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Doctor's Consultation  by Dr. Iain Corness


Update November 26, 2016

Baldilocks and the Three Hairs

Going bald is not something we men can look forward to. Exotic ‘comb-overs’ like Donald Trump’s look a little weird. However, the shaved head look isn’t all that smart either.

Male pattern baldness is a curse bestowed upon men by their fathers. Yes, chaps, the way your hair disappears depends upon the genetic disposition you inherited from your fathers. I also fully realize that some of you will say, “My father had a full head of hair until he was 90 and I am going bald at 50.” The answer is genetic heritage. Did you study the postman’s genes? Or maybe you just had a hard life.

Jokes aside, male pattern baldness (or Androgenetic alopecia, the medical terminology) results from the presence of circulating androgens (sex hormones) in susceptible individuals. The end result is the baldness beginning at the crown of your head, and it all goes on from there. Or I should say, goes off from there.

What actually happens, is that the sensitive scalp follicles are progressively made smaller by Dihydrotestosterone (the male sex hormone DHT), so the hair becomes finer and finer and eventually falls out altogether. It is actually normal to lose between 50 to 200 hairs every day – as you get older, this rate increases.

Another strange fact is that the rest of the hair on the body does the reverse with exposure to DHT. Body hair becomes darker and coarser and more copious.

Unfortunately, our appearance is very intimately involved with our own self esteem. None of us want to get older (though it still beats the alternative!) and we certainly do not wish to be reminded of this fact every time we look in the mirror.

Consequently there are many forms of “treatment” for male pattern baldness, and the range is quite extensive (and expensive). The simplest, but most unsatisfactory method is straight out camouflage. This includes spray can hair sprays that hold the hair in place and color the scalp. Unfortunately they are messy and the dye can run in the rain.

The next form of treatment is the covering wig. These come in many forms from quite good to downright dreadful. Unfortunately, the cheaper acrylic hair models are very easily detectable. Interwoven models, where the artificial hair is entwined with natural hair looks fine for a while, but have to be re-adjusted as the normal hair growth lifts the wig away from the scalp.

There are medications that can be used. The one that has been around the longest is Minoxidil, usually sold as “Regaine” and comes in 2% and 5% solutions. These have to be rubbed into the scalp twice a day for ever thereafter. The main problem with Minoxidil is that it takes two to three months before it stops the hair shedding and another four to eight months before regrowth may be apparent. On the downside, only around 50% respond and scalp irritation from the liquid is quite common.

There is also a drug called Finasteride, taken by mouth. This drug blocks conversion of androgen to DHT and the results would seem to show that for most men, hair loss is slowed or stopped and a significant proportion actually get regrowth as well. Again it is necessary to take the medication for at least three months before any change will be observed.

Finally, there is surgery to take good hair from the back and side of the scalp and transplant it into the bald areas. Again this is time consuming, and in the intermediate stages looks most un-natural. The best is transplanting individual hairs, rather than the punch graft tufts, but it is naturally longer and more expensive a procedure.

There is now another procedure called Robotic Hair replacement which my hospital has now invested in, which is like transplants, but the replacement hair is inserted by robot, with the donor site and the recipient site being very small as to be almost unnoticeable. It is also almost painless and a safer method.

So that’s the good news, gentlemen. You don’t have to go bald, but expect your wallet to get slimmer instead. The choice is yours.

Update November 19, 2016

Killed by Mobile Phones?

Every man, woman and child in Thailand has a mobile phone these days and having the mobile seems more important when eating in a restaurant than the knives and forks themselves!

However, remember the first mobile phones? We used to have to carry a suitcase full of batteries and needed three months at Thor’s gym to lift the thing. Who would have believed that one day we would be able to slip the mobile phone into our shirt pockets, where its death dealing invisible rays would kill us.

However, new developments always bring out the soothsayers and harbingers of doom. Forget attacks by extremists, we are all carrying a loaded time bomb in our mobile phone pockets.

I read a banner headline the other day which 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, according to results of a study released at an American Society for Reproductive Medicine conference in New Orleans.”

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. Can’t you see the headlines, “Driver’s gonads blown to bits by mobile phone while waiting at traffic light!”

If that was not chilling enough, Australian scientists are investigating if children are more vulnerable than adults to the effects of radiation from mobile phones. This should have us worried for our children, as Thailand has one of the highest usage rates of mobile phones. Every Thai, from the age of two, or the age of being able to speak, has one. Every child takes one to school. Even the national way of greeting has been changed to suit the mobile phone fad. The traditional ‘wai’ is now done by holding the mobile phone between your palms and bringing it up to touch your nose. True, just look around you.

The study of 110 adults at the Australian Center for Radiofrequency Bioeffects Research has apparently confirmed mobile phones cause a change in brain function by altering our alpha waves.

The center is now investigating the effect on 40 children aged 12 to 13, and 20 people aged 55 to 75 years.

Associate Professor Rodney Croft, from the center, said while studies had been conducted on adults, the effect on children had, until now, remained untested. “Although there’s a tiny effect on healthy young adults, there is a possibility that it could be much stronger in children or the elderly,” said the worthy Professor.

Now, Mobile phones are hardly new technology, although the latest 4G variety seem to be able to do everything from cleaning the house, watering the garden, tying your shoelaces and washing the dog, as well as making and receiving telephone calls. There have been claims that using mobile phones produces brain cancer because people with brain cancer have used mobiles, and that is about as stupid as claiming that shoes are the greatest killer in the western society because 99 percent of people who died last year wore shoes.

