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Doctor's Consultation  by Dr. Iain Corness

 

Update November 28, 2015

I can see clearly now …

One of the medical journals I subscribe to has “Risk Factors” in wearing contact lenses as the leading article this month. They had carried out a large sample of contact lens wearers in the US, asking them about particular risky behaviors and their prevalence was noted as follows:
Sleeping overnight in contact lenses: 50.2 percent
Napping in contact lenses: 87.1 percent
Mixing new solution with old solution in a contact lens case (as opposed to replacing old solution entirely): 55.1 percent
Extending the recommended replacement frequency of lenses: 82.3 percent
Showering in contact lenses: 84.9 percent
Swimming in contact lenses: 61.0 percent
I don’t know about you, but I’m guilty to the lot of them.
You do take your lenses out each night, don’t you? Even with all the advances in lenses, the ophthalmologists still recommend you give the eyes a rest each night. After all, contact lenses are still ‘foreign bodies’.
As you can see (pun intended), it isn’t just a case of bunging some in and forgetting about it. Quite the reverse. With all our organs that can go wrong, did you know that eye problems are some of the commonest reasons for a doctor visit? And for those of you who wear contact lenses (like me) there are even more eye problems for us to get, despite the common use of contact lenses these days.
There are many types of contact lenses, the old hard ones were made of a material called polymethylmethacrylate (PMMA) which is rigid and does not let oxygen through, but the newer ones have a material called siloxane which is gas permeable. These hard lenses are the most trouble free, although the most difficult to look after. Sounds topsy-turvy, I know.
The second type of lens is the soft contact lens, of which there is a “permanent” style and a disposable type. These are made of hydroxymethylmethacrylate (HEMA) which contains between 30-60 percent water and are gas permeable. However, soft disposable lenses give the most problems, but are the easiest to look after, in direct contrast with the hard lenses. Again sounds weird, I know.
The commonest problems with all contact lenses is infection, and since the lens is a foreign body, there is a good reason to get an infection immediately. For those of you who leave your lenses in the eyes overnight, you have an increased risk of infection by a factor of 10. Take them out every night, you have been warned!
Infection is not to be thought of as something that just happens and when it does you just pop in a few eye drops and get better automatically. Bacterial infection can be sight threatening and the cornea (the clear bit in the centre that you look through) can be destroyed in 24 to 48 hours. There is also a parasite that can get into the eye of contact lens users who have rinsed their lens with contaminated water, or who have worn their lenses swimming in contaminated water.
One very common problem is “losing” the lens in the eye, both the hard and soft types. The most important thing to remember is not to panic. The lens cannot go “behind” the eye. It just rolls itself up under the lid. Try to avoid rubbing and it will reappear in an hour or so. Just like the stray dogs in your soi.
The other very common problem is eye irritation. This is caused by material under the lens or damage to the lens itself, such as splitting or tearing. If you take out the lens and you find it breaking up, do not put it back in – you run the risk of damaging the cornea. Do not be like me and wear your “two week” contacts until they fall apart –you are running a risk!
Lens care is the most important feature and you should always wash your hands before removal or insertion. The lens container should be scrupulously clean and the storage/cleaning fluid should be fresh, and never use water.
Look after your lenses, take them out at night, change them frequently and remove them immediately when there is any irritation or redness. “See” you next week!


Update November 22, 2015

Phuket launches offensive?

