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Update September 2017

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Update by Natrakorn Paewsoongnern

Doctor's Consultation  by Dr. Iain Corness


Update September 23, 2017

Hear today – gone tomorrow

I used that headline a few years ago now, but it seems nobody listened! Should I have shouted it a little louder? But jokes aside, deafness is an increasing problem in Thailand, a fact which is being acknowledged by the various noise abatement bodies in this country (and yes, amazingly there are some).

For some reason, noise seems to have become part of the local ‘culture’. How many times have you heard people screaming into their telephones? At volumes so loud they really don’t need the phone at all. Go into shopping centers and be physically assaulted by noise levels so great they approach the threshold of pain. I personally experienced one promotion for children that had passers-by holding their hands over their ears, whilst two screaming and amplified emcees exhorted the children to crowd around the stage (and its boom boxes). The damage to the hearing of young ears could be horrendous! Even walking down the street your ears are assaulted by not just motorcycles but slow moving promotional vehicles with mobile boom boxes to tell you all about the newest shopping center, where you can shop in comfort, other than unrestricted noise!

What does not seem to be understood by the public at large, however, is that hearing, like eyesight, deteriorates over time. However, damage the hearing early in life and when the hearing loss through aging is added to the hearing loss from noise exposure, you are guaranteed of increasing deafness as you get older.

What is not understood is that “noise” is not just measured by intensity, but it is volume multiplied by time of exposure. If the industrial noise level exceeds 90 decibels (dB) for a 40 hour week, this is known as a ‘noise dose’ of 1.0. If the noise level experienced by the unprotected ear was over 120 dB, then the ‘safe’ exposure was measured in minutes. And as an example of 120 dB, that is the level reached by an ambulance siren – or a rock concert. Other examples are the hammer drill that you use to drill holes in concrete which operates at 114 dB or a headset for personal listening at full volume, so the ‘safe’ level here is 15 minutes a day. Even a hand drill operates at 98 dB, so the unprotected ear should not be exposed to this level for more than two hours.

The noise induced deafness characteristically affects the hearing at 4 kHz first, and that is towards the upper musical ranges, and it goes on from there. If this noise induced hearing loss begins early in life, then the chances of the person ending up clinically deaf by the time he or she is 50 years old is very high.

So what can be done? Various research papers from around the world have managed to quantify the risk, and others have managed to show that the risk is perceived by older children and young adults, but they are not likely to do much about it. In some ways I can agree with them. Why bother going to a rock concert if you have to sit quietly to hear the music?

The Canadian Journal of Public Health looked at this problem and reported that 74 percent of rock concert attendees thought it was likely or very likely that noise levels at music concerts could damage their hearing, but only three percent wore hearing protection.

Dr. Jeannie H. Chung and co-workers from the Harvard Medical School found a few years ago that only eight percent of young adults thought hearing loss was a very big problem and yet most respondents had experienced tinnitus or hearing impairment after attending concerts (61 percent) and clubs (43 percent).

So we know the problem exists. We know the relative ‘safe’ levels of noise exposure, but is wearing ear protection the answer? Quite frankly, this is a classic example of the ambulance at the bottom of the cliff, rather than the fence at the top of the cliff. Preventive action needs to be done at the noise source. It is time for us to start shouting at the regulatory authorities! And keep your children away from noisy shopping center promotions!

Update September 16, 2017

Immunizations! The ‘reality’ show

The ‘real’ danger? The thought that immunizing your child makes it more likely that he or she will develop Autism should have been put to rest years ago. Unfortunately this has not been the case, despite reams of scientific reports.

Right at the outset, please take on board the simple fact that MMR vaccine does not produce Autism. I am only going to bore you this once on the subject, but there is plenty of evidence, so please read.

For example, “Although the Wakefield et al. (1998) case reports suggested that the MMR vaccine may be associated with autism, recent epidemiological research has provided strong evidence against any such connection. Kaye et al. (2001) conducted a time trend analysis on data taken from the UK general practice research database. As discussed earlier, they found that the yearly incidence of diagnosed autism increased dramatically over the last decade (0.3 per 10,000 persons in 1988 to 2.1 per 10,000 persons in 1999). However, the prevalence of MMR vaccination among children remained virtually constant during the analyzed time period (97% of the sample). If the MMR vaccine were the major cause of the increased reported incidence of autism, then the risk of being diagnosed with autism would be expected to stop rising shortly after the vaccine was instated at its current usage. However, this was clearly not the case in the Kaye study, and therefore no time correlation existed between MMR vaccination and the incidence of autism in each birth order cohort from 1998 to 1993.”

