10 Tips on Dietary Fiber

10 Tips on Dietary Fiber

1. Keep in mind that a high-fiber diet may tend to improve:
• Chronic constipation
• Coronary heart disease
• Hemorrhoids
• Diabetes mellitus
• Diverticular disease
• Elevated cholesterol
• Irritable bowel syndrome
• Colorectal cancer

2. Try to double your daily fiber intake.
• Average American intake: 10-15 grams per day
• Recommended intake: 20-35 grams per day

3. Understand what fiber is, where it comes from:
• Insoluble fiber
• Cereals
• Wheat/wheat bran
• Whole grains
• Soluble fiber
• Brans
• Fruit
• Oatmeal/oat bran
• Psyllium
• Vegetables

4. Substitute high-fiber foods for high-fat and low-fiber foods.

5. Keep your daily fiber intake stable. Consider a fiber supplement if you:
• Travel
• Eat away from home often
• Find it difficult to get enough fiber through food choices alone

6. Don't shock your system: Increase fiber levels in your diet gradually.

7. Always increase fluids (water, soup, broth, juices) when you increase fiber.

8. Add both soluble and insoluble fiber, from a variety of sources.

9. Compare fiber content of foods:

Grams of Fiber
1 cup of Rice Krispies® 1
1/3 cup of 100% Bran® 9
1 slice of white bread 0.5
1 slice of whole wheat bread 1.4
1/2 cup white rice 0.5
1/2cup brown rice 1.5
Bowl of chicken broth 0
Bowl of thick vegetable (minestrone) soup 1

1. Choose foods high in fiber content.
Fruits and Vegetables
Highest in Fiber Per Serving
Fruits
Artichokes
Apples, pears (with skin)
Berries (blackberries, blueberries, raspberries)
Dates
Figs
Prunes Vegetables
Beans (baked, black, lima, pinto)
Broccoli
Chick-peas
Lentils
Parsnips Peas
Pumpkin
Rutabaga
Squash (winter)
Other Good Fiber Choices
Barley
Bread, Muffins (whole wheat, bran)
Cereals (branflakes, bran, oatmeal, shredded wheat)
Coconut
Crackers (rye, whole wheat)
Nuts (almonds, Brazil, peanuts, pecans, walnuts)
Rice (brown)
Seeds (pumpkin, sunflower)

Eating high-fiber foods is a healthy choice for most people. If you have ever received medical treatment for a digestive problem, however, it is very important that you check with your doctor to find out if a high-fiber diet is the right choice for you.

Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

For more health info and links visit the author's web site www.hookman.com

10 Tips on Constipation and Incontinence of Stool

1.Despite widespread belief, constipation is not necessarily a part of growing older.

2.Bowel habits are similar in both younger and older healthy people.

3.Constipation is defined as stools that are:
Too small
Too hard
Too difficult to pass
Infrequent (less than 3 per week)

4.Constipation is caused by:
Not enough dietary fiber or fluids
Medication side effects
Emotional or physical stress
Misconception about normal bowel habits
Lack of activity
Medical problems

5.How to manage mild-to-moderate constipation:
Gradually add dietary fiber from variou sources
Increase fluids (water, soup, broth, juices)
Eat meals on a regular schedule
Chew your food well
Gradually increase daily exercise
Respond to urges to move your bowels
Avoid straining
See your doctor if these measures don't work

6.Dietary therapy (increased fiber and fluids) and fiber supplements are the preferred treatment for chronic constipation.

7.In some cases, your doctor may recommend the use of stool softeners.

8.Use of mineral oil or stimulant laxatives regularly, consult your doctor to make sure what you are using is right for you.

9.Incontinence of stool or fecal soiling is most often due to leakage around a fecal impaction. Removing the impaction will usually restore continence.

10.Incontinence of stool in healthy older people deserves full education and treatment. Treatment options include:

Adjustment in dietary fiber to reduce amount of stool
Medications to decrease stool frequency
Prescribed use of enemas (not soap enemas)
Biofeedback training
Surgery to restore anal function

Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

For more health info and links visit the author's web site www.hookman.com

5 Tips on Swallowing and Heartburn

1.Abnormal swallowing is commonly perceived as food "sticking on the way down." If this complaint persists, it is sometimes due to a serious condition and should always prompt medical attention.

2.Swallowing difficulty may be caused by a number of different problems including:
* Poor or incomplete chewing (possibly the result of dental problems, poorly fitted dentures, or eating too quickly)
* Abnormal muscle contraction
* Scar tissue from chronic inflammation
* Infection
* Cancer

3.Heartburn is a very common problem caused by regurgitation or reflux of gastric acid into the esophagus, which connects the mouth and the stomach.

4.Heartburn can often be eliminated by avoiding:
* Smoking
* Fatty food in the diet
* Caffeine
* Chocolate
* Peppermint
* Overeating
* Bed-time snacks
* Tight-fitting clothes that constrict the abdomen
* Certain medications
* Heavy lifting, straining

5.It is important to consider the possibility of heart disease before attributing any kind of chest pain to gastroesophageal reflux.

Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

For more health info and links visit the author's web site www.hookman.com

A BETTER ANSWER FOR DOCTORS WORRIED ABOUT HIGH MALPRACTICE INSURANCE PREMIUMS ?

Tom Baker, a professor at the University of Pennsylvania Law School, is the author of “The Medical Malpractice Myth. Says that our medical liability system needs reform. But anyone who thinks that limiting liability would reduce health care costs is fooling himself. Preventable medical injuries, not patient compensation, are what ring up extra costs for additional treatment. This means taxpayers, employers and everyone else who buys health insurance — all of us — have a big stake in patient safety.

Eighty percent of malpractice claims involve significant disability or death, a 2006 analysis of medical malpractice claims conducted by the Harvard School of Public Health shows, and the amount of compensation patients receive strongly depends on the merits of their claims. Most people injured by medical malpractice do not bring legal claims, earlier studies by the same researchers have found.
On the other hand, risk managers, for example, and spurring anesthesiologists to improve their safety standards and practices. Even medical societies’ efforts to attack the liability system have helped, by inspiring the research that has documented the surprising extent of preventable injuries in hospitals. That research helped start the patient safety movement. When it comes to rising medical costs, liability is a symptom, not the disease. Getting rid of liability might save money for hospitals and some high-risk specialists, but it would cost society more by taking away one of the few hard-wired patient safety incentives.
Besides, there’s a better answer for doctors worried about high malpractice insurance premiums.

