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XII No.11 - Sunday June 2 - Saturday June 15, 2013

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Doctor's Consultation  by Dr. Iain Corness


Breast cancer and Angelina Jolie

I am sure everyone in the modern world will have read about Angelina Jolie’s double ‘prophylactic’ mastectomy after finding she carried the hereditary breast cancer gene. Her mother died from the effects of breast cancer, so there is some degree of justification, but personally I think she has over-reacted somewhat. Having the breast cancer gene is not a 100 percent predictor of getting breast cancer.
However, “Cancer” is still a word which induces fear. And in some cases, rightly so. Cancer can be a killer, but not always. There are many people who have had cancer and lived to tell the tale. My dear old Mum had cancer of the womb and ended up having a hysterectomy before she was 50 years of age. She was 94 when she died of pneumonia, so I think we can safely say the operation was a success!
The treatment for cancer is classically surgery, chemotherapy and radiotherapy. Much depends upon the type of cancer, and how long it has been growing, and how far it has spread. This can be a single modality, or combined. There is also much work being done with the immune system and cancers, with a vaccine for some types of cancer on the horizon.
However, I came across an article the other day referring to advanced breast cancer survival rates and compared two similar kinds of cytotoxic drugs. The end result of the study was that Drug A was more effective than Drug B, but had significantly more side effects as well. Reading further, it was reported that Drug B extended life by 13 point something months, while Drug A had the sufferer living 15 point something months; however, the downside to these two extra months included mouth ulcers, infections and low blood counts. However, the researchers had come to the conclusion that Drug A was best.
I ask you, best for whom? In my book, it wasn’t the patient! Yes, it’s my old hobby horse - the Quality of Life. What is the point of saying you can have Drug A to give you two extra months of life when that is a life of misery? One thing is for sure, I will put my last baht on the fact that none of the research team took either drug! At least the famous medico John Hunter gave himself syphilis to try to find the cure. And it wasn’t the ‘fun’ way, but self administered syphilitic pus. You won’t find that kind of dedication today, even though some people would call it foolishness.
We must never forget that in all our research we are not dealing here with body cancers - we are dealing with patients that have cancer! We, the medical profession, must treat the whole person, not the disease.
Now I mentioned breast cancer at the start of this item for a couple of reasons. One is the fact that screening tests can be done, and I would suggest that all you ladies over the age of 40 (or over the age of 30 if your mother or a maternal aunt died of breast cancer) should consider annual mammograms in addition to your monthly Breast Self Examination.
The second reason I mentioned breast cancer is that it is not, as many western women think, the greatest killer of women. For many 10 year groups of women, heart disease is the greatest killer. Yes, heart disease, the greatest killer of men is now firmly entrenched in women’s medicine.
So what can you do about this? The simple answer is to take a leaf out of the Eastern ladies’ handbooks on living. An Asian diet, which is high in vegetable content and low in animal fats is a good start. More of a Thai ‘jai yen yen’ approach to life’s problems also helps. Use the ‘family’ network to get problems solved, and in fact the family approach to living, with each member helping when necessary, is another good example from the Asian book of life. And finally, the Buddhist practice of moderation, the middle way, applies to the women folk as well the men.
And if you haven’t done it already - give up smoking.

Is there a medical place for the “F” word?

Somber and staid are descriptions used for doctor’s surgeries. They are not thought of as places for humor. However, it has been shown to the satisfaction of the medical world, that humor and a good laugh really is good medicine. Some hospitals even employ clowns to brighten up the days of the inpatients. And no, I am not the clown.
However, one of my favorite jokes involves a parrot that was prone to ‘bad’ language, and consistently used the “F” word. After threatening the talkative bird with dire consequences, its owner put it in the freezer chest for five minutes. After being retrieved from the freezer, the parrot was asked if it would now behave. “Yes,” said the shivering parrot, “I won’t say the ‘F’ word again, but please tell me what did the effing chicken say?”
Now, the F word in medicine. Inappropriate use of the F word (there are some appropriate situations, in my mind at least) is part of an interesting condition known as Tourette’s Syndrome. These are involuntary movements (and sounds) and can be related to the magic “F” word, and is usually seen in children (not parrots) around the age of 5-7 years. Boys outnumber girls three to one!
So is this just a case of little Johnny parroting off (sorry about that, couldn’t help myself) dirty words he has heard at home? Actually no. This is a developmental problem that comes under the general heading of ‘Tics’ (as opposed to ‘ticks’ that are parasitic problems).
Tic disorders can affect up to almost 20 percent of children at some stage of their development. At one end of the spectrum are children with brief episodes of single tics, whereas at the other are children with chronic multiple tics, including our friend Tourette’s syndrome.
Tics are abrupt and recurrent involuntary motor or vocal actions. Motor tics include eye blinking, grimacing, nose twitching, lip pouting, shoulder shrugging, arm jerking, head jerking, kicking, finger movements, jaw snapping, tooth clicking, frowning, tensing parts of the body, and rapid jerking of any part of the body are simple tics. More complex ones include hopping, clapping, touching, throwing, arranging, gyrating, bending, biting the mouth, the lip, or the arm, head-banging, picking scabs, writhing movements, rolling eyes upwards or side-to-side, making funny expressions, sticking out the tongue, kissing, pinching, writing the same letter or word over and over, and tearing paper or books.
However the tic can also be vocal, with simple ones being coughing, spitting, screeching, barking, grunting, gurgling, clacking, whistling, hissing, sucking sounds, and syllable sounds such as “uh, uh,” “eee,” and “bu.” The complex vocal tics can involve complete phrases such as, “Oh boy,” “you know,” “shut up,” “you’re fat,” “all right,” and “what’s that.” Take that a little further and you get repetitive bad language (which we call Coprolalia, because we love big words) and that is the best known example of Tourette’s syndrome.
Children who have these tics can be looked upon as fools by their peers, and there is a no more predatory group than other children. Parents also can feel helpless in these situations. Form the medical point of view, one has to treat the entire family, not just little Johnny with the foul mouth!
Most children with tics can lead normal lives, and the tics themselves usually slow down in teenage years. Parents should be encouraged to get support for themselves from various organizations such as the Tourette Syndrome Association ([email protected]). With a good understanding of tics and related problems, including acceptance from teachers and education of the child’s peers, most children with tics do not need regular medical follow up.
Parents and children need to understand that, although all these symptoms relate to an underlying brain disorder, breaking the cycle may be extremely simple - for example, just allowing the child to have a short “tic break” in a long school lesson may be enough.
Drug treatment can be used, though there are differences in opinion on the efficacy, with some researchers claiming only 30 percent can be helped. However, tic severity and frequency can be reduced. Studies of Risperidone in Tourette’s syndrome have shown that it is efficacious too.

HEADLINES [click on headline to view story]

Breast cancer and Angelina Jolie

Is there a medical place for the “F” word?



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