That was the UK. In the US it was a similar story. “Most recently, the U.S. governments Institute of Medicine, in a comprehensive report cosponsored by the National Institutes of Health and the Centers for Disease Control and Prevention, recently concluded that there exists no good evidence linking the MMR vaccine and autism (Stratton, Gable, Shetty, & McCormick, 2001).”

And finally, in 2004, the Institute of Medicine (IOM) Immunization Safety Review Committee, an independent body of experts who have no conflict of interest with pharmaceutical companies or organizations that make vaccine recommendations, studied a possible MMR-autism link and found no evidence supporting such a connection. A panel of experts brought together by the AAP reached the same conclusion.

Are immunizations ‘dangerous’? Despite claims from some sections of the world’s more vocal communities, I was not at all worried when I took my children to have their “shots”. Sure, I know there are ‘risks’, but all medical interventions have a certain degree of risk attached to them. And when you stop to think about it – just “living” has inherent risks.

I came across some interesting Australian statistics when my son asked how dangerous was it to surf Down-Under. Prepare yourself for some chilling data!

Last year, two surfers were killed by sharks. So that means I’m never going in the water again. However, 300 Aussies drowned, 1,200 had accidental deaths, 2,700 died of cancer and 19,000 died from the results of smoking cigarettes. How are the relative ‘risks’ now? I will chance the water again, though my pool is probably the safest.

I shudder to think about the risks of crossing the road on foot, forget the zebra crossings, as we don’t have zebras in Pattaya, and let’s not talk about the road toll! Yes, the second highest road toll per capita in the world.

With immunization you have to consider the benefit versus risk, and for me, it really is a ‘no-brainer’. I did not want my children to get measles, a much more dangerous illness than most people imagine, for example. The benefit of immunization outweighs risk by far.

The following figures came from the US comparing the results of immunization, versus the situation before immunization campaigns. The first column shows reported diseases and the last column shows the reduction from immunization.

Disease Annual  cases Decrease
Measles 55 99.90%
Diphtheria 0 100%
Mumps 6,584 95.70%
Pertussis  15,632 89.40%
Smallpox 0 100%
Rubella 11 99.90%
Invasive (HiB) 29 99.90%
Polio 0 100%
Tetanus 41 96.90%

Those figures tell you that immunization is effective, and for me, the risks are almost negligible compared to the benefits.

Please consider immunization as a high priority for your children too!

Update September 9, 2017

BSE and it’s not Creutzfeldt-Jakob disease

I had an interesting discussion with a colleague the other day regarding Breast Self Examination (BSE). Is BSE worthwhile? What advances are there?

It made me think back to the words of Dr Michael Moreton, previously the International Medical Coordinator at the Bangkok Hospital Medical Center. I have taken the liberty (with his prior permission) to reprint his letter.

“I was a specialist in Women’s Health care for many years and the techniques used to screen for Breast Cancer are of special interest to me.

“I agree wholeheartedly that Breast Self Examination (BSE) is a useful method of monitoring the breasts. Every woman’s breasts are different in texture and the patient becomes an expert in her own breasts and can recognize changes that a doctor might miss. I suggest to patients that a good time is in the shower or while waiting for the water temperature to stabilize before getting into the shower.

“It is important to know the correct technique. You should press the breast tissue between the chest wall and the flat pads of your fingers, do not use the tips of the fingers. When you have your next physical exam ask your doctor to demonstrate how to do this. Every doctor has had the experience of a woman coming to see them and telling them that they have a breast lump and it is only with the woman’s instructions that the doctor can feel the lump. It’s a good technique; we both recommend that you do this self-examination regularly.

“The debate about Mammography swings one way and another. The modern machines are now using a digital technique. This has several advantages. With the older machines there was a worry that repeated mammograms might even cause cancer due to radiation. There is no chance of that now. With the computer we can also zoom in to worrying areas and get more information. Digital also has the advantage that the pictures can be sent electronically for a second opinion or put on a disk so that you can keep the pictures and show a doctor in another country if that is your wish.

“Ultrasound, can also be useful in certain situations. In order to perform mammography the breast has to be compressed between two plates and X-rayed, in women with small breasts this can be difficult and U/S may be a better method for these women. Similarly women with breast implants may be additionally assessed with this method. If I am particularly interested in one area of the breast I will ask the technician to look carefully at the area. The U/S can be angled in from different directions and this can be useful in examining a worrisome area of the breast. Most modern U/S machines also have a Doppler ability and they can identify areas of the breast with a particularly rich blood supply, which can be a sign of trouble.

