Dr. Saleeby's Blog
Web Log (Blog) of the writings of Dr. Saleeby (and occasionally others) on preventive medicine, longevity and nutritional medicine. A NEW Integrative Medicine 21st century paradigm.
Friday, October 06, 2006
Monday, October 02, 2006
West Nile Virus
Authored by Jennifer Quick & reviewed by JP Saleeby, MD
History/Demographics
Protecting ourselves against those pesky mosquitoes could save you not only from an annoying bug bite, but also from transmission of a nasty virus introduced into the United States fairly recently. West Nile Virus (WNV) was first isolated from a female patient presenting with fever like symptoms in Uganda in 1937. It is, however, a relatively new disease to the Western Hemisphere, presenting itself in 1999 when the first cases in America were documented in New York City. The outbreak resulted in 62 infections causing serious illness and seven deaths. Since then, the virus has spread to multiple areas including the mid-west, southern and western states, resulting in a steady increase in the number of infections annually. According to the Center for Disease Control, as of August 22, 2006 there were already 581 reported cases of West Nile Virus infection, with 18 of those cases resulting in the death of the victim. Not only are humans targeted by this virus, WNV infects birds as well as other mammals. Researchers continue to study the pathways of infection, trends in immunity, and signs and symptoms of the illnesses in order to more effectively combat this spreading pathogen.
Bird Infection
Although WNV can be a fatal infection in humans, it is primarily a detrimental disease in birds. The virus is transmitted to other birds through different species of mosquitoes including Aedes, Culex, or Anopheles. These mosquitoes carry and amplify the virus in their salivary glands and subsequently, during a blood meal, the virus is transfered to the bird. The transmission cycle continues as the birds transmit the virus to other feeding mosquitoes and those mosquitoes go on to infect more birds or other mammals. As of September 2000, WNV has been isolated in at least 70 different species of dead birds found throughout the United States.
There are some differences in WNV infection among various species of birds. Dr. Richard Bowen, a researcher at the Animal Reproduction and Biotechnology Laboratory at Colorado State University, has explored some of these differences in various birds such as crows, chickens, and pigeons. He comments that, “There are a lot of differences among birds. Very few American crows survive WNV and typically circulate at 10^8 to 10^9 pfu's of virus/ml of blood. Fish crows, on the other hand, have only a 25-50% mortality rate.” When studying chickens, Dr. Bowen found that, “Chickens greater than 1 week of age that become infected have low viremia levels and usually never get sick. On the other hand, baby chicks infected at less then one week of age do get higher viremias causing illness and death.” Additionally, Dr. Bowen has studied the effects of WNV immunity and immunosupression in chickens. His findings conclude that when immune hens (female chicken) give birth, they transfer their antibody to the chick, thereby protecting the chick with this maternal antibody for approximately one month. After that time, the chicks become susceptible to viremia but do not show signs of illness. Also, it was found that immunosuppression of the chickens increased the magnitude of viremia, but did not make them susceptible to illness. Pigeons, on the other-hand, are “sort of between non-susceptible chickens and highly susceptible American crows.” They show moderate viremia levels with very low mortality rates. As for future research, Dr. Bowen is working on trying to understand what is so lethal about the NY99 strain of West Nile Virus. He is also working on determining whether immunity to WNV makes birds immune to other related viruses such as Japanese encephalitis.
Human Infection
The virus affects not only birds but humans as well. Twenty percent of infected individuals will develop symptoms and one out of 150 of those infections results in encephalitis or meningitis. Additionally, the mortality rate from severe illness is 3-15% depending on who is collecting the data. The severity of infection depends on the degree of central nervous system (CNS) invasion, exposure to multiple bites, and age of the victim. Morbidity and mortality increase with ages over 50 and prove to be especially significant in people over the age of seventy-six. High-risk areas include the Midwest, accounting for 55% of cases, as well as the Southern and Western states. Symptoms in patients usually appear in June and taper off in November.
2006 West Nile Virus Activity in the United States |
http://www.cdc.gov/ncidod/dvbid/westnile/Mapsactivity/surv&control06Maps.htm
The West Nile Virus is a member of the family Flaviviridae. It is an enveloped, spherical, positive sense single stranded RNA virus that contains one open reading frame. The (+) ssRNA serves as the mRNA template that is then translated into one polypeptide and subsequently processed by cellular and viral proteases producing various proteins. These proteins include a capsid protein (C), an envelope protein (E), a premembrane protein (preM), as well as seven non-structural proteins. The E and M proteins are thought to give the mature virion it’s rough appearance.
In order to gain entry into host cells, WNV attaches to a yet unknown receptor on the host cell and undergoes clathrin-mediated endocytosis. More research must be done to verify the actual mechanism of entry, but it has been observed that there is an interaction of the virus with toll-like receptors as well as an increase in tumor necrosis factor alpha (TNF-a) before penetration of the virus into the CNS. Toll-like receptors (TLR's) are transmembrane proteins that were first identified in the fruit fly and later found to be present in various types of mammals and even in plants. There are various types of TLR's and when activated, these proteins begin a cascade of events that alert the immune system to begin combating a pathogen such as a virus. In order to better understand the entry of WNV after supposed interaction with TLR's, it is imperative to know a bit about it's entrance into host cells via clathrin- mediated endocytosis. This process starts when the virus binds to its receptor which then causes a clathrin coat to build up inside the membrane below this binding. The clathrin forms around the pit that is to eventually be endocytosed into the cell (It is thought that clathrin drives the process of endocytosis as well as stabilizes the whole process). Once endocytosed, the vesicle containing the virus loses its coat. Then, vesicles join other vesicles uniting to become what is known as an early endosome. After a series of steps in which the early endosome transforms into a late endosome, the late endosome is then fused with a lysosome. A drop in pH within this lysosome causes a conformational change in the E surface protein thus causing the hydrophobic domain of that protein to insert itself into the lysosome membrane. This fusion allows the nucleocapsid of the virus to be inserted into the cytoplasm of the host cell and begin its replication. This ends the whole process of entry into the host. At this point, host cell ribosomes translate the (+) ssRNA into the mRNA template going on to the Endoplasmic reticulum (ER) to be translated into various proteins. These proteins are cleaved by viral and host proteases and directed to their corresponding places within the cell by host direction. For instance, the E and preM proteins are synthesized in the membrane of the ER and are translocated by host interaction into the lumen of the ER. Similarly, host cell machinery directs the C protein as well as additional proteins such as N2A through N5 into the cytoplasm of the cell.
In order to make more virions it is imperative that more (+) ssRNA be made. Synthesis of this vital component is accomplished in part by the protein N5 which is thought to be the viruses' RNA dependent RNA polymerase. Along with the help of N3 it is able to synthesize (-) RNA from the (+)RNA . This allows more (+)RNA to be made which can then function as an additional template for mRNA synthesis or go on to be packaged in virions that will exit the cell and go on to infect other cells.
