Make Chiangmai Mail | your Homepage | Bookmark

Chiangmai 's First English Language Newspaper

Pattaya Blatt | Pattaya Mail | Pattaya Mail TV


Doctor's Consultation  by Dr. Iain Corness


Update May 28, 2016

Diabetes – a disease you don’t want

Some very disquieting news out of Australia last week. About 300,000 of the one million people living in western Sydney are conservatively estimated to have diabetes or be at high risk, with more than half the population overweight.
Health advocates in Australia are predicting if the population continues to consume too many calories and convert to diabetes, they will have to build factories to cut off people’s toes, feet and limbs and help them when they go blind.
Diabetes costs Australia at least $14.6 billion annually, a figure expected to blow out to $30 billion by 2025.
To counteract this, proposals have been put forward about taxing sugary drinks, looking at what is in school canteens and about the distribution and availability of fresh foods and fast foods, and urban design generally.
Before we go much further, just exactly what is Diabetes? Quite simply, it is an inability of the body to handle glucose correctly. Insulin is produced by the body to keep the glucose system in balance and if the insulin production is lacking, this is called Type 1 Diabetes. With Mature Onset Diabetes (also called Type 2, or Non Insulin Dependent Diabetes Mellitus) the cells become less responsive to insulin, and there may be a reduction in insulin levels as well.
So who gets it? Are you more than 40 years of age? Are you overweight? Do you have a blood relative who has Diabetes? If you answered “yes” to any of those questions, then you may have Mature Onset Diabetes. If you answered “yes” to all three, then it is pounds to peanuts that you do have it. (If you come from Holland, you can make that guilders to gooseberries!)
Insulin is the key and necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells.
When glucose builds up in the blood instead of going into cells, it can cause many problems. First off, your cells may be starved for energy, so you begin to feel tired. Secondly, over time you may develop heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy).
So how do you know if you have developed (or are developing) Mature Onset Diabetes? The main symptoms to look for include a lack of energy, hunger (which comes from the fact that the cells are ‘starving’), excessive passing of urine combined with thirst and a dry mouth, insufficient sleep because of the need to pass urine at night (though this may be due to prostate enlargement in males) and blurred vision (again not to be confused with reading difficulties – short arms – which is called Presbyopia and occurs after 40 years of age), slow healing of minor cuts and sores.
Authorities say that preventing diabetes would require the same level of co-ordination and bipartisanship as tobacco control, which involved targeted awareness campaigns, taxation measures and regulated advertising.
Diet is considered to play a more important role in weight loss than exercise, though people who regularly exercise are more likely to maintain their weight loss as it improves their metabolism.
University of Sydney metabolic health Professor Stephen Colagiuri said the priority should be preventing people at high risk of diabetes from developing the disease, doing something at a population level to encourage healthier eating and more physical activity and making a more concerted effort to prevent pregnant women from developing gestational diabetes.
So if you think you might have it, or are a likely candidate, what next. A simple trip to your doctor and some inexpensive blood and urine tests will confirm or deny.
In the initial stages, dietary measures may be sufficient to control this condition, but oral medication and sometimes insulin injections become necessary as it progresses. But find out if you have it first!
It used to be that obesity in Thailand was very rare, but unfortunately no longer. Overweight Thais are catching up to the overweight Westerners.
Step on your bathroom scales and do something about it before you develop Diabetes!

Update May 21, 2016

Good news for chocoholics!

