Tag Archives: Dr. C Comments

Blood Pressure: What Is Hypertension? (Video)

Learning about hypertension can be intimidating. Leslie Thomas M.D., a nephrologist at Mayo Clinic, walks you through the facts, the questions, and the answers to help you better understand this condition.

Video timeline: 0:00 Introduction 0:39 What is hypertension? 1:13 Who gets hypertension? / Risk factors 2:18 Symptoms of hypertension 2:36 How is hypertension diagnosed? 3:14 Treatment options 3:51 Coping methods/ What now? 4:05 Ending

COMMENTARY:

Hypertension is an elevation of the blood pressure in the arteries. It is measured conventionally by blood pressure cuffs, although a catheter in the artery is more accurate. I’ve had my blood pressure taken countless numbers of times by nurses and doctors who sometimes put the cuff on my arm through a piece of clothing, making it less accurate. Sometimes it is taken by an automatic blood pressure cuff even in the doctors office. The automated cuff can be purchased for $20 or less for you to use it at home, but it’s accuracy is questionable when you have an irregular heartbeat with atrial fibrillation such as I do.

The blood pressure reading which is considered to be normal Is dropping. In the present video, following 2017 guidelines , they state that a systolic reading of more than 120 mmHg is elevated, and anything more than 130 is hypertension. It may be true that studies have been done to show that these slight elevations cause problems, but so can the drugs that are used to lower blood pressure; a cough can be caused by ACE inhibitors. Fatigue and fainting can be caused by an excessive dosage of any blood pressure medication.

Healthy diet, especially avoiding extra salt, Regular exercise and good sleep will go a long way towards keeping your blood pressure at 120 or below on the high reading (systolic), and 80 on the low reading (diastolic).

My systolic blood pressure varies between 120 and 140 systolic, and is usually around 60 diastolic. For a long time I thought the relatively low (diastolic) blood pressure was more important, since diastole is of greater duration than systole, but it has now been determined that the systolic blood pressure reading is the one to worry about. Calcification and lack of elasticities in the arteries as you get older can lead to higher systolic blood pressure.

It used to be thought that the normal systolic blood pressure was 100+ your age in years. Those days are gone, however, and greater life expectancy and health Is one result of carefully monitoring your blood pressure, and working hard to keep it down.

Please refer to the Mayo Clinic article to give you (much) more information.

—Dr. C.

Medical Conditions: Signs And Treatment Of Sepsis

Sepsis occurs when the body’s response to an infection damages its own tissues. When these infection-fighting processes turn on the body, they cause organs to function poorly and abnormally.

As sepsis worsens, blood flow to vital organs, such as your brain, heart and kidneys, becomes impaired. Sepsis may cause abnormal blood clotting that results in small clots or burst blood vessels that damage or destroy tissues. If sepsis progresses to septic shock, blood pressure drops dramatically, which can lead to death.

Nearly 270,000 people in the U.S. die each year as a result of sepsis, and one-third of people who die in a hospital have sepsis, according to the Centers for Disease Control and Prevention.

Signs of sepsis

To be diagnosed with sepsis, you must have a probable or confirmed infection, and all of these signs:

  • Change in mental status.
  • Systolic blood pressure — the top number in a blood pressure reading — less than or equal to 100 millimeters of mercury, or mm Hg.
  • Respiratory rate higher than or equal to 22 breaths per minute.

Signs of progression to septic shock include:

  • The need for medication to maintain systolic blood pressure greater than or equal to 65 mm Hg.
  • High levels of lactic acid in your blood, which means that your cells aren’t using oxygen properly.

Treatment

Early, aggressive treatment increases the likelihood of recovery.

A number of medications are used to treat sepsis and septic shock, including antibiotics, corticosteroids, painkillers and sedatives. Supportive care, including oxygen and dialysis, and surgery to remove the source of the infection, also may be needed.

People who have sepsis require close monitoring and treatment in a hospital ICU. Lifesaving measures may be needed to stabilize breathing and heart function.

Read more at Mayo Clinic

COMMENTS:

The hospital is a dangerous places to be, and the most common cause of death there is sepsis. Sepsis is an underappreciated killer, and it’s getting more common because people are aging, devices are more commonly implanted into the body, immunosuppressive treatment is being used more commonly, and hospital acquired infections are increasingly resistant to treatment.

