A weekly podcast on the latest medical, science and telehealth news.
Category Archives: Opinion
DOCTORS PODCAST: MEDICAL & TELEHEALTH NEWS (AUG 14)
A weekly podcast on the latest medical, science and telehealth news.
DR. C’S JOURNAL: PROTEIN-BASED MEDICATIONS
Proteins, the very structure of life itself, are currently being understood with increasing precision. This will undoubtedly lead to a new generation of medications useful in treating a wide variety of diseases. Such proteins could be coded by DNA or RNA, and churned out by veritable protein factories, yeasts.
This could drastically lower the cost of such medications, which are more stable than RNA, allowing easier distribution and storage. DNA and RNA advances are currently getting all the press, with CRSPR advances in manipulating their structure. Indeed, the RNA vaccines by Moderna and Pfizer have been a rapidly deployed life saver with the COVID-19 epidemic. Correction of genetic disease is also possible in rare instances, if only one gene causes the disease.
PROTEINS, the result of DNA and RNA activity, form the basis of a vast array of signaling molecules, offering many possible treatments of disease.
The reason why advances in protein chemistry has been slow, is that protein is a very large molecule that exercises its effects by its three dimensional structure.This is formed by the loops,foldings, twists, and bunchings of its amino acid string. A molecule’s three-dimensional structure is very expensive to determine at the present time,
Encouraging scientists to attempt predicting the structure by knowing the electric charges and other sticky characteristics of different parts of that amino acid string. Recently, artificial intelligence has come to the rescue, and the field is advancing rapidly.
Novel vaccines are being developed, using small protein pieces of the COVID-19 antibody combining site. Pieces of proteins are being designed that can stick to that antibody combining side and prevent it from attaching. Novel signaling blockers, or even agonists, are looking increasingly possible.
I thought you would like to know about this little island of optimism in the midst of all the gloom. My interest in PROTEINOMICS was fueled by an excellent article in the Scientific American July 2021 issue, by science journalist Rowan Jacobson, who presents the story in a very interesting fashion. I would very much recommend the reading of this article.
–Dr. C
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #49: KYPHOSIS (ROUNDBACK)
Older people are more susceptible to kyphosis. Osteoporosis is a risk factor, so it is no surprise that women are affected more frequently. This rounding tendency of the thoracic spine can be measured on a lateral x-ray of the spine in terms of degrees; 20 to 40° is considered normal. The angle increases with age, and almost half of older people have an angle more than 40°.
Children can also get kyphosis-Scheuermann’s disease-during the rapidly growing years. Kyphosis occurs when the normally block-like vertebrae become wedge shaped, with the narrow part towards the front.
Causes of kyphosis include fractures, with or without osteoporosis, disc degeneration, cancer and cancer treatment. Tuberculosis of the bone used to be a common cause of hunchbacks, but this is no longer a problem.
Kyphosis can produce breathing problems by putting pressure on the lungs, increase digestive problems such as GERD, or compress spinal nerves causing pain.
At the age of 89, I have a problem with kyphosis. At the age of 30, one of my thoracic vertebrae sustained a wedge compression fracture, probably from jumping off a wall or something similarly stupid.
I continually have to fight foreword slouching when I walk, and remind myself to stand up straight, and throw my shoulders back. My neck arthritis makes it difficult to look up when I walk.
I also do angle push-ups to strengthen my back muscles. I have a friend who has severe kyphosis, and recently had an orthopedic operation to correct it. I am hopeful that this operation will relieve his sense of shortness of breath and reduce his GERD.
Treatment includes taking vitamin D and calcium, or other medicines for osteoporosis. Smoking should be avoided, and alcohol limited. There are a number of exercises that are recommended, some of which I have mentioned.
Please refer to the following Mayo clinic article for more information.
—Dr. C.
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #48: URTICARIA (HIVES)
ALLERGY is a type of reaction that can vary from annoying to fatal. The question has always been: what possible utility to the body does the allergic reaction, which has survived evolution, provide? The best theory fingers parasitic infestations; not only can parasites cause allergic reactions, Indicate allergy by showing blood eosinophilia, but the allergic reaction seem to help us fight parasitic infestation, which was much more common in humanity’s past, and in present day underdeveloped societies.