The Australian government is so concerned about their death toll from the annual influenza epidemic that they have once again included a Phuket strain in the 2016 vaccine. This is in addition to the home grown Brisbane strain.
The Brisbane and Phuket strains of the virus contributed to the 25,000 spike in reported cases, explained the Australian Health Minister Sussan Ley. To combat the increase from 65,000 cases to 90,000 cases, Australians will have access to the upgraded vaccine through the National Immunization Program.
In Thailand, from Jan 1 to Feb 23 this year, the Department of Disease Control (DDC) reported 10,032 confirmed cases of the flu, with eight deaths. According to Thailand statistics, a total of 30,024 people throughout the country contracted Type A H1N1 influenza virus last year and 50 of them died. Influenza is an important disease, especially as many Thai people do not have much immunity to the seasonal influenza.
All these statistics were backed up by the World Health Organization (WHO) which reported that in tropical Asia, countries in Southern and South East Asia reported low influenza activity overall - except India, Lao People’s Democratic Republic and Thailand where activity mainly due to A(H1N1)pdm09 virus in India and A(H3N2) virus in Lao PDR and Thailand continued to be reported.
In South Asia and Southeast Asia, a decrease in influenza activity was observed during August and September, and influenza A (H3N2) predominated in Cambodia, India, China, and Vietnam, with smaller numbers of influenza B viruses reported. In Thailand, influenza B viruses were more frequently reported in July and August, but influenza A (H3N2) and pH1N1 viruses also were identified during May 1–June 27, last year.
All these figures show that the influenza virus is present all year round, and the 2016 quadrivalent vaccine is planned to cover two A strains of influenza (California and Hong Kong) and two B strains of influenza (Brisbane and Phuket).
So, what can you do about avoiding a full-blown influenza infection this year? In one word – vaccinate! My hospital has published some of the important facts about Flu vaccination. While how well the flu vaccine works can vary, there are still many good reasons to get a flu vaccine each year.
Quite simply, flu vaccination can keep you from getting sick from flu. Protecting yourself from flu can help protect people who are at greater risk of getting seriously ill from flu, like older adults, people with chronic health conditions and young children.
Flu vaccination may also make your illness milder if you do fall ill. A recent study showed that flu vaccine reduced young children’s risk of flu-related pediatric intensive care unit (PICU) admission by 74 percent during flu seasons from 2010-2012. One study showed that flu vaccination was associated with a 71 percent reduction in flu-related hospitalizations among adults of all ages and a 77 percent reduction among adults 50 years of age and older during the 2011-2012 flu season.
There are special vaccination instructions for children aged 6 months through to eight years of age as some children require two doses of influenza vaccine. Children in this age group who are getting vaccinated for the first time, as well as some who have been vaccinated previously, will need two doses. Your health care provider can tell you whether two doses are recommended for you.
Vaccination is so important that he Government Pharmaceutical Organization (GPO) will construct the country’s first facility to make influenza vaccine in Saraburi’s Kaeng Khoi district, with production set to start in early 2018.
Following the Cabinet’s approval of the GPO project on Tuesday, Public Health Minister Rachata Rachatanavin said the facility would meet the World Health Organization’s manufacturing standards.
After undergoing lab tests and getting an okay from the Food and Drug Administration, the vaccines would be made available to public, he added. Initially, the facility is expected to produce 2 million doses per year, but that could rise to 10 million doses annually, or 60 million dosages in case of a pandemic.
In some quarters there is resistance to influenza immunization, but to be honest, I cannot understand why. Sure, there are risks involved with immunization, but those risks are very, very small compared to the risks in getting the flu.


Update November 14, 2015

Time for an annual check-up?

It may be of interest to know that my hospital gives me a check-up package. Is it just a PR exercise? Or is it an exercise that will benefit both the employee (me) and the hospital itself? (I hope you all chose the latter one!)
My annual medical check-up is an important part of my planning for the future, a future with a good Quality of Life. Check-ups are inherently involved in the Quality of Life. Longevity alone, with no quality, just isn’t worth it in my book.
Many people work on the principle that they would rather not know about any underlying or sinister medical conditions they may have. After all, we are all going to die one day, aren’t we? I have always said that despite all advances in medical science, the death rate will always be the same – one per person! But wouldn’t you rather have pleasant final years than one of poor health, infirmity and aches and pains?
The guiding principle behind check-ups is to find deviations from normal health patterns at an early stage. Early enough that the trend can be reversed, before damage has occurred. Examples of this include Blood Pressure (BP), as high BP can affect many organs in the body, not just the heart. But an elevated BP generally gives no warning symptoms.
Another example is blood sugar. Again, it requires sky-high sugar levels before the person begins to feel that something might be wrong. And by then the sugar levels have affected vision, the vascular system and many other systems, all of which can decrease your future Quality of Life. Amputation of a limb is a common result of unchecked blood sugar levels.
Cardiac conditions and abnormalities, be that in anatomy or function, can also very adversely affect your Quality of Life, but are very easily found during a routine check-up. Various blood tests and an EKG can show just how well the cardiac pump is functioning, and how well it will continue to function in the future. The inability to walk more than 50 meters certainly takes the fun out of shopping, yet this can be predicted – if you have some serial records!
Another of the silent killers can be discovered in your lipid profile, with Cholesterol and its fractions HDL and LDL, being intimately connected with your cardiac status.
Let me give you an example. A younger man who was obviously overweight, but played golf three times a week and had no apparent problems. He enjoyed his golf, and the beers at the 19th hole. Just like his overweight golfing mates.
This chap’s blood tests were not so good, and his diabetic tendency was now more than just a tendency. Despite the fact that he was not having chest pains, he decided to have the 128-Slice CT of the coronary arteries carried out. This showed three blockages. Three corrective stents later he could return to the golf course, but with urgent recommendations to get his weight down and get his blood sugar and cholesterol under control.
There are actually so many conditions that can affect your enjoyment of the future that can be discovered early. Renal (kidney) function and liver function can be monitored through an annual check-up, as can prostate size (indicated by the PSA blood test) or breast tumors (by mammogram).
Hopefully you are now thinking about an annual check-up. If so, I have some very good news for those of you living in, or planning to visit Pattaya. The Bangkok Hospital Pattaya has repeated their previous annual promotional packages with big discounts on check-up packages (up to 60 percent for some individual items, though the check-up packages themselves are generally at 50 percent off).
Even better news is that the discount program continues through to 29 February, 2016, however you must pay by 31 December 2015, to be able to get this huge discount.
I do urge you to take advantage of this, for your enjoyment of the future, if nothing else. This is a genuine offer, and does give everyone the opportunity of ‘preventive medicine’. Catch anything early and you have given yourself the chance to correct it – and get a better Quality of Life in the forthcoming years.


