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Update July 2017

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Update by Natrakorn Paewsoongnern

Doctor's Consultation  by Dr. Iain Corness


Update July 22, 2017

Avoid being run over

As I write this, the Tour de France is in full swing, with racing cyclists breaking collarbones as they crash into each other or the surroundings. They should have learned by now that doing it by car is quicker and less strenuous. After all, the T de F pedaled off in 1903, sponsored by a newspaper called L’Auto, so it was probably all part of a publicity stunt to show that it really was quicker by car.

Unfortunately homo sapiens, as a group, are slow learners.

True stories – an acquaintance of mine turned 40, decided he wasn’t fit, bought a bicycle to ride to work each day and was run over by a bus.

But this fascination with bicycles persists. I have two friends who should know better who regularly post in the social media just how far they rode this morning, and how long it took them. My reply is always the same – it’s quicker by car. And another plus for the anti-bicycle movement is it is also drier by car (the rainy season is upon us), and you don’t have to wear those ridiculous lycra outfits while driving.

As a means of getting “fit” bicycles do nothing but harm to the knees (ignoring the collarbones from clumsy dismounts), so should be banned by the Health and Safety wallahs anyway.

Now don’t get me wrong, I am not against getting “fit”, it is just the means of doing it that I question. I have attended a gymnasium – twice! Once was for three months, after I promised the gymnasium instructor that I would try it for the proscribed period. I have to say that pedaling an exercise bicycle to nowhere I found a giant bore. I was glad when the three months were up. I did not feel any “fitter” either. The second time was before a Four Hour race at the Bira Circuit, to tone up my neck, back and arm muscles. That I found a giant bore as well, but I did feel that the muscles were stronger and did last the race without a problem.

Probably the commonest advice a doctor gives out at the end of the year is to lose weight and get some exercise. Was that part of the advice after your annual physical check-up? Very likely.

Unfortunately, there seems to be very little real understanding of what exercise should consist of, how often, what type, how long and what about sex? However, getting a little serious, exercise will be good for you, provided that you pick a form of exercise that is not harmful for you!

Now I know that looks as if I have put my money on both horses in the race, but take that sentence at its face value. Enough research has been done to show that regular exercise is beneficial for everybody, in both the physical and psychological aspects, but, and it is a big ‘but’, all forms of exercise have relative bodily risks, and this has to be taken into account before you buy a pair of expensive jogging shoes and the lycra and tackle a 10 km trot in the middle of the day.

One important factor is never exceed your limit. Remember that it is not the harder the better. If you have acute medical problems (such as fever, or pain), stop exercising. If you have chronic medical conditions (such as hypertension, diabetes, ischemic heart disease and arthritis), seek advice from your doctor or physiotherapist beforehand. All of these I agree with. If you are happy to take your body to your medical advisor when it is sick, take it back to your doctor for advice on how to tone it up as well.

Do not over-exert yourself. Forget about “powering through the pain barrier”. Leave that for drug-fuelled cyclists in France.

The form of exercise should be one that you enjoy, and I recommend swimming as it does not affect the knees and ankles.

As well as the form of exercise, there is the frequency. At least three times per week, 20-30 minutes (or more) is necessary each time, to derive the maximum benefit. And sex? A fitter body means better sex. OK?

Update July 15, 2017

Prostate Cancer – and the PSA

Question for all you males over 50: What is your PSA number? You don’t know it? Amazing, as almost all the older males in the community know exactly what their PSA numbers have been for the past 10 years. You think I joke? I do not.

The male child is born with a subconscious fascination for the anatomy in his nappy. Watch an infant learning his anatomy. As the boy turns into man, what goes on in his underpants becomes a major pre-occupation. As the man turns older, fear of cancer in the underpants is an even greater pre-occupation.

Unfortunately prostate problems are extremely common, a situation we men have to live with. Like all things, there is a downside as well as the fun side. In fact this year in the United States, almost 180,000 men will be told that they have prostate cancer. But how significant is it?

With all our older friends getting prostate problems, does this mean there is a rise in the incidence? Are our underpants too tight? One reason for the ‘apparent’ increase is the fact that prostate cancer is a disease of aging, and we are all living longer. The statistics show that by age 50, almost 50 percent of American men will have microscopic signs of prostate cancer. By age 75, almost 75 percent of men will have some cancerous changes in their prostate glands. Do the maths. By 100 we’ve all got it!

