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— Mayo Clinic (@MayoClinic) October 12, 2021
Category Archives: Women’s Health
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.
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.
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.
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.
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.
—Dr. C.
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #56: LUPUS
Lupus, which used to be called lupus erythematosus because of its butterfly rash and light sensitivity, is an auto immune disease, along with celiac disease and several other autoimmune diseases, it is the great imitator. It can affect almost any organ system.
The great variety of symptoms, and relative rarity leads to a difficulty in establishing the diagnosis. Eventually, you may be lucky enough to find someone who figures it out.
The butterfly rash over the bridge of the nose and cheeks is the most typical finding but it’s not present in all patients. Rheumatoid symptoms, including fatigue fever and joint involvement is common. Chest pain and shortness of breath can occur. Headache confusion and memory loss occurs. Involvement of the kidneys can also occur, it is often the involvement that is life-threatening. These are symptoms maywax and wane over a number of years.
The cause of lupus may involve a black background of infection, the medication, or even sunlight. As with most auto immune diseases, the actual cause is obscure.
Laboratory findings may include an anemia, kidney or liver involvement, and especially anti-nuclear antibody’s. Most people with lupus have a positive ANA test, but not all people with these positive tests have lupus. Other test maybe necessary.
Treatment is usually with Drugs which diminish the immune system. Targeting the B-lymphocytes specifically with rituximab or bulimumab may be helpful.
Lupus, the wolf, can be stealthy and severe. Patients often have to be their own advocate in order to get properly treated.
Please see the following mail clinic article for more information.
—Dr. C.
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #55: ALOPECIA (HAIR LOSS)
Alopecia is the medical term for baldness. The word has an interesting linguistic derivation, and comes from the Greek word Alopex, meaning fox. Foxes in Hippocrates time apparently were afflicted by hair loss from mange.
Men and women have different kinds of hair loss. In men, there is the receding hairline with age. As women age, there’s some thinning of the hair generally, and at the top of the head.
A special kind of hair loss that occurs in discrete areas is called alopecia areata. This is an auto immune disease, and is increased in frequency with people who have other autoimmune diseases. Hair loss can also be due to a fungal disease (ringworm) especially in children.
Cancer treatment can cause generalized hair loss, and we have all seen the bald children receiving cancer therapy, especially radiation.
Hair loss and regrowth comes in cycles. We all lose many hairs each day, but they regrow. When the cycle slows, there is a net loss of hair.
When I was in medical practice, my partner had early onset baldness, and was given hair transplants, which were effective. Treatments include minoxidil, which apparently increases the speed of hair cycles. An irritant, such as anthralin, will sometimes help Alopecia areaway by causing inflammation, apparently resetting the immune reaction that’s causing the hair loss.
Finasteride, which interferes with local testosterone production, can stimulate hair growth. I take Finasteride for prostate enlargement, and was surprised to hear about it’s effect on hair growth. Maybe that’s why I have such a bushy head of hair.
Please read the following at Mayo clinic article for a more organized discussion.
Doctors Without Waiting Rooms 