Tag Archives: Dr. C’s Journal

Dr. C's Journal, Medicine, Opinion, Resources

DR. C’S JOURNAL: IT PAYS TO BE KIND TO YOUR STOMACH

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This whipping boy of humanity is regularly insulted by all sorts of concoctions dictated by our taste buds and psyche, not to mention the many drugs required to treat our poor health. It is amazing how much abuse it can absorb with minimal complaint.

The stomach has evolved as a “fiery pit” of high acid content to intercept various bacterial invaders. Fortunately a few escaped to populate our intestinal tracts, where they are mostly beneficial. One bacterium in particular evolved to tolerate the high acidic conditions of the stomach, like extremophile bacteria tolerate the “smoking vents” underneath the sea. This is the famous helicobacterium pylori, which caused most gastric ulcers in the early days of my medical career. Ulcers were then treated by an ongoing special diet. Now they are treated by a simple course of antibiotics.

The stomach evolved a special lining to tolerate the acid, and a valve to keep it in place. Over time this valve may weaken, allowing the acid to reflux back into the swallowing tube, the esophagus. This produces the familiar heartburn that most of us have experienced, and if chronic, can produce inflammation and the condition called Barrett’s esophagus, which frequently leads to gastric cancer.

Gastric cancer comprises only about 1.5% of cancers in the United States, but in Korea it is the most common cancer. This may be because of the Korean diet, Which often finds nitrites in close proximity to proteins, which donate an amine group to form the carcinogen nitrosamine.

I have begun a time restricted eating program, where I eat my entire days food within a six hour window. My stomach has seemed to tolerate this, but I have noticed that when I eat a lot of fat late in the day (I like half-and-half on my oatmeal) my stomach will object. Alcohol does the same thing, and when I was in medical school we used to give a dose of alcohol to stimulate stomach acid production, as a test.

If you have a lot of pain in the area of the stomach (the epigastrium), chronic heartburn or trouble swallowing chunks of meat, you may well need to see a gastroenterologist, who will look into the esophagus and stomach to check for problems.

Please check the following Mayo clinic articles for more information.

—Dr. C.

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Dr. C's Journal, Medicine, Resources

DR. C’S JOURNAL: SIGNS OF A SILENT HEART ATTACK

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Heart attacks are something that most people know about; the sudden severe chest pain, radiating into the jaw or left arm,  associated with shortness of breath, nausea, and the like. However there’s a lot of confusion also; not all heart attacks have typical symptoms (silent heart attacks). Some significant chest pain is not due to a heart attack, and some significant cardiac disease is something different from a heart attack.

I will cover these three scenarios one at a time, beginning with the most dangerous, the silent heart attack.

The silent heart attack has the same effect as the more typical variety, and is caused by blockage in the coronary arteries,  which interferes with oxygen and glucose delivery, and causes death of heart muscle. It occurs under physically or emotionally stressful circumstances, particularly in the cold. It may be more common in women, and accounts for at least half of all heart attacks.

Risk factors are identical to those of a regular heart attack, and include being overweight, diabetic, not exercising regularly, having high blood pressure, high cholesterol or smoking cigarettes.

The symptoms may be Flu like, fatigue, indigestion, and perhaps a soreness in the chest, upper back, arms or jaw. My mother-in-law died in my house after a stressful incident, and was heard to be vomiting in the middle of the night. My father had inordinate fatigue and paleness, which caused my mother to take him to the doctor, who sent him by ambulance for a bypass operation.

Many silent heart attacks are discovered when the doctor takes an electrocardiogram in the course of an  examination. This is a good argument for the regular physical examination, since having a silent heart attack increases the likelihood that you will have another.

The frequency and seriousness of heart attacks is of course an excellent argument for proper sleep, diet, exercise, and other good preventative habits.

—Dr. C.

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Dr. C's Journal, Men's Health, Resources, Women's Health

DR. C’S JOURNAL: SIGNS & SYMPTOMS OF NARCOLEPSY

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Narcolepsy is a sleep disorder with daytime drowsiness, sudden episodes of falling asleep, sometimes sudden loss of muscle control, and occasionally hallucinations.

If this sounds like the bad, overbearing, uncontrolled brother of REM sleep, that is because it is. The features of REM sleep are there; sleepiness, muscle paralysis(cataplexy) and Hallucinations(dreams). This combination of symptoms can often disrupt jobs, and can be dangerous, leading to accidents.

The cause of narcolepsy is unknown, but there is an association with decreased blood levels of the neurochemical hypocretin. The disease starts in youth, and sometimes occurs and families. The patients are often overweight, and can have sleep apnea in addition.

The Diagnosis is usually made in specialist sleep centers, which find an unusually rapid entrance  into sleep, beginning in the REM stage. Normally REM sleep occurs later in the 90-minute sleep cycle.

There are a lot of different stimulants and some sleep-restoring and paralysis-reducing medications used to treat narcolepsy. This and other information may be found on the accompanying Mayo clinic article.

—Dr. C.

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

DR. C’S JOURNAL: WOMEN AND AUTOIMMUNE DISEASE

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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.

Dr. C's Journal, Medicine, Men's Health, Women's Health

DR. C’S JOURNAL: AMBLYOPIA

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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, Medicine, Men's Health, Women's Health

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

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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, Men's Health, Opinion, Women's Health

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

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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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Medicine, Men's Health, Resources, Women's Health

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

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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, In The Lab, Medicine, Research

DR. C’S JOURNAL: STEM CELLS

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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, Medicine, Men's Health, Opinion, Women's Health

DR. C’S JOURNAL: PROTEIN-BASED MEDICATIONS

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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