Critics point to defensive medicine as the hidden burden that liability imposes on health care. Yet research shows that while the fear of liability changes doctors’ behavior, that isn’t necessarily a burden. Some defensive medicine is, like defensive driving, good practice. Too often, we can’t distinguish between treatments that are necessary and those that are wasteful. Better research on what works and what doesn’t — evidence-based medicine — will help. And it will address the more general challenge of avoiding costly but unnecessary care.
Just as we need evidence-based medicine, we also need evidence-based medical liability reform. The research shows, overwhelmingly, that the real problem is too much malpractice, not too many malpractice lawsuits. So medical providers should be required to disclose injuries, provide quicker compensation to deserving patients and — here’s the answer for doctors worried about their premiums — shift the responsibility for buying malpractice insurance to hospitals and other large medical institutions. Evidence-based liability reform would give these institutions the incentive they need to cut back on the most wasteful aspect of American health care: preventable medical injuries.

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

For more health info and links visit the author's web site www.hookman.com

Don't spend your life trying to impress others

Because even if you convince others that you're great, have you convinced yourself?

I’ve heard a great sermon. It’s this.

Next time you're in a conversation, see how long it takes the other person (and yourself!) to start mentioning personal accomplishments. A movie star who believes his fan mail is in trouble. Because he's built a house of cards. And when he falls, he'll fall hard. Chasing after honor is a sign that you don't sufficiently respect yourself. It's like saying, "I might not amount to much, but if I can make others think I do, then I'm worth something."

One of the most destructive ways of trying to impress others is by role-playing. We act out characters that we think others will like. Did you ever notice how your personality can change in the presence of different people? We may go through 10 or 20 roles per day!

But it's not true. It's chasing "fool's gold" -- yellow and glittery, but worthless. Deep down you feel like a fraud. People who are satisfied with themselves don't need public recognition to reassure their worth. If you depend upon the opinions of others to determine how good you are, then you become like a leaf in the wind, fluttering in whichever direction the fads of the time blow you. If you have confidence in your own worth, you'll be better able to follow opinions that are your own and not society's.

Always ask yourself: "What is my real motive?"
Advice.
• Don't get trapped in the obsessive need for recognition.
• Seeking the approval of others harms you, because it keeps you from the real work of becoming great.
• If you need others to verify your significance, it's time to examine your self-esteem.
• When you act to impress others, you feel the emptiness inside.
• When you get the urge to toot your own horn, ask yourself: Who am I trying to impress?
• Even if you convince people that you're the greatest person in the world, have you convinced yourself?

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for Cancer Care too Expensive.

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Avoidable Post Hospital Discharge Errors Are Common

Adverse events after discharge from the hospital are common. Many of these adverse events are avoidable or ameliorable.

400 consecutive patients discharged home from the general medical service of a tertiary care academic hospital were followed in one study. After discharge, 76 patients (19%) had adverse events, defined as injuries occurring as a result of poor medical management. Of these, 23 patients had preventable adverse events, defined as adverse events judged to have been caused by an error, and 24 patients had ameliorable adverse events, defined as adverse events in which the severity could have been decreased.

Adverse drug events accounted for 66% of adverse events, and procedure-related injuries for 17%. Of the 25 adverse events that caused a transient or permanent disability, 12 events were preventable and six events were ameliorable.
Adverse drug events [ADEs] are almost as common among outpatients and they have important litigation consequences.

A summary analysis of more than 1500 published case reports of ADEs yielded information on possible risk factors for drug-related deaths, disabilities, and life threats and on which events may have been preventable.

The study showed that the drug categories most commonly involved in ADEs were central-nervous-system agents, antimicrobials, antineoplastics, and cardiovascular agents.

CAUSES OF ADES

Faulty prescribing was the most common reason for medication error, and
Wrong dosage was the most common type of error.
Overall, 52% of the cases were judged to have been preventable;
Of these, 50% could have been prevented by a pharmacist.

Litigation was reported for 13% of the cases; Settlements and judgments averaged $3.1 million.


Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. Am J Health Syst Pharm. 2001;58:1399-1405.

Ann Intern Med. 2003;138:161-167
Comment: “In theory, there is no difference between theory and practice. In practice there is.”- Yogi Berra

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for Pressure Stockings 'Should Not Be Used' to Prevent DVT

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ARE THE PPI’S SAFE IN PREGNANCY?

Heartburn and acid reflux are common medical disorders in pregnancy and can result in serious discomfort and complications. Furthermore, some pregnant women also experience more severe gastrointestinal conditions, such as helicobacter pylori infections, peptic ulcers, and zollinger-ellison syndrome. To allow the use of proton pump inhibitors (ppis) in pregnancy, the fetal safety of this drug class must be established. The aim of this study is to determine the fetal safety of ppis during early pregnancy through systematic literature review.methods. All original research assessing the safety of ppis in pregnancy was sought from inception to july 2008. Two independent reviewers identified articles, compared results, and settled differences through consensus. The downs-black scale was used to assess quality. Data assessed included congenital malformations, spontaneous abortions, and preterm delivery.

A random effects meta-analysis combined the results from included studies.

Results:of the 60 articles identified, 7 met inclusion criteria. Using data from 134,940 patients, including 1,530 exposed and 133,410 not exposed to ppis, the overall odds ratio (or) for major malformations was 1.12 (95% confidence interval, ci: 0.86-1.45).

Further analysis revealed no increased risk for spontaneous abortions (or=1.29, 95% ci: 0.84-1.97); similarly, there was no increased risk for preterm delivery (or=1.13, 95% ci: 0.96-1.33).

In the secondary analysis of 1,341 exposed and 120,137 not exposed to omeprazole alone, the or and 95% ci for major malformations were 1.17 and 0.90-1.53, respectively.

Conclusions:on the basis of these results, ppis are not associated with an increased risk for major congenital birth defects, spontaneous abortions, or preterm delivery. The narrow range of 95% cis is further reassuring, suggesting that ppis can be safely used in pregnancy.

am j gastroenterol 2009; 104:1541-1545; doi:10.1038/ajg.2009.122; published online 2009.

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for How to Find a Good Hospital

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

Women Still Drinking During Pregnancy

Despite the Surgeon General's warning that alcohol can affect unborn children, pregnant women haven't changed their drinking habits much over the past two decades, the CDC saidAbout 40% of women realize they're pregnant at four weeks' gestation, a critical period for fetal organ development,

The U.S. Surgeon General has consistently advised women against drinking alcohol during pregnancy. National prevalence of fetal alcohol syndrome is about 0.5 to 2.0 cases per 1,000 births, but the other fetal alcohol spectrum disorders occur about three times as often, the researchers said.

