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Doctor's Consultation  by Dr. Iain Corness


Update February 21, 2015

Is your mobile phone killing you?

Like most doctors, I subscribe to clinical education websites. These are a great way to stay in touch and see the directions that medicine is taking. However, like almost all articles in the public domain, there is a difference between proven facts and personal opinions.

The latest subject was (once again) mobile phones. The item began with, “During the last decade, there has been a dramatic global increase in wireless communication use, resulting in greater exposure to radiofrequency electromagnetic fields (RF-EMF). Health risk concerns center on the brain, which is the main target of RF-EMF during use of mobile or cordless phones.”

Now some “evidence” suggests the possibility of increased brain tumor risk associated with use of wireless phones, but findings to date have been mixed and inconclusive. The International Agency on Research on Cancer (IARC) at the World Health Organization concluded that RF-EMF exposure is “possibly” a human carcinogen.

Reached for a comment on the latest “study data”, L. Dade Lunsford, MD, Lars Leksell Professor of Neurosurgery, and director, Center for Image Guided Neurosurgery, University of Pittsburgh, Pennsylvania, said that the new study provides additional “but as yet unconvincing” evidence of a potential role of cell or cordless phone technologies in the production of gliomas (brain tumors).

So the latest is brain tumors in the long list of “side effects” of the mobile phones.

Other effects were supposed to be male infertility where it was claimed: “Hours of chatting on a mobile phone are suspected to be slashing male fertility around the world, new research shows.” It went on to say that “Men who use mobile phones for more than four hours a day produce fewer and poorer quality sperm.”

This is just another assault on mobile phones which have in the past been blamed for pilots losing their way taxiing to the terminal (after all, you are expressly warned not to turn them on until the plane has stopped), and now an attack on one’s manhood. I mean this is so serious, we should never keep mobile phones on our laps, or heaven help us, slipped between your legs as you drive the car. Next time you are standing at the urinal, don’t shake it, Willy the wonder wand might fall off, if we are to believe all this “research”.

However, I too have done my research and can prove that I have identified the world’s greatest killer. In fact, my research shows that in Thailand last year, this factor was significant for 92 percent of the people who died. Yes, a staggering 92 percent of people who died last year wore shoes. What further proof is required? The statistics prove it! How do you argue against 92 percent? Shoes are the nation’s biggest killer!

Of course, this is fallacious use of the numbers. Always remember that there are lies, damned lies and statistics. Just because something happens does not mean that the cause is what you suggest it is. You are maybe measuring factors that have no relationship to the outcome. And I believe that this latest barrage against mobile phones comes in that basket.

What is not said in all these shock, horror headlines, is that these research chappies in the hallowed halls of academia need finance to keep going, and they are all in competition with each other to grab a slice of the research dollar. The more shock, horror headers they can get, the more likely they are to get further funding. It is the money train again.

Now there are groups doing genuine research into the malaises of mankind, and the influence of cholesterol on cardiac deaths is a classic example. The Framingham study kicked it all off, and it has been progressively studied since then. High cholesterol is an adverse factor as far as your cardiac condition is concerned. Believe it. And is unaltered by mobile phone use. Believe that one too.

In the health business, the only 100 percent surety is that you are going to die. Nobody has lived forever! But I am also convinced that mobile phones will not herald the end of mankind!

Beware of ‘scientific breakthroughs’ reported in the popular press. It may just be fishing for funding.

Update February 12, 2015

Will you need an MRI?

Unfortunately some people think that an MRI is a curative treatment. It isn’t. MRI is one of the battery of diagnostic examinations. The procedure is similar to an X-Ray, as the end result shows the internal structures of the body - but without the use of X-rays. MRI uses a large magnet, radio waves, and a computer to produce these images.

Some folk are a little apprehensive about these newer tests, but the risks to the average person are negligible. The MRI uses magnetic fields, rather than radio-active imaging. However, the magnetic field is very strong. Walk into the examination room and the MRI can wipe the details from the magnetic strip encoding on your credit card, stop your watch and even pull the stethoscope from the doctor’s pocket!

People who have had heart surgery and people with the following medical devices can be safely examined with MRI: surgical clips or sutures, artificial joints, staples, cardiac valve replacements (except the Starr-Edwards metallic ball/cage), disconnected medication pumps, vena cava filters or brain shunt tubes for hydrocephalus.

However, there are some conditions may make an MRI examination inadvisable. Tell your doctor if you have any of the following conditions: heart pacemaker, cerebral aneurysm clip (metal clip on a blood vessel in the brain), pregnancy during the first three months (we are just being super cautious here), implanted insulin pump (for treatment of diabetes), narcotics pump (for pain medication), or implanted nerve stimulators (“TENS”) for back pain, metal in the eye or eye socket, cochlear (ear) implant for hearing impairment, or implanted spine stabilization rods.