URTICARIA consists of a number of little welts or bumps that pop up on the skin and are very itchy. This reaction is caused by little darkly-staining cells called MAST CELLS, which release Histamine and other irritants into the skin, causing hives. These mast cells are provoked into releasing their irritating cargo by IGE antibodies, the basis of true allergy.
Treatment consist of removing the cause, blocking the action of the IgE antibodies, or giving medication to block the action of the histamine( anti-histamines).
There are multiple common causes, several giving its name to a type of Urticaria. Pressure urticaria can be caused by a belt or tight fitting clothing pressing on the skin to cause the hives. Solar urticaria can be caused by sunlight.
Cold urticaria can be caused by exposure to very cold objects. Hives can also be caused stress, exercise, different foods(seafood and strawberries are the most famous), different drugs(penicillin and aspirin are the most famous), and scratching on the skin(dermatographia).
Hives can occur as a feature of ANAPHYLAXIS. If the IgE-mast cell reaction is extensive, the blood pressure can drop, internal organs can be affected, and emergency treatment must take place to prevent death.
My only experience with hives was after a bee sting, when I broke out with itchy bumps. I had desensitization with honeybee venom, although this is not always done these days. Be sure to check with your doctor if you have such a reaction, however.
The biggest recent improvement in treating people who are incapacitated with frequently recurring and long lasting hives is anti-IGE, an expensive but very effective injection.
If you have hives, be sure to keep a record of events that immediately preceded the hives, including foods, activities,, and exposures. Although the recommended Mayo clinic article that follows suggests that you see a dermatologist or an allergist, I would reverse that and suggest the allergist first.
—Dr. C.
DR. C’S JOURNAL: WHAT IS VALVULAR HEART DISEASE?
I continue to be amazed by-and grateful for -the astounding collection of miracles that is the human body. Each element is durable if properly maintained and potentially provides us with a long and healthy life. The heart Valves are a part this wonderful orchestra, opening and closing about 2 billion times in a full lifetime.
It is possible to visually appreciate our heart and it’s valves, but millions of other microscopic-nanoscopic-little protein machines are also opening, closing, twisting and folding anonymously, allowing us to live and move.
Now is a particularly good time to talk about the heart valves because imaging devices are available to detect, and surgical techniques are at hand to treat, the common problems that develop in the course of optimally guiding our blood through the heart, into 2 separate circuits, the pulmonary, and the systemic. Life can be defined as an island of order in a sea of chaos. Energy is required to allow this island to fend off dissolution. The energy is used to continually maintain the integrity of our cells, the island in this metaphor, and keep entropy at bay. Myriads of biochemical mechanisms direct this repair. Sleep, diet, and exercise aid in the mending.
We use our bodies in the daytime, and at night switch to a cleansing and repairing function, sleep. Diet, and our resident microbiome, provide the materials for this restoration. Exercise helps utilize excessive nutrients, and directs our metabolism towards regeneration and repair.
Some valvular problems are present at birth because of defective development. Bicuspid aortic valves and mitral prolapse are examples. Hypertension places a strain on the entire system. Type two diabetes can cause inflammation and abnormal deposits in the valves. A variety of biochemical pathways active during the formation of the heart can go awry and fail to maintain the neatly layered deposits of collagen, proteoglycans and elastic tissue that forms the basis of the valves, and the endothelial cells that line them.
Tobacco smoke, which harms in so many other ways, can also damage the heart valves, as can infections, which sometimes grow on the heart valves themselves. Symptoms of heart valve disease include abnormal sounds that your doctor can hear, or the the presence of fatigue, shortness of breath, swelling of the ankles, and dizziness, which are common symptoms of cardiac malfunction. Unusual chest pains, particularly with mitral prolapse, and irregular heartbeat can also be present.
Replacement of some valves via a catheter inserted in an artery is one of the recent advances in treatment of Valvular heart disease.
Ultrasound is particularly useful in diagnosing valvular heart disease, but a whole cafeteria of diagnostic tests are available to doctors these days.
Please refer to the following Mayo clinic article for more information.
—Dr. C
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #47: POST-TRAUMATIC STRESS DISORDER (PTSD)
PTSD, post traumatic stress disorder, has been increasingly recognized by the medical community, and was admitted to the status of a psychiatric disorder in 1980. It was first recognized as “shell shock” in combat soldiers.
The movie, “Patton”, featured one such case; abusive behavior of a soldier by Patton hit the newspapers, and he was sidelined for the start of “ operation overlord“. Since the majority of soldiers were not incapacitated , Patton thought the soldier was cowardly.
