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Update January 2016


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Update by Natrakorn Paewsoongnern
 
 
 

Doctor's Consultation  by Dr. Iain Corness

 

Update January 30, 2016

Back Pains – Again

One of the most common ailments to result in a GP consultation is low back pain. The cause of this is locked in the history of the development of mankind. You see, when we walked on all fours, we didn’t get low back pains at all, because our spines were designed to be horizontal and weight was carried on the back, just like a horse does today. The design of the vertebrae is such that the spine ‘locks’ to be able to bear weight.
Now, here’s where it all went wrong. We decided we looked much better standing upright and we could walk much quicker using our hind legs only. This meant that our spine was now vertical and we could bend it backwards and forwards. Backwards and the bones all locked together again, but forwards and the vertebrae unlock making the spine unstable.
The next factor was we began to try and lift weights in this new upright position. We bent forwards (unstable) and lifted items like that. The era of low back pains had arrived.
I was reminded about back problems when I experienced an acute lower back pain myself last weekend. The symptoms were classical and the ones we meet so frequently. I had been bending over, wrapping tape around the garden hose, and suddenly I was frozen in position.
As an aside, 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 very much like 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 and produce pain that way. The disc actually stays exactly where it is, but the center of the disc (called the nucleus) pops out forwards 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 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.
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, as well as standing erect. 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. Might even be a good idea to miss the next couple of golf games. 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 January 23, 2016

G stands for Gluttony

I was watching my 10 year old son the other evening. We had gone to a restaurant with some friends from America who gave him their extra French fries from their plates. It was almost as if he had entered a competition to see how many fries he could pick up with one hand, and then how many of those he could cram into his mouth at one time. A prime example of gluttony.
In his case, gluttony might kill as he could have choked to death. Not that he would have minded. Death by French fry is probably more acceptable to a 10 year old mind than death from gluttony at age 44.
Unfortunately, our diets are far from healthy these days, and that includes both food and drink, especially the kinds of drinks that come in dark green or brown bottles. I am sure you know the types.
The problem here is the fact that being overweight puts a strain on the cardiovascular system, which sends the blood pressure up. That in turn affects all the organs and systems, and everything goes pear-shaped from there on, as well as your body shape.
In these situations, the combined effects can be life threatening. We call it co-morbidity and is also called ‘Syndrome X’ and is also possessed by around 40 percent of adults over 40. Nice numbers you should remember. The combination of diabetes and obesity, for example, can be a disaster waiting. The combination of diabetes, smoking, obesity, hypertension and high triglycerides (blood fats) is cardiac dynamite. Your conclusive heart attack is a matter of ‘when’ not ‘if’. The risk factors stemming from all those conditions become not a case of simple addition, but should be multiplied together.
The problem from your point of view is that most of these factors come on very slowly, and become part of your daily living. You’ve smoked for years and never had a smoker’s cough, so why stop now? Every time you get some trousers made the waistband has to be that little larger. Your belt has been let out two more holes over the past two years. Your doctor said you had a “Little bit of blood pressure” three years ago, but you haven’t been back to check, as you feel quite OK in yourself. Your ‘triglycerides’? “My what?” Your blood sugar? “It was OK last time it was checked five years ago!”
The big problem is that the “Little bit of blood pressure”, even say 150/100, can produce a very dangerous situation when the person with that BP has elevated blood sugar as well. Or smokes. It is the multiplication effect again. Whereas you can (almost) ignore mild elevations like 150/100 if you have absolutely nothing else wrong, ignoring it when there are other conditions co-existing brings up that co-morbidity problem again. And the likelihood of a cardiac calamity at age 44.
Likewise, a “little bit of extra weight” that we all excuse ourselves for carrying, may (just ‘may’) be fine for someone with no other medical conditions, but represents an enormous risk factor for someone with the Syndrome X.
For those who like figures with their information, here are some chilling ones. Between 87-100 percent of people with fatal coronary heart disease, or a non-fatal heart attack, had at least one of the following risk factors – smoking, diabetes, increased blood fats and high blood pressure. Syndrome X is characterized by having diabetes, increased blood pressure, and raised blood fats. Can you now see the importance of doing something about weight, blood fats and blood pressure? I for one would not like to be sitting with a condition that gives me between 87-100 percent chance of a cardiac problem.
So what is this week’s message? Quite simply, if you have diabetes, do something about the other risk factors. If you are overweight, do something about it. Stop smoking and get your BP and blood fats checked. If you don’t even know what your blood sugar level is, then get a check-up and find about all of it! Gluttony can kill.
In the meantime, take 100 mg of aspirin each morning. It is known to be cardio-protective. I do!


