fast food, modern diets.

–Dr. C.

Medicine, Men's Health, Opinion, Women's Health

DR. C’S MEDICINE CABINET: “B-COMPLEX VITAMINS”

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The Idea that lack of certain nutritional factors could cause disease predates the germ theory by hundreds of years. British sailors could be saved from the ravages of SCURVY by a little sour fruit, and were called LIMEYS. Just before the first World War, a “milk factor” was found to be contained in butterfat, and was called Vitamin A.

The factor in “rice polishings”, known for decades to prevent disease caused by a diet exclusively of white, or “polished”rice was called Vitamin B.

Thus the Lettering system of vitamin-naming began. It wasn’t known until just before the Second World War that “vitamin B” was in fact several different substances (B1. B2. etc.), and later yet until these factors were found to be small, non-protein molecules that were “cofactors” in important enzymatic reactions essential in the body.

The metabolic pathways of our Hunter-gatherer ancestors could depend on the DIVERSE FOOD sources of Paleolithic man to supply these vital substances. Therefore, the body did not need to synthesize them, saving energy, but paving the way for future problems.

As a group, B vitamins produce energy from nutrients, support immune function, regulate cell growth, maintain Myelin, and maintain RBCs, among other crucially important things.

Some substances used to be considered B Vitamins, were later found to be synthesized in our bodies: these include Choline, Carnitine, Lipoic acid and PABA.

The latter is essential to Bacteria, leading to the development of the Sulfa Drugs, which Block PABA synthesis. Another pair of substances are so widely present in foods as to be rarely deficient: B5, Pantothenic acid, and B7, Biotin.

Three important, essential B Vitamins, B6, Pyridoxine, B9, Folic acid, and B12, Cyanocobalamin are so intertwined in their effects, they are best considered a unit. For instance, if B9 is supplemented while B12 is deficient, severe neurological problems arise. B6,9 and 12 must be kept balanced.

That leaves B1,B2, and B3, Thiamine, Riboflavin, and Niacin. Thiamine and Niacin deficiencies used to be common, especially when white rice and white flour replaced the more common brown variety, and led to Beri-Beri and Pellagra respectively.

My own Medicine Cabinet used to have the enriched B-vitamins, called B50 and B100 at Trader Joes. To cut down on pills, I switched to a multivitamin rich in most B vitamins. With the additional 4 mg. of Folic acid, I now take 1000% of the MDR of B6, B9 and B12, which I explained in a previous post to be driven by my elevated Homocysteine.

The Medical establishment and much research demeans the “health food nuts” as doing little more than making their toilets healthier. Indeed, research on Vitamin E supplementation has shown to cause cancer, Vitamin D supplementation to be useless, and folic acid supplementation to be potentially bad. Vitamin C supplementation does nothing but increase the likelihood of Kidney stones, etc.

The experiments are performed, and MDRs calculated on GROUPS of people, however, and with the INDIVIDUAL VARIATION in metabolism, with AGING of the human body (research on nutrients rarely includes the Elderly), and the lousy fast foods of the modern diet, I will continue with my supplementation.

In 2 of the vitamins, D and folic acid, B9, I am on firm ground, having blood levels of 25 hydroxy Vitamin D, and Homocysteine respectively to give me a frame of reference.

The truth is that the medical profession is poorly educated in nutrition, has little incentive to improve their knowledge, and has scant spare time to take dietary histories even if they knew more.

Even in the 60s when I routinely had my Patients keep a “diet diary” so I knew what they were eating, most doctors did not think this worth the time.

Educate yourself on SLEEP, DIET and EXERCISE, resolve to practice what you learn, and leave the medical profession to do what they are best at, and paid for: give medicines and perform procedures and surgery.

–Dr. C.