Once enough protein and (+)RNA has been made, the virus is ready to package these items and export them out of the cell in the form of new infectious particles. A nucleocapsid is formed from multiple copies of the C protein. (The C protein is one of the three structural proteins encoded by the (+)RNA.) Shortly thereafter, all components are gathered. As the virion is exiting the host cell, the E and preM proteins complex, rendering E ineffective. This critical step is important so membrane fusion does not occur and the virion is able to exit the cell without reentry. Exit of the virion continues with budding through the ER membrane and final departure via the secretory pathway. On exiting the cell, host proteases cleave the preM protein that was once in complex with the E protein, thereby rendering the E protein effective so that the new virus is capable of entry into new cells.
Pathogenesis / Symptoms
After infection by a mosquito vector, the virus incubates in mammals for around 5-15 days. In the 20% of individuals that show signs of infection, symptoms will usually only last for about 3-6 days. Those showing symptoms are classified as either having WNV encephalitis, in which neurological signs of disease are seen, or classified as having WNV fever, ill victims but showing no signs of CNS malfunction. Neurological signs of disease include muscle weakness, flaccid paralysis, photophobia, seizures, mental status changes, respiratory symptoms, inflammation of the brain and spinal cord. WNV fever symptoms include fever, nausea, anorexia, malaise, myalgia, headache, rash, eye pain, and vomiting. Those infected who never show symptoms may never know they were infected unless tested for antibody to the virus.
Diagnosis
The most effective way to diagnose West Nile Virus infection involves serologic testing to detect IgM antibodies specific for WNV. This is done with the use of the IgM antibody capture Enzyme-Linked ImmunoSorbent Assay (MAC-ELISA). This test can, however, provide false positives due to the close relation of WNV to other Flaviviruses and should therefore be confirmed with a plaque reduction neutralization test (PRNT). Also helping in diagnosis is a detailed history from the patient including information about visits to high exposure areas as well as information on exposure to outdoors during peak times of mosquito prevalence. Information about histories involving organ transplants, breast feeding in mothers, as well as blood transfusions is also imperative as contraction the virus has been observed via these routes as well.
Prevention / Deterrence
There is no known medical treatment (pharmaceutical or vaccine) for West Nile Virus infection at this time aside from supportive care. Avoiding mosquitoes is thus the primary way of preventing this disease. This can be done with the use of insect repellents containing N,N-diethyl-meta-toluamide (DEET, 10-30% is considered effective) and ethyl hexandiol, using clothing to cover exposed areas of the body, and staying indoors from dusk till dawn can help in reducing the risk of infection. There is even a clothing manufacturer with the trade name Buzz Off that uses a permethrin compound incorporated in the clothing material.
An alternative to DEET is Picaridin, also known as KBR 3023, an ingredient found in many mosquito repellents used in Europe, Australia, Latin America and Asia for some time. Evidence indicates that it works very well, often comparable with DEET products. Still another “natural” alternative is Oil of lemon eucalyptus (also known as p-menthane 3,8-diol or PMD) is a plant-based mosquito repellent that provided protection time similar to low concentration DEET products in two recent studies.
Also, reporting dead birds to the proper health officials is important in early detection of this virus in your area. Other deterrence mechanisms include picking up garbage and draining standing water from vacant areas and parks in order to hinder breeding grounds for mosquitoes. Researchers on intently studying ways to develop a human vaccine and antiviral drugs to treat WNV for the years to come.
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Reference:
Childs, Gwen V. “Receptor Mediated Endocytosis.” Text copyright 1996.
http://www.cytochemistry.net/Cell-biology/recend.htm. Accessed September 15, 2006.
Microbiology and Bacteriology. “The West Nile Virus.”
Timothy Paustian. 1999-2006. http://www.bact.wisc.edu/Microtextbook/index.php?name=Sections&req=viewarticle&artid=206&page=1. Accessed August 25, 2006.
“New York State West Nile Virus Response Plan – Guidance Document.” May 2001.
http://www.health.state.ny.us/nysdoh/westnile/2001/responseplan/2001wnv_responseplan.pdf
Accessed August 26, 2006.
Salinas, Jess D. et al. West Nile Virus. www.emedicine.com/pmr/topic236.htm. Accessed August 26, 2006.
“Statistics, Surveillance, and Control.” Center for Disease Control.
http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount06_detailed.htm.
Accessed August 26, 2006.
“West Nile Virus Transmission Cycle.”
http://environmentalrisk.cornell.edu/WNV/WNVEducDocs/WNVTransCycle.pdf.
Accessed August 26, 2006.
http://www.ces.ncsu.edu/depts/ent/notes/Urban/repel.htm, Accessed October 2, 2006.
http://www.buzzoff.com/ Accessed October 2, 2006
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Jennifer Quick received her BS degree (2006) in Microbiology from Colorado State University. Also obtaining a minor in Biomedical Sciences (Anatomy and Neurobiology). She has experience as a research assistant in a West Nile Virus lab (2003-2005) as well as an HIV lab (2005-2006); Jen is acknowledged in a publication titled "Derivation of phenotypically and functionally normal macrophages from lentiviral vector transduced human embryonic stem (hES) cells for HIV-1 gene therapy.”
JP Saleeby, MD is assistant medical director of the Emergency Department at Liberty Regional Medical Center in Hinesville, GA. He held a faculty position at Georgia Southern University in the department of nursing. He is a medical and health writer for several online and print journals. He has authored a book entitled “Wonder Herbs: A Guide to Three Adaptogens”, published in 2006.
© 2006
Sunday, September 24, 2006
Cortlandt Forum - Most Unusual Case - 9/2006

http://www.cortlandtforum.com/content/index.php?id=26&no_cache=1&tx_cortlandtmagissue_pi1[showUid]=891
Sunday, August 13, 2006
A Trip to the Charleston Tea Plantation


As a Lowcountry resident and the recently christened medical and health writer for the Tea Experience Digest magazine, we felt it our duty to visit the Charleston Tea Plantation. If you have not had the opportunity to visit the area, our Lowcountry simply refers to the coastal region of South Carolina. At best Charleston and its surrounding areas are genteel, refined and laid back. In the immortal words of George Gershwin, “Summertime and the living is easy.” At its worst it is hot and humid, hard on us southerners, downright unbearable on our northern visitors, and positively the best environment for tea growing. Armed with pen and paper off we trekked on our adventure, some thirty minutes south of Charleston. The drive was fabulous, a kaleidoscope of shade thrown on the trail by overhanging Spanish moss draped oak trees, so typical of Charleston back roads. What makes this plantation so special is the fact that it is the only tea growing operation in the continental United States. There are growers in Hawaiian islands that have been producing tea since 2000, but this plantation is in our own backyard.
The origins of the plantation, its development, its owners and the tea production are each stories in their own right. And so the journey begins. Calling ahead I spoke with Linda Fasig the plantation’s Tea Shoppe manager who promised me an interview with someone in the know about the operation and the growing of the local tea. Upon our arrival at the Charleston Tea Plantation on Wadmalaw Island, we were ushered back to a corner office in the main building of the facility. At the doorway a burley old salt of a fellow greeted us. Not quite the image one entertains when told you were about to meet a seasoned professionally trained tea taster. William (Bill) Hall, the co-owner of the Plantation (he is partnered with the Bigelow Tea Company), is a commanding figure, with long finger-combed locks of hair and well tanned from days in the field. Bill greeted us with a warm smile and we were immediately put as ease. He took a bit of time out of his busy day for an impromptu interview on this locally produced tea, the history and business of tea in America, and what makes American Classic Tea stand out.
