Friday, March 30, 2007

Undernutrition without malnutrition...

May be the new lifestyle approach to cancer prevention.

While there are certainly disadvantages to life in the Democratic Republic of Congo, the women do enjoy a decreased incidence of breast cancer compared to the US.

Polish researchers theorized that the lower mean daily energy intake for the Congo--7.6 MJ/day vs. 15.3 MJ/day for the United States-- lowers levels of ovarian hormones through the African womens' reproductive years. This, in turn, favorably alters the lifetime risk of developing breast cancer.

In a study done five years ago, Krakow-based scientists found a direct correlation between salivary concentrations of progesterone during the last half of the menstrual cycle and breast cancer rates in groups of women studied from both countries. Not only were the higher hormonal levels in American women proportional to their higher cancer rates, the same mathematical relationship between salivary progesterone and cancer risk held true for populations studied in Nepal, Bolivia, and Poland.

The authors of the study concluded:

The strength of the relation strongly suggests that it is an important biological phenomenon. Furthermore, since ovarian function responds to nutritional status, the risk of breast cancer may be modified if changes are made in a woman's lifestyle.
It's the great cancer cover-up. Panicked into avoiding sunlight by health experts, we are now dying in our thousands from diseases linked to deficiencies of vitamin D. But still the exaggerated warnings come.

The oral intake of vitamin D needed to maintain levels circulating in the blood in the absence of sun exposure may be as high as 4,000 IU/day.

--Oliver Gillie

Tuesday, March 27, 2007

Helluva virus

I once told a young man he had a helluva virus. He pulled out a pen and small notebook and asked me to spell that for him. Well, the helluva virus is back, and I am spending far too much time trapped in tiny exam rooms with miserable patients intent on sharing the little bugger with me.

Here's the litany of troubles caused by HV, and words to the wise about what to do about it. It's possible that we are dealing with HV1 and HV2 here, but they both cause a helluvan illness:

Terrible sore throat
Tiny tickle that turns into a heckuva cough
Body aches
Show-stopping fatigue
Chest pressure and congestion
A feeling of shortness of breath

If you have it, you're probably not sitting at your computer reading this post. If you get it tomorrow because you share office space with one of the patients I saw today, don't go see your doctor. There's nothing we can do for you, except, perhaps, prescribe cough syrup with codeine so you can put a stop to the misery long enough to get some sleep. I'd be willing to do that over the phone in lieu of sharing air space with you.

Drink liquids. Don't take antihistamines, do take Mucinex (guafenisen). Take aspirin or Advil for the aching, fever, and sore throat. Don't go to work. If you get worse instead of better and cough or blow out horrible stuff a week or more into your HV infection, then let's talk antibiotics.

Monday, March 26, 2007

Medicinal chemists may make breast cancers glow for the camera!


on mammograms are not a good sign. These little white dits of calcium can indicate a developing malignant tumor. Some of us are awash in breast microcalcifications, but mammograms can't always tell which are benign.

If you've undergone one of those creepy stereotactic biopsies where the radiologist goes fishing for calcium, you'll be pleased by this news from Dr. John Frangioni in Boston. He and his colleagues have discovered that microcalcifications of the cancerous variety are hydroxyapetite deposits whereas benign mineral collections are generally calcium oxalate. While mammographic imaging can't distinguish one from the other, these Harvard chemists have discovered a way to make those bad boy hydroxyapetite crystals glow infrared.

By injecting pigs and mice with a bisphosphonate drug (think Fosamax and Actonel) that's hooked up with a compound called PAM800 that emits infrared light, the scientists have successfully put purple chemical highlights on hydroxyapetite microcalcifications in the animals. They are hopeful that this line of research will lead someday to successful infrared imaging devices that can pinpoint early cancers by the quality of their calcium.

Sunday, March 25, 2007

Brain busters

I'm not sure whether to thank or curse the person who sent me this link, but they did so anonymously, so I've got no choice. Anyway, bust your brain on these tests; I trust they're good for us in the long run:
Drug pens

These are actually part of my problem, the scads of cheap pens I get from drug companies. On average, they're not handing out roller balls, but rather the low cost type that takes an extra push from my index finger to keep the ink flowing evenly.

