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Update August 2018


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Doctor's Consultation  by Dr. Iain Corness

 

August 18, 2018 - August 24, 2018

Beware of cheap meds!

A few years ago, I was interviewed by a German TV channel which wanted to show that taking over the counter drugs was a dangerous practice. They had gone to great pains to do some secret filming in Thai suburban pharmacies (of which there are numerous).

The drug they wished to highlight was our old friend (or probably better described as the “friend of the old”), the blue diamonds. They had chosen Thailand because so many blue diamonds were being taken here, and they wanted to show the disastrous side effects from taking the fake pills.

During the course of the interview I pointed out that Germany has its own very well-known red light areas, so they could save money on plane fares and get the blue diamond statistics much closer to home. I also pointed out that we were not inundated with octogenarians with heart failure and loaded condoms, and “over the counter” (OTC) drugs could be found all over the world, and not just here.

It might come as no surprise to those who have an inkling of television “news” that they cut my interview out of the feature. Do not forget the journalist’s creed – “Never let the truth stand in the way of a good story”!

So back to counterfeit blue diamonds, how do you find out that yours are real or otherwise? Every day I receive Spam offering me the opportunity to keep a battalion of beauties satisfied. These are the internet email offers of cut-price drugs that will keep me in a state of perpetual priapism, a continuing (and painful) male erection and the term was coined after the Greek god Priapus who is shown in paintings to have a central member like a third leg.

Offers like these which are too good to be true, are usually just that – too good to be true! These cut-price drugs are not the real deal. The chances are very high that they are counterfeit.

One of the patients showed me a box purporting to be genuine brand name Cialis tablets, which were not having the desired effect. I was immediately suspicious as the box was not all that well printed. I was quite sure they were counterfeit when I read the Patient Information slip (the printed sheet that you don’t read). The English grammar was incorrect, and there were spelling mistakes. Eli Lilly, the ‘real’ manufacturer does not send out misspelled literature with their product.

How real is the threat of counterfeit drugs? The World Health Organization estimates that one in three drugs on the worldwide market today is counterfeit. One in three!

Pfizer’s laboratories analyze fakes and stated, “We’ve seen boric acid, heavy metals, road paint, floor wax to coat the pills and give them a shine.”

This is actually a serious situation. If specific drugs are only available through pharmacies, on the prescription of a doctor, is it safe to just buy over the internet (or counter), without any doctor’s advice?

According to WHO, drugs commonly counterfeited include antibiotics, antimalarials, hormones and steroids. Increasingly, anticancer and antiviral drugs are also faked. And you can add to that, the ‘blue diamonds’. Get your medications on a doctor’s prescription. There is a reason for it.

I do know that many of our patients complain that my hospital’s pharmacy is expensive, but that is the price of guaranteeing that your medications are not the WHO’s one in three fake medications in our pharmacy! We may be more expensive, but the medication is the real deal!


August 11, 2018 - August 17, 2018

Siamese Twins

Chang and Eng were the original “Siamese Twins”. Joined at the sternum (front of the chest cage) in 1811, they had been round the world during their lives, members of the popular ‘freak shows’.

However, the Siamese Twins (Conjoined twins) Chang and Eng were not the first to be born with this unfortunate condition. The incidence is about 1 in 10.25 per million births. The major deciding factor in their prognosis is where the joining is, and how many common organs are shared. The most common varieties encountered are joined at chest and abdomen (28 percent), joined at chest (18.5 percent), joined at abdomen (10 percent), parasitic twins (10 percent) and joined at the head (6 percent). Of these, about 40 percent were stillborn, and 60 percent live born, although only about 25 percent of those that survived to birth lived long enough to be candidates for surgery.

This is not a new condition. Elisa and Mary Chulkhurst were one of the first documented cases of conjoined twins when they were born in England in 1100. Most illustrations depict the two joined at the hip, though some picture the two joined at the shoulder as well. Eliza and Mary lived until 1136. There is also the situation that children born with two heads for example, were considered ‘monsters’ and would have been drowned at birth, thereby skewing the statistics.

Conjoined Twins are genetically identical, developing from the same egg, and often share vital organs and limbs.

Current conjoined twins include Abby and Brittany Hensel about whom TV specials have been aired. They share one body and have two heads.

Siamese twins are always newsworthy, and with the advances in surgical techniques, the conjoined twins have a greater chance of independent survival.

Despite the name, Siamese twins can occur in any country, but the most publicized conjoined twins did come from Siam. They were called Chang and Eng Bunker, born in the Mekong Valley of a Chinese father and a Thai-Chinese mother in 1811. The surname came later after they had lived in America for some time, as in 1811 Siamese people did not use any family name.

In 1829, they were discovered in old Siam by British merchant Robert Hunter and exhibited as a curiosity during a world tour. Such was the fate of anyone who had some deformity in those days, and live adult Siamese twins would have been very rare, with most having died at birth or in infancy.

Chang and Eng were joined at the sternum by a small piece of cartilage. Their livers were fused but independently complete. Although 19th century medicine did not have the surgical know-how, modern advances in surgical technology would have easily allowed them to be separated today.

Upon termination of their contract with their discoverer, they successfully went into business for themselves, which is really quite amazing, considering their origin in rural Siam.

In 1839, while visiting Wilkesboro, North Carolina with P.T. Barnum, the twins were attracted to the town and settled there, becoming naturalized United States citizens.

The brothers settled on a plantation, bought slaves, and adopted the name “Bunker.” They were accepted as respected members of the community. On April 13, 1843, they married two sisters: Chang to Adelaide Yates and Eng to Sarah Anne Yates. Chang and his wife had ten children; Eng and his wife had twelve. In time, the wives squabbled and eventually two separate households were set up just west of Mount Airy, North Carolina – the twins would alternate spending three days at each home. During the American Civil War Chang’s son Christopher and Eng’s son Stephen both fought for the Confederacy. Many of their descendants still live in the Mount Airy area (which is also the hometown of Andy Griffith). The twins died on the same day in 1874, as the blood supply to their livers were dependent upon each other, and Eng would have followed Chang, his twin, into death.


August 4, 2018 - August 10, 2018

More(ton) on BSE

My recent column on breast cancer and Breast Self Examination (BSE) produced a response from Dr Michael Moreton, the former International Medical Coordinator at the Bangkok Hospital Medical Center in Bangkok. I have taken the liberty (with his permission) to reprint his letter.

“I was a specialist in Women’s Heath care for many years and the techniques used to screen for Breast Cancer are of special interest to me. I would like to make a couple of additional comments to add to Dr Iain’s words.

“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.

“Another technique that has been discussed for several years and that you may read about is Thermography. In this method the patient is placed in a cool room and photographs are taken with a temperature sensitive camera. Hot spots on the breast can be identified. The problem is that not all hot spots are caused by cancers; I am not too enthusiastic about this method.

“The most exciting thing on the horizon 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 for reinforcing the message on BSE. From here, it is up to you, ladies!)


HEADLINES [click on headline to view story]

Beware of cheap meds!

Siamese Twins

More(ton) on BSE
 

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