Medicine, Research, SLEEP, Studies

Research: Sleep Disorders Links To Brain Health

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Research on sleep disorders and the importance of regular shut-eye has deepened our understanding of the link between sleep and brain health.

February 2023

Overall, there are more than 80 sleep disorders, ranging from the mildly annoying to the potentially deadly. The best known is probably insomnia; about 10 percent of the general population has chronic insomnia, an inability to fall asleep for multiple nights over a period of months.

Addressing sleep disorders “is paramount to not only protecting the brain down the road but also on a day-to-day basis,” says Daniel Barone, MD, associate medical director of the Weill Cornell Center for Sleep Medicine in New York City and co-author of The Story of Sleep: From A to Zzz (Rowman & Littlefied, 2023). “One of the best ways to take care of our brains is by getting quality sleep.”

Intriguing Clues

Research on sleep disorders has led to improvements in treatment for a variety of sleep and neurologic conditions. Case in point: Studies in the late 1990s on the causes of narcolepsy with cataplexy—the condition Connor was initially diagnosed with—led to the development of dual orexin receptor agonists, drugs now commonly prescribed to treat insomnia. The researchers discovered that people with narcolepsy with cataplexy often had low levels of hypocretins (orexins), brain chemicals that sustain alertness and prevent REM from happening at the wrong time.

“Once they found out, ‘If I take away your hypocretin, it makes you sleepy,’ there was a new idea of how to make a sleeping pill,” says Rafael Pelayo, MD, clinical professor of psychiatry and behavioral sciences at Stanford University School of Medicine in California and a sleep specialist at the university’s Sleep Medicine Center.

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Aging, Infographics, Medicine, Reviews

Infographic: Management Of Osteoarthritis (OA)

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Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees. With OA, the cartilage within a joint begins to break down and the underlying bone begins to change.

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Dr. C's Journal, Medicine, Opinion, Reviews, Women's Health

Medicine: A Historical Look At Breast Cancer

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Breast cancer is best looked at from the historical perspective, as did Lindsay Fitzharris in the December 3, 2022 issue of the Wall Street Journal.

Can you imagine having breast cancer in the mid 1800s before the germ theory was developed? 50% of all surgeries died of severe infection at that time.  Before the development of anesthesia, of course, cancer removal was extremely painful as well. Even if the patient escaped dying from infection, the one size fits all  often meant removal of some chest wall muscles, leading a gaping wound.

Today, prophylactic breast imaging (mammography) often discovers the cancer at a very early and treatable stage.

Searching the cancer cells for rogue genes and surface markers often shows the way to better treatment; no longer does one size fit all.

Sometimes the breast lump is removed with minimal surgery and radiation is used, often yielding better results than the old time radical mastectomy.

Surgery itself is often aided by tissue biopsy, and now, with “intelligent” knives, gases from the surgical cut, using mass spectrophotometry, can tell the surgeon whether the tissue being cut is cancerous or normal.

Immunization methods are in development which will help your immune system to conquer any residual cancer, and “smart” T cells can be used to attack cancer cells directly.

Breast cancer Is still the most common cause of cancer deaths in women, even with all of the modern developments. Early detection is very beneficial, as with Breast self-examination and regular mammograms as prescribed by your doctor.

Extra care should be taken in families with certain genetic markers like like the BRCA gene.

—Dr. C.

In The Lab, Medicine, Reviews, Science, Uncategorized

Cancer & Genetic Testing: Nine Questions Answered

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“Many health conditions have a genetic link,” says Breanna Mitchell, a genetic counselor at Mayo Clinic Health System in Eau Claire. “Genetic testing can help you and your health care team understand if you have an increased risk for developing certain conditions that are present in your family. If you are at risk, you may be able to take preventive measures to decrease your risk or undergo genetic testing to clarify your risk.”  

Mayo Clinic (February 6, 2023) – Your genes play a role in nearly all areas of your health. A gene is like an instruction manual for your body that tells your body how to function, develop and stay healthy. People have about 20,000 genes in their bodies.  

Here are nine common questions about genetic testing:  

Do all types of cancers have a genetic component?  

Most cancers are considered sporadic, meaning the cancer happens randomly or has environmental influences, such as smoking and lung cancer. About 25% of cancers are considered familial. This is when multiple members of a family are affected by cancer. These family members have some shared genetic factors in combination with shared environmental factors that lead to the development of these cancers.  

“About 10% of cancers are considered hereditary or have a single specific genetic component that can be tested and increase a person’s risk for developing cancer,” Mitchell says. “Genetic counseling and genetic testing can help determine which category a person’s individual or family cancer falls into. It also can help estimate your risk for developing cancer.” 

What types of genes are examined during genetic testing?  