Do these pens buy my loyalty to the company's product? Are you kidding? I agree with Dr. Thomas Stossel of Harvard as he speaks out against the Prescription Project, a multi-million dollar initiative funded by the Pew Charitable Trusts to squelch pharmaceutical influence on doctors:

I'm not going to fall on my sword for pizzas and pens. If doctors in practice are too dumb to figure out that when a drug rep takes him out to play golf that the rep is trying to sell him something, we're in trouble.

Saturday, March 24, 2007

But PenAgain...

Not. This pen is too small! Either I'm way to grippy about it, or this device needs to come sized to your hand. I finished my charts last night with my little black PenAgain--my index finger was painless, but the knuckles of my third and fourth finger complained as though they'd been jammed together for the duration in a glove two sizes too small.

Friday, March 23, 2007


The very thing for those of us who write all day every day. My handwriting is not bad because I'm a doctor, it's bad because the top joint on my right index finger is twisting east from gripping a pen too hard and too long.

So this quirky little pen is quite the find; it has a silky feel, a silly silhouette, and a little groove where my crooked finger can gently guide the action while fully extended.

You want one? Go to Walgreen's and get one, or check out and read the glowing reviews.

Wednesday, March 21, 2007

Being a pasty white bank official must be the vitamin D equivalent of copping a permanent assignment on a nuclear sub. PWBO had the lowest vitamin D level I've seen yet, and this is sunny Denver from a woman who does drink D-fortified milk.

If your legs look like the first two boards of a picket-fence, and you're not taking extra D, ask your doctor to check your levels.
Chewing the fat

Researchers are still analyzing the fat in our lives--whether worn about the waist or taken in as hollandaise sauce--as a risk factor for breast cancer. They examined food frequency diaries from nearly 200,000 women in the National Institutes of Health-AARP Diet and Health Study abd correlated dieatary fat with incidence of breast cancer over 4+ years.

Study co-author Anne C. M. ThiƩbaut, Ph.D., of the National Cancer Institute noted that doubling fat intake from 20% to 40% increased breast cancer risk by 15%. Drs. Meir Stampfer and Stephanie Smith-Warner both felt that the elevated risk from dietary fat was way overshadowed by the influence of body fat on cancer risk. They wrote:

Thus, from a prevention perspective, interventions to control the amount of body fat (e.g., promotion of exercise and caloric restraint) are likely to have a greater impact on breast cancer incidence than a reduction in fat intake.

Tuesday, March 20, 2007

Keeping up with D news

Two new studies brought to my attention by Gretchen of Denver:

The data were very clear, showing that individuals in the group with the lowest blood levels had the highest rates of breast cancer, and the breast cancer rates dropped as the blood levels of vitamin D increased. The serum level associated with a 50 percent reduction in risk could be maintained by taking 2,000 international units of vitamin D3 daily plus, when the weather permits, spending 10 to 15 minutes a day in the sun.
--Cedric Garland, Dr.P.H.

Through this meta-analysis we found that raising the serum level of 25-hydroxyvitamin D to 34 ng/ml would reduce the incidence rates of colorectal cancer by half. We project a two-thirds reduction in incidence with serum levels of 46ng/ml, which corresponds to a daily intake of 2,000 IU of vitamin D3. This would be best achieved with a combination of diet, supplements and 10 to 15 minutes per day in the sun.
--Edward D. Gorham, Ph.D.
On making connections

Social isolation isn't good for the body or soul. Lori Levy writes of a brief encounter with a stranger on a busy day:

And though I do not stop to chat--
for that would be as out of character as
a bashful child jumping up to sing--
my smile widens and turns real,
melting inward like a flood of warmth,
as when a song you've always loved
comes on the radio and fills you up again,
if only for a moment.