Women with the highest rates of drinking during pregnancy were older, college graduates, employed, and unmarried.

Between 2001 and 2005, 17.7% of pregnant women ages 35 to 44 reported having at least one drink in the past 30 days, compared with 8.6% of women ages 18 to 24.

While it's not well understood why drinking habits differ across certain aspects of social status, the researchers had a few possible explanations. It could be that older women may be more alcohol dependent and have more difficulty abstaining from alcohol while pregnant, they speculated. Also, they said, more-educated women and employed women might have more discretionary money to spend on alcohol. And unmarried women might attend more social occasions where alcohol is served, the researchers said. They emphasized that healthcare providers should routinely ask women of childbearing age about their alcohol use and inform them of the risks of drinking during pregnancy.

Alcohol use levels before pregnancy are a strong predictor of alcohol use during pregnancy, the researchers said. Many women who use alcohol continue to do so during the early weeks of gestation because they don't realize they're pregnant, as about half of all births are unplanned.

Denny CH, et al "Alcohol use among pregnant and nonpregnant women of childbearing age -- U.S., 1991 -- 2005 MMWR 2009; 58(19): 529-32

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for ARE THE PPI’S SAFE IN PREGNANCY?

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

Stronger warnings on drugs containing acetaminophen

In May, 2009 an FDA report recommended stronger warnings and dose limits on drugs containing the painkiller acetaminophen," which is "the active ingredient in Tylenol and a host of other pain relievers." The report "cites an increased risk of liver damage." The FDA working group that issued the report, "made up of 12 top officials in the FDA's Center for Drug Evaluation and Research, recommended lowering immediate-release tablet strength to no more than 325 milligrams from the current 500 milligrams and reducing the single adult dose to 650 milligrams, from 1,000 milligrams.

The FDA also warned that acetaminophen "overdose was linked to 458 deaths and 26,000 hospitalizations annually from 1990 to 2001," and the drug "is a leading cause of acute liver failure in the US."

These recommendations cover "both prescription doses and over-the-counter medication" and "include enhanced public information efforts, stronger labels warning of liver side effects, and dose limitations."

On June 30 the FDA panel recommended that prescription Vicodin [hydrocodone bitartrate and acetaminophen] and Percocet [oxycodone and acetaminophen] be banned, and that over-the-counter Tylenol, Excedrin, Nyquil, and Theraflu contain stronger warning labels...The problem, according to FDA advisors, is that they all contain acetaminophen, which can cause liver damage."

The FDA Drug Safety Advisory Committee also "recommended lowering the maximum daily nonprescription dose of acetaminophen," Current doses are "at four grams a day or eight extra strength Tylenol a day. The committee...said the maximum single adult dose, should be 650 milligrams. And while extra strength Tylenol recommends two, 500-milligram pills at once, the panel recommends that dose would require a prescription."

The FDA "panel noted that patients who take Percocet and Vicodin for long periods often need higher and higher doses to achieve the same effect." "The two drugs combine a narcotic with acetaminophen," and the panel's vote to "recommend a ban on the combination drugs was one of 11 it took" at the meeting. The experts also recommended "that the FDA reduce the highest allowed dose of acetaminophen in over-the-counter pills...to 325 milligrams, from 500," and "to reduce the maximum daily dosage to less than 4,000 milligrams."

The panel "of 37 doctors, pharmacists, and researchers voted on the recommendations after spending two days discussing steps the FDA should take to reduce the number of acetaminophen overdoses."


Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for the IMPORTANCE OF CHLAMYDIA SCREENING.

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ILLEGAL USE OF OPIOIDS

Data from the National Survey on Drug Use and Health in 2007 suggested that 33 million people over the age of 12 used an opioid for a nonmedical purpose at some point.

Most obtained the drug for free from a friend or relative or in the case of Michael Jackson as an alias..

The FDA's Center for Drug Evaluation and Research is drafting a Risk Evaluation and Mitigation Strategy (REMS) aimed at reducing adverse events caused by opioids.

Physicians who prescribe opioids must register with the Drug Enforcement Agency (DEA), but the drugs might be less likely to be misused if more regulations were imposed on physicians who prescribe opioids. According to the DEA, a clinician who prescribes controlled substances has an obligation to take "reasonable measures" to prevent the drug from being diverted to those who use it for a nonmedical purpose.

Schedule II agents include morphine, oxycodone, pure hydrocodone, and methadone. A handful of hydrocodone and morphine combination products are listed in Schedule III, but the analgesic options in this class are relatively scarce.

State medical licensing boards, health insurance plans, and law enforcement officials must play a big role in enforcing the REMS.

FDA officials acknowledged the interplay of the FDA and the DEA on the issue of opioids. While the FDA normally focuses on the safety of drugs for medical purposes, it can't ignore the fact that millions of people use the drugs to get high.

One suggestion is that the FDA require opioid manufacturers to put serial numbers or microchips in opioid tablets, linked to the prescription that released them to a patient. That way, if law enforcement officials seize pills, the prescriber and patient can be easily traced. Other ways are creating opioid medications that are "less abusable" such as crush-proof pills.

The FDA is already considering serial numbers on some classes of medication for a different reason -- to confirm the integrity of the supply chain.

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for Stronger warnings on drugs containing acetaminophen.

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Part II of II: SHOULD EVERYONE TAKE ASA?

PART II OF II DETRIMENTAL EFFECTS OF ASPIRIN

SHOULD EVERYONE TAKE ASA?

Aspirin and other platelet aggregation inhibitors may increase the likelihood of asymptomatic cerebral microbleeds among older adults. Microbleeding has gained recognition over the past decade as a marker of small-vessel disease in the brain.

The analysis involved 1,062 participants in the longitudinal, population-based Rotterdam Scan Study, all age 60 or older and free of dementia. They underwent MRI over a period of roughly one year to assess the presence and location of microbleeds. Pharmacy records showed that 34.2% had used an antithrombotic drug as an outpatient in the years before their MRI. The study determined that these antithrombotic drug users were more likely to have cerebral microbleeds than nonusers after adjustment for age and sex (odds ratio 1.55, 95% confidence interval 1.14 to 2.09).The association remained after additional adjustment for cardiovascular risk (OR 1.56, 95% CI 1.15 to 2.12).