Tea cultivation in the United States was first attempted back in 1744 when the Trust Garden in Savannah, Georgia acquired a few tea seeds. The very first recorded successful cultivation of the tea plant (Camellia sinensis) were those grown on Skidaway Island near Savannah in 1772. The history of the Charleston Tea Plantation goes back to a tea grower by the name of Dr. Charles U. Sheppard. In 1888 he established the Pinehurst Tea Plantation near Summerville, SC. Dr. Sheppard’s farm was maintained by a force of child laborers, who had the arduous task of picking tea leaves by hand. In exchange for their hard work they received an education on the grounds of the plantation. The Pinehurst plantation produced award-winning teas for many years. In fact at the 1904 World’s Fair their oolong tea took home first place awards.
It turns out that Dr. Sheppard originally obtained the tea plants from Robert Fortune in 1842. Robert Fortune was a cantankerous Scotsman who trained at the Botanic Garden in Edinburgh in the mid-1800s. After his training he became what is know as a “plant hunter” and landed on the shores of China in 1843. For the next three years, often disguised as a Chinaman with shaved head and ponytail, he navigated the interior where few Europeans had been before. He was able to acquire hundreds of plants including C. sinensis, the tea plant, to be shipped back to England. It is from this stock that the plants reached the new world.
Upon his death in 1915, Dr. Sheppard’s plantation became dormant and the tea plants flourished unattended. In 1963 the Lipton Tea company set up a research site on Wadmalaw Island and transplanted some of the original tea plants from Sheppard’s garden to their new site, a former potato farm. Lipton maintained this research facility due to fears that the third-world tea producing countries would not be politically stable enough to ensure a consistent supply of tea leaves to US markets. It remained in operation until 1987 when Bill Hall and Mack Fleming acquired it from Lipton. They turned the research facility into a working tea producing farm until 2003. The Bigelow Tea company then partnered up with Bill to purchase the plantation at auction in 2003. After a three-year renovation of the plantation by Bigelow, it opened in January of 2006 for tours and full production. The brand American Classic Tea is made up predominately with tea grown from this plantation. This tea besides being home grown is free of pesticides and synthetic chemicals necessary in other tea growing regions.
Bill describes this chemical-free gown tea as those produced without the use of pesticides, herbicides, and fungicides of any sort. Fortunate for the American grower, there are no know indigenous insects or opportunistic flora that infest or threaten the plants. In Asia, tea growers have to contend with tea green leafhoppers, red spider mites, mosquito bugs, thrips and red borers that can impact harvest yields. It is not termed “organic tea” on account of the fertilization. The proper nutrient balance of nitrogen, phosphorus and potassium is maintained by a commercial N-P-K fertilizer. The plantation crop is analyzed periodically by taking the 3rd leaf from the top as a sample and testing in a laboratory for N-P-K content. Adjustments can then be made to the fields to bring the soil up to optimal levels. To truck in “organic” chicken guano fertilizer, guests visiting the plantation would be trotting through three inches of the highly offensive material, hence the use of commercial fertilizers. Aside from the type of fertilizer used this tea is about as “natural” as you can get.
The tea plants are propagated by means of cloning. This is not some futuristic science project, but rather the term that describes taking cuttings from existing plants and subjecting them to a chemical that will sprout roots. These cuttings are then planted and will become identical offspring in each and every way to their parent plant. After growing for 3 to 4 years they are ready to give up their top shoots for the production of the tea we drink.
The tea is harvested every 15 to 18 days. To keep the cost of the harvest competitive, the plantation mechanized the harvesting process by customizing a tobacco harvester lovingly called the “Green Giant”. With this machine, the only one of its kind, they could cost effectively harvest the top leaves of the plant with a minimal human labor force.
After laying dormant during the winter months the first “flush” (top leaves of the plant) is the most prized. Three-to-five inches of new shoots grow in between harvests to provide about 10 harvestings each summer from each plant.
Some 5000 pounds of leaves are harvested a day. Once the clippings reach the factory they are loaded on a machine that blows warm-dry air through the leaves. This is know as the withering period. After eighteen hours some 12% of the moisture in the leaves evaporates. From there the leaves move into a Rotovane where the leaves are ground in order to rupture the tea leaf cells. Tea leaves are comprised of 20% solids and 80% liquids and in order for them to be able to oxidize and release all the aromas we taste the cells need to be ruptured. These shredded leaves are referred to as dholl.
From the Rotovane leaves are spread 2 inches deep on a slow moving conveyor belt. This is the oxidization bed where it is determined what type of tea is produced. For white and green tea, no oxidization occurs and the leaves are immediately steamed to halt any oxidation process. The term fermentation is often used here, but is a misnomer. There is no fermentation as one would see in winemaking. No conversion of sugars to alcohol via yeast metabolism occurs here. So the term oxidization is more appropriate as oxygen in the atmosphere produces an enzymatic reaction with the liquids in the tea. For black tea the leaves remain on the belt for 50 minutes. For oolong tea it requires only 15 minutes.
From the oxidization belt the leaves are then placed in the dryer room where they sit at 250 degrees Fahrenheit for 25 minutes. This removes unwanted liquid and moisture from the leaves and stops any further oxidation by inactivating the enzymes in the leaves. They are then ground up and passed through two sets of sieves that remove the stock and fiber. A final static electricity machine is used to remove the miniscule amounts of stock and fiber that may have passed the sieves. For every 5 pounds of tea leaves harvested from the field this process yields one pound of ready to steep tea. Finally, these leaves of American Classic Tea are sealed and packaged awaiting shipment to retailers and ultimately the hot water of your teapot.
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JP Saleeby, MD is an ER Physician and medical-health writer for several local and regional magazines including the Tea Experience Digest Magazine.
Sharon Coopersmith is a pediatric respiratory therapist at MUSC in Charleston, SC. She co-writes articles on a regular basis with Dr. Saleeby.
© 2006
Wednesday, August 02, 2006
Destination Democracy
DESTINATION DEMOCRACY
by Michael Saleeby (Abu Yusuf, my father)
Much has been written and said about the desire to bring freedom, liberty and democracy to the oppressed regions of the world thereby resulting in peace. This is a noble goal. It is based upon our experience in Japan and Germany following WW II. Wars are sometimes necessary in order to achieve this goal, even though they are extremely costly in terms of human life and suffering as well as material things.