You may have an increased risk for some health conditions, including some types of cancer, based on your genes. A genetic test looks for specific harmful gene changes, called mutations or pathogenic variants, that can cause you to develop a genetic condition. Gene changes are like spelling errors within your body’s instruction manual.  

Most genetic tests look for changes in a group of genes called a panel. However, testing may look for changes in a single gene when there is a known genetic mutation in your family. The most common genes typically thought of related to cancer risk are BRCA1 and BRAC2. These genes are associated with breast and ovarian cancer. It’s known that changes in other genes can increase risk for these cancers, as well.  

There also are gene panels that assess risk for other cancers, such as colorectal, pancreatic, prostate, liver, uterine and endometrial cancers. 

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Medicine, Reviews, Rx

OTC Pain Relievers: Types & How To Safely Use Them

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The two main categories of commonly used pain relievers (also known as analgesics) are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

  • Acetaminophen (Tylenol) controls pain and fever but doesn’t help with inflammation. It’s an active ingredient in many drugstore headache and cold remedies.
  • NSAIDs include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn). These ease pain and lower fever like acetaminophen, and also work as anti-inflammatories. NSAIDs are popular pain relievers for inflammation-related conditions like arthritis and injuries.

Potential side effects

Acetaminophen. High doses can damage the liver. The maximum recommended per day is usually 4,000 milligrams (mg), equivalent to 12 regular-strength or eight extra-strength Tylenol tablets. It’s also possible to develop liver problems after taking small to moderate amounts if done so over an extended period.

To be safe, take no more than 3,250 mg of acetaminophen a day. The FDA recommends using products containing no more than 325 mg per pill or capsule to avoid excessive dosages. Also, be cautious when mixing multiple products containing acetaminophen, such as a pain reliever, a cold medication, or a prescribed narcotic. “And do not take acetaminophen if you drink alcohol more than moderately on a regular basis or if you have liver disease,” says Dr. Gilligan.

NSAIDs. The most common side effect is stomach irritation which may cause pain, bloating, or heartburn. These medications also may cause ulcers, which can lead to internal bleeding. Excessive use of NSAIDs increases the risk of heart attack, stroke, and kidney failure. The most common daily limits are 1,200 mg for ibuprofen and 660 mg for naproxen.

All NSAIDs (except aspirin) tend to boost blood pressure. While the effect is most potent in people who already have high blood pressure, anyone taking an NSAID may see an increase in readings.

People who are concerned about possible side effects can try topical pain relievers, such as products containing diclofenac (Voltaren gel) or lidocaine. “They are a safe choice for pain due to soft tissue injury or osteoarthritis as smaller amounts are absorbed by the body,” says Dr. Gilligan.

Read more at Harvard Health

Aging, Dr. C "Comments", Medicine, Reviews, Women's Health

Women’s Health: Risks & Treatment Of Menopause

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As levels of estrogen, a crucial chemical messenger, trend downward, women are at higher risk for severe depressive symptoms. Bone loss accelerates. In women who have a genetic risk for Alzheimer’s disease, the first plaques are thought to form in the brain during this period. 

February 4, 2023

About 85 percent of women experience menopausal symptoms. Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh who studies menopause, believes that, in general, menopausal women have been underserved — an oversight that she considers one of the great blind spots of medicine. “It suggests that we have a high cultural tolerance for women’s suffering,” Thurston says. “It’s not regarded as important.”

Even hormone therapy, the single best option that is available to women, has a history that reflects the medical culture’s challenges in keeping up with science; it also represents a lost opportunity to improve women’s lives.

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COMMENTS:

The New York Times, Sunday magazine, posted an article by Susan Dominus entitled “the vicious cycle”, in which was a long discussion of the disease burden of menopause. It is well worth reading.

“Forever Feminine” was a book by Robert Wilson, in 1966, which promoted hormone treatment for “enjoyment of sex” in menopausal women. The use of estrogen skyrocketed.

Alarming research in 1975, which linked estrogen usage to endometrial cancer, halted the rise of the drug’s popularity.

Without hormonal treatment, the many symptoms of  menopause were devalued and quietly suffered by women.

The medical profession has been slowly recovering from whiplash. New, better controlled research is being done and slowly a more nuanced approach is being taken. Women with a history of heart attack or stroke are still generally advised against hormonal therapy, but many others are being given birth control pills, which is a combination of estrogen and progesterone.

The average age of menopause is approximately 50 years of age, but symptoms can anticipate menopause by several years. An elevated FSH is the usual laboratory test to indicate perimenopause.

Early menopause can be associated with a decreased lifespan, increased likelihood of osteoporosis, cardiovascular disease and dementia, and is often treated with hormonal therapy. A delayed menopause is less likely to be treated with hormonal therapy, because of increased risk.

There are a lot of risk factors to be balanced against the symptoms involved, such as hot flashes and the entire panoplay of symptoms indicated in the infographic.

