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Your Health & Happiness

The Doctor's Consultation

Agony Column

Camera Class by Snapshot

Money Matters

Life in the Laugh Lane

Your Health & Happiness: Prostate Cancer – Have you any options?

Dr. Iain Corness

Last week we published one medical viewpoint on the desirability of treating early stage cancer. The writer was of the opinion that treatment is always necessary, however, this is not necessarily agreed to by all medical schools of thought. Since the treatment for prostatic cancer can alter one’s lifestyle dramatically, Quality of Life has to be considered, as does the age of the patient. Here is an alternate view.

This week, three of my friends contacted me to say they had just been diagnosed as having prostate cancer. They range in age between 50 and 70. One has had already had the operation to remove the prostate gland completely, the second is waiting till November to have his prostate removed, while the third has gone to Europe, hoping for a magic cure. Unfortunately, he will find there isn’t one.

Prostate cancer is also extremely common, something we men have to live with. After all, our women are always telling us how lucky we are to be men and not have to go through childbirth for example, so it’s probably only right and equitable that there is a male downside. In fact this year in the United States, almost 180,000 men will be told that they have prostate cancer. That’s 180,000 downsides.

With all our older friends getting prostate problems, does this mean there is a rise in the incidence? Has the urbanized world or greenhouse gasses struck as all a death blow? Or is it just underpants that are too tight? Simple answer – No! One reason for the ‘apparent’ increase in prostate cancer is the fact that prostate cancer is a disease of aging, and thankfully, we are all living longer. The statistics would show that by age 50, almost 50 percent of American men will have microscopic signs of prostate cancer. By age 75, almost 75 percent of men will have some cancerous changes in their prostate glands. Do the maths. By 100 we’ve all got it!

So does this mean that life really ends at around 76? Fortunately no. Most of these cancers stay within the prostate, producing no signs or symptoms, or are so slow-growing, that they never become a serious threat to health.

The good news is that in other words you die of something else before the prostate gets you! You die with it, rather than from it. It may be a sobering thought to all you spritely chaps who are still 10 foot tall and bullet-proof, that despite all medical research and advances, the death rate will always be the same – one per person. We all have to die of something – even me, and I just hope it isn’t from boredom! That would be a real killer.

While the numbers quoted above look fearsome, the real situation is not quite so bad. A much smaller number of men will actually be treated for prostate cancer. About 16 percent of American men will be diagnosed with prostate cancer during their lives; 8 percent will develop significant symptoms; but only 3 percent will die of the disease. Put another much more positive way, 97 percent won’t die from prostate cancer. This means I must be OK, as my three friends hopefully make up the three percent of my acquaintances.

While prostate cancer can be ‘aggressive’, breaking out from the prostate gland itself and attacking other tissues, including brain and bone, fortunately this is the minority scenario. The great majority of prostate cancers are slow growing, and it can be decades between the early diagnosis and the cancer growing large enough to produce symptoms.

So let’s look at diagnosis and get the “blood test” out of the way first. The blood test is called Prostate Specific Antigen, or PSA for short (we medico’s love acronyms). Up till then we had another acronymical test called DRE (digital rectal examination), which, quite frankly, was not all that popular. As medical students, we were taught “If you don’t put your finger in it, you’ll put your foot in it!” Despite this, ‘buyer resistance’ was high, so when news came through about a “blood test”, millions of men began rejoicing and the sale of rubber gloves plummeted. Unfortunately, PSA is not a go-no go test. A normal range test doesn’t guarantee you haven’t got it, and an elevated result doesn’t automatically mean that you are about to claim early on your life insurance (or your dependants, anyway).

However, there is good news. We are becoming smarter with the PSA test. Elevated PSA levels in the blood correlate roughly with the volume of cancer in the prostate, with the stage and grade of the tumor, and with the presence or absence of cancer metastases or growths in other tissues. Serial PSA examinations can also show the rate of this growth, another good reason for regular check-ups.

Like many other cancers, prostate cancer can only be fully diagnosed by examining prostate tissue samples under the microscope. When your doctor suspects prostate cancer on the basis of your symptoms, or the results of a clever finger rectal examination (DRE), and/or a PSA test – the definitive diagnosis will need a biopsy.

