Tag Archives: Dr. C’s Journal

DR. C’S JOURNAL: AMBLYOPIA

Amblyopia is an example of how the body suppresses or gets rid of activity that is not used. Amblyopia “ex anopsia” is the leading cause of poor vision in children, and the most common reason is a “lazy eye”. If the eyes do not work together for binocular vision, the weaker of the two eyes has suppressed development and eventually eyesight is lost.

I have a friend who was going in the pilot training, it was found to lack good depth perception, and could not proceed. He now complains occasionally of double vision, and may be an example of the suppressed eye with lack of binocular vision.

I have a muscle in balance which causes a rotation of my eye so that it’s hard to fuse on a horizontal linear object. I was probably able to fuse  when I was younger and avoid this loss of vision in the weaker eye.

So be on the alert for a squint, or wandering eye in children. Get them in early for treatment, the earlier the better, and it must take place before age 5 to 7.

—Dr. C.

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DR. C’S JOURNAL: WHAT IS AUTOIMMUNE DISEASE?

Our immune system contains cells that are part of us, and they evolved to protect us. They generally do a good job of this, as witnessed by our survival in a sea of viruses, microbes, and parasites.

However, just like our police force, occasionally the protective function goes awry and damage is done to our own body, in the protective act. For many years I was a practicing allergist, and observed this protective function misfiring. In allergic rhinitis and allergic asthma, tiny harmless particles in the air are interpreted by the body as a threat. The TH2 immune system, initially evolved to fight parasites, is activated, and causes considerable disease and misery.

Some of the antigenic determinants on the surface of the pollen, animal dander or dust particles are interpreted as being dangerous by the immune system, which causes chronic inflammation with acute allergy attacks.

Autoimmunity is a similar misreading, in which our own cells are deemed dangerous. In this case the immune agency is the more powerful Th-1 system, which often causes crippling or even fatal results.  

Millions of people are sickened by an immune system that is supposed to defend them.

An article in the September 2021 issue of the Scientific American lists 76 of these disorders, and classifies them as to frequency, patient gender and age of onset. It is worth reviewing, at least for the listing on page 32 and 33.

Auto immunity must be considered as a possible cause in any illness that is not easily diagnosed, common, and well known to your doctor. Many patients have to be their own advocates, and persist in trying to get themselves diagnosed.

Celiac disease, Lupus, and Addison’s disease come to mind as tricky customers. Although “autoimmune disease” in toto is common, many of the individual diseases occur in less than one in 1000 patients, and are not high on the diagnostic list of most doctors.

The skin, nervous system, endocrine system, and digestive system are the most common areas involved. Recent advances in blood and antibody testing offers to give needed diagnostic help to the medical profession. These illnesses must be detected early to avoid functional loss in the tissues and organs affected.

Treatments are improving. In the past, immune suppressing cancer drugs and cortisone were the main drugs available. With increasing knowledge of the mechanisms of the separate diseases, treatment can be directed towards the specific causative antibody, receptor, or interleukin involved, hopefully with less side effects than the shotgun drugs previously available.

As with medicine in general, these modern treatments are excessively expensive as a rule, because much money and research went into their development. Prevention is obviously preferable. A healthy diet, with its attendant healthy microbiome comes to mind, as well as the avoidance of cigarette smoking and environmental toxins.

Proper sleep, exercise, and stress relief should also be helpful.

—Dr. C.

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DR. C’S JOURNAL: SOME TIPS FOR CARE OF THE FEET

When not walking barefoot at night or on the beach, my toes have been squeezed together most of my life. Closed-toe compression stockings for my varicose veins plus inadequate space at the front of my shoes have encouraged my big toe to “scissor” and to cross over the second toe. At that point I started wearing open-toe stockings, and tried to give my toes more room in larger shoes. I also used a spacer to push the big toe out.

Walking on the beach is a wonderful place to free up your toes. For a while, I walked in the deep sand at the top of the beach, trying to get more exercise. Periodically I would get some thorns in my feet, and go to podiatrist to get them out.

During one visit, the podiatrist told me that I was getting a hammer toe in the toe right next to my big toe, and I now use a little ring shaped cushion for that second toe, incorporated with a spacer.

It is amazing how little we use the musculature of our feet, and how surprisingly well they hold up. People that are really in good athletic shape stress flexibility as being very important, and athletes often do stretching exercises before they do their workout. Practically anything that will stretch a joint is helpful, such as flexing, extending, and spreading the toes, plus flexing and extending the foot.

You can overdo it, however, as I have learned to my discomfort. You must do any exercise within the limitations of your body, beginning slowly, and working up to your desired level.

My big toe has almost no flexibility, and the joint that attaches it to the foot is enlarged and pretty fixed. I am very careful how much range and pressure I use .Even something as simple as stretching the Achilles tendon can be a problem if you do too much of it all at once. Always work slowly into your exercises to make sure that you do no harm.

Ingrown toenails have also bothered me from time to time. I very carefully try to trim them back and avoid breaking the skin; the foot is easily infected, particularly among diabetics and older people. A podiatrist is very helpful if you let things go too far.

My toenails, particularly on my big toe, are getting white and thick with a nail fungus. This can be treated with an oral medication, dispensed by a doctor or a podiatrist. I have chosen to keep it in check with clotrimazole cream, and that seems to be working. I worry from time to time about creating a resistance factor in the fungus, but they are very slow growing, and not likely to develop a mutation.

If you would like further discussion on foot exercises, please check the following reference, one of many on the Internet.

—Dr. C.

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DR. C’S JOURNAL: WHAT IS MULTIPLE MYELOMA?