Some day, artificial intelligence will be used in order to make more explicit the benefits and risks involved. Until that time, the patient suffering from premenopausal or menopausal symptoms should find a Doctor Who would actually listen to her, a difficult task these days.

—Dr. C.

In The Lab, Medicine, Reviews

Medical Screening: The Thyroid Function Test

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When you are low on your thyroid, or hypothyroid, you may feel sluggish, gain weight, and think slowly. When your body produces too much thyroid hormone, and you have hyperthyroidism, you may feel nervous, shake, and lose weight.

During a physical examination, the doctor should palpate, or feel, your thyroid gland, which is in the neck, straddling the wind pipe, below the larynx, or voice box. If it is enlarged or bumpy, there may well be an abnormality,  most common of which is a generalized enlargement, usually due to Hashimoto’s thyroiditis, which eventually leads to hypothyroidism, or a low functioning of the thyroid.

Because of its importance, thyroid function is often taken as a screening test.

When there is not enough thyroid hormone in your bloodstream, the pituitary, or master gland  increases the TSH, or thyroid stimulating hormone. Less commonly, when the function is excessive, the TSH drops to an excessively low level.

The thyroid panel usually consist of FT4, or free thyroxin, and a TSH, as a counter check.

Sometimes, often in older people, the TSH rises for seemingly no reason, although the FT4 remains normal. The doctor then determines clinically whether or not your thyroid  is low and you need to have oral thyroid supplementation.

                      Result value.                Ref. Range.

FT4.                  1.03 ng./dL.              0.76 – 1.46 ng./dL

TSH.                  12.10.  (H).                0.36 – 3.74 uIU/mL.

I am Currently not taking any thyroid supplements. I feel a little fatigued much of the time, but I’m losing, rather than gaining weight, and sometimes I feel pretty peppy. I also have atrial fibrillation, and have had NSVT, which could be worsened by thyroid supplementation. With my age, my physician is comfortable not giving me thyroid, and so am I.

—Dr. C.

Diet Health, Medicine, Prevention, Reviews, Videos

Prevention: How Our Diet Boosts The Immune System

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New Scientist – The biggest immune organ is our gut and what we eat can support a healthy immune response. From eating the rainbow, consuming more fermented foods or fasting longer overnight, King’s College epidemiologist Tim Spector has top tips to boost your immunity through what you eat.

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In The Lab, Medicine, Reviews

Cholesterol: How To Read The Lipid Panel Blood Test

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There are three general types of large molecules of which our body is composed. There are PROTEINS, essential components of the Nanomachines that power of our bodies, the CARBOHYDRATES which can form structures, as well as provide and store nutrients, and LIPIDS, which can function as a storehouse of nutrients.

Lipids, unlike carbohydrates and proteins, are essentially nonpolar, that is they have no profusion of charged molecules. The main characteristic of lipids is that they do not dissolve in water, thereby allowing for domains and structures to develop in the cell and beyond.

Cholesterol is a lipid that is essential to our cell membranes, and therefore to life. As people get older, however, cholesterol tends to accumulate and get stored in unwanted places, such as under the lining membranes of blood vessels. In this location, they can cause blockages that threaten the very life for which they are essential.

All of the lipids measured in the comprehensive lipid panel measure lipids in different forms that have different functions and significance in the body. The only one of the lipids that is almost always good, or at least neutral, is the high density lipoprotein, the HDL. The level of this lipoprotein is under genetic control and is increased by EXERCISE and FISH OIL, among other things.

“Good Genes”, healthy diet and exercise will help keep down the bad lipids, especially the LDL, and elevate the main good lipid , HDL.

Coronary artery disease and strokes are the main killers in mid and into later life, and are therefore very important to control. Many people do not seem to have the self-discipline that healthy diet and exercise requires. Fortunately, we have a miracle drug. the HMG- CoA inhibitors, the “statin” drugs, which most people tolerate without the muscle pain and myolysis side effect.

I have taken the statin drugs for years, ever since I discovered my cholesterol was 220, above the optimal level. Fearful of muscle effects, since I am a heavy exerciser, I started out on 1/2 of the lowest dose, 2.5 mg., of Rosuvastatin. This amazingly took my cholesterol level all the way down to 180, and my LDL down below 100, a powerful medication indeed.

My most recent Lipid panel results are below:

                                      Result value.              Ref. Range

Triglycerides.                    51 mg./dL.                <150 mg./dL

Cholesterol.                        186 mg./dL.                <200 mg./dL

HDL.                                    90 mg./dL.                  > 60 mg./dL

LDL direct.                          95 mg./dL.                  <100 mg./dL.

The authorities have lowered the normal range a couple of times during my lifetime. It is true that even lower values than mine show ever more benefit.

It is best to keep your lipids under control with diet and exercise, so stay healthy!

—Dr. C.

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