Antithrombotics were also linked to presence of brain infarcts and high white matter lesion volume, but exclusion of participants with a known history of cerebrovascular disease attenuated these associations.

Location appears to be important: strictly lobular microbleeding suggests cerebral amyloid angiopathy, in which accumulation of amyloid protein leads to degeneration of smooth muscle cells and increases risk of ruptures and hemorrhages. Aspirin users in the population-based study were also more likely to show microbleeding limited to lobular areas of the brain, the researchers reported.

Past microbleeding -- indicated by small deposits of the iron-storing protein hemosiderin on brain scans -- was 71% more common with use of platelet aggregation inhibitors than without antithrombotic drugs.

Exclusive use of platelet aggregation inhibitors accounted for most of the antithrombotics (23.1% of the cohort). Another 5.9% exclusively used anticoagulants. These were overwhelmingly warfarin (Coumadin) and other vitamin K antagonists rather than heparin.
Although not significant, anticoagulants displayed a magnitude of microbleeding risk (OR 1.49, 95% CI 0.81 to 2.67) similar to platelet aggregation inhibitors (OR 1.71, 95% CI 1.21 to 2.41) in the fully adjusted model.

One researcher speculated that "It may be that microbleed formation is more dependent on the sealing of small-vessel-wall defects by platelet aggregation than it is on clot stabilization."

Source reference:
Vernooij MW, et al "Use of antithrombotic drugs and the presence of cerebral microbleeds: The Rotterdam scan study" ARCH NEUROL 2009; 66: DOI: 10.1001/archneurol.2009.42.

COMMENT:
This brings up the question as to the indications for everyone—healthy with minimal cardio-vascular risks and those with greater risks taking small doses of aspirin as prophylaxis for heart attacks and stroke, as well as the advanced elderly.

Aspirin is enormously useful as a prophylactic for cardiovascular events including myocardial infarction and ischaemic stroke. There has been concern, however, that aspirin can also increase hemorrhagic strokes and cause gastrointestinal bleeding. This study investigated the balance of positive and negative effects, and the results indicate no overwhelming difference. For individual patients, therefore, it depends on whether it is better to risk an MI or a gastrointestinal bleed says findings in the Lancet, Volume 373, Issue 9678, Pages 1849 - 1860, 30 May 2009 doi:10.1016/S0140-6736(09)60503-1

These findings "challenge guidelines that endorse the use of aspirin for primary prevention as a general public health policy and reinforce the need to take each patient's preferences and goals.

Researchers undertook an analysis of six primary prevention trials encompassing some 95,000 individuals at low-average risk assigned to take aspirin or no aspirin. Aspirin was associated with a significant reduction in risk for serious vascular events (0.51% vs. 0.57% per year), but the net effect on stroke was not significant. Aspirin increased risks for major gastrointestinal and extracranial bleeding. Therefore everyone using aspirin in the primary prevention of cardiovascular disease is "of uncertain net value," reports this Lancet meta-analysis.

Why?

This major study shows that although regular use can cut the rate of non-fatal heart attacks, it can also increase the risk of internal bleeding by a third.

Healthy adults who take daily aspirin to prevent heart attacks could be doing more harm than good, warn researchers. The researchers "found that healthy people who take aspirin reduced their already small risk of heart attack or stroke by 12 percent, while the small risk of internal bleeding is increased by a third." This means there were five fewer non-fatal heart attacks for every 10,000 people treated. This pro was was offset by the con of a comparable increase in bleeding -- one extra stroke and three cases of stomach bleeding per 10,000 people treated."

Meanwhile, the secondary prevention studies showed that where patients were taking aspirin to prevent a repeat attack -- aspirin reduced the chances of serious vascular events by about one-fifth and this benefit clearly outweighed the small risk of bleeding.

Older age, male sex, diabetes, and high blood pressure were associated with significantly elevated absolute ischemic stroke and major coronary event risk, but also with significantly increased risk of major extracranial bleeding and at least a trend for hemorrhagic stroke as well.


Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for ILLEGAL USE OF OPIOIDS

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CAUTION YOUR FAMILIES ABOUT SWIMMING POOL DISEASES

Reports of gastrointestinal illness from use of public pools and water parks have risen sharply in recent years, according to the Centers for Disease Control and Prevention. The leading culprit is a microscopic organism that lives in human feces.

The CDC is increasingly documenting cases of "gastrointestinal illness from use of public pools and water parks," noting that a "microscopic organism that lives in human feces" appears to be at the center of the trend. "Called cryptosporidium, it is a parasite transmitted in an egg-like shell that can survive as long as 10 days even in chlorinated water." And "in 2007, the last year for which statistics are available, it was responsible for 31 recreational water outbreaks involving 3,726 people...up from seven outbreaks and 567 people in 2004." Although officials are not clear as to why this rise is taking place, CDC epidemiologists have pointed out that "detection and reporting had probably improved since a treatment for the diarrheal illness -- called cryptosporidiosis, or crypto for short -- became available in 2002." Furthermore, "the recent large outbreaks, she said, have raised awareness and led to better reporting."

Called cryptosporidium, it is a parasite transmitted in an egglike shell that can survive as long as 10 days even in chlorinated water. In 2007, the last year for which statistics are available, it was responsible for 31 recreational water outbreaks involving 3,726 people, according to the disease centers — up from 7 outbreaks and 567 people in 2004. One of the largest recent crypto outbreaks occurred in Utah in 2007. There were 2,000 confirmed cases, but that number vastly underestimates the illness’s total impact.

COMMENT:
People should not swim or allow their children to swim when they have diarrhea. The water you swim in is shared with everyone, so what one swimmer does has consequences for all the swimmers.

The symptoms of crypto resemble those of food poisoning. Though most cases clear up on their own, the illness can require hospitalization, particularly in small children and people with weakened immune systems.

In addition to not swimming while ill with diarrhea, health experts say people should shower before swimming and never use the pool as a toilet. Parents should wash young children before they enter the pool and take them on frequent bathroom breaks. Children in diapers require vigilant attention.


Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for Drugs that increase photosensitivity

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WHAT KIND OF SPF SUNSCREENS TO USE

SPF is often misunderstood says the Prescriber’s Newsletter.

SPF applies only to UVB...not UVA. UVB causes the familiar sunburn. SPF is an estimate of how long a person can stay in the sun without obvious sunburn.