Update November 7, 2015

Now it’s going bananas

There are so many “breakthroughs” every week, I am flat out reading the scientific journals. In fact there are so many researches going on that they are producing even more journals!
The latest “amazing” development is the claim that a drug made from a protein in bananas can kill a wide range of viruses – including hepatitis C, flu and AIDS.
The new wonder compound is called BanLec and it supposedly works by clinging to sugar molecules found on the surface of some of the world’s deadliest viruses.
Once the drug has locked on to the virus, it is rendered harmless – and can easily be disposed of by the body’s immune system.
The new form of BanLec, called H84T, stopped animals from getting flu. It also worked in the lab on tissue and blood samples against AIDS, hepatitis C and influenza.
The researchers believe the drug may even work on Ebola, as all of these viruses are covered in similar sugar molecules that BanLec clings to.
However, they warn that eating regular bananas will not have the same beneficial effect, as the ingredient is a modified version of the chemical found in the fruit.
The chemicals (called Lectins) have the potential to be a virus beater as they are able to bind to the sugars that are present on the surface of a range of viruses including HIV, influenza and Ebola, many of which have caused or have the potential to cause severe epidemics or even pandemics.
The key question now, the researcher stressed, was whether the drug will work in humans. Dr David Markovitz, professor of internal medicine at the University of Michigan said, “There are lots of hurdles that still need to be overcome before antiviral Lectins find their way into clinic,” he said. “For one thing, there’s a risk the immune system will recognize this as foreign and mount an immune response to it, potentially rendering it ineffective.”
Dr David Markovitz, co-author of the scientific paper, published in the journal Cell, said, ‘What we’ve done is exciting because there is potential for BanLec to develop into a broad spectrum anti-viral agent - something that is not clinically available to physicians and patients right now.”
“But even so, given recent events, generating antivirals that can work against a range of viruses is well worth pursuing.” However, several years of research still lie ahead before BanLec can be tested in humans.
Despite this, Dr Markovitz and his co-author, Dr Hashim Al-Hashimi, professor of biochemistry at Duke University, hope the team’s work can help address the lack of antiviral drugs that work well against many viruses - or against viruses that change rapidly, such as influenza.
“Tamiflu is only modestly effective, especially in critically ill patients, and influenza can develop resistance to it. But we also hope that BanLec could become useful in situations such as emergency pandemic response, and military settings, where the precise cause of an infection is unknown but a viral cause is suspected.’
“Better flu treatments are desperately needed,” said Dr Markovitz.
British researchers such as Professor Wendy Barclay, chair in influenza virology at Imperial College, London, called it ‘a new strategy for combating a wide range of viruses’ and ‘beautiful science’.
Dr Ben Neuman, a virologist at the University of Reading, said, “In this new study, the researchers changed the banana lectin just enough to stop the side effects, while keeping its virus-blocking properties intact.”
And Jonathan Ball, professor of molecular virology at the University of Nottingham, added, “Each new virus outbreak is a timely reminder of our need for antivirals that can work against a range of viruses.”
But, whilst viral infections are important, remember that according to the WHO, cancer killed around eight million people worldwide, and was the leading cause of death globally. Lung cancer was the most lethal type, and accounted for 18 percent of all cancer deaths. And finally, don’t smoke – the incidence of all cancers is greater in smokers.
Unfortunately, even though we understand more of the nature of cancer, there is no universal “cure” as yet. However, catching cancers at an early stage gives you a much better prognosis (outcome). And you can only do that if you look. Check-ups are of value.


HEADLINES [click on headline to view story]

I can see clearly now …

Phuket launches offensive?

Time for an annual check-up?

Now it’s going bananas