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Update August 2015


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Update by Natrakorn Paewsoongnern
 
 
 

Doctor's Consultation  by Dr. Iain Corness

 

Update August 29, 2015

Test results

This morning I bumped into a delightful chap in the foyer of my hospital. He started to tell me about his blood test results and was slightly perplexed when I asked him exactly which tests did he have done. “The usual ones I have done every six months.”
It was then I explained that there are many, many tests. The Australian Royal College of Pathologist’s Manual of Use and Interpretation of Pathology Tests that sits on my desk lists 150 pages of tests that can be carried out. These include such items as a Reptilase Time, something I have never requested in 40 years of practice, or a red cell Galactokinase ditto.
You see, your ‘usual’ blood tests do not test for “everything”. No, when we send you off for a blood test, we have to try and be reasonably specific, and sometimes even have to give the pathologists a clue as to where we are heading, and be guided by them as to some specific testing.
However, many times we are really just casting a ‘wide net’ to see what abnormalities we can turn up to use as a pointer towards the definitive diagnosis. One of the commonest is the “Complete Blood Count”, usually called a CBC, since we medico’s love acronyms, but remember this testing is in reality very far from “complete”.
The CBC does provide important information about the kinds and numbers of cells in the blood: red blood cells, white blood cells, and platelets. A CBC can help us evaluate symptoms such as weakness, fatigue, or bruising and even directly diagnose conditions such as anemia, infection, and many other disorders.
The CBC test usually includes the white blood cell (WBC) count as these cells protect the body against infection. If an infection develops, white blood cells attack and destroy the bacteria, virus, or other organism causing it. White blood cells are bigger than red blood cells and normally fewer in number. When a person has a bacterial infection, the number of white cells can increase dramatically. There are five major kinds of white blood cells: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. The numbers of each one of these types of white blood cells give important information about the immune system. An increase or decrease in the numbers of the different types of white blood cells can help identify infection, an allergic or toxic reaction to certain medications or chemicals, and many conditions (such as leukemia).
The red blood cell (RBC) count is also part of the CBC. Red blood cells carry oxygen from the lungs to the rest of the body. They also help carry carbon dioxide back to the lungs so it can be exhaled. The red blood cell count shows the number of red blood cells in a sample of blood. If the RBC count is low, the body may not be getting the oxygen it needs. If the count is too high (a condition called polycythemia), there is a risk that the red blood cells will clump together and block blood vessels (thrombosis).
Another part is the Hematocrit (HCT). This test measures the amount of space (volume) red blood cells occupy in the blood. The value is given as a percentage of red blood cells in a volume of blood. For example, a hematocrit of 38 means that 38 percent of the blood’s volume is composed of red cells.
Hemoglobin (Hb). Hemoglobin is the substance in a red blood cell that carries the oxygen. The hemoglobin level is a good indication of the blood’s ability to carry oxygen throughout the body.
There is also the Platelet (thrombocyte) count, which is an important part of the CBC. Platelets are the smallest type of blood cell and play a major role in blood clotting. If there are too few platelets, uncontrolled bleeding may be a problem, such as occurs in Dengue Hemorrhagic Fever.
So while CBC does test for many factors, there are still another 149 pages of tests that can be done! If you want to know your blood group, or your HIV status, you have to ask! And males over 50 should look at serial prostate blood tests too.
Finally get your doctor to explain the significance of the tests!


Update August 22, 2015

Smoking in cars? Another risk factor?