Sepsis can be caused by an overwhelming infection with bacteria, but can also be caused by viruses, fungi, and severe trauma. Low blood pressure is a common  problem, and is associated with change in mental status, and increased breathing rate in raising a red flag for sepsis. Endotoxins play an important, if confusing, role. Endotoxins derive from Gram negative bacteria, but the most common bacterium causing sepsis is the gram positive staphylococcus aureus. With sepsis, though,the gastrointestinal tract may become more leaky, and Gram negative organisms may thereby gain  access to the blood stream.

A ccmmon test to detect sepsis is the serum lactate, which becomes elevated if oxygen utilization is diminished, such as in sepsis. There is also a direct test for endotoxin in the bloodstream, performed by using LAL, or Limulus amebocyte lysate. This substance, derived from the cells of the blood of the horseshoe crab, is very sensitive to endotoxins, and coagulates in its presence. This test is also used to detect endotoxins in Biological products and devices, making horseshoe crab is quite valuable.

Maintaining general health, keeping up on your immunizations, wishing your hands, keeping cuts and burns free from infection, ovoid smoking, controlling diabetes and avoiding hospitals whenever possible are useful preventative techniques.

—Dr. C.

Prostate Cancer: Its Signs And Advanced Symptoms

Prostate cancer is one of the most common types of cancer. Many prostate cancers grow slowly and are confined to the prostate gland, where they may not cause serious harm. 

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However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.

Prostate cancer that’s detected early — when it’s still confined to the prostate gland — has the best chance for successful treatment.

Prostate cancer may cause no signs or symptoms in its early stages. When it’s more advanced may cause signs and symptoms such as:

  • Trouble urinating
  • Decreased force in the stream of urine
  • Blood in the urine
  • Blood in the semen
  • Bone pain
  • Losing weight without trying
  • Erectile dysfunction

Read more

COMMENTARY:

PSA screening will pick up prostate cancer very efficiently. However, it will also pick up slow growing cancer that might never be require treatment, and responding to the positive test could cause problems ranging from pain and convenience to erectile dysfunction and incontinence.

It takes 1000 men screened to produce one life-saving treatment for prostate cancer.

Risk reward analysis means that the younger you are, the more reasonable is a test, since you have many more years of potential life. The older you are, conversely, the less you have to gain. The problem is that most cancers are slow growing, and might never cause a problem, especially if you have only a few years left to live.

Most experts recommend a test when a man reaches the age of 45, but reserve annual testing for those who are at high risk, such as having a brother or father with aggressive prostate cancer.

When a man reaches the age of 70, most experts would decline to test.

Sometimes, emotional considerations present themselves; worry is very much a disease. For instance, the best man at my wedding stopped getting his PSA test about three years before he was diagnosed with fatal metastatic prostate cancer. I am inclined to continue getting my annual prostate test, and would worry if I didn’t.

A recent study in the journal Cancer reported that more than half of a group of men 75 years and older had PSA tests and biopsies.

As an interesting aside, the PSA test is the only test I have ever had rejected by Medicare, presumably because of this expert opinion factoring in the cost benefit analysis of using the test.

—Dr. C.

Covid-19: China Approves The First Inhaled Vaccine

The vaccine, called Convidecia Air, changes the liquid form of the vaccine into an aerosol using a nebuilzer. The vaccine can then be inhaled through the mouth using the nebulizer machine. The needle-free vaccine “can effectively induce comprehensive immune protection in response to SARS-CoV-2 after just one breath,” Cansino said in a statement.

In July, Chinese scientists published a pre-print study showing that people who received one booster dose of Cansino’s inhaled vaccine after two doses of the inactivated jab from Chinese maker Sinovac developed more antibodies than people who received three Sinovac shots. Four weeks after receiving the inhaled booster, 92.5% of people had developed neutralizing antibodies for Omicron.

Those who got three doses on Sinovac’s jab did not demonstrate any neutralizing antibodies for Omicron, either four weeks or six months after getting a booster.

Read more

COMMENTS:

Spray vaccines will be our best chance to stop Covid.

However, there are two big problems that have to be solved.

The first problem is keeping up with the blitzkrieg mutation capacity that Covid has. Our best chance to do that is with the mRNA technology, which permits vaccine generation with minimal delay. However, mRNA vaccines are too fragile to be suitable for a nasal or oral spray. The particles would be destroyed before they could activate the mucosal immune system.