The world seems to hell bent in finding yet another health hazard, which if ignored, will cause everything from premature ejaculation through to premature death itself.
Registering high on the doom and disaster scale continues to be the omnipresent mobile phone. Do mobile phones give you brain cancer? Take it from me, they don’t, and while I am at it, the Illuminati are not poisoning the human race with Chemtrails.
When we first developed mobile phones, they were in a suitcase and weighed several kilos. The danger to health there was dropping the thing on your foot, bruising at best, fracture at worst. Yes, from the outset, mobiles have had the ability to affect your health. But brain tumors? No.
I read a lot of scientific papers every week. It seems that all over the world there are groups of scientists devoting their laboratory lives to study the effects of radiation from mobile phones. One group even went so far as to suggest that pregnant women should not place their mobile phones on their abdomens as the radiation can get as far as the developing brain in the fetus as the skull is so much thinner than adults.
Now one of the articles I read admitted that scientists worldwide agreed there is no evidence linking electromagnetic radiation emitted by mobile phones to adverse health effects, but claims still persist that frequent use can cause headaches, nausea, problems with concentration, cancer and brain tumors. And has anyone studied the effects of the ‘unlock’ button on your ignition key?
This form of thinking reminds me of an elderly relative who would put plasters over the electric power points as she was sure the electricity would leak out and discolor the wall paper.
However, as well as the good news that your iPhone isn’t carcinogenic comes a university study (so it must be true) where a new University of South Australia study has revealed that people who eat any type of chocolate at least once a week perform better on a range of multiple cognitive tasks compared with those who eat the sweet treat less often.
It is believed the reason why people observed better memory, concentration and problem-solving skills was because of flavonols - a type of antioxidant - found in cocoa and chocolate, and also found in wine, fruit and vegetables.
The study by researchers from the University of Maine, the Luxembourg Institute of Health and UniSA headed the Maine-Syracuse Longitudinal Study, a study which tracked 1000 people over 30 years and measured a whole range of health indicators.
As part of the research, the scientists determined whether eating chocolate regularly had any association with brain function - with surprising results.
Lead author Dr Georgie Crichton, of the UniSA, said chocolate and cocoa flavonols were associated with cardiovascular benefits but it was less known about the effects of chocolate on neurocognition and behaviour.
“The (study) ... found that those who ate chocolate at least once per week (or more), performed better on multiple cognitive tasks, compared to those who ate chocolate less than once per week,” she said.
“Previous research has mostly examined the acute effects of increasing chocolate consumption on cognition immediately after consuming a chocolate bar/cocoa drink.”
Despite the latest good news for chocolate lovers, Dr Crichton said chocolate consumption should always be balanced with a healthy diet and lifestyle.
“Of course chocolate intake should be considered within an overall healthy eating pattern, with consideration given to total energy intake and an individual’s energy needs,” she said.
The good news actually started last year when, a British and Danish study of 21,000 people revealed eating up to 100 gm of chocolate a day - the equivalent of two chocolate bars - reduced the risk of coronary heart disease.
In that study, more people who ate both milk and dark chocolate were linked to a reduced risk of heart disease and stroke than those who ate none at all.
And that, gentle reader, is what it is all about. We don’t know if anything is “safe” in all circumstances, but there is a burgeoning industry out there calling for funds to “prove” that shoes actually don’t kill people as 99 percent of those dying wore shoes. Give generously.

Update May 14, 2016

Is Opdivo the melanoma answer?

News came through to me the other day of a very expensive treatment for Malignant Melanoma. Called Opdivo, the specialist from Royal Adelaide Hospital said, “The most striking thing is that at one year 73 percent of patients are alive on Opdivo,” this compares to just 43 percent who survived on standard chemotherapy treatment.

“The other striking thing is patients had tumors shrink 40 percent on Opdivo compared to 17 percent shrinkage on standard chemotherapy,” he said.

And patients whose tumors shrank maintained that shrinkage whereas on standard chemotherapy tumors began to grow again after six months, he said.

Typically only 15 percent of patients with advanced melanoma survive for five years, a third of patients treated with Opdivo lived at least five years and the trial is still continuing. (You can also read that as two thirds are dead by five years!)

“I’ve seen many big tumor masses shrink, it really can be dramatic,” Professor Brown says.

Around eight percent of tumors shrink completely on the drug while one in three have some shrinkage.

Around 1500 patients in Australia, with advanced melanoma, are expected to benefit from the treatment that is delivered by injection every two weeks. And the price? $A170,000, which puts it out of the reach of most people.

While researching an item on the cancers of women, I also came across the somewhat disquieting figures that Malignant Melanoma has the second fastest increasing incidence of cancer for women. In fact, the age-standardized rates have risen by 46 percent in the last decade. Some of the apparent increase may be due to increased surveillance and early detection as well as improved diagnosis, but most is considered to be real and linked to changes in recreational or holiday exposure to UV rays (including sunlight and sunbeds), and we do get the odd bit of sunshine here in Thailand.

I remember the first time I went to a beach in Thailand and saw all these people emerging from the sea fully clothed, that I thought the Thaitanic must have gone down offshore. However, I later realized that Thai people are not silly when they go fully clothed to the beaches to swim! It is generally just the pale skinned farangs that go there to fry.

When we first began to keep statistics on the incidence of melanoma in Australia, it became quickly evident that the further north you went (towards the equator) the greater the numbers of melanomas. White skin and UV radiation did not go well together.