Update January 16, 2016

Nasal hairs linked to long life

Research by a group of Ear, Nose and Throat specialists is hinting that cutting nasal hair can cause premature death. This result has come from intense statistical examination and it was found that 66 percent of all who cut their nasal hairs each month died within six months of their birthday. The number of people (3) in the study was not enough to state this was a cause with any confidence, but the researchers felt there was enough of a connection to make further research important.
I read that sort of nonsense every week with new “research” results coming through the internet. This is the basic problem with the internet in that it is not moderated or checked for accuracy. Anybody can get their pet hobby horse uploaded into the clouds, where it takes on biblical characteristics and is quoted as gospel. Say a black cat is really a white one with black genes enough times and it eventually becomes accepted. Folk lore turns into fact lore and away it goes from there. Eventually my 10 year old son will come home with the incontrovertible truth that black cats have been given a bum rap, and they actually have white DNA inside.
From that lack of any real research, you can build an entire industry. Nasal hair clippers that are designed to cut across the grain of the hair, stopping the chances of an early unexpected death. Nasal oils which will nourish the hair, making it stronger and able to trap pollution. Special infra-red filters which can take over when the hairs get tired and lose the ability to be straight. And you can buy it over the net for $19.99. All sound a bit familiar?
Then of course there are the naysayers, the people who claim that immunization causes Autism. I’m not going to waste space on this page to discuss this. Just take it that it does not cause autism, and by the same token, immunization has changed the face of disease in the past 50 years.
Take Influenza vaccination, for example. Flu vaccination 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 also may make your illness milder if you do fall ill.
Flu vaccination can reduce the risk of more serious flu outcomes, like hospitalizations and deaths.
A recent study showed that flu vaccine reduced children’s risk of flu-related pediatric intensive care unit (PICU) admission by 74 percent during flu seasons from 2010-2012. Seventy four percent reduction!
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.
Flu vaccination is an important preventive tool for people with chronic health conditions. Vaccination was associated with lower rates of some cardiac events among people with heart disease, especially among those who had had a cardiac event in the past year. Flu vaccination also has been shown to be associated with reduced hospitalizations among people with diabetes (79 percent) and chronic lung disease (52 percent).
Vaccination helps protect women during pregnancy and their babies for up to six months after they are born. One study showed that giving flu vaccine to pregnant women was 92 percent effective in preventing hospitalization of infants for flu.
Other studies have shown that vaccination can reduce the risk of flu-related hospitalizations in older adults. A study that looked at flu vaccine effectiveness over the course of three flu seasons estimated that flu vaccination lowered the risk of hospitalizations by 61 percent in people 50 years of age and older.
There are special vaccination instructions for children aged six 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 child’s health care provider can tell you whether two doses are recommended for your child.


Update January 9, 2016

Gout – is it just diet?

Gout is far more prevalent than you would imagine. This week I am looking at the diet for those with gout, and there are some famous sufferers out there, and in history. If you have gout, then you join with Henry VIII, Benjamin Franklin and Thomas Jefferson. It is indicated in around five percent of all cases of arthritis and is present in around three to five percent of the population, with males outnumbering women around nine to one. Afro-Americans and many Asian races also have higher incidence than Caucasians.
Gout is in its simplest fashion, a recurrent form of arthritis, and which generally affects just one joint – most commonly the joint in the big toe. This arthritis, or inflammation, occurs in association with high uric acid levels in the blood.
It is a condition that is still being researched, and there is still no complete agreement on the preventive treatment for this condition.
The higher the concentration of serum uric acid (SUA), the more likely you are to get an acute attack. The ‘normal’ range for SUA is taken as less than 0.42 mmol/L (called ‘milli moles’ per liter), but if your concentration is 0.54 mmol/L then you are five times more likely to get gout.
Basically what happens is, that with high concentrations of uric acid it crystallizes out into the joint, leaving very sharp, needle-like crystals crunching inside the articular surface of the joint. Very painful!
The typical gout sufferer is male in his 50’s, overweight, with high blood pressure, carnivorous and consumes large quantities of alcohol. Is that you? Could almost be anyone in a pub near you!
Gout affects almost four million men in the USA. It has long been thought that purine-rich foods and a high protein intake are risk factors, and sufferers are advised to avoid meats, seafood, purine-rich vegetables, and animal protein. But this advice was based more on the theory of how excess blood uric acid can occur, rather than actual clinical studies.
One of the newer studies began on over 50,000 men from health professions in 1986. Food-frequency questionnaires were sent out at baseline, and again in 1990 and 1994. Weight, medications, and medical conditions were recorded every two years.
The participants were assigned to groups according to the total intake of meat, their consumption of seafood, purine-rich vegetables, dairy products, low-fat dairy products, total protein, and animal protein.
During the study, there were 730 new cases of gout during the 12 years of follow-up. Most of them were aged 55 to 64.
When total meat consumption was analyzed, the risk of acquiring gout was 1.41 times greater in the high meat eaters; in other words, eating more meat was a risk factor for gout. Similarly, high seafood eaters were 1.51 times as likely to develop gout. (Grass should be fairly safe I believe!)
In contrast, gout was less common in those taking more dairy products. Men who drank two glasses a day of skim milk, or ate a serving of low-fat yogurt more than twice a week, halved their risk of developing gout.
In this study at least, purine-rich vegetables, and total protein had no influence on the chances of getting gout.
This large study confirmed that a diet high in meat and seafood increases the likelihood that a susceptible person will develop gout. It also showed that milk proteins increase the excretion or uric acid in the urine.
So, to avoid developing gout, try to limit your intake of meat (beef, pork, lamb, and offal) and seafood, while increasing your intake of low-fat dairy products (skim milk, yogurt).
This is all very important, as the long term outlook is not good for the unrepentant gout sufferer. Constant high levels can lead to uric acid ‘stones’ being deposited in the kidneys (producing renal problems) and even discharging lumps (called ‘tophi’) around joints, on the forearms and even on the outer ears. Really a most bleak and depressing future, and not one I’d like to have.
Note too, that it is low-fat milk that is being proposed, as high fat milk introduces the cholesterol problems again! It really is a fine line that we must all tread!