Let us also look at some recent alternatives to these global wars. Take, for instance, Chile where Allende was, by all accounts, "freely" elected as president . His Communist regime was not favorable to the USA. Remember that Hitler was also "freely" elected, and so was Hamas in the Palestinian territories. Free elections are not necessarily a good measure for liberty and democracy. It may not be free choice at all. It may be akin to a shot-gun wedding. Anyway, in situations such as these, we may desire to change regimes either by our force by conquering, but not occupying, the Country, or via a military coup. Occupation is not wise, considering what happened to the Israeli forces when they occupied Lebanon in the 80's, or what's happening right now to US led Coalition in Iraq and Afghanistan. It all takes very careful planning such as identifying a local military figure capable of carrying out the PLAN. Such a plan would start out by cleansing the regime of undesirable elements, clamping down on anarchy and corruption, and pacifying the country by any and all means necessary short of torture or murder. Then and only then a GRADUAL and sure-footed road to democracy would ensue. The road may be long, hard, costly and even dictatorial at first. But, in the end, it is worth it. We should always cultivate LOCAL figures to execute a well thought-out plan with our full moral, logistic and material support in order to achieve this noble destination.
Michael Y. Saleeby
Melbourne, FL
mysaleeby@aol.com
Sunday, July 23, 2006
Tick Borne Illness

Tick Borne Illness
by Jennifer Quick & JP Saleeby, MD
With over 800 different species of blood-sucking parasites ready for their meals during the summer months, it's no wonder that humans who roam the outdoors risk becoming inadvertent victims of these insects. Chief among these summer pests are ticks, which inhabit woods, tall grass, weeds, and brush throughout the United States, and are excellent vectors for a variety of pathogens known to cause illness in humans. A vector is a term used to describe in this case an insect that carries a disease to humans. The vector itself does not cause disease but rather the pathogens it carries and spreads from one host to another are the culprits of various illnesses. People need to be aware of how ticks transmit disease, what the symptoms of these diseases are, what the treatment options are, and, most importantly, what they can do to prevent tick borne diseases.
An essential feature for disease transmission to humans is the life cycle of the tick. Ticks go through various stages, all of which are characterized by a blood meal from one or more hosts including mammals, reptiles, and birds. Although some animals are more common prey of certain ticks, there is no real preference, hence the reason why humans fall victim.
It is not the tick that causes disease, but rather the bacteria or pathogen present in the tick. One tick can carry multiple pathogens. It is a consequence of feeding on a human that the tick transfers these disease causing pathogens into the human body, successfully evading man’s first line of defense against infection, the skin. Pathogens actually get a great "free ride" and would actually never infect humans if not for these tiny pesky vectors. While the tick secretes substances such as anticoagulants, immuno-supressives, and anti-inflammatories which help fasten itself to the host as well as remain inconspicuous, the bacteria are also able to utilize these substances at no expense. These substances help pathogens to establish themselves successfully and subsequently they begin causing illness rather quickly.
Some of the pathogenic microorganisms in a tick cause what are known as rickettsial diseases. This specifies a group of bacteria taxonomically divided into different genera's including Rickettsia, Erlichia, Orientia, and Coxiella. After entering the body, these organisms exert their pathologic effects by adhering to various organs and then invading the subsequent endothelial lining. It is after this point that the specific types of bacteria in the different genera's cause various illnesses spanning a range of self-limiting, to mild, to life threatening. Other pathogens causing tick borne illnesses include protozoans such as Babesia and specific types of spirochete organisms such as Borrelia burgdorferi.
Illnesses and Symptoms
Rocky Mountain spotted fever (RMSF), caused by the bacterium Rickettsia rickettsii, is the most common fatal tick borne illness in the United States. Small deer ticks become infected with it when they feed on an animal possessing this bacterium. The infected tick then transmits these rickettsiae after feeding/biting another organism. The tick must be attached for 6-24 hours to transmit the bacteria. The rickettsiae then multiply in the endothelial cells (inner lining) of small blood vessels. A major difference seen in RMSF compared to other rickettsiae diseases is its tendency to invade throughout the body instead of localizing in one area. The result is leakage of intravascular fluid into the tissue space causing what is known as vasculitis. Increased vascular permeability also leads to edema (accumulation of fluid), hypovolemia (decreased amount of blood), & hypotension (low blood pressure), .
RMSF is also heralded by fever, headache, and myalgia (muscle pain) in addition to a characteristic petechial rash in around 90% of infected patients. A petechial rash presents itself with non-raised purplish spots, like tiny dose of hemorrhaged blood. This rash, along with history of exposure to a tick bite, help in the clinical diagnosis of this disease. It is also important to note RMSF is the only tick borne illness that can cause congestive heart failure. Because of these serious complications, if not treated, death can easily occur.
In contrast to the localization of RMSF, Q-fever is also a rickettsial disease, but is caused by the organism Coxiella burnetii, affecting mainly the respiratory system. Unlike RMSF, Q fever has other modes of transmission besides tick exposure which predominate. It is spread mostly via the aerosol route but in the late 1930’s an American bacteriologist named Dr. Herald R Cox discovered the tick vector transmission of the disease and thus the organism was named after him (Coxiella).
Interestingly, this vector transmitted bacterium is able to produce spores allowing it to live for months to years in rather harsh environments. Because of this and its low infectious dose, it has actually made the list of biological warfare agents.
Sometimes referred to as "spotless RMSF" the disease ehrlichiosis is another vector transmitted illness caused by infection of a Gram negative organism closely resembling that of rickettsia. Usually seen within one week after exposure to the tick bite are symptoms such as fever, myalgia, and headache that are extremely similar to those seen in RMSF. Contrasting between the two diseases, vasculitis is not observed with ehrlichiosis and rashes are rare. In the event that a rash does appear it is maculopapular instead of petechial, distinguishing it from RMSF. A maculopapular rash contains discolored spots that are not elevated above the skin as well as papules that form bumps on the skin. Because of the absence of many physical findings, it is sometimes difficult to diagnose ehrlichiosis and many victims go untreated.
Also causing tick borne illness is the protozoan Babesia, causing the illness babesiosis. Named for its finder, Dr. Victor Babes, a Romania bacteriologist who in 1885 discovered this organism, this tick borne malaria-like illness can cause life-threatening disease in the elderly, immune-compromised, and asplenic(absence of spleen or functioning spleen) individuals. An interesting side note about Dr. Babes. His nephew, Aurel Babes, also a physician, discovered a screening test for cervical cancer, later popularized by Dr. Papanicolau and known as the "Pap smear".
Clinical manifestations of babesiosis arise after 1-3 weeks and include hemolytic anemia (low blood counts due to red blood cell destruction), thrombocytopenia (low platelet count), and atypical lymphocyte formation, caused by the infection of red blood cells. The spleen normally captures these infected cells and presents them to macrophages for degradation as part of the human immune system. This helps to explain why asplenic patients have a hard time overcoming the disease and why healthy individuals are usually asymptomatic. If infection does progress, symptoms are similar to those of malaria. Symptoms include chills, followed by fever and profuse sweating, in addition to dizziness, nausea, and weakness caused by depletion of body fluids and electrolytes. Babesiosis is yet another disease difficult to diagnosis due to lack of unique physical findings.