“The most exciting thing is the use of genetic studies in assessing the chances of cancer in any one patient. We know that there are two genes BRCA1 and BRCA2 which can be inherited and will increase the chances of cancer developing. When this blood test is perfected any woman will be able to have a blood test to see if she has a high risk or a low risk of getting breast cancer. Then different screening programs can be arranged.

“A few dietary steps can be taken which may help to reduce the chances of cancer. A diet full of fat is thought to be dangerous; one more reason to avoid them. One positive step that mothers should take is to breast feed their babies as it is found that this activity is protective.”

Thank you Dr Moreton, your thoughts from a few years ago are just as relevant today. The genetic studies have to be thought of as “risks” not an absolute diagnosis. Newer technology now has three-dimensional mammography (also called digital breast tomosynthesis, digital tomosynthesis, or just tomosynthesis) creating a three-dimensional picture of the breast. A conventional mammogram only creates a two-dimensional image of the breast from two digital images of each breast.

And while the boffins develop even better techniques, it still needs you ladies to go looking too.

Update September 2, 2017

Are Multivitamins the answer?

There are many supplements including Vitamin B 12, that have been touted as “the answer” for everything from old age and Alzheimer’s to heart disease, breast cancer, high cholesterol, and sickle cell disease. However, the results have been inconclusive. Studies are also suggesting that vitamin B-12 does not help with stroke risk or lung cancer. Nor will it take strokes off your golf handicap.

However, there is some evidence to suggest that some supplements can enhance health in different ways. The most popular nutrient supplements are multivitamins, calcium and vitamins B, C and D. Calcium supports bone health, and vitamin D helps the body absorb calcium. Vitamins C and E are antioxidants - molecules that prevent cell damage and help to maintain health.

One trend is to take daily doses of antioxidants such as beta carotene, vitamin A and C or selenium to protect yourself against cancer, heart disease or signs of premature ageing. There is some scientific evidence that people who have a high level of antioxidants in their diet have a lower risk of heart disease and certain cancers. That is why the nutritionists say we should eat at least five portions of fruit and vegetables a day. However, other studies also suggest that taking those same antioxidants in pill form may not have the same effect and may even be harmful. Who do you believe!

Here’s where we start to have a ‘belief’ problem. Is Big Pharma blocking the sale of health giving supplements because Big Pharma doesn’t “own” them? One problem in the supplements studies is the fact that supplements are not as rigidly tested as are front-line treatments, so the supplements you want to take, may in fact be useless. Or worse, downright dangerous.

When Big Pharma develops something new it then takes several years before this new wonder drug hits the market, after expenditure of millions of dollars. And remember that if Big Pharma can’t make money from new drugs, then all research will halt. The drug to cure cancer will not be found. It is not being held back by Big Pharm, let me assure you. The pill to stop cancer will make the owners of the patent gazillions, not just billions.

But I sidestepped myself. We are all living longer, so what can we do to get our hands on the elixir of youth? If you believe folklore, the answer to aging is again multivitamins. Peddling mega-vitamins is a megabuck industry, credited with improving your health, your love life and fixing everything from falling chins to falling arches.

Unfortunately, “There’s still conflicting evidence about whether taking certain vitamin supplements can affect a person’s risk of cancer,” says Dr Alison Ross, at Cancer Research UK. “These products don’t seem to give the same benefits as vitamins that naturally occur in our food.”

Catherine Collins, chief dietitian at St George’s Hospital in London says, “The whole idea that you must meet some vitamin and mineral target every day of your life is a marketing myth. You can eat lots of fruit and veg one day and not much the next but over a week you will still get the right amount of nutrients. There is very little scientific evidence that there is any benefit whatsoever in taking a daily multivitamin - even in old people. You cannot exist on a poor diet then shore yourself up with a multivitamin. The idea that taking high quantities of vitamins will give you a health boost - like putting premium petrol in your car - is complete nonsense.”

Dr Toni Steer, nutritionist with the British Medical Research Council’s Human Nutrition Research in Cambridge, states supplements cannot compete with real food because when we eat fruits and vegetables the vitamins and nutrients interact with other chemicals to produce positive effects on the body. “If these same vitamins are pulled out and isolated in pill form, there is no guarantee at all that they will have the same effect.”

A study in the journal of the American Medical Association found that people who took antioxidant vitamin tablets (particularly vitamins A and E, and beta-carotene) were more likely to die earlier than those who did not. Oops! What next?

HEADLINES [click on headline to view story]

Hear today – gone tomorrow

Immunizations! The ‘reality’ show

BSE and it’s not Creutzfeldt-Jakob disease

Are Multivitamins the answer?



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