So let’s imagine that now you have had a positive biopsy. You’ve got it! What are the real options? Actually very many and depend mainly upon the ‘stage’ of the cancer and your age at the time of diagnosis.

‘Staging’ has four main grades. Stage I cannot be felt and is diagnosed through pathological testing. Stage II can be felt, but it is confined to the prostate. Stage III is coming out of the gland and Stage IV has grown into nearby tissues.

Treatment can be ‘watch and wait’, surgery, radiation, hormone therapy, eating herbs or muttering mantras. Often it will be a combination of some of the above (but I’d forget the mantras, if I were you).

This is where you need to discuss your options with your doctor. If you are a young man with stage IV, then you have to make up your mind quickly. But if you are 75 with stage I or II, then you have more time, as you will most likely die of other causes before the prostate cancer gets you.

Watch and wait has much going for it, but you must be prepared to get to know your urologist on first name terms. You will be seeing a lot of him over the years, so pick a young one!

The Doctor's Consultation: Exercise for Health. Does that include sexercise?

by Dr. Iain Corness

Probably the commonest advice a doctor gives is to lose weight and some exercise. Does that ring a bell in your memory? Was that part of the advice after your annual physical check-up?

Unfortunately, there seems to be very little real understanding of what exercise should consist of, how often, what type, how long and what about sex? For example, I was reading an article on exercise the other day and it said authoritatively that one should wear comfortable clothing and socks with the correct size of non-slippery, shock-absorbing shoes. If this includes sexercise, there are some strange shoe fetishes out there that I haven’t heard of yet!

However, getting a little serious, exercise will be good for you, provided that you pick a form of exercise that is not harmful for you! Now I know that looks as if I have put my money on both horses in the race, but take that sentence at its face value. Enough research has been done to show that regular exercise is beneficial for everybody, in both the physical and psychological aspects, but, and it is a big ‘but’, all forms of exercise have relative bodily risks, and this has to be taken into account before you buy a pair of expensive jogging shoes and tackle a 10 km trot in the middle of the day. True stories – a medical colleague in Australia took up playing squash when he turned 50 and dropped dead on the court of a heart attack, and another acquaintance of mine turned 40, decided he wasn’t fit, bought a bicycle to ride to work each day and was run over by a bus.

The same article that advised non-slippery shoes, did have some wise words however. These included to choose appropriate exercise according to your ability. Never exceed your limit. Remember that it is not the harder the better. If you have acute medical problems (such as fever, or pain), stop exercising. If you have chronic medical conditions (such as hypertension, diabetes, ischemic heart disease and arthritis), seek advice from your doctor or physiotherapist beforehand. All of these I agree with. If you are happy to take your body to your medical advisor when it is sick, take it back to your doctor for advice on how to tone it up as well.

The other words of wisdom suggested that for prolonged exercise such as hiking, continually drink water to supplement the loss of body fluid due to sweating. Do not wait until you are thirsty. Take appropriate breaks during exercise. Do not over-exert yourself. Forget about “powering through the pain barrier”. Leave that for Olympic cyclists.

As well as the form of exercise, there is the frequency. At least three times per week, 20-30 minutes (or more) is necessary each time, to derive the maximum benefit. And always remember, if there is dizziness, fainting, shortness of breath, chest pain, vomiting, nausea or severe pain during exercise, stop exercising immediately and seek medical advice as soon as possible.

Now I did mention at the start of this week’s article, the word “sexercise”, and some of you have been impatiently reading, while nervously fiddling with your expensive packet of Viagras, Kanagras, Cialis and other lead-in-your-pencil medications (I draw the line at tiger willy). OK, what about sex? The advisability of this form of exercise when you have some chronic complaint (such as hypertension, diabetes, ischemic heart disease etc), should be part of the advice you get from your doctor beforehand. The danger of over the counter willy stiffeners is that you don’t get advice with them.

Finally, the learned article did say “Exercise with friends. Company provides enjoyment, mutual encouragement and support.” That goes for sexercise too!

