by Dr. Iain Corness
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
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
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
So the latest is brain tumors in the long list of “side effects” of the
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
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.
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
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
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.
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
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
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
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
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.
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
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
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
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
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
EPS can save your life.