For example, if a person would burn in 10 minutes with NO protection, then an SPF 15 sunscreen will protect 15 times longer or 150 minutes...and an SPF 30 would protect 30 times longer or 300 minutes.There's no proof that an SPF over 50 gives any measurable added benefit.

UVB ratings get the most attention, but are only part of the story.
UVA ratings will appear on some sunscreens. You'll see 1, 2, 3, or 4 stars indicating low, medium, high, or highest protection.
UVA causes skin aging and skin cancer...not visual sunburn.

Recommend sunscreens labeled broad-spectrum. These contain UVA blockers such as avobenzone, zinc oxide, and/or titanium.

You'll now see Mexoryl SX (ecamsule) in some Anthelios sunscreens. Mexoryl SX covers some of the shorter UVA rays that are not covered by avobenzone...and it's more stable in sunlight.

But when avobenzone is combined with octocrylene, oxybenzone, or other ingredients it's more stable and has a broader spectrum.

Recommend zinc oxide or titanium dioxide for sensitive skin. They block UVA and UVB by sitting on top of the skin...not binding to it.

Water resistance ratings refer to how long the product is effective during swimming, heavy sweating, etc.

Explain to patients that a product labeled "water-resistant" lasts about 40 mins in water...and a "very water-resistant" product lasts about 80 mins.

Proper application is key. Instruct people to apply sunscreen 20 minutes before sun exposure...and reapply at least every 2 hours.

Emphasize applying enough...about 1/2 to one teaspoon per body part (leg, arm, back, face, etc)...or about 1 ounce for the full body. Applying only half the amount will give only half the protection.

Advise avoiding sunscreen/insect repellent combos. Suggest using separate products because the sunscreen needs to be applied more often than the repellent. Advise patients to apply the sunscreen first, then the repellent.

SUMMARY-COMMENT:
There are new ways to help you prevent the kind of damage to your skin that can cause not only wrinkles, but also skin cancer, which is the second most common form of cancer in the United States.

• Use skin care products with UVA/UVB and broad spectrum protection. Before going outside, apply sun-resistant skin care products such as body wash, makeup, and lip balm. Use sunscreen (SPF 30 or greater) that contains a broad spectrum protection ingredient such as oxybenzone, sulisobenzone, avobenzone, ecamsule, titanium dioxide or zinc oxide.

• Buy clothing with UVA/UVB protection. Everyone knows that the more you cover up, the less chance you have of damaging your skin. But did you know that you can get additional protection by choosing clothes made from fabrics that reflect ultraviolet light? These fashions, from bathing suits to sweatsuits, come with a label that states the UPF (ultraviolet protection factor) of the clothes. The higher the UPF, the more protection you receive.

• Add UPF to your own clothes. Special laundry additives are available that apply sun protection to your clothes for up to 20 washings. You can find more information about additives and purchase them online.

• Choose sun-resistant accessories. While you are outside, wear sunglasses that block at least 99 percent of UVB rays and at least 95 percent of UVA rays. Select a sun hat made with UPF fabric. Take an umbrella with you, even when it’s not raining.


* Tune in tomorrow for Sun Allergies!

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

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Circumcision Prevents Sexual Transmitted Diseases (STDs)

Is there a reason why Catholic nuns and Jewish women have a decreased incidence of cervical cancer and the opposite applies to groups such as blacks and Hispanics, where rates of HIV, herpes, and cervical cancer are disproportionately high?

Johns Hopkins scientists, along with researchers in Uganda, are saying that "circumcision significantly reduces the risk of contracting herpes (HSV-2) and human papillomavirus (HPV)," contributing more hard data to a pool of "growing scientific evidence that the procedure helps stem the spread of some sexually transmitted diseases." A little "over half of male newborns in the US get circumcised, according to research published earlier this year in the American Journal of Public Health." It’s ironic that apparently, that "percentage has declined over the past decade, in part because the American Academy of Pediatrics said in 1999 that the evidence is 'not sufficient to recommend routine neonatal circumcision.'" But, pathologist and Hopkins' team member Aaron Tobian, MD, PhD, said, "The scientific evidence for the public-health benefits of male circumcision is overwhelming now."

For example, "landmark studies from three African countries, including Uganda, previously found circumcision lowered men's chance of catching the AIDS virus by up to 60 percent. The new work "stems from the Uganda research and looked at protection against three other STDs" -- herpes, HPV, and syphilis.

The research teams set up two parallel, but independent, trials comprised of "a total of 5,534 uncircumcised men between the ages of 15 and 49 who were negative for the AIDS virus. Then, "1,684 of the 3,393 men who tested negative for herpes were circumcised immediately, and the others received a medical circumcision after 24 months." In addition, "352 men in the circumcised group and 345 in the delayed circumcision group were evaluated for HPV at the start of the trial and at 24 months."

Two years later, investigators noted that "circumcised volunteers were one-fourth less likely to have genital herpes and one-third less apt to carry a type of HPV that causes cervical cancer, compared with the still-uncircumcised males." Even "when all HPV types were assessed, including those causing genital warts, the circumcised volunteers were still nearly one-third less likely to carry one of the types.”

COMMENT:
There are "several reasons that removing the foreskin of the penis might help reduce transmission of certain infections. The foreskin, has two different sides," with the outside being very much like "regular skin cells," but "the inside is mucosal, similar to a woman's vagina." And, "during intercourse, the skin side is pulled back and the mucosal side is open and exposed." One researcher opines that "it's likely that there are viral receptors on that mucosal side that make it easier for a virus to get into the cells." Moreover, "if a woman has passed along viral cells, they're now trapped inside the foreskin, in a moist environment that's conducive for the virus to replicate."

The study authors say their findings "should guide public health policies for neonatal, adolescent, and adult male circumcision programs," according to MedPage Today (3/25/09, Smith), particularly since "circumcision rates in the US are falling, especially among groups such as blacks and Hispanics, where rates of HIV, herpes, and cervical cancer are 'disproportionately high.'"