Agony Column

Camera Class:  Cats and kids – you have been warned!

by Harry Flashman

Cat pic by Ernie Kuehnelt

When someone says you take great photos and asks you to take a photograph of their offspring – forget the warm glow this gives you and turn down the offer! Staying away from kids and animals used to be the maxim for stage performers. It is the same for photographers. While every mother and pet owner wants wonderful photographs of their charges, it is very difficult to get one that you will be happy with, let alone the owner of kid/pooch/cat (delete those not applicable).

The biggest problem is the short attention span demonstrated by children and pets. Something they can be interested in will last around 2 milliseconds if you are lucky. Hang about composing, focussing and other fiddling will see the child turn round, the dog will start licking something you would not want recorded for posterity and the moggie will just stalk off, tail in the air. Or it can be a combination of all three.

The answer is to be fore-warned and therefore fore armed. You have to visualize the shot first and make it happen second. It is not a case of following the child around and going snap, snap, snap and hoping one will turn out OK. It won’t, and you’ll get tired.

What does help is to look at photographs in magazines and books, and when you find a pose that you like, then work out just how did the photographer get the shot. This is important if you are going to try to capture that same “look” with your shots. By the way, this is not cheating or blatant copying, which I am totally opposed to, all you are doing is seeing how you can technically get a pleasing result.

Chances are, when you have found the shots you like, that you will find that to get the shot, the camera is on the same level as the subject. This goes for about 99 out of 100 shots of alert kids/pooches/cats. When they are asleep, then take from above – the 1 in a 100 shot!

It is for this reason that pro photographers have a couch they put kids on – just to bring them up to normal camera level. Likewise, those demented photographers who make their money by photographing animals do the same. After all, you look a right proper idiot crawling round on your belly taking shots in front of the startled owners!

OK, let’s get down to action with your kids and animals. Begin by setting the scene and you begin with the background. A dull mottled material background works well as it does not have fussy details to take your eyes away from the main subject. You should also position this background at least 1 metre away from where the subject will be placed. You can either paint this background yourself, or you can buy rolls of it from professional camera houses.

Now position something in front of the camera to represent Phido or Philip. Place it where you expect the subject to sit and pre-focus and set your exposure details (or just set the camera on Auto and let it do the work). Now look through the viewfinder and make sure you have all of the background material in the frame, as well as the child/animal sized dummy. A large stuffed toy can be used for this purpose. If you have a tripod, it is a good idea to use it here too.

Now get a favourite toy (for the humans) and some bacon fat for cats and a box of matches for dogs. Speed is now the name of the game. Position the child where the stuffed toy or whatever was seated and give it to the child. Start snapping NOW! If you are lucky, you will have caught that “magic moment” of childish glee. If you’re lucky.

With the cat, have the owner smear the bacon fat on its mouth and it will reward you with the tongue lick shot. With the dog, rattle the matches and it will prick its ears up for that “alert dog” look. That is just before it lunges at you from the table! Stay away from kids and animals. You have been warned.

Money Matters:  Investing closer to home - Part 2

Alan Hall
MBMG International Ltd.

Stocks are on occasions cheap for good reasons. One such reason rests on the perceived prospect for an imminent downturn in the relevant industry. For instance, many portfolio investors are concerned with petrochemicals and shipping hitting a cycle peak in 2005-6. While we do not dispute that the broad petrochemical and shipping industries could both be in for a period of product and service prices levelling off beginning in 2006, we also see exceptions to the general expectation. We believe that the small handy dry-bulk shipping sector is not about to be flooded by oversupply of new vessels in the next 12 months. We also believe the aromatics cycle is likely to see new capacity come on line later than other sub-sectors in the petrochemical industry.

In common with other emerging economies in Asia, we expect the Thai economy to grow at a decelerating rate. Rising interest rates around the world and high crude prices for the second year in the row would slow down growth in consumer expenditure and turn Thailand’s trade account into a deficit.

