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Doctor's Consultation  by Dr. Iain Corness


Let’s discuss this over coffee

Did you have a cup of coffee this morning?  If you did, and you are pregnant, then one more cup in the next 24 hours is dangerous, according to some researchers.  However, if you are not pregnant, you may be reducing your risk of ovarian cancer, one of the top six killer cancers!

Controversy has raged since the Middle Ages as to the medicinal, or otherwise, effects of coffee.  A 1661 tract titled, “A character of coffee and coffee-houses”, listed some of the perceived benefits:

“Tis extolled for drying up the Crudities of the Stomack, and for expelling Fumes out of the Head.  Excellent Berry! which can cleanse the English-man’s Stomak of Flegm, and expel Giddinesse out of his Head.”

However, just like today, there was another side to the coffee bean.  An anonymous “Women’s Petition Against Coffee” in 1674 declared:

“ ...the Excessive Use of that Newfangled, Abominable, Heathenish Liquor called Coffee has Eunucht our Husbands, and Crippled our more kind Gallants, that they are become as Impotent, as Age.”

So there you have it.  In the Middle Ages coffee cleared your head but had disastrous effects on the male dangly bits.

These days we pride ourselves on being much better educated on all fronts, with armies of researchers all over the world looking at everything, including coffee.  Every week in the lay press you are bombarded with horror stories of what dangers we all face.  These horror stories come from reports done by legitimate researchers, picked up by the media and away it goes from there.

On the surface, it all seems very probable.  Take the two cups of caffeine and be ready to miscarry item.  Dr De-Kun Li of Kaiser Permanente Division of Research, whose study involved 1063 pregnant women who never changed their caffeine consumption during pregnancy.  What they found was women who consumed the equivalent of two or more cups of regular coffee or five 340 ml cans of caffeinated soft drink - were twice as likely to miscarry as pregnant women who avoided caffeine.

However, this study of 1063 pregnant women is also a very small percentage of women world-wide who drink coffee while they are pregnant.

However, two days after the shock-horror miscarriage item hit the world media, there was another report.  Researchers now claim the much-demonized substance may fight cancer.

After studying more than 80,000 women, US and Australian experts found foods containing caffeine - such as coffee, tea, cola and chocolate - may reduce the risk of ovarian cancer, the sixth-most common cause of cancer deaths among Australian women.

According to Assistant Professor Shelley Tworoger of Harvard University in Boston and her colleagues - including medical epidemiologist Associate Professor Dorota Gertig of the University of Melbourne and Victorian Cytology Service - caffeine was beneficial, but decaffeinated coffee showed no health benefit at all.

For reasons they cannot yet explain, the group also found the beneficial effect of caffeine was strongest for women who had never used oral contraceptives or postmenopausal replacement hormone therapy.

The researchers analyzed data from the Nurses’ Health Study, an ongoing assessment of the well-being of 212,701 female registered nurses that began in 1976 when the nurses were aged 30-35.

Every two years, researchers at Boston's Brigham and Women’s Hospital checked up on the surviving women.  After studying the nurses’ history, Professor Tworoger and Professor Gertig’s group found only a very small association between smoking and mucinous tumours, a rare form of ovarian cancer.  They also found no connection between alcohol consumption and ovarian cancer.

Oncologist Ian Olver, head of Cancer Council Australia, said, “It’s well worth looking into further,” and even coffee and chocolate couldn’t hurt and might even help.  “My standard advice is everything in moderation,” he said.

The whole research really hangs on Professor Olver’s statement, “It’s well worth looking into further.”  And research salaries and equipment costs money, and where does it come from?  Make the biggest claims with the greatest amount of shock-horror and funding will be forthcoming.  Mark my words, the chocolate manufacturers will jump on this like blowflies on a dead donkey.

Now I must go and have a cup of coffee.  I don’t have to worry, I’m male!

More avian diseases?

With Bird Flu apparently on the rise again in Cambodia, will it fly across the Mekong and infect Thailand?  Of course it will, and probably has done already.  But since the world statistics from Bird Flu (A/H5N1) has only been 564 cases over eight years, you are more likely to be run over on the road (especially during Songkran).

However, there is another “chicken” disease, Chicken pox!  Actually, chicken pox (AKA Varicella) is not really caused by chickens, nor even carried by them.  Chicken pox is a very common disease caused by the varicella zoster virus which is a member of the herpes virus family.  It is very contagious and all communities experience epidemics.

A few years back there was a real outbreak in Thailand, with 22,833 patients with the complaint between January and May.  This nasty condition never actually leaves the community, lying quiet for a while and then attacking in epidemic proportions.  Make no mistake about this one, it is a most aggressive disease that sweeps through schools and institutions and while generally a disease of children, it can attack adults too with devastating results.

The varicella zoster virus is known for the characteristic chickenpox lesions.  These come out very quickly after an initial period of vague symptoms such as fever and aches in muscles and joints.  The lesions (vesicles) are very superficial on the skin and grow like a mini-Vesuvius, burst and then crust over.  That cycle of events takes around four days, but new crops of vesicles come up in waves in the first three or four days, so you can have some vesicles growing bigger while earlier ones are drying up and crusting over.

