MARCH 25, 2019 PROSTATECTOMY VS WATCHFUL WAITING

This is a very personal topic regarding prostate cancer. There are many treatment options after a man receives a diagnosis of prostate cancer. The decision does rest upon the patient but treatment options bvary from urologist to urologist. In the Internal Medicine ALERT released by Relias Media it was discussed that the incidence of death in the prostatectomy patients versus those men who did watchful waiting. These are two options that may be discussed with a patient with prostate cancer.

The cumulative incidence of death was 71.9 % for the radical prostatectomy group and 83.8 % for the watchful waiting group There has always been debate of what benefit does surgery offer versus the new watchful waiting . The new term in 2019 is active monitoring which is now preferred to immediate surgery

The conclusion is that men with advanced prostate cancer who have radical prostatectomy offers both survival and disease free survival benefits.

A lot to consider

Until tomorrow…

MARVCH 23-24, 2019 STRENGTH TRAINING BEST FOR HEART

We have been told that dynamic exercise as walking, treadmill and cycling is the best form of exercise for the heart. This may not be true.

A recent study published in November 2018 revealed that static exercise, as strength training might be superior to dynamic exercise for conferring protection against cardiovascular disease. The data was extrapolated rom 2005/2006 National Health survey ( NHANES) The study found that for adults greater than 45 years - 28 % engaged in static compared to 21 % in dynamic. Both groups had cardiovascular protection but better in the static group and in the younger age groups

The conclusion is that static appeared to better than dynamic for cardio-protection. This results were presented at American College of Cardiology conference on November 16, 2018

Until tomorrow…

MARCH 22, 2019 WHY WE NEED SLEEP

There have been many studies on the benefits of sleep. You must get quality sleep every night Many use conventional medications to sleep as Ambien, Trazadone, Lunesta, and Clonazepam. I usually want people to sleep without the conventional medications as some are addictive and have side effects. I utilize magnesium, theanine, CBD oil and many nervine herbs as Passion flower, Skull cap, California Poppy, Valerian and even Chamomille.

Quality sleep is known to facilitate the consolidation of memory as well as enhancing cognitive function. Over time it has been estimayted that quality sleep may protect against the development of dementia .

It has bene studied that restorative sleep , both stage 3 ( slow wave deep) and REM sleep have shown to reduce the deposition of amyloid ( beta ) in the brain and also facilitate (AB) ) clearance. It also enhances the glymphatic system of the brain enhancing drainage in metabolic toxins

These studies are encouraging. More needs to be done

Until tomorrow…

MARCH 21, 2019 SLEEP APNEA AND SLOW HEART BEATS

An evaluation for sleep apnea needs to be done for patients with slow heart rhythms as sinus node dysfunction, bradycardia, and sinus pauses. I also feel these patients should be screened for Lyme disease . It has been shown that treatment of sleep apnea offer cardiovascular benefits beyond reduction in nocturnal slow heart rates ( bradycardia)

It is important to make a correlation with appropriate testing of the amount of bradycardia in the face of sleep apnea. We do know that permanent pacemakers are recommended regardless of symptoms for patients with acquired second degree AV block Mobitz Type II, high grade block or third degree block.

Permanent pacemakers are not recommended for patients with AV block that are due to reversible causes as Lyme carditis.

Any patient with a history of snoring and day time tiredness should be evaluated for sleep apnea. There is also a major correlation between sleep apnea and coronary artery disease

Until tomorrow…

MARCH 20, 2019 ANTIBIOTICS AND KIDNEY STONES

Antibiotics do serve a purpose. Sometimes these antibiotics can be miraculous cures, but there are side effects. The main side effect is a disruption in the gut microbiome. Now there is also evidence that patients with kidney stones ( nephrolithiasis) have an altered gut microbiome compared to those without kidney stones. This is important information

The question is how this could happen ? The proposed mechanism is that changes in the gut microflora ( due to antibiotics) alter macronutrient leading to increased calcium formation. This increased calcium formation will lead to kidney stones.

Another hypothesis is that antibiotics select for multi resistant pathogens that promote kidney stone formation. It has been shown that 70 % of bacteria cultured from stones are multi resistant pathogens.

This has to be researched and studied more

Until tomorrow…

MARCH 19, 2019 OBESITY AND CANCER

WE do know that obesity increases the risk of developing cancers. It has been studied and well documented that obesity increases immune aging, tumor progression and even other proteins.

What is more paradoxical is that obesity or excess weight helps immunotherapy drugs kill cancer cells.

This study was done in mice and more needs to be done. The same study was mirrored in man. Those cancer patients with a higher body mean index had better survival than those lean cancer patients.

It was found that there was a difference in T cell function in obvese and non obese individuals.

Until tomorrow…

MARCH 18, 2019 AVOCADOS

WHY EAT AN AVOCADO?

An avocado is power packed with nutrition for many reasons. There are more than 20 vitamins and minerals in an avocado - It provides 21 % potassium, 25 % vitamin C , 30 % folate an d 39 % vitamin K. Each one of these supplements can be used for a variety of conditions.

The healthy fats in an avocado is great for heart health and reduces heart attacks and strokes by lowering total and bad ( LDL) cholesterol. I feel this is a good food for a diabetic as it reduces blood sugar and great at regulating insulin levels.

Since an avocado is packed with B vitamins it is great for the pregnant female It contains lutein and zeaxanthin which is important for eye health

Eat an avocado at least two to three times a week

Until tomorrow…

MARCH 13, 2019 FISH OILS

There was a positive primary endpoint of the REDUCE -IT trial when it comes to the benefit of omega 3 ( EPA). It was presented at the American Heart Association Scientific Session to an outstanding applause. The mechanism might be poorly understood and even accepted but the results are compelling.

This was a large multicenter trial compared patients with high cardiovascular risks and elevated triglycerides who took 4 grams of EPA /day to a group that took a mineral oil placebo. At the end there was a 4.5 % lower risk of dying from cardiac events or experiencing myocardial infarctions, stroke, coronary revascularization than than those who took the placebo

With such results, there was speculation about the placebo oil and if it caused harm. The other flaw was other cardiac risk factors were not measured.

I will continue to describe omega 3 ( EPA) supplementation to my cardiac patients.

Until tomorrow…