The SET trades at about 12x 2004 market EPS and 10x 2005 market EPS at present. The average PER of the SET between 1988 and 2004 is about 13.5x. Given the outlook for slowing macro-economic growth in Thailand and in the rest of the world, tightening credit and crude prices remaining stubbornly high, a top down approach to portfolio investing would likely avoid interest sensitive stocks, such as banks, consumer finance companies and residential property developers, and treat with caution cyclical stocks, growth companies and exporters in 2005. Based on a typical top down approach, investors would likely select infrastructure plays, defensives, such as big cap energy companies and reliable dividend payers. As stated before, there is better value to be had by the bottom end approach.

Seamico, as usual, has been pretty spot on so far, but by the year end, we’d want to see more signs supporting M.R. Pridiyathorn’s optimism and less justification for our caution or else we’d move from long to short in our SET view. It’s interesting that everyone seems to be jumping on the bandwagon right now - last week the International Herald and Tribune chipped in by reporting that certain hedge fund operators and the media services have been in overdrive these days, warning of a repeat of the 1997-98 Asian financial crisis. The Indonesian Rupiah has been said to be in freefall with reports of the same happening in Thailand and elsewhere. The reason for this is the oil price hit to Asian trade balances and government failure to follow the market and raise local fuel prices and lift interest rates.

The article reports that while most Asian countries are heavily dependent on imported oil and most do have high energy ratios to GDP, partly due to low energy prices, with the cost of energy subsidies having a negative impact on government budgets and energy distributors profitability, but these prices are being held down for short-term political reasons and most subsidies will be removed as soon as possible.

Furthermore Indonesia, for example, while said to be in a current mini-crisis, is an energy exporter of coal and gas, which offset the small net oil imports. The impact is not on its balance of payments but on the budget.

Thailand is reported to be in a danger zone due to the current account deficit cited above. The IHT was significantly less detailed than M.R. Pridiyathorn attributing most blame to the tsunami’s damage to tourism income. It rightly stated that Thailand’s fiscal position cannot stand permanent domestic price subsidies but also that currently domestic demand requires a temporary cushion against a sudden fall in consumer spending power.

Malaysia, also said to be acting irresponsibly with regard to oil prices, is helping its economy sustain consumption at a time when the current account surplus is running at more than 15% of GDP, money which is mostly going to prop up the spending of deeply indebted households in the US, UK and other developed countries.

In all of these instances it failed to take account of the future impact of global slowdown. Thailand is healthier and in many ways better positioned than in 1997 but the sustained high oil prices feared by M.R. Pridiyathorn and the sustained global economic downturn feared by many analysts could be a very unfortunate combination.

However, it may be that the best news for the Thai economy happened a couple of thousand miles away, where incumbent Japanese Prime Minister Junichiro Koizumi’s Liberal Democratic Party (LDP) won 296 seats in the 480-member House of Representatives, well above the 241 seats needed for a majority and above the 249 seats the party held when Koizumi dissolved the chamber, and a landslide affirmation of his stated intention to reform Japanese society. By calling the snap election in August, Koizumi effectively set a national referendum on his bid to privatize Japan Post, a financial-services giant with $3 trillion in savings and insurance assets. The move would effectively create the largest bank in the world.

Postal privatization is pivotal to Koizumi’s wide-sweeping reform agenda. “The election was carried out under difficult circumstances at first,” Koizumi told a news conference. “In the end, we got much more support from the people of Japan than expected. I accept the judgment of the people with a sense of great responsibility, and will work to pass the postal reform bills as soon as possible. I intend to push forward policies on other issues of concern to the people, such as social insurance, in parallel with postal reform,” he said, without giving details.

Both the stock markets (the Nikkei finished above 12,850 at a four-year high) and the yen gained responded positively to the news. While we don’t expect progress in Japan to be straightforward we do expect Japan to take 2 steps forward for every step back - the converse of the ratio that we expect to see in the West. Japan may represent some economic salvation for emerging Asia, although we would start to increase exposure to Japan cautiously right now and wait a little longer to see how the picture develops for Thailand, ASEAN and emerging Asia.