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for Part I of IV, Believing in Treatments that don't work

Deepen your understanding of How to Be an Effective Medical Expert www.MedMalBook.com

BOOKS TO READ ON THE BEACH

BOOKS TO READ ON THE BEACH SO YOU CAN SMARTLY CONVERSE AT LIBERAL DOCTOR HATING COCKTAIL PARTIES THIS FALL – OR READ THIS AND SAY YOU DID

Guy Clifton, a neurosurgery professor at the University of Texas Health Science Center in Houston, argues in his book Flatlined: Resuscitating American Medicine that there are two ways to control healthcare costs: price controls with rationing (used by most industrialized nations and abhorred in the U.S.) or increased efficiency. Clifton points out that the cost of healthcare is so high that it is affordable only if someone else is paying for it, such as government or employers. The "haves" consume the healthcare of the "have nots," to the detriment of both. An estimated 30,000 patients die each year from overtreatment. He estimates that 50 percent of healthcare is a waste, if you factor in excessive medical care and patient health behavior.

In The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will), cardiologist Michael Ozner claims that the annual 1.5 million U.S. angioplasties and coronary bypass surgeries, for which the price tag is $60 billion, neither save lives nor prevent heart attacks. He cites Harvard research that 70 to 90 percent of those procedures are unnecessary.

The U.S. is the only industrialized nation not to guarantee healthcare to its citizens. We spend more than twice as much per capita as any other country, yet if longevity is the criteria comparatively we do not live longer lives. Medical professor Nortin Hadler, author of Worried Sick: A Prescription for Health in an Overtreated America, says healthcare interventions rarely, if ever, improve longevity. He defines two types of medical malpractice. Type I malpractice: Doing something medically necessary unacceptably poorly. Type II malpractice: Doing something unnecessary very well.

Journalist Shannon Brownlee, author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, gives partial credit of overtreatment to Americans’ blind faith in technology and science. About 34 percent agreed with the statement in a Harvard survey that modern medicine can cure almost any illness with the right technology. However, Brownlee points out that 25 to 40 percent of autopsies show that patients were being treated for the wrong diagnosis, which is virtually unchanged from 1910.

Physician Dennis Gottfried, who wrote Too Much Medicine: A Doctor’s Prescription for Better and More Affordable Health Care, wants to ban direct-to-consumer advertising for medications and aggressive promotion of pharmaceuticals to physicians because both result in prescription of more expensive, less effective drugs. About 31 percent of patients who see these advertisements ask about the drug, and a significant portion of them want it even though they are clueless to its effects. Unfortunately, he says,a significant percentage of doctors comply because they do not want to lose a fully insured patient.

DOES ALCOHOL MAKE YOU FLUSH?

The Flushing Questionnaire
The flushing questionnaire consists of two questions:
(A) Do you have a tendency to develop facial flushing immediately after drinking a glass (about 180 ml) of beer?

(B) Did you have a tendency to develop facial flushing immediately after drinking a glass of beer in the first one or two years after you started drinking? For both questions, the choice of answers are: yes, no, or unknown.

If an individual answers yes to either question A or B, they are considered to be ALDH-2 deficient. The addition of question B is important because some individuals can become tolerant to the facial flushing effect.

The alcohol flushing response is a biomarker for ALDH2 deficiency. ALDH2-deficient patients have an increased risk for esophageal cancer if they drink even moderate amounts of alcohol. Because of the intensity of the symptoms, most people who have the alcohol flushing response are aware of it. Therefore clinicians can determine ALDH2 deficiency simply by asking about previous episodes of alcohol-induced flushing.

ALDH2-deficient patients can then be counseled to reduce alcohol consumption, and high-risk patients can be assessed for endoscopic cancer screening. The authors estimate that there are at least 540 million ALDH2-deficient individuals in the world, representing approximately 8% of the population. In a population of this size, even a small reduction in the incidence of esophageal cancer could result in a substantial reduction in esophageal cancer deaths worldwide.

Philip J. Brooks e al has documented that approximately 36% of East Asians (Japanese, Chinese, and Koreans) show a characteristic physiological response to drinking alcohol that includes facial flushing nausea, and tachycardia,

This so-called alcohol flushing response is predominantly due to an inherited deficiency in the enzyme aldehyde dehydrogenase 2 (ALDH2) found mostly in Asia but also present in the West.

Few are aware of the accumulating evidence that ALDH2-deficient individuals are at much higher risk of esophageal cancer (specifically squamous cell carcinoma) from alcohol consumption than individuals with fully active ALDH2.

Esophageal cancer is one of the deadliest cancers worldwide, with five-year survival rates of 15.6% in the United States, 12.3% in Europe, and 31.6% in Japan.
When detected early, esophageal cancer can be treated by endoscopic mucosectomy, a standard and relatively non-invasive procedure. However, once the cancer has grown large enough to penetrate the submucosal layer, the likelihood of lymph node metastasis increases significantly. Only about 20% of esophageal cancer patients survive three years after diagnosis, emphasizing the importance of disease prevention.

In view of the approximately 540 million ALDH2-deficient individuals in the world, many of whom now live in Western societies, even a small percent reduction in esophageal cancers due to a reduction in alcohol drinking would save many lives. Increasing evidence also points to the metabolism of ethanol by microorganisms in the oral cavity as an important source of acetaldehyde in saliva and, by extension, in the esophagus. Acetaldehyde levels in saliva are 10–20 times higher than in blood, due to the local formation of acetaldehyde by oral microorganisms. Importantly, ALDH2 heterozygotes have two to three times the acetaldehyde levels in their saliva compared to fully active ALDH2 individuals after a moderate dose of oral ethanol.

For patients at high risk of esophageal cancer, doctors should also consider endoscopy for early cancer detection.
Using a version of the health risk assessment that includes the flushing questionnaire as a major component, it has been estimated that approximately 58% of esophageal cancers in the population could be detected by screening.

Philip J. Brooks et al. The Alcohol Flushing Response: An Unrecognized Risk Factor for Esophageal Cancer from Alcohol Consumption. PLoS Med 6(3): e1000050. doi:10.1371/journal.pmed.1000050

Part II of II: GERD- Heartburn of Pregnancy

Part II of II.

Gastro-esophageal reflux is the phrase used to describe the backward flow or regurgitation of stomach contents passing up into the esophagus. The typical symptom of GERD is a burning discomfort behind the breast bone. Some describe heartburn as indigestion, a "sour" stomach, pain in the upper abdomen or chest, regurgitation of food or bitter liquid into the mouth or excessive production of saliva. GERD is a common condition and symptoms of heartburn are experienced at least once a month by more than 60 million Americans.

For women, the first experience with heartburn is often during pregnancy. Studies suggest that over 50% of pregnant women will experience heartburn during pregnancy. This is due to hormones of pregnancy and pressure from the growing fetus. Symptoms of heartburn resolve in most of these women after delivery of the baby.