Update January 1, 2016

The Tale of Tanujin

The item you are about to read is one of my favorite medical case histories. Bruises on a child’s body are often considered proof that a baby has been battered. A visible bruise on the buttocks, the shape of a hand and five fingers is almost ‘undeniable’ proof.
There was a very celebrated instance of a GP in the UK having discovered that so many of the Asian babies in the practice were showing signs of being ‘battered’ that the children’s welfare people were called in and an enormous number of children taken away. However, the highly observant GP was wrong!
In Thailand, and the rest of Asia, a new-born baby with the ‘handprint’ bruise is very common, while child abuse is not common at all. The problem, or rather the condition, relates back to Genghis Khan and the Mongol hordes. It is a wonderful piece of folklore and a fine example of applied genetics.
Let’s look at the folklore first, and you are going to have to dig very deep to get this tale anywhere else! A Mongolian baby, called Tanujin, was born just over 1,000 years ago, but did not breathe. His father, in desperation, held his new-born son upside down and smacked him severely over the bottom, so much so that the baby drew breath and lived, but carried the life giving bruise for the rest of his days. That baby later became Genghis Khan, (which means King of the Earth), and by the time he died in 1227 he was the ruler of a large chunk of it, including the area which later became known as Thailand.
History has chronicled that the Mongol hordes raped, pillaged and annexed countries from China to Persia. His highly mobile troops traveled the difficult terrain of Siberia. Famous cities were captured and looted such as Tashkent, Baghdad (still a good place to stay away from, thanks George) and Bokhara. Cities that surrendered were spared but those that resisted were razed and the people slaughtered. The Mongols conquered northern India and Afghanistan. In 1222, they defeated the Russian and Bulgarian armies. At the time of Genghis Khan’s death, his empire stretched from China’s Yellow River to the Dnieper, in Russia.
And now back to some interesting folklore. The descendants of Genghis Khan also showed the hand-shaped bruise on the buttocks, beginning with his four sons Ogdai, Jagatai, Juji and Tule, who were given one quarter of the empire each after their father died. They in turn passed on this ‘trademark’ and so this continues till today. If your “Luk Krung” children have the sign of Genghis Khan, called Mongolian Blue Spot, you can claim descent from the warrior king. However, there is quite a number of you, so I think there won’t be much left in Genghis’ estate by today.
Now Mongolian Blue Spot, as a clinical condition, is well documented, and I came across figures suggesting that at least one Mongolian spot is present on over 90 percent of Native Americans and people of African descent, over 80 percent of Asians, over 70 percent of Hispanics, and just under 10 percent of fair-skinned infants (Clinical Pediatric Dermatology, 1993).
Medically we describe Mongolian Blue Spot as flat bluish to bluish gray skin markings that commonly appear at birth (or shortly thereafter) and scientifically they are called congenital dermal melanocytosis. They are flat, pigmented lesions with nebulous borders and irregular shape. They appear commonly at the base of the spine, on the buttocks and back, but also can appear as high as the shoulders and elsewhere. The medical text books also warn that occasionally Mongolian Blue Spots are mistaken for bruises and questions about child abuse arise. Obviously a text book that the UK GP did not read! Mongolian Blue Spots are birthmarks, not bruises.
So, for all of you with children with a peculiar blue birthmark on their bottoms, or for those interested in checking friends and neighbors (or the young ladies dancing in the chrome pole palaces), it seems fairly positive that the lineage is verified. You really have found descendants of the man who conquered more of the world than Alexander the Great. And guess what – my children have it too!


HEADLINES [click on headline to view story]

Back Pains – Again

G stands for Gluttony

Nasal hairs linked to long life

Gout – is it just diet?

The Tale of Tanujin
 

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