Sunday, March 18, 2007

Hip pain

Sometimes it's hard to tell what's what when hips hurt. Arthritis of the hip joint hurts in the groin or the front of the thigh. It increases over time, gets worse with activity, and limits the range of motion of the hip, particularly to internally rotate the joint (accomplished by turning the foot or knee inward towards the middle of the body).

Bursitis, or an inflammation of the lubricating lining of the hip, hurts at night, making sleeping on the affected side difficult. Bursitis also nags when you first rise from a seated position, but this pain subsides quickly.

Finally, pain from the sacro-iliac pain also is improperly identified as hip pain. Lie on your back bending the affected leg at the knee and placing the ankle on the opposite knee in a 'figure 4' configuration. If downward pressure on the knee of the affected side causes pain in the groin, it's the hip. If the pain is around back, the pain is probably from the sacro-iliac joint.

Saturday, March 17, 2007

Just say 'scat' to scat

I'm not sure I'll ever get over the unexpected pleasure of seeing the neighborhood wildlife which includes a coyote, a fox or two, falcons, a pair of hawks, and at least one family of raccoons. I suppose losing the family cat to one of the predators would take some of the fun out of it, but, according to JAMA, here's what one of these critters may bring to the 'hood:

Scientists and public health experts say it's time to remove the welcome mat, because the animals often carry a roundworm parasite that is increasingly recognized as the cause of a rare but deadly form of encephalitis, especially in children.

This warning, from JAMA, points out an unexpected problem with sharing our living space with wild animals.

For more details, see the upcoming issue of Femailhealthnews. Not yet on the subscription list for this free e-mail newsletter? Send a blank e-mail to

Sunday, March 11, 2007

Dressing like a doctor, Part II

I mentioned in a previous post (Dressing like a doctor, Part I) my unsuccessful attempt to break free of the stodgy middle-aged travel knit look of Chico's into the young modern insouciance of Anthropologie. This weekend I tried a less ambitious attempt to look the professional part while out on errands.

I inevitably run into patients at my local King Soopers when I'm decked out head to toe in my son's hand-me-downs. One seventy-something patient, beautifully dressed for church in heels and a silk dress, eyed me up and down in produce and said "My don't you look comfortable." So yesterday I donned a blouse over jeans that actually fit, a necklace, and a touch of make-up, and headed for Rite-Aid and Sunflower Market.

Score! Ran into patients at both stores, and no need for embarrassment!

Saturday, March 10, 2007

Quit puffing, start huffing

I quit smoking 29 years ago this month. Coincidentally, my daughter and I went to a Jazzercise class this a.m. This hour of hopping to hip hop, along with many, many other such classes I've attended through the years cuts this ex-smoker's chance of getting lung cancer by 37%.*
*The Association of Physical Activity with Lung Cancer Incidence in a Cohort of Older Women: The Iowa Women's Health Study, Cancer Epidemiology Biomarkers & Prevention Vol. 15, 2359-2363, December 2006
© 2006

Friday, March 09, 2007

Taste test?

Scientists have noted that otherwise healthy persons taking selective serotonin reuptake inhibitors--antidepressants such as Prozac and Lexapro--become extra sensitive at detecting sweet and bitter tastes. On the other hand, volunteers taking selective norepinephrine reuptake inhibitors like Effexor improved their detection of sour and bitter tastes.

These neurotransmitters, serotonin and norepinephrine, are known to be involved in taste signaling as well as mood control. Physiologist Lucy Donaldson of the University of Bristol felt this connection might be useful in the treatment of depression. She concluded:

It may be feasible to use a simple taste test to see what kind of medication people should be given.

Tuesday, March 06, 2007

From a patient's point of view

The opportunity to view medical care from the other side of the consultation desk is always an eye-opener. I recently accompanied a family member to a couple of medical appointments, and the experiences were polar opposites.

The un-named dermatologist entered the room with nary a howdy-do or even a trite 'how 'bout all this snow?' He immediately began mumbling about diagnoses and treatment options in terms not meaningful to your average layperson even though he had no notion at the time that I was a doctor. The only reason we reached a clear care plan by visit's end was at my insistence.