As an allergist, I was sent one case of PTSD; Believe it or not, the referring physician thought it might be an “allergy”, so little was it understood.
Now, memory consolidation is considered to be one of its dimensions. An incompletely consolidated memory allows flashbacks to be considered the real thing.
PTSD is partly under genetic control, since identical twins are more more likely to experience the condition. Anxiety and other psychiatric problems such as depression and substance abuse can be associated. Women are more likely to experience it. Individuals with low cortisol, elevated norepinephrine or a small amygdala or more likely to develop PTSD. Even children can be involved if they have been abused physically.
Any kind of a frightening experience, especially sexual, can be a cause.
Symptoms can include recurrent distressing memories, flashbacks, or nightmares of the traumatic event, or emotional distress and anxiety on exposure to a similar experience.
Treatment can include medication for depression, but benzodiazepines should be avoided. Cognitive behavioral therapy has enjoyed some success, but treatment is generally difficult. Please consult the attached Cleveland clinic article for more information.
–Dr. C
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #46: COCCYDYNIA
Pain is the hallmark of Coccydynia (Tailbone Pain). The word can be divided into two parts; the first, coccy, refers to the triangular structure itself, which sits at the bottom of the vertebral column, and comes from the Greek word for ”cuckoo”. I previously thought it translated as “tail”. The second part of the word, -“dynia” translates as “pain”, which is much more appropriate.
The coccyx, or tailbone, is one of those useless vestiges of evolution, joining ranks with the appendix and paranasal sinuses. It sits just above the gluteal cleft on your backside, and is the conjunction of four or five boney segments which are either fused, or joined by a variety of bony, cartilaginous or fibrous unions.
If these unions are damaged, irritated, or fractured, PAIN can result.
The attached muscles, the anus in front, and the buttocks(gluteus maximus) in back, account for some of the activities that can cause pain when the coccyx is disordered.
The main causes of coccydynia are falling on your backside, sports has bicycling, especially on irregular surfaces, or childbirth, which requires mobilization of the coccyx in order for the baby to exit.
One of my friends recently developed coccydynia from riding for several hours on a very bumpy dirt pathway. She has had the pain for two or three weeks now, has pain while sitting & upon getting up, but can walk without pain. Sleeping, especially on her side, causes no problems.
Ibuprofen affords temporary relief, but she likes to avoid taking it regularly because of side effects. Most people with coccydynia will recover after a few weeks, or occasionally a few months, and will be sufficiently impressed to avoid the causative activities.
If the pain persists for a long time or prevents normal activities, you should visit the doctor for diagnostic tests.
Please refer to the article by the Cleveland clinic for more information.
—Dr. C.
DOCTORS PODCAST: MEDICAL & TELEHEALTH NEWS (JULY 31)
A weekly podcast on the latest medical, science and telehealth news.
DR. C’S JOURNAL: WHAT IS PNEUMOCYSTIS PNEUMONIA?
Pneumocystis is found in the respiratory tract of most mammals and Man. Pneumonia from this organism was extremely rare or unknown before the advent of AIDS.
When the lymphocyte count of a person with AIDS drops below 500, or especially 200, pneumocystis pneumonia is a frequent complication. Symptoms include cough, fever, rapid breathing, and shortness of breath.. The chest x-ray typically shows a “ground glass” appearance, caused by fluid inside the air sacs and throughout the lung. Treatment is usually with trimethoprim sulfa.
Immunosuppressive therapy is often given for organ transplants and auto immune diseases these days. Patients and doctors should be on the lookout for pneumocystis symptoms in this situation. Even long-term corticosteroids can produce enough immunosuppression to allow pneumocystis to invade the body.
Pneumocystis Jeroveci is the causative organism, and used to be called pneumocystis Carini. Doctors suspect this disease when an immuno-suppressed patient, especially AIDS , has a dry cough, with pneumonia and a very low oxygen concentration, more severe than expected. Fluid taken from the lung shows several organisms in little sacks or cysts.
Treatment is with sulfonamids, if they are tolerated. Cortisone must be given not the same time to prevent a severe reaction from absorption of the dead organisms. Pneumocystis is a yeast-like fungus and is also discussed under opportunistic fungal infections.
The following article will give you more information.
—Dr. C.
Doctors Without Waiting Rooms 