The most common tick borne illness in the United States is Lyme disease. The name of the disease originates from the first documented cases located in Lyme, Connecticut. It was thought that a simple outbreak of arthritis had occurred when in fact the arthritis was due to a disease caused by the bite of a tick carrying the spirochete Borrelia burgdorferi. Once introduced into the skin the bacterium spreads and in 7-14 days it causes a rash known as erythema migrans or a "bulls-eye" rash. The name of the rash describes the characteristic rings or multiple rings that form and look literally like that of a bulls-eye. This also accompanies one or more of the following: fever, chills, myalgia, arthralgia (pain in joints), headache, and malaise. Further dissemination into the bloodstream leads to common infections of the skin, eye, muscle, heart, and central nervous system. Interestingly, the bacterium specifically targets the seventh cranial nerve causing Bell’s palsy (a unilateral paralysis of the facial muscles). After a period, usually weeks to months, it can also travel to synovial fluid causing and explaining the arthritis like symptoms. Another grave symptom is the effect on the heart. Approximately 8% of those suffering Lyme disease will acquire a heart-block that interfere with electrical conduction in the cardiac muscle and can result in sudden death.
Diagnosis/Treatment
Diagnosing tick borne infections can be difficult. As with the case of Q-fever, babesiosis, and ehrlichiosis, there is no one tell-tale sign of infection. With Q-fever half of the patients are asymptomatic. A babesiosis infection is also usually asymptomatic in healthy individuals and only presents with broad malaria-like symptoms if immune-compromised. Ehrlichiosis presents with broad symptoms as well which are difficult to narrow down to one illness. The one test that could clue the doctor into ehrlichiosis is a chest radiograph (x-ray) which would show up as abnormal due to respiratory symptoms caused by this disease. However, this is only seen in 50% of patients and is not a confirmatory test. It is imperative that physicians take a good history from the patient and it is crucial that it be determined if tick exposure was present. Known exposure to tick infested areas during the summer to fall months poses a greater possibility and therefore deeper analysis of more specific symptoms related to each illness. Finally, confirming diagnostic tests can be performed to verify the presence of tick borne pathogens.
For Q-fever, the enzyme linked immunosorbent assay (ELISA) test can be used in addition to the indirect immunofluorescent antibody test (IFA) or the polymerase chain reaction (PCR) testing. Isolating the bacteria from the blood is not recommended due to the fact that laboratory technicians have developed the illness while performing such tests. For babesiosis, the best test is the Giemsa or Wright stain of a blood smear that would show the protozoan. Additionally, IFA can be used as well as PCR which holds additional promise for detecting small numbers of the parasite. Similarly, ehrlichiosis uses the Giemsa or Wright stain that reveals morlulae (globular mass of cells) in the cytoplasm of leukocytes.
Some tick borne illnesses are a bit easier to diagnose. Lyme disease possesses a characteristic "bulls-eye" rash. This, along with a history of being in an infectious area, makes for a convincing clinical diagnosis. Confirmation tests for the later stages of Lyme disease include a two step serology test, first requiring an ELISA or IFA and then a Western blot analysis against specific antigens. Similarly RMSF is a bit easier to diagnose with its distinctive petechial rash. Confirmation tests include IFA, latex agglutination, or enzyme immunoassay. Also, skin biopsies stained with immunofluorescent or immunoperoxidase reveals the Rickettsia rickettsii bacterium.
Treatment plans vary according to the illness. Antibiotics such as doxycycline, the penicillin class and cephalosporin class are the mainstay of therapy. Doxycycline is a common and inexpensive antibiotic of choice for treatment of RMSF, ehrlichiosis, and Q-fever. Especially important in RMSF is this antibiotic treatment as it reduces mortality rates from 20% to 5%. Treatment for Lyme disease is a bit more complicated depending on the symptoms and course of the illness. For early localized/disseminated diseases with no central nervous system (CNS) involvement, amoxicillin or cefuroxime is recommended. If CNS involvement is seen, ceftriaxone or penicillin is recommended for longer periods of time. Recommended treatment for babesiosis is clindamycin or a macrolide antibiotic and an oral quinine for 7-10 days.
Prevention
Prevention of tick borne illnesses is fairly straight forward. Education and awareness is vital in preventing such diseases. During the peak seasons of tick exposure, mainly the summer to fall months, wearing long pants and tucking pant legs into socks is key in preventing ticks to leg exposure. Also, wearing bright colored clothing helps ticks to be spotted more easily when doing tick checks after being in high exposure areas. These areas include the northwestern and northeastern United States as well as any areas that are grassy or full of shrubbery. Additionally, insecticides such as DEET on the clothing or skin helps deter ticks.
Inspecting areas of the body after being in high exposure area's is also critical, remembering to check in inconspicuous places such as behind the ears and in the hair. Inspect pets as well before letting them into the house. If you see a tick, quick removal is necessary since it takes only hours for the transmission of the pathogen. When removing a tick make sure that the mouthpart is removed without damaging the tick. To do this, take forceps or tweezers and grab the tick where it attaches to the skin and gently pull the tick out. Don’t crush the tick, as this maneuver will cause the "injection" of infecting pathogens found in the tick’s salivary glands to increase the likelihood of infection.
Taking a couple of minutes to do these things can save one from uncomfortable and perhaps deadly illnesses. Be cautious, be aware, be educated, and ticks will have to find another host to target!
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Jennifer Quick received her BS degree (2006) in Microbiology from Colorado State University. Also obtaining a minor in Biomedical Sciences (Anatomy and Neurobiology). She has experience as a research assistant in a West Nile Virus lab (2003-2005) as well as an HIV lab (2005-2006); Jen is acknowledged in a publication titled "Derivation of phenotypically and functionally normal macrophages from lentiviral vector transduced human embryonic stem (hES) cells for HIV-1 gene therapy.”
JP Saleeby, MD is assistant medical director of the Emergency Department at Liberty Regional Medical Center in Hinesville, GA. He held a faculty position at Georgia Southern University in the department of nursing. He is a medical and health writer for several online and print journals. He has authored a book entitled “Wonder Herbs: A Guide to Three Adaptogens”, published in 2006.
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Reference:
Amitai, Allon. Et al. "Tick-Borne Diseases, Rocky Mountain Spotted Fever." http://www.emedicine.com/emerg/topic510.htm. Accessed July 23, 2006.
Bachur, Richard G. et al. "Lyme Disease."
http://www.emedicine.com/ped/topic1331.htm. Accessed July 23, 2006.
Cunha, Burke A. et al. "Babesiosis." http://www.emedicine.com/med/topic195.htm. Accessed July 23, 2006.
Edlow, Jonathan A. "Tick-Borne Diseases, Q Fever." http://www.emedicine.com/emerg/topic589.htm. Accessed July 23, 2006.
Ellow, Jonathan A. "Tick-Borne Diseases, Introduction." http://www.emedicine.com/emerg/topic584.htm. Accessed July 23, 2006.
Friedman, Allan D. et al. "Babesiosis."
http://www.emedicine.com/ped/topic193.htm. Accessed July 23, 2006.
Henderson, Sean O. et al. "Babesiosis." http://www.emedicine.com/emerg/topic49.htm. Accessed July 23, 2006.
Meyerhoff, John. "Lyme Disease." http://www.emedicine.com/med/topic1346.htm. Accessed July 23, 2006.
Migala, Alenxandre F. et al. "Q Fever." http://www.emedicine.com/ped/topic1973.htm. Accessed July 23, 2006.