At the other end of the spectrum, Dr. Andrew Nemechek, a surgical oncologist specializing in head and neck cancers was as warm and easy to talk to as the previous doctor was inscrutable. He outlined care options on paper with an easy-to-follow, step-wise flow sheet. We are lucky to have such a specialist here in Denver; I highly recommend his services to you, but I hope you'll never need them.

Monday, March 05, 2007

Overresection of the nasal tip

Think Michael Jackson, as in so much plastic surgery there's no cartilage left in the nose to remold.

Plastic surgeons have now perfected a technique that grafts seagull wing cartilage to overdone noses, providing new definition to the profile and a new definition to the term 'winging it.' One author of an outcome study published in The Archives of Facial Plastic Surgery noted that 'patient satisfaction was high.' In this series, 92% of the subjects who flew through the procedure were pleased with the lift.

Sunday, March 04, 2007

A primary care doc, writing in JAMA lists those things she won't miss as she makes plans to leave her practice:

No more forms to fill out for workers comp, diability, SSI, student loan forgiveness, long-term-care insurance coverage, FMLA, or temporary suspension of billing for credit card or mortgage or rental furniture payments owing to customer illness...

No more requests for a personally crafted letter swearing that 'Medically, it is in the patient's best interest...' to change apartments, own a pet, not swim in gym class, work only part-time, be excused from jury duty, change shifts, or not travel at this time...

No more writing a prescription for Winner med only to find out it is not on the patient's pharmacy plan. So I phone in SecondBest instead, but the formulary gods will only approve RunnerUp, but by golly I fight for SecondBest and win. Until the patient calls bbecause SecondBest is still a second-tier drug with a $50 co-pay. Could I please prescribe something cheaper, like that RunnerUp her beautician takes?

In case you wonder how I spend my office hours when not seeing patients.

Saturday, March 03, 2007

American Heart Association on pain control*

Cardiologists have launched a save-the-heart-and-bear-the-pain campaign. Their cardiocentric viewpoint may leave those of us at risk for heart disease sidelined with aging, aching joints.

The AHA just issued new guidelines discouraging the use of COX-2 inhibitors such as Celebrex in heart patients or even those at risk for heart disease. Noting that these drugs increase sodium retention, decrease blood flow to the kidneys, and increase blood pressure, they encouraged non-drug treatments such as weight loss and physical therapy as the first-line defense against musculoskeletal pain.

If these measures are 'too little too late,' they recommended reaching for tylenol, tramodol, or narcotics before considering the so-called NSAIDs (non-steroidal anti-inflammatory drugs). Of all these various drugs (ibuprofen, piroxicam, etodolac and others), they endorsed naproxen (OTC Aleve) as cardiac neutral.

In the real world of aching joints holding up aging hearts, these guidelines create as many problems as they seek to avoid. There's obviously no losing weight without exercise, and there's no exercising while the arthritic knees are screaming. Naproxen may be cardiac neutral, but I just sent a middle-aged lady to the ER yesterday when she began passing blood clots instead of stool after five days on this drug. And another sixty-something patient in the midst of training for a triatholon is hobbling instead of running now that she's off NSAIDs and on blood thinners for intermittent atrial fibrillation.

Cardiologist Dr Scott Solomon of Brigham and Women's Hospital summed up the broader picture:

Physicians need to weigh any potential cardiovascular risks of nonselective NSAIDs together with the clear increased risk of GI bleeding against risk of abuse with narcotics.

*Information from AHA updates NSAID advice

Friday, March 02, 2007

High school students can download to their cellular phones ultra high-frequency ring tones that are inaudible to most of their teachers.

---Robert Dobie, MD, University of California, Davis

No wonder I never hear my cell phone when it rings in my purse. Not that it rings much, but that darling little trill of a tone just doesn't register on my aging ears on the rare occasions when someone calls.

Dr. Dobie notes that loss of ability to hear sounds of the highest frequencies begins in early adulthood and accelerates with age. Ultimately, lower, conversational frequencies start to drop out as well, so then the teenagers can actually answer their ringing phones in classes taught by 70-something substitute teachers.