Prostate cancer screening

September 22nd, 2010

Prostate cancer screening remains highly controversial.  The only blood test, the PSA, is perhaps the most inaccurate test that I order.  Part of the problem is that PSA is made by normal prostate glands and it goes up gradually in men with age.  Individuals with prostate cancer may have a higher PSA, but even that is not always true.  A normal PSA level does not rule out cancer, nor does a mildly high PSA rule it in.  Added to this inaccuracy is the uncertainty towards the value of treatment nor which treatment is clearly superior.  Finally, most men who get prostate cancer will not die from that disease so the value for screening is more questionable particularly as one gets older with other medical problems becoming more common.

Two recent studies now suggest that a single PSA test (rather than annually) may be enough of a screen if the result is solidly normal (less than 2, normal usually up to 3.5 to 4).  The most recent study included 86,000 men between ages 55 to 74 and followed for 9 years.  Close to 70% of men had low PSA baseline numbers of less than 2 and for that majority there was no benefits for continued screening as related to death from prostate cancer.  A similar conclusion was made in another large study published in the British Medical Journal.

Unfortunately, this will probably not change the physician community behavior anytime soon where annual PSA tests are done frequently often leading to more tests and invasive procedures.   More and more information however is suggesting this needs to change.

Flu shot

September 22nd, 2010

Yes, it is that time again! The office has the flu shots available either during a visit, or just by dropping in at the office. For those not needing to be seen, flu shots are done Tuesday, Wednesday or Thursday in the morning (9 to 11) or afternoon (2 to 4) and you do not need to call in advance. Ideally flu shots should be done soon, but certainly by the end of November or December at the latest.

Vaccine Time

October 30th, 2009

Our office did get another shipment of the regular (seasonal) flu vaccine.  Vaccines ideally should be received by the end of November and certainly at least by the end of December.  There is then plenty of time still, but not necessarily plenty of vaccine at least at our office.  Drop in days are for established patients, mid mornings or afternoons, T,W,TH. and we request a phone call (503-293-1515) from those planning to stop by.

More Quackary

October 28th, 2009

Yesterday I blogged about a local chiropractor’s claim that bordered on the insane and certainy lacked evidence.  These kinds of claims are more pervasive and common than many know, but no more so than in the field of alternative medicine, especially naturopathic medicine.

On my desk today is an invitation for me to attended a seminar on QRA.  What is QRA you might ask?  According to this brochure, it is a “breakthrough” in understanding “true root causes of chronic health” by using “quantum physics to permanently restore quantum biofield energetics.”

If that sounds confusing to you, then relax, you are normal.  Silly claims often ride on the coattails of scientific words and ideas (like quantum physics) but then add to them.  In this case by suggesting then there exists something like “biofield energetics” which is made up mumbo-jumbo.  Despite using these complicated words, they assure those that attend that this incredible discovery “can be easily learned in one weekend” and (get ready for this one) one will learn how to do a “one-second test” that so quickly identifies “toxic nutrients, foods or supplements” that could be avoided.  In one second!

What happens next?  I am glad you asked, as it then will somehow magically “induce quantum cellular resonance in specific glands and organs.”  This ultimately will acheive a “rejuvenated bio-energy pattern” and I guess some amazing health.

There may be some cellular responses that are at the quantum level, but that could not be known and certainly one could not measure this change.  Moreover, there is not such thing as a bio-energy pattern.  Craziness, plain and simple.

Perhaps it is true some might say.  Of course that is not even slightly feasible.  The wonders of science and medicine is that true statements are rapidly distributed and supported and usually adopted worldwide.  Of course that is not even slightly true in this case.   This is just another example of modern day snake oil hogwash, and in this example a naturopathic (not chiropractic) one of a heaping pile of male cow poo poo.

Snake oil

October 27th, 2009

The flu season continues along and at least for my few unlucky patients made ill by this germ; so far it has been a mild illness with recovery in a week to 10 days.

This has not stopped the concern and worry of course.  It also has not stopped some unusual claims by others.  In the local community paper this week was an ad by Steven Pettigrew, a chiropractor.    This provider suggests that manipulation or spinal adjustments can help “the body fight illness” and should be considered in order to stay healthy.

It’s worth taking a look at his subsequent claims both for education and to serve as a warning about some conclusions people can make.

First he notes that “the spine is the central corridor from which the body’s nervous system emanates.”  Well, this is partially true.  There are nerves traveling to the face, the cranial nerves, that avoid the spinal cord.  Still, I have no major worries about this first point.  It is pretty much everything else that I consider hogwash.

“Nerves control every aspect of the body, including the immune system.”

No, goodness no, that is not true.  This is reducing a complex process to a simple statement that is not accurate.  It is beyond the scope of this blog to address this in great detail, but suffice it to say that there are massive numbers of chemicals released from different organs independent of the effects of nerves.  Sugar levels sway how the pancreas works, thyroid levels feedback to the brain and on to the thyroid and other chemicals and blood numbers are influenced by so many other factors that have no nerves controlling this process.  This is especially true for the immune system made up of billions of cells of various sorts floating about in the body (hence, could not have a nerve attached) or in glands (lymph glands, spleen in particular).  The immune system is not under control of any of the nerves from the spinal cord.  Individuals with complete paralysis due to spinal cord injury, have normal immune systems.