So does this mean that life really ends at around 76? Fortunately no. Most of these cancers stay within the prostate, producing no signs or symptoms, or are so slow-growing, that they never become a serious threat to health. The good news is you die of something else before the prostate gets you! You die with it, rather than from it. Digest and remember that.

The real situation is that a much smaller number of men will actually be treated for prostate cancer. About 16 percent of American men will be diagnosed with prostate cancer during their lives; 8 percent will develop significant symptoms; but only 3 percent will die of the disease. Put another much more positive way, 97 percent won’t die from prostate cancer.

While prostate cancer can be ‘aggressive’, breaking out from the prostate gland itself and attacking other tissues, including brain and bone, fortunately this is the minority scenario. The great majority of prostate cancers are slow growing, and it can be decades between the early diagnosis and the cancer growing large enough to produce symptoms.

So let’s look at diagnosis and get the “blood test” out of the way first. The blood test is called Prostate Specific Antigen, or PSA for short (we medico’s love acronyms). Up till then we had another test called DRE (digital rectal examination), which, quite frankly, was not all that popular. As medical students, we were taught “If you don’t put your finger in it, you’ll put your foot in it!” Despite this, ‘buyer resistance’ was high, so when news came through about a “blood test”, millions of men began rejoicing and the sale of rubber gloves plummeted. Unfortunately, PSA is not a go/no-go test. A normal range test doesn’t guarantee you haven’t got it, and an elevated result doesn’t automatically mean that you are about to claim early on your life insurance (or your dependents, anyway).

However, there is good news. We are becoming smarter with the PSA test. Serial PSA examinations can show the rate of growth. This gives us ‘Staging’ with four main grades. Stage I cannot be felt and is diagnosed through pathological testing. Stage II can be felt, but it is confined to the prostate. Stage III is coming out of the gland and Stage IV has grown into nearby tissues.

This is where you need to discuss your options with your doctor. If you are a young man with stage IV, then you have to make up your mind quickly. But if you are 75 with stage I or II, then you have more time, as you will most likely die of other causes rather than prostate cancer. “Watch and Wait” has much going for it, but you must be prepared to get to know your urologist.

Update July 8, 2017

How’s my blood test?

I am often asked, “What were my AIDS results,” or “What is my blood group?” In most instances I have to disappoint them, because unless the specific test for HIV or blood group, was requested at the time of the original testing, there will be no record of it, even though the initial test was called a “complete blood count”

The reason for this is simple. There are so many tests that can be done, that testing would go on for weeks if you wanted “everything” checked, and don’t think about the cost. For example, the Australian Royal College of Pathologist’s Manual of Use and Interpretation of Pathology Tests that sits on my desk lists 150 pages of tests that can be carried out. These include such items as a Vasoactive Intestinal Polypeptide or Serum aluminium, something I have never requested in 40 years of practice, or Centromere antibodies ditto.

No, when we send you off for a blood test, we have to try and be reasonably specific, and sometimes even have to give the pathologists a clue as to where we are heading, and be guided by them as to some specific testing.

However, many times we are really just casting a ‘wide net’ to see what abnormalities we can turn up to use as a pointer towards the definitive diagnosis. One of the commonest is the “Complete Blood Count”, usually called a CBC, since we medico’s love acronyms, but remember this testing is in reality very far from “complete”.

The CBC does provide important information about the kinds and numbers of cells in the blood: red blood cells, white blood cells, and platelets. A CBC can help us evaluate symptoms such as weakness, fatigue, or bruising and even directly diagnose conditions such as anemia, infection, and many other disorders.

The CBC test usually includes the White blood cell (WBC) count as these cells protect the body against infection. If an infection develops, white blood cells attack and destroy the bacteria, virus, or other organism causing it. White blood cells are bigger than red blood cells and normally fewer in number. When a person has a bacterial infection, the number of white cells can increase dramatically. There are five major kinds of white blood cells: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. The numbers of each one of these types of white blood cells give important information about the immune system. An increase or decrease in the numbers of the different types of white blood cells can help identify infection, an allergic or toxic reaction to certain medications or chemicals, and many conditions (such as leukemia).

The Red blood cell (RBC) count is also part of the CBC. Red blood cells carry oxygen from the lungs to the rest of the body. They also help carry carbon dioxide back to the lungs so it can be exhaled. The red blood cell count shows the number of red blood cells in a sample of blood. If the RBC count is low, the body may not be getting the oxygen it needs. If the count is too high (a condition called polycythemia), there is a risk that the red blood cells will clump together and block blood vessels (thrombosis).