Moellering, R.C, et. al., "Avian flu, West Nile virus, and Lyme disease: Tracking the progress of hot
zoonoses." Patient Care, April 1, 2006.
Rathore, Mobeen. Et al. "Rickettsial Infection." http://www.emedicine.com/ped/topic2015.htm. Accessed July 23, 2006.
Snyder, Richard H. et al. "Rocky Mountain Spotted Fever." http://www.emedicine.com/med/topic2043.htm. Accessed July 23, 2006.
Walker, David H. Medical Microbiology 4th Edition. "Rickettsiae." Ed Baron, Samuel. The University of Texas Medical Branch at Galveston, 1996 ch. 38. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.chapter.2078. Accessed July 23, 2006
©2006
Monday, July 03, 2006
Dear Doctor Gupta.. Thanks a lot man.

Dear Dr. Gupta,
Firstly, congratulations on passing your boards and becoming a diplomate of the American Board of Neurosurgery. That is a lot of time, sweat and money dedicated to that field of medicine to ultimately practice journalism. Secondly, your article “How I passed my boards” (TIME magazine, July 3, 2006, Vol. 168, No. 1) absolutely infuriated me. On June 10th I posted an article entitled “The Problem Facing Emergency Departments” lamenting the whole board certification issue.
A few things you should share with your readership:
1. Board certification does not necessarily make a better doctor. I know of a double-boarded physician who I would not let touch my pet hamster. While there are many GPs who are not BE/BC who are extremely capable and good doctors because of their years of experience (I consider myself one of those in practice). I believe experience is the true barometer of a competent physician.
2. Board certification examinations are limited to those who complete residency training. They shut out those doctors who have practiced and self-learned (via CMEs) from taking the test and becoming BC. It is as if the state required everyone taking their driver’s test to take drivers education. Not fair in my opinion. Downright discriminatory. But I know the reasons that may not be obvious to the lay person. The colleges have a stranglehold on the subjects they are certifying. They want to imprison them in residency training programs for years as a source of cheap labor in our healthcare system in return for permission to take the exam.
3. Furthermore, in recent years the American College of Medical Specialties (ACMS) have required repeat examinations to re-certify physicians. They claim the reason is to keep a set standard. My impression is that they are lining their pockets over and over again by bilking the American doctor thousands of dollars to re-take the exams. Every state requires a set number of CMEs to be completed to maintain a medical license. Enforcing these requirements should insure a physician’s ability to keep up with the current standard of care and the cutting edge new technologies in medicine. I take my CMEs very seriously, I go over and above what is required for my licensing and you will never see me cutting class to swing a golf club.
4. The American public, hospital administrators and other involved have been duped by the ACMS into believing that boarded physician’s are better. They along with Medical Malpractice Insurance Companies & JCAHO have convinced hospitals to change bylaws banning capable non-boarded physicians from practice. They are tightening their chokehold on our healthcare system to no ones benefit. While we have over 800,000 physicians in this country we are in a shortage which will be getting worse.
Respectfully,
JP Saleeby, MD
www.saleeby.net
Environmental Estrogen Endocrine Disruptors
A subject this author wrote her thesis on inspired by an article I wrote on this subject matter.
ENVIRONMENTAL ESTROGEN ENDOCRINE DISRUPTORS
AND THEIR EFFECT ON WILDLIFE
written by:
Kathryn Guardiola
Biology 4950
Advisor: Dr. Smith
Senior Seminar Coordinator: Dr. Smith
July 3, 2006
Table of Contents
Table of Figures *
Outline *
Abstract *
Background of EDCs and their environmental effects *
Historical background *
The environment remains in danger *
Controversy surrounding EDCs *
EDCs have a variety of sources, chemical structures and effects on organisms *
Sources of EDCs *
Bioaccumulation *
Endocrine Disruption spans the food web *
EDCs are discovered in higher organisms *
EDCs omnipresent in environment *
EDCs are found in various organisms throughout the world, they cause many detrimental effects and they must be stopped *
EDCs span the globe and the food web *
EDCs have affected countless organisms *
EDCs require further investigation *
A call to action *
References *
Table of Figures
Figure 1: Selected Steroidal Hormones *
Figure 2: Pesticides determined to cause endocrine disruption *
Figure 3: Selected Industrial chemicals and their structure *
Figure 4: An example of a Marine Antarctic food web *
****Figures not included*******
Outline
Thesis statement: Endocrine disrupting chemicals are being unremittingly introduced into nature via countless sources, and these substances are having profound, detrimental effects of a variety of wildlife organisms. Unless immediate action is taken, EDCs pose a threat to the future existence of healthy ecosystems.
I.EDCs have a history of controversy and environmental effects.
A.EDCs have a long historical background.
1.DDT, a known EDC has been widely used in the past.
2.DDT was discovered to cause harm to the environment.
a.Rachel Carson exposed effects of DDT in her book "Silent Spring."
b.DDT was banned by the EPA in 1972.
B.The environment remains in danger.
1.DDT breaks down slowly and has harmful by-products.
2.Other EDCs are being introduced to the environment at profound rates.
3.There are various sources of EDCs both natural and synthetic.
4.EDCs interfere with the endocrine system of the body.
a.EDCs interfere with hormones in the body.
b.EDCs interfere with development, growth and reproduction.
C.There is controversty surrounding EDCs.
1.The EPA named EDCs a top research priority.
a. The initiative came after the EPA was threatened by lawsuit.
b.The paper industry attempted to keep negative effects of dioxin hidden.
2.The commercial value of EDCs keeps them hotly debated.
a.Many popular products are sources of endocrine disruptors.
b.Many industries desire to keep products on market regardless of environmental implications.
II.EDCs have a variety of sources, chemical structures and effects on organisms.
A.There are a number of sources
of EDCs (Hohenblum, Gans, Moche, and others 2004).
1.Natural and synthetic steroidal hormones are a source of EDCs.
a.Estrogens produced by the body are a source of EDCs.
b.Synthetic estrogens used in pharmaceuticals are a source of EDCs.
2.Anthropogenic industrial chemicals are a source of EDCs.
a.Pesticides are a source of EDCs.
b.Polychlorinated biphenyls (PCBs) are a source of EDCs.
c.Dioxins are a source of EDCs.
d.Alkylphenols are a source of EDCs
e.Bishpenol A is a source of EDCs.
B.There is a basic common chemical structure of EDCs.
1.EDCs usually have at least one aromatic ring in their chemical structure.
2.Many EDCs have chlorine atoms attached.
3.The close resemblance to natural estrogens allows synthetic compounds to bind receptors with ease.
4.Mimicking, blocking or disrupting may still be achieved by EDCs regardless of molecular structure.
C.EDCs move up the food chain during bioaccumulation.
1.It is believed that EDCs enter the environment at the base of the food web.
a.EDCs have been discovered in sea ice algae, krill, and plankton.
b.The base of the food web is where bioaccumulation begins.
2.EDCs are lipophilic, causing them to absorb and magnify in creatures with
higher body fat (Chiuchiolo, Dickhut, Cochran, and others 2004).
3.Experimenters found that lipid content of several analyzed tissues was the
determining factor in the accumulation of EDCs (Hoekstra, O’Hara, Backus, and
others 2005).