What causes GERD?
Acid is produced in the stomach every day. Normally, a small amount of acid passes into the esophagus through a valve between the esophagus and stomach called the lower esophageal sphincter. When the frequency or amount of acid in contact with your esophagus increases, symptoms and damage to your esophagus can occur.

What are the stimuli of heartburn?
Pregnancy
Eating a large, especially fatty meal
Tomato sauces (spaghetti & pizza)
Lying down after a meal
Chocolate, peppermint
Coffee and tea
Smoking
Alcohol and carbonated beverages
Some muscle relaxers and blood pressure medicines
Excess weight
Eat more frequent, but smaller meals

What to avoid?
fatty food, coffee & tea, chocolate, peppermint, alcohol, smoking, carbonated beverages.

What to do?
Maintain a normal weight
Avoid eating 2-3 hrs before bedtime
Elevate the head of the bed 4-6 inches
Don’t lie down after eating

What medications are effective in relieving symptoms?
Antacids
(liquid or tablets):
Tums®, Rolaids®, Mylanta®, Maalox®, Gaviscon®, and many others.

OTC Acid Blockers:
Pepcid AC® , Tagamet HB® , Zantac AC® ., Prilosec OTC®
*Important Note: If you are pregnant or nursing a baby, seek the advice of a doctor before using OTC acid blockers.

Proton Pump Inhibitors:
esomeprazole, Nexium®; or
lansoprazole, Prevacid®; or
pentaprazole, Protonix®; or
rabeprazole, Aciphex®;

Pro-motility Drugs:
cisapride, Propulsid®

Prescription Strength Antacids:
sucralfate, Carafate®

Prescription Strength H2 Blockers:
cimetidine, Tagamet® , ranitidine, Zantac® , famotidine, Pepcid® , nizatadine, Axid®

When should you see a doctor about symptoms of heartburn?

If you have any of the following:
Symptoms of heartburn two or more times a week
Don’t get lasting relief on medication you are taking
Difficulty swallowing, especially solids
Choking, wheezing, hoarseness caused by regurgitation of acid into the throat
Signs of bleeding (vomiting dark coffee ground-like material or passage of tarry black bowel movements)
Unexplained weight loss
Reflux symptoms over more than one year

What treatments for heartburn are safe during pregnancy?
During pregnancy, the medical treatment of reflux should be balanced to alleviate the mother’s symptoms of heartburn, while protecting the developing fetus.

Step 1: Modification of diet & lifestyle

Step 2: Antacids are probably safe.

Sodium bicarbonate can cause a condition known as metabolic acidosis and should be avoided during pregnancy. Magnesium containing antacids may interfere with uterine contractions during labor and should be avoided during the last trimester of pregnancy.

Step 3: sucralfate (Carafate®) has a good record for safety and results with pregnant patients. Acid blockers can probably be administered safely, but require a doctor’s supervision.

Step 4: Other medical therapy should only be used when the benefit of the medicine for the mother outweighs the risk of the medicine to the developing fetus.


Please remember, as with all our articles we provide information, not medical advice.

For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Does Cancer Screening Really Help All?

No evidence so far that it helps with certain cancers reports Robert W. Rebar, MD [Journal Watch General Medicine, 2009].

As much one would like to believe that early detection for all automatically leads to better care, that is not always the case. Although it is true that finding and treating cancer at an early stage will help in some cases — such as colon cancer and Pap smears that reduce deaths from cervical cancer — the data are less conclusive for at least three other cancers.

Ovarian carcinoma
Ovarian carcinoma is the leading cause of death from gynecologic malignancies in the U.S., reports Robert W. Rebar, MD largely because diagnosis usually is not made until disease is advanced.

In a study funded by the National Cancer Institute, of more than 30,000 women in the study’s screening arm who underwent at least one annual screen, 11.1% had at least one positive test result. The positive predictive value of the tests ranged from 1.0% to 1.3% during different screening rounds, and 4.7 to 6.2 cancers per 10,000 women were identified with screening. The ratio of surgeries to detected invasive ovarian cancer cases was 19.5 to 1.

Unfortunately 72% of cancers were late stage. Because the prevalence of ovarian cancer is low, false positives are numerous and screening leads to surgery for many women who do not have cancer. The benefits of screening will outweigh the harms seems unlikely.

Prostate cancer
In an op-ed in USA Today (4/23/09), Kevin Pho, MD, a primary-care physician in New Hampshire, questions whether "early screening" is "always in the patient's best interest." Dr. Pho cited two studies appearing in the New England Journal of Medicine that examine "the effects of prostate cancer screening."

In one study, "sponsored by the National Institutes of Health," researchers "found that such screening did not decrease deaths." Meanwhile, "the second study showed that for every death prevented, 50 men would suffer from over-diagnosis." To put the problem in context: Only 3% of men die from prostate cancer; 97% will die from something else.

Almost one-third of those treated for prostate cancer suffer from significant side effects, including impotence and urinary incontinence. Taken together, the study found that the benefit was minimal, and far from definitive.

Breast Cancer[see Part II in my series of article on Mammagraphy http://drperryhookman.blogspot.com/2009/05/mammography-different-after-age-65-full.html]

Dr. K.Pho notes that "similar issues influence breast cancer screening decisions" and that physicians "cannot be sure of which cancers are dangerous." As a result, "for every life saved from breast cancer, 10 more lives will be affected by" biopsy or breast surgery. He concludes, There cannot be a one-size-fits-all approach" to preventive care.Because doctors cannot be sure of which cancers are dangerous, every woman with a suspicious finding is subjected to a biopsy or breast surgery. For every life saved from breast cancer, 10 more lives will be affected by the ensuing procedures.

Other cancers
The uncertainty surrounding tests is true of other cancers, including lung, skin (malignant melanoma), testicular and pancreatic (pancreatic adenocarcinoma), where little compelling evidence has shown that early screening is beneficial.

My opinion
The problem associated with these studies showing questionable or no benefit to a longer life for cancer victims is the statistics themselves. Statistics are still statistics and you are you. Some lives have been saved from early screening. But for every inspiring story of a person cured from cancer made possible by early detection, there are untold stories of many more who suffer from the side effects of unnecessary invasive procedures stemming from false positive test results.

But when only 1% of a certain population of 100 benefits that 1% may be you-and as far as you’re concerned you are 100% of the study.