Another part is the Hematocrit (HCT). This test measures the amount of space (volume) red blood cells occupy in the blood. For example, a hematocrit of 38 means that 38 percent of the blood’s volume is composed of red cells.

Hemoglobin (Hb). Hemoglobin is the substance in a red blood cell that carries the oxygen. The hemoglobin level is a good indication of the blood’s ability to carry oxygen throughout the body.

There is also the Platelet (thrombocyte) count, which is an important part of the CBC. Platelets are the smallest type of blood cell and play a major role in blood clotting. If there are too few platelets, uncontrolled bleeding may be a problem, such as occurs in Dengue Hemorrhagic Fever.

So even though the CBC does test for many factors, there are still another 149 pages of tests that can be done! If you want to know your blood group, or your HIV status, you have to ask! So now you know!

Update July 1, 2017

The Hitchhikers guide to the sphygmomanometer

I have written many columns about “Blood Pressure” (BP) before and why on a random reading, a ‘high’ figure does not necessarily mean you have “hypertension. What is the answer? Keep reading, I will now tell you.

First off, buy a blood pressure measuring device from the pharmacy. Not expensive and read the instruction manual. Now read it again. The simplest to use has a circular cuff you put one arm through.

Record your blood pressure while you are seated in a comfortable, relaxed position. Try not to move or talk while you are measuring your blood pressure. Be aware that the blood pressure readings may be 10 to 20 mm Hg different between your right arm and your left arm. For this reason, use the same arm for every reading. Blood pressure readings also vary throughout the day. They are usually highest in the morning, decrease throughout the day, and are lowest in the evening. This is normal.

For electronic models, press the on/off button on the electronic monitor and wait until the ready-to-measure symbol appears next to zero in the display window. Then press the start button. The cuff will automatically inflate to approximately 180 mm Hg (unless the monitor determines that you require a higher value). It then begins to deflate automatically, and the numbers on the screen will begin to drop. When the measurement is complete, the symbol stops flashing and your blood pressure and pulse readings are displayed.

Now repeat the same procedure two more times, for a total of three readings. Wait 5 to 10 minutes between recordings. Record your systolic and diastolic pressures, the date and time. Inspect your blood pressure cuff frequently to see that the rubber tubing, bulb, valves, and cuff are in good condition. Even a small hole or crack in the tubing can lead to inaccurate results.

Generally, as long as you don’t have symptoms such as lightheadedness or faintness, the lower your blood pressure the better. If your blood pressure is usually below 90/60 mm Hg and you feel well, don’t worry. However, if your blood pressure “normally” runs high consult a health professional.

Many factors can influence the reading.

The size and position of the blood pressure cuff can affect the accuracy of blood pressure readings. If the cuff is too small, the measurements will be falsely elevated.

As a general guideline, if your arm measures more than 13 in. (33.02 cm) around as its widest point, you will need a cuff in which the inflatable bag portion is at least 33 cm long. These large adult cuffs are available at most hospital and medical supply stores.

Your blood pressure may vary considerably from day to day and from moment to moment. Blood pressure also tends to be higher in the morning and lower at night. Stress, smoking, eating, exercise, cold, pain, noise, medications, and even talking can affect it. A single elevated reading does not mean you have high blood pressure (hypertension). Conversely, a single normal reading does not necessarily mean you do not have high blood pressure.

The average of several repeated measurements throughout the day is more accurate than a single reading.

Do not adjust your blood pressure medications based on your own home blood pressure readings without first discussing any change with your doctor.

Early detection and treatment with a combination of medication and lifestyle changes (weight loss, diet, exercise, cessation of smoking and stress reduction) may reduce the health risks associated with high blood pressure. If you are under treatment for high blood pressure, monitoring your blood pressure once a week is sufficient, though more frequent monitoring may be useful if your blood pressure is not well controlled or if your medications are being changed. Talk to your treating physician about how often you should monitor.

A large difference (greater than 20 mm Hg) between the blood pressure measurements of the right and left arms can indicate a problem. Once again, take this information to your doctor.

For all the above reasons, do not be afraid of your blood pressure. It’s what makes your world go around! You need it!

HEADLINES [click on headline to view story]

Avoid being run over

Prostate Cancer – and the PSA

How’s my blood test?

The Hitchhikers guide to the sphygmomanometer



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