It did not need rocket science to see that perhaps the reason the indigenous native aboriginals did not have the same incidence of melanoma as the white settlers was linked to skin color.

However, human nature being as perverse as it is, the white folks want to be brown (which is why solariums are popular in Australia) and the brown folks want to be white (which is why whitening creams are the number one cosmetic cream sold in Thailand).

Having myself emigrated to Australia from sunless Scotland as a young teenager, I can remember my Mum chasing me out of the house to get my shirt off and get a “healthy tan”! How times and our knowledge have changed! And we can thank all those medical professionals who have kept the statistics to be used by the epidemiologists who could then impart these findings to us all. Statistics which we hopefully take on board to take ourselves out of the danger.

The bad news about malignant melanoma you have already read above, but there is some good news. Protect yourself by covering up and using a very strong sun blocker of SPF 30 and above any time you are at the beach. And re-apply after swimming each time.

However, if you have any dark colored ‘spot’ that has changed shape, color, or become itchy you should get some expert advice from our specialist dermatologists. It is too dangerous to ‘wait and see’. Catch it early enough, before it begins to spread, and you can escape!

I get my spots and dots checked each year and have had a couple removed “just in case!” I suggest you do the same.

Update May 7, 2016

Toes – ridiculous digits

I watched a documentary the other day where an Indian mystic was rubbing a magic mixture of herbs on a broken leg. Have faith, the bone will mend. And it will. However, it will take many months of pain and incapacity and the owner of the fracture will be left with a deformity.
Let me assure you that mystics do not cure fractured anythings. But I must admit they have better PR agents than conventional medico’s. We should do something about that!
Friend of mine fractured some bones in his foot the other day, which made me think about fractured toes. Have you ever broken a toe? Any toe. If you have, you will remember it as broken toes are damn painful. In fact, the pain is much greater than many other fractures, such as a nose, or even a wrist, despite the ridiculously small digits like toes.
Having been born inherently clumsy, I have fractured several toes, with most occurring by walking into table legs or other immovable pieces of furniture. After the initial mutterings of hopping one-legged around the bedroom going “Ow! Ow!” I expected the buzzing throb to quietly go away. It didn’t, but what did come was the slow appreciation that I had done a little more than just a stubbed toe. The toe began to swell and took on a beautiful purple hue, which is almost 100 percent indicative of a fracture. X-Rays really only confirm the clinical diagnosis.
Now I was actually quite lucky. If you must have a fractured toe as a pastime, do not pick the big toe for this. It really is the only important toe, as it is the one that keeps your balance. No joke. When you are standing, there are all sorts of little receptors in your head that tell your brain whether you are stable, or in danger of falling forwards or backwards. These receptors then relay messages to your big toe, to increase or decrease pressure to keep you upright – and you thought the only reason for your big toe was to move family pets out of the way! (This is the same way that Segways work!)
I was lucky in the fact that my Xmas fracture was of the middle toe. After the importance given to the big toe, all the others are only there to fill up the space in your shoes. And no, I’m not joking. Just have a look at your other toes. What a twisted, misshapen bunch of digits they all are. What earthly other use is there for them? About as useful as a box of matches in a typhoon.
So what is the treatment for fractured toes? Let me assure you from nerve tingling personal experience, that the first is pain relief. (As an aside, I have always said that the ideal doctor to consult, is one who has had the ailment you are suffering from. I am now a specialist in fractured toes.) Pain relief! Some paracetamol with a good lump of codeine in it works well for the first 24 hours, and after that, simple paracetamol is really all that is necessary for the smaller toes, but the big toe might need the extra oomph of codeine for a few more days.
Again there is a difference between big and little toes as far as further treatment is concerned. The big toe often needs some kind of immobilization, and splinting or even plaster may be required. For the smaller toes, taping to the next toe up is all that is necessary, or if it is the very tip of the toes that is fractured (that’s the bit we medico’s call the ‘Terminal Expansion’), just masterfully ignore the toe.
Shoes? Or no shoes? Two schools of thought here. The first is just to wear sandals or thick socks only, and undoubtedly this can be more comfortable, but the toes are more vulnerable to more small knocks and bumps. The other school of thought is to screw your eyes up tight and get the foot into a shoe. It contains the swelling, effectively immobilizes the digit and does offer some protection to bumping of the exquisitely painful extremity. There are fancy air splints shoes as well!

HEADLINES [click on headline to view story]

Diabetes – a disease you don’t want

Good news for chocoholics!

Is Opdivo the melanoma answer?

Toes – ridiculous digits