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 eventually funded by you and I. 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 many years ago, 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. And get your cholesterol levels checked as well.

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

Update November 12, 2016

Sleeve Gastrectomy

A bit of talk recently in the bars about the procedure known as “Sleeve Gastrectomy” for weight loss.

Yes, weight loss, with the incidence of obesity increasing every year, weight loss is an important feature today. Yes, even those delightful wispy little Thai girls hanging on to chrome poles are larger than they used to be 10 years ago.

Sleeve Gastrectomy is a surgical procedure to reduce the size of the stomach. This will help to limit the amount of food eaten which makes the patients successfully lose weight.

Many but not all overweight people are able to have this surgery. Surgeons use the Body Mass Index (BMI) as a criteria for surgery, with the normal sized people having a BMI 18.5-24.9 kg / mē

People with a BMI over 30 kg / mē or more are considered as overweight. But it is not yet considered as obese. The person with the BMI 35 kg / mē or more is considered as having severe obesity and a BMI 40 kg / mē or more is considered morbid obesity.

The obese person with a BMI 35 or higher is the person who benefits from the surgery. As a result of the study it has been found that people in this group will not lose weight despite diet, exercise or medication. That makes it very difficult to control ailments that go along with obesity, such as Diabetes, for example.

The benefits of surgery to produce a smaller stomach lies from the fact that the patient will eat less without feeling hungry and feel full faster, thereby limiting the amount of food which in turn results in weight loss.

Sleeve Gastrectomy is similar to Gastric Banding but has surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve like structure making for a smaller stomach and they will eat less.

Because the patients require general anesthesia for this surgery, the risk is the same as any other surgery. Complications can occur in patients with underlying diseases such as diabetes, hypertension, heart disease, etc. The anesthetic doctor will assess whether or not they are suitable for surgery.

Being done by laparoscope, after care is short (3-4 days) but if patients have complications or need to have additional surgery, it may require a longer stay. After the surgery, the patients are given a diet immediately. They will receive a diet plan from the doctor and need to consult a dietitian.

In general, they should do as follows:

The first week after surgery: the patients may eat liquid food such as soups, beverages, but no sugar, (do not take carbonated drinks) water, vegetable juice. Eat a little at a time, but often.

Two weeks later, the patients are able to eat a small piece of soft food, and then convert into a regular diet. It should be eaten in small amounts. They have to chew food thoroughly before swallowing and longer than usual. Do not drink water with meals. The doctor will arrange the appointments for periodic follow-up.

Here is the usual scenario:


Weight gain becomes a health problem

Diabetes, hypertension, osteoarthritis, back pain…

Tried to diet, exercise and pills, but the weight does not come off.

After successful surgery, the patient should eat three meals a day and limit unnecessary snacks between the meals.

Weight loss is successful or not depending on what you eat. Snacking between meals stops weight loss and may actually cause weight gain due to the calorie intake more than necessary.

Not chewing food thoroughly will cause stomachache, nausea, vomiting and stomach irritation. Chewing thoroughly is very important. You should cut the food into small pieces before eating.

Avoid sugar. Reading food labels is essential to note that the sugar in foods is natural or artificial sweetener. You should limit yourself to only 15 grams of sugar or less for one meal to help control calories.

(Body mass index (BMI) is a value derived from the mass (weight) and height of an individual. The BMI is defined as the body mass divided by the square of the body height, and is universally expressed in units of kg/m2.)

With thanks to the Surgery Center, Bangkok Hospital Pattaya Tel. 1719.

Update November 5, 2016

Influenza vaccine worthwhile?

Honestly, I do get more than a little tired of the “facts” being bandied about on the social media on the subject of immunization. Right from the outset let me tell you that immunization does not cause autism, and quite frankly, even if it did (which it doesn’t) the numbers affected versus the number of children protected makes it a no-brainer on the side of immunization.

Now let’s look at some “killer” epidemics. We should not forget the panic with the Swine flu (also H1N1) a few years ago. Bulletins from the WHO every day added to the hysteria.

Where WHO let itself and us down was WHO did not tell the media that the immediate danger of viral infections has two requirements – how easily it passes from one host to another and how lethal is the ensuing infection.

The ‘pandemic level 6’ only referred to the contagious nature of the virus and H1N1 is certainly highly contagious. However, with only around 4000 deaths in the world from that 2009 Swine Flu virus, just how lethal was it, when the seasonal flu kills 36,000 people each year just in the US alone, and 200-300 people in Thailand? Read those numbers again – 200-300 people from the seasonal flu in Thailand! That’s from “nothing out of the ordinary” flu!

Right, what can you do about avoiding a full-blown influenza infection this year? Quite simply, Flu vaccination can keep you from getting sick from flu. Protecting yourself from flu also protects the people around you who are more vulnerable to serious flu illness. That’s the contagious nature again.

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 may also 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.

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 pregnant women and their babies for up to 6 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 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 child’s health care provider can tell you whether two doses are recommended for your child.

A complicating factor comes with the annual make-up of the actual vaccine itself. Since the viral strains dominant in any particular year can change, this does mean you should top up your immune status with an annual jab.

In some quarters there is still resistance to influenza immunization as well as the childhood vaccinations, 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.

HEADLINES [click on headline to view story]

Baldilocks and the Three Hairs

Killed by Mobile Phones?

Sleeve Gastrectomy

Influenza vaccine worthwhile?