I do not like riding in cars where the driver smokes. The smell permeates everything including the roof lining, and the hot embers burn holes in the upholstery. But those are not the real reasons I dislike cigarette smoking in cars.
The real reason was spelled out by Dr Hilary Cass, the President of the Royal College of Paediatrics and Child Health, who said, “Levels of tobacco smoke in a car can be even higher than in a smoky bar and the effect on children can be serious, with second-hand smoke strongly linked to chest infections, asthma, ear problems and cot deaths. You can’t smoke in public places any more. It’s illegal to inflict your smoke on colleagues at work. So why should you be allowed to inflict it on passengers?”
I think most of the readers of this column know my position on smoking, as I am very much against it, but being a pragmatist, I do not try and push the message too hard with adult smokers. They have heard all the statistics and have made up their own minds. I am not going to do a Joan of Arc over it.
However, it has been known for many years that children in smoking households suffer from more respiratory problems than the children from non-smoking households. “Thorax” the International Journal of Respiratory Medicine stated 12 years ago that “Previous reviews in this series have shown that parental smoking is associated with an increased incidence of acute lower respiratory illnesses, including wheezing illnesses, in the first one or two years of life, but does not increase the risk of sensitization to common aero-allergens, an important risk factor for asthma of later onset. Prevalence surveys of school children suggest that wheeze and diagnosed asthma are more common among children of smoking parents, with a greater increase in risk for more severe definitions of wheeze.”
I think you should just accept that at face value, do your own ‘googling’ if you like, but undoubtedly cigarette smoke and children is not a good mix. With the details that levels of cigarette smoke in closed cars is higher than in smoky bars, this should ring some warning bells.
As I said at the beginning of this article, I do not try and push the message to adult smokers, so please do not give me a barrage of ‘hate mail’. However, if this item about kids and smoking has hit a nerve, here is the truth on stopping smoking. The success rate really hangs on commitment. Leaving aside hypnosis and acupuncture, about which I know very little, but the good books tell me do not enjoy high success rates, let’s look at the other methods. Nicotine Replacement Therapy (NRT) gums and sprays make Nicotine available for you in measured doses – much like cigarettes do. You get the craving, you chew the gum. You get the craving, you squirt the spray.
Patches are slightly different. They deliver the Nicotine slowly over a 12 or 24 hour period, supposed to stop the craving before it happens. But often do not. After stabilizing on the NRT it is time to bring the dosage down, which is the next hurdle at which many fall. The end result can be cigarette smoking plus NRT – a potentially fatal combination. In fact, I strongly believe that NRT should only be done under close medical supervision. Too much nicotine can kill too!
So what is the best way? It’s called Cold Turkey. The proof is in the numbers. There has been enough research done and the prime factor is that the quitter has to be committed to the concept of becoming a non-smoker. Doing it (quitting) for somebody else, because you lost a bet, because you are being nagged into it by your wife, girlfriend, boyfriend is doomed to failure, I am afraid. This is something which requires your total commitment. 100 percent all the way.
Cold Turkey demands you stop immediately. Go through any withdrawals. Come out the other side as a non-smoker and you can stay that way for the rest of your life (and your children’s lives).


Update August 15, 2015

Have your discs slipped lately?

Back pain is one of the commonest orthopedic problems, and the often used terms such as lumbago, sciatica and slipped disc get bandied about at the dinner table. However, an acute bad back is not the sort of condition that you want to chat about. How many people have told you that they have a slipped disc? Would you be one of them? However, would you believe me that nobody actually “slips” a disc?
I was reminded about back problems when I experienced an acute lower back pain myself a few weeks ago. The symptoms were classical and the ones we meet so frequently. The patient is doing something and suddenly everything locks up and they are immobilized, frozen to the spot. I was once called out to a factory toilet where the chap was bent over the urinal, and too afraid to move, the pain was so acute. And this was exactly what happened to me! Let me assure you that the condition can be crippling and not “cute” in any way.
Let’s begin then with the “slipped disc” problem. First thing – discs do not “slip”. They do not shoot out of the spaces between the vertebrae (the tower of cotton reels that makes up your spine) and produce pain that way. The disc actually stays exactly where it is, but the center of the disc (called the nucleus) pops out through the edge of the disc and hits the nerve root. When this happens you have a very painful condition, as anyone who has had a disc prolapse (our fancy name for the “popping out” bit) will tell you. Think of the pain when the dentist starts drilling close to the tiny nerve in your tooth. Well, the sciatic nerve is a large nerve! When the nucleus of the disc hits the sciatic nerve, this produces the condition known as Sciatica - an acute searing pain which can run from the buttocks, down the legs, even all the way through to the toes.
Unfortunately, just to make diagnosis a little difficult (if it were all so easy why would we go to Medical School for six years!) you can get sciatica from other reasons as well as prolapsing discs. It may just be soft tissue swelling from strain of the ligaments between the discs, or it could even be a form of arthritis. Another complicating fact is that a strain may only produce enough tissue swelling in around 12 hours after the heavy lifting, so you go to bed OK and wake the next morning incapacitated. And then you have to convince the employer that you did it on his time and not yours.
To accurately work out just what is happening requires bringing in those specialist doctors who can carry out extremely intricate forms of X-Rays called CT Scans, Spiral CT’s or MRI that will sort out whether it is a disc prolapse, arthritis or another soft tissue problem. The equipment to do these procedures costs millions of baht, and the expertise to use them takes years of practice and experience. This is one reason why some of these investigations can be expensive.
After the definitive diagnosis of your back condition has been made, then appropriate treatment can be instituted. The forms of treatment can be just simply rest and some analgesics (pain killers), physiotherapy, operative intervention or anti-inflammatories and traction.
Now perhaps you can see why it is important to find the real cause for your aching back. The treatment for some causes can be the wrong form of therapy for some of the other causes. You can see the danger of “self diagnosis” here. Beware!
So what do you do when you get a painful back? Rest and paracetamol is a safe way to begin. If it settles quickly, then just be a little careful with lifting and twisting for a couple of weeks and get on with your life as normal. If, however, you are still in trouble after a couple of days rest, then it is time to see your doctor and get that definitive diagnosis. You have been warned! There is a branch of the Bangkok Spine Academy in my hospital.