The vesicles generally come out on the trunk and face first, but can spread to all over the body and even inside the mouth and on the tongue.  Now while scarring is always a worry for the Mums of this world, there are far worse effects from this little virus.  There is a distinct possibility of an encephalitis in older children and adults can actually develop a varicella pneumonia.  Pregnant women who get chickenpox also run the risk of infecting the unborn child, and this can run as high as 10 percent.  Very often, especially if the child scratches the lesions, there can be an added infection by an opportunistic bacterium on top of the viral lesions, so you get a double problem.

So what do you do when chickenpox is doing the rounds?  The first thing is to keep away from those who have the disease.  It is highly contagious and is spread by inhalation of micro droplets in the air, or by direct contact with weeping vesicles.  In a family, this means that little Johnny gets his own towel that no-one else must use and a bed-time kiss is strictly forbidden.

Calomine lotion does help with itchy and weeping vesicles and trim the fingernails in young children to lessen the chances of scratching.  With very little ones, I even suggest putting their hands in socks, just as you do with little babies.

If the temperature is raised (more than 37.5 Celsius) then a little paracetamol will help (but not aspirin as this drug should not be used with children), and if there is the “super-infection” by a bacterium it will be necessary for your doctor to prescribe an appropriate antibiotic.

The other important duty that you have as a parent, is do not send little Johnny back to school until the very last vesicle has dried up.  This is generally around a week to ten days, but is so important in trying to stop the epidemic.

The other nasty part of this virus is that it lies dormant in your system and can strike back many years later as Shingles, or as we medico’s call it, Herpes Zoster.  No, chickenpox is not fun, and to those of you who are struggling with it right now, you have my sympathies.

However, we do have a varicella vaccine these days, and vaccination is recommended from about 12 months of age.  Like all vaccination programs, this will radically reduce the impact of epidemics.

The Japanese Connection

How much of your living is dedicated to try and avoid dying?  Every second magazine (especially women’s mags) has some advert for something that will extend the readers’ lives, be that taking megavitamins or doing colonic washouts.

I have dealt with the megavitamin myth before, so I won’t cover that again today, but colonic washouts have been spared my pen dipped in hemlock - until now.  Just how, pray tell me, does sticking 300 mm of garden hose up your fundamental orifice assist you to become more healthy?  Let me assure you that the colon was designed to cope with human poo.  It was not designed to cope with garden hose loaded with mystical ingredients that will make you live longer.  Put the garden hose away.  It will not work.  However, I should point out that a medical colleague does believe and attributes his recovery from cancer on his coffee enemas.

However, we still all want to be immortal, so if your ambition is to live to be 100, the Okinawa Express is now leaving from platform number three.  According to an article I have read, the Japanese Health Ministry claims that Okinawans have an average life expectancy of 81.2 years - 86 for women and 75 for men (note for the marriageable - choose an Okinawan woman 11 years older than you are and go for a double cremation).

The other amazing fact was that Okinawan centenarians come in at about 34 per 100,000 of the population, almost three and a half times more than the figures from America.

So what are the Okinawans doing right?  Is it the center of colonic washouts?  Or what is it that we are doing wrong?  When you look at this conundrum, it is interesting to note that if you take the Okinawans out of Japan and relocate them in another culture, they end up with the same statistics as the culture in which they are now living.  The same has been shown in comparative statistical examinations of all races, for all diseases.  East Africans do not get tooth decay, but when working for British Rail (“Mind the gap!”) and living in the UK, end up with a set of typical British rotting teeth - or a fine set of NHS dentures (mind the gap, again)!

So the true story is probably not lucky genes, but revolves around diet and lifestyle.  Okinawans are doing better because their lifestyle suits them better, and their diet isn’t poisoning them or blocking their arteries.

The lifestyle on Okinawa is apparently very slow and the stress experienced by the local populace is not high.  Now if this were the be all and end all, my car washer will live to be 134 years old, but Thais, despite a nice slow pace don’t do all that well in the longevity stakes either.  So there’s more.

The researchers cite diet, and the Okinawans are apparently strong on fruits, vegetables, fish and ‘moderation’.  (Once again, the middle way looks like being the best, as a simple Buddhist observation.)  Looking at one of their recipes, it ends up being a tofu mish-mash with 59 calories per serving.  It is certainly not the high cholesterol stew that we as farangs tend to eat.

The other factors associated with longevity - or the lack of it - cigarettes and booze, were not mentioned in the article - because I think it would be there that you would find another clue.  Despite Uncle Ernie who lived to be 103 and smoked 60 cigarettes a day and drank a bottle of bourbon before lunch and died when shot by a jealous husband, we do know that smoking doesn’t help you live longer (when I typed that last phrase, I had inadvertently put “love” longer - but that’s true too).  Like wise, we know that with alcohol, the middle way is also best.

So, rather than take the train to Okinawa, look at your diet, look at your stresses in life, stop smoking, drink in moderation and you too may make a 100.  Of course, if you die of boredom aged 103, it wasn’t really worth it, was it!  Has anyone seen my garden hose?

Prostate Cancer - demystified

Most males as they get older have a subconscious fear - Prostate cancer!

Prostate problems are 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, 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?  Are our underpants too tight?  One reason for the ‘apparent’ increase is the fact that prostate cancer is a disease of aging, and we are all living longer.  The statistics 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 you die of something else before the prostate gets you!  You die with it, rather than from it.

The real situation is that 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.

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 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, and the rate of increase is very significant.

Like many other cancers, prostate cancer can only be fully diagnosed and ‘staged’ by microscopic analysis.  ‘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.

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.  For these people, “Watch and Wait” has much going for it, but you must be prepared to get to know your urologist.