Category Archives: Resources

Melanoma: How To Catch Skin Cancer Early (Mayo)

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #45: SLEEP APNEA

Sleep apnea and obesity are bound together as Charles dickens observed in his Pickwick papers. The Pickwickian syndrome is obesity associated with alveolar hypoventilation(insufficient breathing) with an increase in CO2 in the bloodstream which causes narcosis, or SLEEPINESS, in the daytime.

When I went in for my sleep apnea study, I noticed a number of double wide chairs available for the usual clientele there. OBESITY is one of the major risk factors for sleep apnea. Depositions at the base of the tongue and throat interfere with breathing, and causes snoring to the point of tracheal blockage and apnea at night.

Some people with normal “ BMI”, have sleep apnea. Sleep apnea can run in families, occur when you are older, or have a thick neck. So no matter what your weight, if you have daytime sleepiness after an apparently full night of sleep, you should be considered for a sleep study.

A SLEEP STUDY requires that you go into a sleep center overnight, get hooked up to an electroencephalogram machine, oxygen monitor, chest straps, and the like. This is the gold standard for a diagnosis of sleep apnea, but a recording pulse oximeter will let you know a lot less expensively if you have the critical problem, a drop in oxygen saturation. The type of sleep apnea I have been discussing so far is obstructive sleep apnea. Of course there are other types such as central, or complex sleep apnea.

Most sleep apnea responds to nasal CPAP, if you can tolerate it.
My own sleep apnea was diagnosed as moderate, 15% central and 85%  obstructive in type.  I have a stuffy nose which I believe to be the main problem setting me up for sleep apnea, and I could not tolerate the positive nasal CPAP. There is also a dental apparatus that I tried unsuccessfully. I wound up sleeping on my side, and propping myself in that position with pillows .This seems to help me, but I still wake up several times a night, usually at the end of a 90 minute sleep cycle, and with a full bladder.

I sleep through better on days when I have had more physical or mental exercise. Avoiding a full stomach at bedtime is also helpful with both sleep apnea and GERD.

I do use Afrin on the left side of my nose, which is more obstructed. I restrict the use to every third day, although I have heard that you can use it every other day, alternating sides, if you have a stuffy nose that has resisted other treatments .I have also heard that using corticosteroid nasal sprays makes Afrin better tolerated. Be sure to get clearance with your doctor before trying this.

— Dr. C

Read more at Mayo Clinic

Mayo Clinic: ACL Tears – When Surgery Is Needed

ACL tears can sideline an athlete or crush an Olympic dream. It’s a common knee injury affecting nearly twice as many women than men. Dr. Cedric Ortiguera, a Mayo Clinic orthopedic surgeon and sports medicine specialist, says 150,000‒200,000 ACL injuries occur each year in the U.S., and that number is growing as more children become involved in competitive sports year-round. The good news is that surgery can help get some athletes get back in the game.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #44: SYPHILIS (STD)

Syphilis is a venereal disease, or STD, that is unusual,  unique in many ways. First of all, it is one of the few major diseases to have originated in the Americas, the New World, and carried back to Europe most likely by Columbus; Popularized by “guns germs and steel”, the infectious disease traffic was almost all the other way, most famously smallpox which decimated the Native Americans.

A second unusual characteristic is that it’s treatment(penicillin) is known, cheap, easy, and yet Syphillis infects millions of people yearly, most commonly to be sure in the developing world, but also large numbers in America where is helped by AIDS, and spread by men having sex with men.

A third unusual characteristic  is that syphilis can mimic practically any disease. There are three stages.  The first stage is a painless ulcer, usually on the genitals.  After a few weeks, the second stage develops, showing a widespread rash and other symptoms.  After a few more months, problems develop in the heart, brain, or growths ( gummas) in many other areas .

When I was in medical school we used to go to an old peoples home to listen for aortic regurgitation, and observe the neurologic symptoms of syphilis patients. Syphilis is still a cause of aortic  insufficiency, if untreated.

Treponema pallidum, The causative agent, is also unusual. It has a very small geome, and has many missing cellular mechanisms, making it dependent upon Homo sapiens, it’s only known Reservoir. The fragile but very active organism will die in a few hours outside of its human host. Like it’s confederate,AIDS, The infection can easily spread from mother to child with devastating consequences. It is one of the major diseases for which pregnant mothers are tested.

Syphilis is one of the best arguments for being monogamous. If this can’t be, remember that syphilis is easily treatable, and that you should report any unusual illnesses to your doctor.

—Dr. C

RESEARCH: ‘THE SCIENCE OF HEALTHY AGING’ (SCRIPPS)

Although growing older comes with a number of major life changes, science can help inform the things we do in the here in and now to forestall the most serious features of the aging self, promoting healthspan and not just lifespan.