Update August 7, 2015

The killer in your top pocket

Let’s begin this week with a quote from the New American Standard Bible: “Seek, and you will find” (Matthew 7:7). So just what made me consult a bible?
It was a report in the New England Journal of Medicine that stated South Korea has experienced a thyroid cancer epidemic in recent years. “Thyroid cancer is now the most common type of cancer diagnosed in South Korea.”
So has North Korea managed to produce a thyroid cancer agent they are hurling across the DMZ? No. This is what I call a ‘pseudo’ epidemic. Even the authors of the scientific paper attribute the “epidemic” to a government-sponsored cancer screening program. Back to the “Seek and you will find!”
This is one of the dangers of wide-net screening. Are we turning up cancers that would never have been a problem if we had left them alone? In other words, are we looking just too intently?
It also would appear that the same “epidemic” has been seen in other developed countries. The Martians must be putting the cancer agent into the chemtrails left by jet aircraft.
However, the doomsayers ask, could exposure to the electromagnetic radiation (RF and ELF) emitted by cell phones and cordless phones be contributing to this worldwide thyroid cancer epidemic? Isn’t it time for our government to fund research on the risk factors underlying this epidemic?
According to the American Cancer Society, although some thyroid cancers can be linked to exposure to ionizing radiation, “the exact cause of most thyroid cancers is not yet known.”
Now far be it for me to suggest that this could be a giant waste of money, researching something that produces asymptomatic cancers. The old adage “If it ain’t broke, don’t fix it” comes to mind. The research budget to look at cancers that don’t kill you or adversely affect your quality of life, is not money well spent in my view.
I have written before about the adverse health effects of mobile phones, and to be honest, I do not believe there are any. It seems that all over the world there are groups of scientists devoting their laboratory lives to studying the effects of radiation from mobile phones. One group even went so far as to suggest that pregnant women should not place their mobile phones on their abdomens as the radiation can get as far as the developing brain in the fetus as the skull is so much thinner than adults.
If that was not chilling enough, Australian scientists are investigating if children really are more vulnerable than adults to the effects of radiation from mobile phones.
Apparently, a study of 110 adults at the Australian Centre for Radiofrequency Bioeffects Research, partly funded by the Federal Government, confirmed mobile phones cause a change in brain function by altering brainwaves known as alpha waves.
“Although there’s a tiny effect on healthy young adults, there is a possibility that it could be much stronger in children or the elderly,” said Professor Rodney Croft. However, there was no indication from the adult tests if the effect on health was positive or negative.
There have been claims that using mobile phones produces brain cancer because people with brain cancer have used mobiles, and that is about as stupid as claiming that shoes are the greatest killer in the western society because 99 percent of people who died last year wore shoes. Lies, damned lies and statistics.
Now one of the articles I read admitted that scientists worldwide agreed there is no evidence linking electromagnetic radiation emitted by mobile phones to adverse health effects, but claims still persist that frequent use can cause headaches, nausea, problems with concentration, cancer and brain tumors, and I think you can pop thyroid cancer in there too.
Professor Croft admitted Australian studies using unborn or newborn mice had failed to find significant changes in growth rate, brain function and behavioral development. However, I also believe we should keep mobile phones away from mice as they can play havoc gnawing on the cases.
Let’s divert the research dollar from pseudo epidemics to real problems like lung cancer, liver cancer and brain cancer for example.