MRI is also different from X-Rays in what it can pick up. The MRI can detect tumors, infection, and other types of tissue disease or damage. It can also help diagnose conditions that affect blood flow. Tissues and organs that contain water provide the most detailed MRI pictures, while bones and other hard materials in the body do not show up well on MRI pictures, as opposed to X-Rays which do show bone well but not soft tissue. For these reasons, MRI is most useful for detecting conditions that increase the amount of fluid in a tissue, such as an infection, tumors, and internal bleeding. In some cases a contrast material may be used during the MRI scan to enhance the images of certain structures. The contrast material may help evaluate blood flow, detect some types of tumors, and locate areas of inflammation. The MRI machine is also very expensive!

I think most people are familiar with the standard X-Ray procedure, stand there, breathe in, hold it, now breathe out routine, but MRIs are a little different. These are done with you lying there and inserted into the MRI scanner, which is like a tunnel. Those people who are claustrophobic can have a little problem here, as the MRI “tunnel” is very tight. When I had my own MRI done I noticed that my nose was close to the top of the tunnel and both elbows were brushing the sides, and I am considered a reasonably slim individual. I have to say that although not claustrophobic, I do not particularly like being in enclosed spaces, and found that the best way to endure the MRI was to pretend I was lying relaxing in a field.

During the procedure, which can take up to an hour, you can hear the operator talking to you, and he or she can hear your reply, but you still will feel rather isolated in your magnetic tunnel. You can also hear (and feel) muffled thumps and groans that come from the tube, which can be somewhat unsettling.

In some cases a contrast material may be used during the MRI scan to enhance the images of certain structures which may help evaluate blood flow, detect some types of tumors, and locate areas of inflammation. The contrast material is injected via a vein, and the MRI operator will advise you when this is being injected. You may feel a warmth or even tingling feeling as this is happening, but this is not worrisome.

The radiologist then reviews the pictures produced and will advise you of the outcome. I hope it will be good news! And yes, we have an MRI scanner.

Update February 5, 2015

Bowled over by BPPV

BPPV (Benign Paroxysmal Positional Vertigo) is much more common than you would imagine. In fact 20 percent of those people who report to their GP with giddiness have BPPV as the cause.

How does it affect you? Ever turned over in bed and the room began to spin? It might have been Benign Paroxysmal Positional Vertigo (BPPV). If you have it, after you move in a particular way, you feel that the room spins around you and you cannot stop it. It is like being so drunk that when you lie down on the bed the spinning rotation is so bad you grip the edges of the bed to stop falling off. That is what BPPV is like - but without the hangover the next morning!

BPPV was first described by Barany in 1921, but in 1952, Dix and Hallpike performed the provocative positional testing named in their honor. They went on to localize the pathology to the ear during provocation testing.

Activities that bring on symptoms will vary, but are almost always produced by a rapid change of position of the head. Getting out of bed or turning over in bed are common ‘problem’ motions. Because people with BPPV often feel dizzy and unsteady when they tip their heads back to look up, BPPV is sometimes called ‘top shelf vertigo.’ It also tends to be recurrent.

To understand BPPV, you have to understand the workings of your inner ear. You have three semi-circular canals aligned in different directions, which act like spirit levels (the builders type, not the three fingers on the glass barman type) which have cells with fine hairs bathed with fluid as your head moves in different directions. The movement of the fine hairs sends electrical impulses to the brain to tell it (and you) which way is “up”.

However, with BPPV, the natural movement inside the semi-circular canals is disrupted, so the fine hairs send the wrong signals to the brain, and being unable to work out which way is really “up” the sufferer is bowled over, totally unable to save themselves from hitting the floor. Debilitating and embarrassing! Ask anyone who has had BPPV.

The commonest cause of interruption to the normal ebb and flow in the semi-circular canals is produced by something we have called “ear rocks”. These are made up of crystals of calcium carbonate, and we medicos call these “otoconia”. Every time you move your head, your “ear rocks” swish around.

However, it is not all that simple (it never is, is it?) as the commonest cause of BPPV in people under 50 is head injury. In older people, the most common cause is degeneration in the semi-circular canals of the inner ear. BPPV becomes much more common with advancing age, but in 50 percent of all cases, BPPV is called ‘idiopathic’, which is a fancy word we use when we don’t know!