The above data and research was compiled from sources believed to be reliable. However, neither MBMG International Ltd nor its officers can accept any liability for any errors or omissions in the above article nor bear any responsibility for any losses achieved as a result of any actions taken or not taken as a consequence of reading the above article. For more information please contact Alan Hall on alan@mbmg-international.com

Life in the Laugh Lane: Laugh Lane Spam Attack!

by Scott Jones

An unsolicited email arrives from Elpidius Barberio. Subject says - Re: mastodon whitening. Hmm, possible in Thailand. Land of Smiles, lots of whitening creams, elephants with off-white tusks. Another from Innocenzo Lakes - Re: dancing salesman. Hmm. Does he sell dancing lessons or will a festive, door-to-door, vacuum cleaner peddler gyrate up my walk doing the mambo with an Electrolux to the tune of “Suck It to Me, Baby”? Re: toad defrost. Re: spontaneous tortilla. Re: monsieur buffoonery. Re: innermost hemorrhage. Over the next few weeks, 12,000 more spam emails litter my bulk folder. I open some at an internet shop in case they contain a virus that explodes computers. They all list the same four drugs for sale, none of which I’ve ever heard of, but are obviously very versatile since they can take care of mastodon whitening, toad defrosting and your innermost hemorrhage.

This is not a marketing technique that I understand. Thousands of sales geeks named Rashida Ranallo, Ganesha Laws, Shahrizad Kent and Fabian Nail babbling in my virtual front yard does not whip me into a shopping frenzy. “Grizzled guillotine! Repeated toweling! Yogurt accessory! Entrails guarantee! Syphilitic limekiln!” I assume some random word and name generator devised to slink past spam filters is despoiling mankind, but I cannot find one other person who is having this problem. Who would spend this much energy bothering only me? As young scamps, we’d harass the neighborhood meanie, Old Man Gruber, by putting dog poop in a paper sack on his step, setting it on fire, ringing his door bell and laughing till we wet our pants as he stomped out the flames, but he must be dead by now.

The perpetrators may be Alvin Plummer and Diane Jensen, two unfortunate souls who took the brunt of our elementary school class harassment. When I met Alvin in 6th grade, he’d already flunked twice so he was taller and older, but had the mental capacity of an eraser. His social doom was sealed in gym classes during a push-up session as the teacher paused in his chant of “Down…down…down…” to say, “Alvin, you have to push up between the downs.” I moved on but he remained in 6th grade where he may still be.

I don’t know why we picked on poor Diane since she wasn’t fat, ugly or stupid - deadly traits in grammar school. She may have been from the wrong side of the tracks, but hey, the whole state of North Dakota is still on the wrong side of the tracks, the wrong side of America, and as far as I’m concerned now, the wrong side of the world. We’d play a terrible game of tag where someone would touch Diane and then tap anyone else while yelling, “You’ve got Diane Jensen Germs!” Pandemonium broke loose as everyone tried to get rid of her germs. We never did this to anyone else. I still feel bad about it. I’d hoped she’d attend a high school reunion so I could grovel and apologize, but she never wanted to see us despicable monsters again. I suspect the victims of this current email virus are my 6th grade class and the masterminds are Alvin and Diane who have since married, became millionaire computer geniuses and decided it’s finally payback time: “You want Jensen Germs? Take this!!!”

It takes days to wade through the spam to assure I don’t delete anonymous charitable contributions or clues to Diane’s correct email, but I’m learning novel ways of combining English words (tuba panic, misconception table, unbaked bra, crotch photomicrograph, moleskin mispronunciation), considering new professions (compost nurse, hammock botanist, contextual cosmetologist, oil derrick knitter, lumberman debater, turpentine smuggler, handrail finder, applecart roguery, electric copulation, lizard pharmacy, parliamentary fornication, scrooge authentication) and discovering choice names for a hard rock band: Thong Trembler, Spurious Crumb, Swill Decanter, Satanic Universe, Sextant Glandule, Niggle Lineament, Squawk Airport, Armored Alcoholics, Bazooka Dixie and Oleomargarine Blowfly. If you ever meet Diane, please tell her I’m sorry.

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