Update August 1, 2015

“Sugar” in the (medical) news again

Diabetes (“sugar”) is in the news again, but it isn’t “good” news. There are 60 million people living in the UK (I’d probably say ‘surviving’ in the UK is more accurate) and 2.1 million of these have been diagnosed as Diabetic, of which 1.8 million had the Maturity Onset form of the condition. Official estimation from the UK would also suggest there were another 1 million walking around with Mature Onset Diabetes that did not even know they had it. That’s a worry. Not for me, but for them.

So who gets it? Are you more than 40 years of age? Are you overweight? Do you have a blood relative who has Diabetes? If you answered “yes” to any of those questions, then you may have Mature Onset Diabetes. If you answered “yes” to all three, then it is pounds to peanuts that you do have it. (If you come from Holland, you can make that guilders to gooseberries!)

Before we go much further, just exactly what is Diabetes? Quite simply, it is an inability of the body to handle glucose correctly. Insulin is produced by the body to keep the glucose system in balance and if the insulin production is lacking, this is called Type 1 Diabetes. With Mature Onset Diabetes (also called Type 2, or Non Insulin Dependent Diabetes Mellitus) the cells become less responsive to insulin, and there may be a reduction in insulin levels as well.

Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells.

When glucose builds up in the blood instead of going into cells, it can cause many problems. First off, your cells may be starved for energy, so you begin to feel tired. Secondly, over time you may develop heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy).

So how do you know if you have developed (or are developing) Mature Onset Diabetes? The main symptoms to look for include a lack of energy, hunger (which comes from the fact that the cells are ‘starving’), excessive passing of urine combined with thirst and a dry mouth, insufficient sleep because of the need to pass urine at night (though this may be due to prostate enlargement in males) and blurred vision (again not to be confused with reading difficulties – short arms – which is called Presbyopia and occurs after 40 years of age), slow healing of minor cuts and sores.

How does Diabetes cause such diverse symptoms? Large blood vessels may be damaged by atherosclerosis, which is a major cause of coronary artery disease and stroke. Other long-term complications result from damage to the small blood vessels throughout the body. Damage to blood vessels in the light-sensitive retina at the back of the eye causes the visual impairment (diabetic retinopathy). Diabetes also increases the risk of developing cataracts.

If diabetes affects blood vessels that supply nerves, it may cause nerve damage. There may be a gradual loss of sensation, starting with the hands and feet and sometimes gradually extending up the limbs. Loss of feeling, combined with poor circulation, makes the feet and legs more susceptible to ulcers and gangrene. The nerve and blood vessel damage may also produce impotence in men (which Vitamin V may not be able to fix).

Damage to small blood vessels in the kidneys may also lead to further complications. Damage to the nerves controlling the body’s internal functions (autonomic neuropathy) can lead to problems with low blood pressure on standing (postural hypotension) or disturbance of the GI tract (vomiting or diarrhea) and increases the risk of sudden cardiac death.

So if you think you might have it, or are a likely candidate, what next? A simple trip to your doctor and some inexpensive blood and urine tests will confirm or deny.

In the initial stages, dietary measures may be sufficient to control this condition, but oral medication and sometimes insulin injections become necessary as it progresses. But find out if you have it first!


HEADLINES [click on headline to view story]

Test results

Smoking in cars? Another risk factor?

Have your discs slipped lately?

The killer in your top pocket

“Sugar” in the (medical) news again
 

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