4.Bioaccumulation was reiterated by a study on lobsters (Walker, Bush, Puritz,
and others 2005).
D.Endocrine Disruption spans the food web.
1.EDCs are found in organisms ranging from the base of the food chain up to the
highest predators.
2.Many lower organisms are being negatively affected by EDCs.
a.Crustaceans are being affected by EDCs (Walker, Bush, Puritz, and
others 2005).
b.Echinoderms (invertebrates) are being affected by EDCs (Roepke,
Snyder, and Cherr 2005).
c.Fish are being affected by EDCs. (Toft and Guillette 2005), (Elango,
Shepherd, and Chen 2006), (Zha, Wang, and Schlenk 2006).
d.Amphibians are being affected by EDCs (Bogi, Schwaiger, Ferling, and
others 2003)
e.Reptiles are being affected by EDCs (Gunderson and Bermudez and
others 2004)
E.EDCs are discovered in higher organisms
1.EDCs have been found in marine mammals.
a.EDCs have been discovered in polar bears (Dietz, Riget, Sonne, and
others 2004), (Verreault, Muir, Norstrom, and others 2005).
b.EDCs have been found in Arctic beluga whales (Stern, Macdonald,
Armstrong and others 2005).
c.EDCs have been found in dolphins (Fossi, Marsili, Lauriano, and others
2004), (Marsili, D’Agostino, Bucalossi, and others 2004).
F.EDCs omnipresent in environment
1.An encompasing study found EDCs in dozens of different species from Alaska
(Hoekstra, O’Hara, Backus, and others 2005).
2. An encompasing study found EDCs in dozens of different species from
Greenland (Vorkamp, Riget, Glasius, and others 2004).
III.EDCs are found in various organisms throughout the world, they cause many
detrimental effects, and they must be stopped.
A.EDCs span the globe and the food web.
1.EDCs are found in every corner of the globe.
2.EDCs are found in organisms of every hierarchical status.
B.EDCs have affected countless organisms.
1.The negative effects of EDCs have been seen in many organisms.
2.Negative effects of EDCs have been observed in crustaceans, echinoderms, fish,
amphibians and reptiles.
C.EDCs require further investigation.
1.More research is needed to find effects EDCs are having on higher organsims.
2.Several researchers mentioned the dire need for further investigation.
D.The author proposes a call to action.
1.The author suggests temporary restrictions on suspected EDCs.
2.The author suggests ceasing use of products suspected to be EDCs.
3.The author suggests writing letters to government officials.
4.The author suggests doing one's best to get the word out on EDCs.
Abstract
Environmental estrogen endocrine disruptors (EDCs) are both natural and synthetic compounds that interfere with the homeostatic bodily functions of countless organisms. Affecting creatures throughout the entire span of the food web, these substances have been found to interfere with embryonic development, induce hermaphroditic characteristics, cause hormonal imbalances and more. The compounds are lipophilic, giving them a tendency to magnify as they move up the food chain through the process of bioaccumulation. Many EDCs have high commercial value, bringing controversy to the subject and opposition to their restriction or ban. The investigator aims to inform readers and of the environmental dangers associated with EDCs, while acting as an advocate for change. Unless immediate action is taken, EDCs pose a threat to the future existence of healthy wildlife organisms. The investigator proposes initiatives to help put a stop to the problem.
ENVIRONMENTAL ESTROGEN ENDOCRINE DISRUPTORS
AND THEIR EFFECT ON WILDLIFE
Background of EDCs and their environmental effects
Historical background
In 1948, Paul Muller received the Nobel Prize in medicine after introducing the world to the insecticide abilities of the compound dichloro-diphenyl-trichlorethane (DDT). Soon after, the compound was used widely and carelessly to curb problems caused by insects including insect typhus, malaria and lice, not to mention it served as a solution to preventing too many pesky mosquito bites and the like. DDT was used worldwide, and at times was even dusted over entire cities. During the 1950s, estrogenic properties of DDT were discovered, and the drug was found to disrupt the sexual development of roosters. However, it was not until after Rachel Carson’s famous book "Silent Spring" was published that the world started to take notice. DDT was found to be estrogenic in mammals and birds, to cause eggshell thinning, and other health problems in animals. The pesticide was banned by the Environmental Protection Agency (EPA) in 1972, and has been ever since.
The environment remains in danger
Although DDT may have been restricted, the environment and the animals that were affected are still in danger. DDT has a lengthy degradation pathway, with a biological half-life of eight years, so its breakdown products are still persistent in the environment. Also, compounds that have become known as environmental endocrine disruptors (EDCs) are being unremittingly introduced into nature via countless sources, and these substances are having profound, detrimental effects on a variety of wildlife organisms. Detergents, polychlorinated biphenyls (PCBs), dioxins, pharmaceuticals, plastics and many more chemicals have been named as sources of environmental estrogen. These endocrine disruptors act by interfering with messages communicated by the body’s endocrine system. The endocrine system consists of a series of ductless glands including the thyroid, pituitary, adrenal, ovaries, testes, and others, along with their associated hormones, or chemical signals that regulate certain bodily functions. Sexual development, metabolism, growth and reproduction are all partially maintained through the endocrine system.
EDCs affect the endocrine system in a few different ways. The chemicals can act as estrogen mimics, in which they bind to the body’s estrogen receptors, causing unnatural bodily reactions in organisms. The compounds may also act as anti-estrogens, in which case the chemicals prevent the binding of estrogen to its receptor. It is also possible for EDCs to interfere with the synthesis, functionality, or degradation of hormones or hormone receptors. Endocrine disruptors pose a threat to the well being of all kinds of creatures from algae, krill, and crustaceans to alligators, dolphins and polar bears. Unless immediate action is taken, EDCs pose a threat to the future existence of healthy wildlife organisms.
Controversy surrounding EDCs
The EPA recently named endocrine disruptors as one of its top 6 research priorities and it began the Endocrine Disruptors Research Initiative. However, this seemingly responsible call to action has not always been the position held by the EPA. In 1986, the EPA agreed to demands from the paper industry to keep the results of its National Dioxin Survey from the public. (Dioxin is a by-product of several industrial processes including pulp and paper bleaching.) Eventually, the EPA was threatened with a lawsuit, and agreed to release the results, which found that dioxins cause damage to the immune, nervous, endocrine and reproductive systems at levels found in the general public. The topic of EDCs continues to remain quite controversial due to the fact that most EDCs have high commercial value. Birth control pills, several types of detergents, packing materials, plastic coatings, adhesives and many other popular products are sources of EDCs. Thousands of businesses would be affected by the regulation or banning of these chemicals, so one can imagine the desire many industries have to keep these products on the market regardless of the consequences.
EDCs have a variety of sources, chemical structures and effects on organisms
Sources of EDCs
The sources of EDCs have been confirmed through numerous studies. They are usually separated into two groups. The first group consists of both natural and synthetic steroidal hormones, which can be seen, in figure 1.