Summer 2021
  • Build Muscle – Muscle mass is one the best predictors of health and longevity. Muscle tissue is known to release its own chemicals called myokines, which can have benefits that span cognition, immunity and anti-cancer activity. By performing regular, resistance-based exercise that prioritizes strength, we can delay the loss of bone density and risk of physical injuries.
  • Vitamin D – Commonly known as the sunshine vitamin, vitamin D is in fact a critical hormone that helps maintain healthy bones, boost our immune system and improve our cardiovascular function. With age, the production of vitamin D in the skin can become less efficient, so if we don’t spend enough time outdoors, our risk of vitamin D deficiency may increase.
  • Neurodegenerative Diseases – One of the most unsettling aspects of aging is the potential for neurodegenerative disease. These conditions are increasingly prevalent in those with diabetes, suggesting that the brain’s blood flow and energy supply may be compromised. Research indicates that regular physical exercise, a healthy whole foods diet and staying intellectually active could at least slow the rate of decline.
  • Mindfulness – As we get older, major arteries can become thicker and less flexible, leading to increased blood pressure and undue strain on the heart. A regular mindfulness practice such as yoga or meditation has been shown to stem the release of stress hormones like cortisol and adrenaline. By freeing us from this “fight-or-flight” state, this habit can improve blood flow and reduce the risk of heart attack and stroke.
  • Stay Social – As social animals, maintaining a strong sense of community and close personal relationships into old age are underestimated contributors to longevity. While social isolation in seniors can result in significant physical and mental decline, research suggests that close loved ones offer important emotional support and behavioral modifications that can overcome periods of high stress.
  • Metabolism – “My metabolism is slowing down!” That’s what we often hear, as the aging body becomes less effective at using energy, placing us at risk of obesity and type 2 diabetes. By maintaining our muscle mass and reducing sugar consumption, we can support hormonal health, preserve our metabolism and keep our vitality into those advanced years. As scientists continue to find ways to extend our lives, paying attention to these keys to healthy aging can help increase the quality of those extra years.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #43: CELIAC DISEASE

Celiac disease – I know of no disease more rare that is a fixation for more people. Practically everything I see in the processed food area advertises itself as being gluten free, yet celiac disease affects about only one in 100 people.  Even the dogs that I see on my walk are claimed by their owner to be on a gluten restricted diet.

Celiac disease-it’s hard to imagine a more complicated and variable disease. Although Coeliac Disease runs in families with HLA-DQ2 and HLA-DQ8, having these markers is not alone sufficient to cause Coeliac Disease. Eating gluten is not even sufficient, but requires an enzymatic change via tTG2 to make gluten fire up the immune system. Testing  for an antibody to tTG2 is one of the better tests for celiac disease, and a drug that blocks tTG2 has recently proven helpful as a treatment for celiac disease.

CD often starts in young children, but the disease can begin at any age. Although gastrointestinal symptoms such as diarrhea or constipation, bloating, and bulky, oily stools are typical, even clear-cut cases may have no recognized symptoms at all. In other cases almost any organ can be involved, or the symptoms can be non-specific such as Weight loss, anemia and fatigue.

it is estimated that only about 10% of people with celiac disease are ever proven to have the diagnosis. It Is massively under diagnosed in spite of permeating the popular lore.

A lot of people place themselves on a gluten-free diet and  claim to feel better, but being on a gluten-free diet makes the diagnosis difficult to make; if celiac disease is seriously suspected, the doctor will place the patient on a gluten-containing diet which allows the tests, such as  anti-t-TG2, or villous atrophy of the small bowel to become positive.

Among people who actually have real, valid, proven celiac disease, who have every reason to want to restrict gluten to improve their Disease, 40% of them have great difficulty in adhering to the necessarily draconian gluten free diet.

Even the doctors can have a blind eye to celiac disease, since it is quite rare. A good friend of mine with chronic bloating went to a gastroenterologist who declared her free of disease, without having ruled out celiac disease. One would think that a gastroenterologist  would be tuned in to coeliac disease, given the prominence of gastrointestinal symptoms and pathology.

The patient should be her own advocate.

—Dr. C

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DR. C’S JOURNAL: CAUSES & SYMTPOMS OF INSOMNIA

Sleep has many functions, among which are clearing the body of toxins and consolidating memory. The exact amount we need is determined by age, and genetics among another things. From what I’ve read, eight hours is required, plus or minus an hour.

That being said, there are a few  among us who are super sleepers. Going back in history this probably included Mozart and Thomas Edison: They could live healthy, productive lives with as few as three or four hours of sleep. Genetic mutations, including changes to the Orexin Gene receptor account for true super-sleepers.

Familial fatal insomnia is a genetic disease operating through prion proteins, and does not illuminate the problem of insomnia. In most people  there are two major forces which determine the onset of sleep, the circadian rhythm, and sleep pressure.

The TIMING of the sleep varies from morning larks to night owls. These shifts in the circadian rhythm is also genetic, involving many genes, including PER and CRY. Diurnal rhythm can apparently be changed, But with difficulty.

The sleep pressure is caused by the gradual daily accumulation of adenosine in the system, apparently resulting from the stripping away of the phosphate groups from the energy currency, ATP.  This can be assuaged by caffeine containing drinks, such as tea or coffee. Caffeine temporally blocks the effect of adenosine, but when it wears off, you usually go right back to your fatigue state.

INSOMNIA occurs when you do not get as much sleep as you need, and are tired in the daytime. This is a major problem for a lot of people.

Insomnia has many causes. Stress will cause an increase in Cortisone in the bloodstream which interferes with sleep. Caffeinated drinks nicotine and other stimulants can cause you to have difficulty falling asleep, and alcohol will help you fall asleep but will often result in awakening in the middle of the night when the alcohol is metabolized.

Depression, Parkinson’s, chronic pain, gastroesophageal reflux and any other medical conditions can interfere with sleep. Sleep apnea, often associated with overweight and heavy snoring, is a special problem that sometimes needs the help of a sleep specialist.

Some poor habits such as reading in bed, doing work in bed, eating at bedtime, and heavy exercise just before bed can also be a problem.
A regular routine of Preparing for sleep, such as brushing and flossing and taking a warm shower are also helpful; you can get more details by looking up “sleep hygiene”.

A lot of people take a nap, but this can cause some difficulty in going to sleep. Among things you can do to prevent insomnia include living an active life, making your bedroom comfortable for sleep, and using your bedroom ONLY for sex and sleep.

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

—Dr. C.

Mayo Clinic articlehttps://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167