But it is still possible, using laboratory technology to convert this mRNA into peptides and proteins suitable for use as a spray. Using AI to generate three dimensional shapes, surely a  stable molecule of suitable configuration and stability could be eventually generated.

The second appears to have been partially solved by the Chinese, according to the Fortune  article, namely getting an injectable vaccine into a suitable form and dose to survive the bodies mucosal clearance mechanisms and enzymes, designed to keep foreign sprays and mists out of the body, in enough concentration to stimulate the mucosal immune system.

Our bodies have developed a parallel Defense system using a unique immunoglobulin, IGA, and  special support cells. When stimulated, immunity bristles as a first line of defense to deny incoming viruses entrance to the body. This is what is needed to prevent infection from occurring in the first place, so extremely important for a highly infectious and potentially lethal virus such as Covid.

The Chinese, with their autocratic system,  have a better chance of making everybody take this vaccine, even though it requires a cumbersome liquid nebulizer to generate the mist.

Better would be a handheld inhaler, and, hopefully, this is what some dozen pharmaceutical corporations, working on a nasal or inhaled vaccine , are aiming for.

—Dr. C.

Insulin Resistance: Risk Factors And Treatment

Learning about insulin resistance, or prediabetes, can be intimidating. Eleanna De Filippis, M.D., Ph.D., an endocrinologist at Mayo Clinic, walks you through the facts, the questions, and the answers to help you better understand this condition.

Video timeline: 0:00 Introduction 0:41 What is insulin resistance? 1:32 Who gets insulin resistance? / Risk factors 2:38 Symptoms of insulin resistance 4:04 How is insulin resistance diagnosed? 4:34 Treatment options 5:21 Coping methods/ What now? 5:41 Ending

COMMENTARY:

The (developed) world just has too much food. Food producers race with each other to make It tastier, to advertise it widely, and make it available on demand. As a consequence of their success, at least 1/2 of the developed world is overweight and has decreased insulin sensitivity, prediabetes or diabetes. This leads to severe health consequences in the form of hypertension, arteriosclerosis, heart disease, brain disease, liver disease, and a variety of back and joint problems.

Mankind did not evolve in an environment of chronic nutritional oversupply, but rather it’s reverse. Mankind did not develop in a sedentary environment, but rather it’s reverse.

Insulin resistance is caused by overfilled energy stores (excess fat), increased inflammation from distended, dying fat cells, excess fatty acids and stresses to some of the important micro structures in our cells, such as mitochondria and endoplasmic reticulum, not to mention metabolic pathways such as the mTOR and Sirtuin systems.

Eating is a pleasure, and turning down food takes self-discipline, which is a pain, and is becoming increasingly unpopular. “Maybe a pill will come along to get rid of fat and prevent its accumulation”. but don’t count on it. The main hope for avoiding the danger of overnutrition is being discriminating about what and how much you eat.

Exercise is inconvenient and uncomfortable, but is the second necessity for a healthy life. Two of its many benefits is to increase adiponectin, which increases burning of the fatty acids which are so toxic to the body, and to increase insulin sensitivity, counteracting type two diabetes.

The third necessity is getting enough sleep.

Replay the old record. Diet, exercise and sleep, sleep  diet and exercise.

Please excuse me, it’s time for my evening exercise.

—Dr. C.

For more reading visit: https://mayocl.in/3waShVV.

INFOGRAPHIC: ‘DIFFERENCES BETWEEN COVID-19, THE FLU AND ALLERGIES (2020)

COMMENTARY:

The infographic by the allergy and asthma foundation aims to distinguish between Covid, Influenza and allergy. I would like to discuss more than symptoms. Covid and Influenza are both caused by invading infectious viruses.

Allergy is an over-response by the sensitized body to harmless proteins from the environment Covid and Influenza viruses cause direct damage to the lining membranes of the respiratory tract provoking a protective response by the body which produces inflammation in the nose and lung. Rhinitis, bronchitis and pneumonia result, depending on the site of the inflammation.

The symptoms of Allergy are far different from both Influenza and covid. ITCHING of the nose, eyes and skin is the hallmark of allergic Rhinitis, allergic conjunctivitis and Hives, respectively. Influenza or Covid Infection of the nose, eyes and airways can produce sneezing, redness, coughing and difficulty breathing, but not usually itching.