Viruses can be accused too, such as those causing vestibular neuritis, minor strokes such as those involving anterior inferior cerebellar artery (AICA) syndrome, and Meniere’s disease are significant but unusual causes. Occasionally BPPV follows surgery, where the cause is felt to be from a prolonged period of lying on the back with the chin raised (for the anaesthetic tubes to slip down your throat), or ear trauma when the surgery is to the inner ear. The simple situation is that we can make the diagnosis, but it can be harder for us to exactly pinpoint the cause.

To make it even harder, an intermittent pattern is common. Your BPPV may be present for a few weeks, then stop, but then come back again.
Is there any treatment? Yes there is, if ear rocks are the cause.

Treatment usually consists of a series of maneuvers you are put through which are designed to move the ‘ear rocks’ around till they no longer cause problems. These result in around a 90 percent cure rate. The most common is called the Epley maneuver or the particle repositioning or canalith repositioning procedure, but we have our Hearing Speech Balance Tinnitus specialists who can investigate and show you how to do this.

Update February 1, 2015

Living longer with EPS?

Back in the good old days when oils came out of the ground, and not manufactured in a research lab, there was a type of lubricant called “EP”. That acronym stood for “extra pressure” but has nothing to do with the medical EPS acronym, which stands for ElectroPhysiolgic Study. Of course, one of the great problems with acronyms, is that the letters can stand for all sorts of other things, such as in this case “Earnings Per Share” (currently a doubtful entity with Wall Street still tottering) or even more esoteric, “Elizabeth’s Percentage System, a mathematical formula developed by Elizabeth Zimmermann to determine how many stitches to cast on for a sweater” - but who knits sweaters these days?

Medical EPS is a relatively new diagnostic procedure in which we can see just how well the electrical side of your heart is working. Just the same way as your engine needs a correctly timed electrical spark to each cylinder, your heart chambers need a correctly timed electrical impulse to make them contract at the right time (the rhythm or heart beat).

When the electrics start malfunctioning, the heart will also malfunction. Disturbances of normal heart rhythm may only cause annoying symptoms (palpitations, lightheadedness, dizziness) that pose no serious threat to life. Other rhythm disturbances, however, can be associated with dangerous risks (loss of consciousness, seizures, stroke or cardiac arrest). These varying symptoms can occur when the heartbeat is seriously slowed, dangerously rapid, or just highly irregular. Heart rhythm disorders can be part of almost any type of heart disease, and can be provoked by various medications or electrolyte abnormalities, but can also occur in the absence of readily identifiable underlying heart problems. These disorders are called ‘arrhythmias’.

Some arrhythmias can occur without symptoms and may only be picked up during an ECG (electrocardiogram), but the simple ECG will not pinpoint the electrical breakdown, only indicate that there is a malfunction somewhere.

An ElectroPhysiologic Study (EPS) is one of a number of tests of the electrical conduction system of the heart performed by a cardiac electrophysiologist, a specialist in the electrical conduction system of the heart.

The EPS should pinpoint the location of a known arrhythmia and determine the best therapy, determine the severity of the arrhythmia and whether you are at risk for future life threatening heart events, especially sudden cardiac death, and can also check the efficacy of medications being used to regulate heart rhythm, and evaluate the need for a permanent pacemaker or an implantable cardioverter-defibrillator (ICD).

The way the EPS is done is where modern medical technology is used. Just as when an electrician tests the conductivity of a wire with a testing light, to test the heart’s electrical system, several thin, flexible, electrical catheters (fancy wires each about the thickness of a strand of spaghetti) must be inserted into various parts of the heart, to test the electrical pulses.

To provide maximal sterility of the catheters being inserted, the introduction sites are thoroughly cleansed. Most catheters are inserted via needle punctures through the anesthetized skin, making cutting and stitching unnecessary. Once the catheters are carefully positioned inside the heart, the electrophysiologist uses computer equipment, making recordings of the heart’s intrinsic electrical properties. Occasionally, electrical stimuli are administered to the heart by the conductive catheters, to check its response.

The catheters enter the heart via the right atrium, which is the low pressure side of the heart. The advantage of this is that the right atrium is where the electrical generator (the SA node) is located. The right atrium is also the location of most of the common re-entrant pathways associated with atrial flutter. If a catheter is placed with the distal tip in the right ventricle, it may be possible to measure conduction through the central electrical tissue bundle, which is useful to determine the level of heart block (where the atria and the ventricles beat independently. If the catheter is placed in the coronary sinus, it is also possible to measure electrical activity in both the left atrium and the left ventricle without entering the high pressure arterial system associated with the left side of the heart.
EPS can save your life.

HEADLINES [click on headline to view story]

Is your mobile phone killing you?

Will you need an MRI?

Bowled over by BPPV

Living longer with EPS?