“The brain and the immune system are the two major adaptive systems in the body” he adds next.

No, this is wrong.  The endocrine system (hormones), the digestive system (stomach and intestines), the renal system (kidneys) and cardiovascular system (heart and vessels) would all disagree.  They all work, adjust, adapt in a constant dance of life without claims to superiority.

“When the immune system has to respond to a (flu), it reacts with the brain to maintain balance in the body” is his next sentence.

No, how absolutely wrong and silly is this comment.  The flu is a virus that invades cells throughout the body, mostly the respiratory system.  It does not react, in a positive way, with the brain.  As it spread in the body, immune cells release chemicals that may cause a fever (feedback on the brain) or the flu may infect the lining of the brain (viral meningitis) or worse get in the brain (encephalitis).  There is no brain effects that balance anything.

“Any misalignment in the vertebrae can cause malfunction and weaken the immune system” is his following sentence.

What?  Wait, I thought it was about the brain?  What does the spinal cord have to do with it?  The answer is nothing of course.  Not to mention the fact that there is not a shred of evidence to suggest a bone in the back (or several) can be moved around to then have some distant effects on the chemicals floating about in the body that fight infection.  This is all just complete silliness and wishful thinking.

He finally ends by suggesting chiropractic treatment should be done to help the nerves to help the immune, hence to help you stay healthy.

Save that money and instead work on eating well, exercising, washing your hands and avoiding those who are ill.  If you can, and most importantly, get a flu shot!

H1N1

September 30th, 2009

Of course just after my last post I would hear on the national news (and by forwarded email) of a young healthy teenager who tragically died from the H1N1 virus.  As disturbing and gut-wrenching such stories always are, it is also disturbing to me how the media portrays the event.

The story does include comments on how this is very rare, that most cases of these illnesses will be self-limiting and mild to moderate, but that is only briefly mentioned.  As presented, it will increase fear and demands for stock piling of anti-viral medicines like Tamiflu (that have minor effects on the illness at best) and demands for the vaccine from many who have lower risks.

Tens of thousands of deaths will happen each year from the regular strain of influenza, and many others from other infections.  It makes little sense to fixate on this one more than the others, or the 40 thousands deaths each year from car accidents or those who pass away from cardiovascular troubles from heart attacks to strokes.  While H1N1 deserves our attention, it’s important to stay focused on the big picture and overall risks and take care of things that we can influence with healthy lifestyle and common sense.

September 28th, 2009

So far there has been no exciting news to share at our office.  This is a good thing of course.  While I have seen some illnesses now and then, they have not been either concerning or serious.  This happens every September as people return to school.  So far I have not seen any influenza like illness, but it is just a matter of time.

Apparently the H1N1 vaccine will soon be made available.  Our office continues to pursue options for getting a supply, but so far we have not been succesful.  If you meet the criteria for those at greater risk and can get the shot, please do and ideally get the shot and not the nasal spray where studies have shown less protective benefits.  More to follow…

September 17th, 2009

Greetings to my new blog!  This is the first of what I hope to be many other posts in the future.  I am trying to learn about this program, I have a “WordPress for Dummies” book from the library, and no doubt this will be a work in progress.

It seems that the most pressing questions I have had recently revolve around the flu illness, vaccination, and medicine (Tamiflu) so here are some of my thoughts.

Influenza is the virus that causes this illness.  It is not the same as the stomach flu with vomiting and diarrhea, and this flu typically causes no such problems (except in the very young sometimes).   It can cause a horrific illness often with very bad body aches, headaches, fever to 102 range, and a cough that can be severe.  If that does not sound like fun to you, then get the flu shot which is now available.  True, it may not cover the strain this year or offer complete protection, but the potential benefit makes it worthwhile in my opinion for nearly everyone.

The H1N1 is also influenza, but a different strain and latest mutation and is the called the “swine” flu in the news.  Vaccines for that have recently been approved by the FDA and will (hopefully) soon be available.  It is very unlikely I will have any at my office although we keep inquiring about the availability.  This is a second flu shot that may require a “booster” shot as well.  It looks like single shots may offer enough protection from early studies however.

Tamiflu is a medicine for the illness but has very limited value.  It makes the illness a day or two shorter at best and only when used very early on in the illness.

Prevention otherwise is the key.  If you can’t or will not take the vaccine, try and limit exposure risks.  Avoid anyone with a cough illness when possible as this is an illness easily breathed in from those who are ill.  It is not really by touching anything although good hand washing is always a good idea as well.

If the illness happens, then usual care is best with plenty of fluids, rest and medicines for symptoms.  For more serious illness, a visit here is a good idea of course.