Fever is characteristic of Influenza and Covid, but not of uncomplicated Allergy. Asthma can result from either infection or allergy, but is a separate beast, caused by release of different inflammatory cytokines.

The ASTHMATIC REACTION shows itself in the BLOCKAGE of breathing of air OUT of the lung, on EXHALATION. This blockage on exhalation in asthma is heard as wheezing, a musical sound. Just ask the wheezing person to take a deep breath IN, which should be easier, and then breathe out as fast as possible, which should be slower and more difficult. Fever is not a feature of uncomplicated Asthma. Influenza and Covid.

Both produce FEVER, fatigue, aching and usually coughing. Covid has the greater linkage with Coughing, which often progresses to Shortness of breath. Both Influenza and Covid can produce a sore throat and runny nose. LOSS OF SENSE OF SMELL is unique to Covid, although if your nose is stuffy, the sense of smell can be impaired. Influenza preys on the very young, which are generally spared from Covid.

If you are careful about social distancing and wear masks in public, and get sick, Covid is more likely, since COVID IS MORE CONTAGIOUS THAN INFLUENZA. Covid protections will probably result in fewer cases of Influenza this winter.

To summarize,both the “flu” and Covid 19 are infectious conditions, vastly different from allergy, which is a derailed body defense mechanism. Any of the three can result in an asthmatic reaction, though the fever of influenza often lessens the Asthmatic response to that condition.. Covid is much more contagious and severe than influenza and can cause more widespread organ damage. Be sure to practice MASK WEARING AND SOCIAL DISTANCING.

If you have asthma and it worsens, in my opinion, this favors covid. My asthmatic patients often got better with the fever of Influenza. If you have a CHILD that gets sick, it is more likely to be Influenza than Covid.

–Dr. C

PODCAST: “THE EFFECTS OF HEARING LOSS ON COGNITIVE DECLINE” (JAMA REVIEWS)

Even limited hearing loss might be associated with cognitive decline. If true, early intervention with hearing aids might help people have better cognitive performance. 

Michael Johns III, MD, online editor for JAMA Otolaryngology, speaks with Justin Golub, MD, MS, assistant professor of otolaryngology at Columbia University, whose research has shown that very mild hearing loss can be associated with cognitive disability.

COMMENTARY

Hearing loss and cognitive ability decline together as we age, starting earlier in some people than others.

LIVING A HEALTHY LIFE STYLE-with good SLEEP, DIET, EXERCISE and COGNITIVE STIMULATION -seems to help benefit almost everything, including hearing, while a poor life style, neglecting the 4 Pillars, smoking, and drinking alcohol to excess seems to hasten our aging.

Certain medications, often taken to treat the results of a poor life style, can also harm our hearing.

LOUD SOUNDS (such as AMPLIFIED MUSIC), especially if prolonged, are particularly bad. SOUND POLLUTION contaminates the modern world as much as industries‘ excesses. I would often wear ear plugs to Football games (108 dB on my meter) and even in row 4 of the Symphony.

Once damaged, the delicate HAIR CELLS of our inner ear don’t grow back, although medical science once again is working feverishly to save us from ourselves.

Hearing aids can now be programmed to compensate for our particular pattern of frequency loss.

The premise made in the above article and podcast, that decreased HEARING is accompanied by (and Causes?)decreased COGNITION could be supported by a study demonstrating that Improved hearing restores the cognition. I understand that early results may suggest a cognitive benefit of hearing aids.

But PRESERVING BOTH with healthy living would of course be better- at least in my opinion.

Prevention, unfortunately, is a very hard sell in a world of costly medical treatments, where we are protected from directly confronting those costs by ever-expanding insurance. How about Medical savings accounts?

—Dr. C.

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HEALTH: “HOW THE BODY CLEARS COVID-19” (VIDEO)

Understanding how the body clears the new coronavirus is becoming more important as the U.S. begins to reopen. WSJ’s Daniela Hernandez explains how the body fights infection and why feeling better doesn’t equal being virus-free. Photo illustration: Laura Kammermann

COMMENTARY

This excellent video is well worth watching and listening to. It revisits how the immune system, both innate and adaptive responds to SARS CoV and other viruses.

It shows graphically how long the body takes to clear the the Covid 19 virus.

And it makes me, a susceptible 88 year old, even more alert to infection. We should keep our guards up.

Even if an effective vaccine is found, it will probably take its place, incorporated into influenza vaccine as an annual immunization.

Dr. C.