Another example is that mammograms detect a number of slow-growing tumors that will never be harmful. But because doctors cannot be sure of which cancers are dangerous, every woman with a suspicious finding is subjected to a biopsy or breast surgery. Although it’s true that for every life saved from breast cancer, 10 more lives will be affected by the ensuing procedures, yours may be the life that’s saved.

Unless you believe with Gilbert Welch, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who says, "I place considerable value on not suffering the side effects of treatment" and "death is not the only outcome that matters," you may choose not to undergo these uncertain screening procedures.

But at least you will be making an informed decision. As Dr. Pho states “patients must be better informed of the potential consequences either choice can bring.”

Please remember, as with all our articles we provide information, not medical advice.

For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Farrah Fawcett Documentary

This Friday May 15 former "Charlie's Angels" actress Farrah Fawcett will appear on most NBC TV stations in her documentary about her terminal disease. Please be sure to see it. Fawcett has been working on this documentary, "A Wing and a Prayer," for NBC about her cancer battle. Ms Fawcett age, 62, received a diagnosis of anal cancer in 2006.

he American Cancer Society estimates that 5,000 new cases of anal cancer are diagnosed each year and about 680 people die from it annually. Meanwhile, colorectal cancer has 148,000 new cases and about 50,000 deaths each year. Anal cancer it treatable, but becomes more difficult to treat if tumor spreads Anal cancer affects more women and the illness is usually found in people who are in their early 60's.

What are the symptoms?

• More than half of anal cancer patients experience bleeding as a symptom. Others have no symptoms or report common conditions, such as “hemorrhoids, fissures, or warts.”

• Symptoms also include itching or pain in that area. The most common thing people think it's a hemorrhoid and unfortunately do nothing significant about it.

• changes in the diameter of stool,

• abnormal discharge,

The following stages are used to describe anal cancer:

In stage 0, abnormal cells are found in the innermost lining of the anus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called “carcinoma in situ.” In stage I, cancer has formed and the tumor is 2 centimeters or smaller. In stage II, the tumor is larger than 2 centimeters. In stage IIIA, the tumor may be any size and has spread to either: lymph nodes near the rectum; or nearby organs, such as the vagina, urethra, and bladder. In stage IIIB, the tumor may be any size and has spread: to nearby organs and to lymph nodes.

In stage IV, the tumor may be any size and cancer may have spread to more distant lymph nodes or organs and has spread to distant parts of the body.
What are the risk factors for anal cancer?

• A suppressed immune system,[e.g.HIV, certain medications]
• HPV, [human papilloma virus], Thus getting vaccinated is a step in prevention.
• STDs [sexually transmitted disease]
• Being over 50 years old

People tend to view anal cancer negatively, because they associate the cancer with a few of its publicized risk factors -- such as sexually transmitted diseases or anal sex—but it is only one of the risk factors, not the only risk factors.

When anal cancer is caught early, chemotherapy and radiation are highly effective. But if the cancer doesn't respond to treatment and spreads to other areas of the body, the five-year survival rate plummets to less than 20 percent.


Please remember, as with all our articles we provide information, not medical advice.

For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Was Napoleon poisoned?

Some conspiracy theorists believe Napoleon Bonaparte was poisoned with arsenic 188 years ago.

After his defeat at the battle of Waterloo in 1815, Napoleon was exiled to St. Helena, an island in the South Atlantic Ocean. He died in 1821 at age 52. During most of his exile, Napoleon lived with a retinue of about twenty people who included some who had a motive for wanting to murder him. Even Napoleon was paranoid about his illness during the last months of his life. He specifically requested that an autopsy be performed on him in the event of his death with “particular focus” on what was in his stomach at the time of death. The autopsy report listed gastric cancer as the cause of death. But the rumors continued.

A number of Napoleon's staff had kept locks of the Emperor's hair, which were passed down the generations, sometimes coming up for auction. In the 1960s a Glasgow University forensic scientist Professor Hamilton Smith, who had developed the nuclear techniques to record very small levels of arsenic showed that small quantities of arsenic were present in Napoleon's hair. Thus the rumors continued that Napoleon had been murdered.

I just came across an article written by my good friend Dr. Genta, a Texas pathologist-gasteoenterologist. He and fellow researchers analyzed Napolean’s original autopsy reports, Napoleon's medical history, memoirs from his doctors and other documents.

Dr. Genta and Swiss and Canadian researchers decided to see for themselves, having been intrigued by the idea that Napoleon could have changed the history of our world by escaping exile. For their study, they relied on current medical knowledge and historical data.

The autopsy reports showed that Napoleon lost a lot of weight in his last months, a sign of severe illness. His stomach was filled with a dark material resembling coffee grounds, which indicated that gastrointestinal bleeding could have been the immediate cause of death.

Researchers compared the data with images of 50 benign ulcers and 50 gastric cancers. They concluded that Napoleon had a stage III gastric cancer, which today has less than a 50% survival rate of one year and less than 20% survival for five years.

"He was sentenced to death [by the cancer]," Dr. Genta said who also speculated that Napoleon likely had a history of chronic Helicobacter pylori gastritis, which probably increased his risk of gastric cancer.

Will Genta’s study finally let Napoleon rest in peace?
Doubtful. "The conspiracy theories will continue," says Dr. Genta.

If Napoleon had escaped and returned to power, his illness would have made for only a brief reign. "There was no need to poison him," Dr. Genta said. "He would have died in a short time."

So where did the arsenic in Napoleon’s hair come from? would’ve asked Dr. Watson

What was the name of the house lived in by Napoleon on St. Helena? replied the great detective.

It was Longwoood House. What has that got to do with it? responded the puzzled Watson.

Elementary my dear Watson, would’ve said Sherlock Holmes.

If you look at the decorating log of that house like I did you would see that the wallpaper of Napoleon’s bedroom was green. And in the weeks prior to Napoleon’s death the weather was hot and humid according an almanac of that day.

Scheele's Green was a coloring pigment that had been used in fabrics and wallpapers from about 1770. It was named after the Swedish chemist who invented it. The pigment was easy to make and was a bright green color but under certain circumstances the copper arsenite could be deadly. Napoleon’s wallpaper contained Scheele's Green which when it became damp and moldy in hot and humid weather, the mold could carry out a chemical process to convert the copper arsenite into a gas which would have been present in the hair of people who lived in the room.

REFERENCES
Jones, DEH, Ledingham, KWL "Arsenic in Napoleon's Wallpaper" Nature, Vol. 299 Oct. 14, 1982 p. 626-7.