Archive for the ‘Preventive Care’ Category

Prostate cancer screening

Wednesday, 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.

Vaccine Time

Friday, 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.

Snake oil

Tuesday, 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

Wednesday, 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.

Monday, 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…