There are many types of cells in the human body, and any of them can mutate, and become cancerous.  Cells of The immune system are no exception, ironically,  even though their one of their jobs is to fight cancer.

The plasma cell is an immune system cell that develops from lymphocytes(B-cells) and specializes in producing “Gamma Globulins”, a type of antibody.

When cancer involves plasma cells In the bone marrow it tends to crowd out the other cells. This can produce bone pain and anemia.

All of the cancer cells come from a single progenitor cell and form a “clone”. This clone produces a large amount of defective protein that would normally be combined with other proteins into the making of antibodies. The large amount of the same protein can often be  detected in the urine, as a “Bence Jones” protein.

In modern terminology, the condition is called a “monoclonal gammopathy”. This mass of protein gets into the bloodstream, and can deposit in various tissues, where it is called “amyloidosis”. The kidneys are often damaged in the process of excreting the overproduced, repetitious chains of useless protein.

I had a friend who was a pilot in the military during the Vietnam war. He was around “agent orange”,  which was on the news a lot in the 80’s. Agent orange was contaminated by a toxic chemical called Dioxin, which is known to cause cancer. My friend developed a cancer, primary amyloidosis, which is a close relative of multiple myeloma, and in his case produces what is called light chains.

His first warning was an elevated creatinine on a metabolic panel blood test, which pointed to the kidneys.  Medical investigation uncovered his plasma cell cancer, and he began treatment.  His kidneys eventually started to fail.

His daughter donated one of her kidneys, and currently he’s doing well, since medical treatment curtailed the light chain production.
Please refer to the accompanying Cancer association article on multiple myeloma.

A Mayo clinic article was posted on DWWR on May 25, 2021.

—Dr. C.

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DR. C’S JOURNAL: STEM CELLS

The ultimate stem cell is the fertilized egg from which we came. This omnipotent stem cell divides countless times, “differentiates”, and forms more and more specialized tissues, and our body is the eventual result. All of our tissues contain some stem cells, which grow increasingly rare as we age.

Regenerative medicine takes advantage of stem cells derived from diverse sources. An embryo, an umbilical  cord, or your bone marrow contains stem cells. Even one of your mature connective tissue cells that has been dedifferentiated, or sent back along the pathway that originated from the single cell from which you came, can be induced to form a stem cell (iSC).

If the stem cell originates from your own tissues, it is  accepted by your body, as one of its own.

I have an wealthy acquaintance whose Parkinson’s disease is being treated by one of his own cells induced to form a dopamine containing neuronal stem cell.

The article posted previously regarding rotator cuff surgery apparently used stem cells to shorten the recovery time.

I have heard about the use of stem cells in heart failure, osteoarthritis, and other joint problems, and I’m sure we will hear about this increasingly as time passes. However, there are hurdles to be overcome, moral, legal and medical. The possibility (small) of induced stem cells to evolve into cancer is one medical hurdle, and if the Stem Sell originates from another individual, immunosuppressive treatment must be used in the recipient to allow the stem cells to work. Also, the use of the other individual’s stem cells may involve some moral, legal and possibly religious objections.

Please refer to the following Mayo clinic article for more information.

–Dr. C

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

Read Scientific American article

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

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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.

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DR. C’S JOURNAL: A WORD ABOUT DREAM THEORIES

Dreams are very egalitarian. I really believe that one person knows just about as much about dreams as another person, since almost all of us do a lot of it, and no two theories about dreaming are the same. However, I would like to give you some of what I have learned from my own dreams and readings about them. In addition, I have included a reference that discusses Scientific dreams studies in some detail.

When I was about 14 years of age, and burning up with a desire to learn more about medicine, I bought the only “medical” book I could find in Grass Valley, California: The interpretation of dreams, by Sigmund Freud. I vividly remember being amazed at how Freud could  figure out the symbolisms in the dream case studies he published. The interpretations were not at all clear to me, even after I was told the answer, and chewed on them a bit. I subsequently read the opinion that a lot of them were made up. The essence of Freuds theory of dreams is that they were wish fulfillments, which is patently not always true.

REM sleep was linked to dreams in 1953, a couple of years before I graduated from medical school. For years, dreams were studied in a unitary context of REM sleep, and in the opinion of some, this has slowed down progress on the knowledge of dreams immeasurably. We now know that dreams are not always linked to REM sleep. Dreaming can be neurologically interrupted, while REM sleep goes on. REM sleep can be eliminated while dreaming goes on.

So we go back to the starting block; what are dreams?

The Ancients put a lot of stock in dreams, such as Joseph’s dreams predicting a seven-year drought, which earned him a place on the pharaohs Staff. Martin Luther thought they were the work of the devil. My son Michael thinks they are a good thing, since when you dream you are sleeping, and sleep is a wonderful restorative.

My own theory is that they are random fragments of experience which are ordered and supplemented to form a story. These random fragments can either be from recent experiences, perhaps being consolidated in memory, or old experiences that are being pruned as unnecessary. These snippets are then aggregated under the influence of mood neurochemicals, and flow out in the dream narrative.

Sensations coming in from the environment can play a role. I will always remember the story of a sleep study patient, who was slapped on the back of his neck by a wet towel. He awakened immediately, and vividly remembered a dream about the French Revolution, in which he was guillotined. I read that dreams take 5 or10 minutes of time to develop, however.

I dream almost every night, and most are  forgotten rapidly. Some have enough detail and meaning for me too mull over before I get up. Some of my more common dreams are of flying, or getting lost. The pleasant dreams are definitely in the majority. Only rarely, a sinister one will wake me up.

The following reference details about 50 of the most common dreams that people experience. Much other pertinent information is contained. What is your theory on the causes and meaning of dreams? You probably have as good an idea as anybody else.

—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