Figure 1:Selected Steroidal Hormones
Compound
Structure
17-beta estradiol
17-alpha estradiol
Estriol
Estrone
17-alpha ethinyl estradiol
The main compounds here include the three natural estrogens produced by the body, namely, estradiol, estriol, and estrone, as well as the synthetic estrogen, 17-alpha ethinyl estradiol, the agent found in common pharmaceutical contraceptives. 17-beta estradiol is the major estrogen present in both male and female organisms, and 17-alpha estradiol, a metabolite of 17-beta estradiol, is found naturally in cattle and in some pharmaceuticals. Estriol, another member of this group is produced by the fetus and can cause developmental problems if found at low levels during pregnancy. Next is estrone, an estrogenic hormone originating from the gonads or the adrenal cortex.
Adapted from Table 1 in Hohenblum, Gans, Moche and others (2004).
Estrone in naturally occurring, but it can be used as the primary estrogenic component in various pharmaceutical preparations. These hormones are released into nature through the excretion of feces and urine of both humans and other organisms. Pharmaceutical contraceptives play a major role in allowing steroidal hormones to reach the environment because the body does not absorb the majority of the estrogen found in the drugs. The excess estrogen is flushed down the drain and introduced to the environment through delicate aquatic ecosystems (Hohenblum, Gans, Moche, and others 2004).
The second group of endocrine disruptors is the anthropogenic industrial chemicals, which include pesticides, detergents, plastics, dioxins, styrene and more. The EPA developed a program in 1996 to test compounds for endocrine disrupting properties. This program, known as the Endocrine Disruptor Screening Program (EDSP) is currently still underway, so clear categories have yet to be set up. However, many studies, including several that will be discussed here have shown the disruptive properties of several groups of industrial chemicals. These compounds encompass a very broad range of consumer products and many of them have important applications to modern life. The pesticides include dieldrin, lindane, mirex, heptachlore, and DDT, which is now banned but is still being found in wildlife, as well as many others. Some of these pesticides have been presented in Figure 2.
Figure 2: Pesticides determined to cause endocrine disruption
Adapted from http://www.nyu.edu/pages/mathmol/library.edu
Next among the industrial chemicals are the polychlorinated biphenyls, or PCBs, which were used in lubricants, capacitors and transformer fluids until they were banned in the 1970s. PCBs are very stable chemicals, and therefore cannot be easily degraded. This property is demonstrated by the fact that PCBs are continuing to be found in the environment regardless of the fact their use has been banned for over 30 years. The basic structure of a PCB molecule can be seen in Figure 3.
Dioxins, the next group of compounds, are considered to be some of the most toxic chemicals known to science. The EPA has identified dioxins as a serious health threat and the compounds have been linked to various health problems including cancer. Dioxins are formed as a by-product during paper manufacture, incineration, and water treatment. The structure of the molecule is depicted in Figure 3. Another group of industrial chemicals are the detergents and epoxy resins, chemically known as alkylphenols. These chemicals are used at a rate exceeding one million pounds annually in the United States alone. Products formed with alkylphenols include spermicides, wool washing detergents, car washing detergents and different types of paints. Plastics, some epoxy resins and coatings, adhesives, paints, electronic equipment, automobile parts and sports equipment are just some of the products made using the industrial chemical known as bisphenol A, or BPA. The compound is used globally, and is currently one of the most extensively tested materials being used. The structure of alkylphenols and bisphenol A can be seen in figure 3.
Figure 3: Selected Industrial chemicals and their structure
Compound
Chemical Structure
PCB
Dioxin
Alkylphenol
Bisphenol A
Implications of EDC Chemical Structure As one can see in figures 1, 2, and 3, molecules that act as endocrine disruptors usually have at least one aromatic ring. Notice in figure 1 how closely the synthetic estrogen matches the naturally occurring estrogens, allowing the molecule to bind to estrogen receptors with ease. Many of the structures have chlorine atoms attached, especially the pesticides. The structure of endocrine disruptors in many cases allows the substances to mimic hormones and bind to receptors improperly. However, the mimicking, blocking or overall disrupting Adapted from http://www.nyu.edu/pages/mathmol/library.edu of the endocrine system can still be achieved by these chemicals regardless of their shape.
Bioaccumulation
EDCs move their way up the food chain through a process known as bioaccumulation. A recent study on the base of Antarctic marine food web discovered the presence of various chemicals in sea ice algae, water column plankton, and both juvenile and adult krill sampled from the western region of the continent. It is believed that these food sources provide the avenue through which EDCs enter the food web. Here, at the base of the web (See Figure 4) is where the bioaccumulation begins.
Figure 4: An example of a Marine Antarctic food web
Available from http://www.landcareresearch.co.nz/research/biodiversity/penguins/food_web.asp Concentrations of the chemicals may be found in organisms at low trophic levels such as those mentioned, but the animals that prey on them are more greatly affected. EDCs are lipophilic, or fat loving, which means they tend to accumulate and magnify in organisms with higher body fat (Chiuchiolo, Dickhut, Cochran, and others 2004). As one can guess, this leaves the predators at highest tiers of the food web most vulnerable.
The tissues of bowhead whales, bearded and ringed seals, and several species of fish were analyzed gravimetrically and ordered according to lipid content. Experimenters found that the physical and chemical properties of the compounds played a part in the magnitude of bioaccumulation within the organisms tested, reiterating the lipophilic nature of EDCs. In marine mammals, the highest concentrations of EDCs tend to be found in blubber. Among those analyzed, the lipid content of the tissues was the major determining factor in the accumulation of EDCs (Hoekstra, O’Hara, Backus, and others 2005). Other reports of bioaccumulation have been made, including a study on juvenile lobsters, in which it was discovered that endocrine disrupting pesticides entered the body of the lobster through food sources, and were subsequently found to concentrate "up to 125-fold over the surrounding seawater in the hepatopancreas, gonadal tissue, nervous tissue, and epidermal cells of the adult lobster" (Walker, Bush, Puritz, and others 2005).
Endocrine Disruption spans the food web
Endocrine disrupting compounds are found in organisms ranging from the base of the food chain up to the highest predators. Many of these creatures are experiencing detrimental effects caused by the EDCs. As previously outlined by Chiuchiolo, Dickhut, Cochran, and others and Dickhut and others (2004), EDCs were discovered in algae, plankton and krill, species important to the proliferation of thousands of other organisms both directly and indirectly. The endocrine disrupting effects of compounds become better illustrated as one climbs up the food chain. Located a step above the organisms mentioned at the base of the web are fish, crustaceans, and echinoderms. Roepke, Snyder, and Cherr (2005) investigated the affect of both groups of EDCs on sea urchin embryonic development. Endocrine disruptors experimented with included 17-beta estradiol, estrone, estriol, bisphenol A, 17-alpha ethinyl estradiol, and others. Normal development of the embryos was inhibited by levels of EDCs tested that matched those found in the environment. Abnormal larvae, delayed development of larvae, inhibited growth and morphological problems were all found as a result of introducing EDCs to developing sea urchin embryos.
Several species of fish have been shown to be affected by EDCs. Lake Apopka, a freshwater lake located in Florida, fell victim to heavy pollution due to an industrial chemical spill. Since then, the lake has been a point of interest for scientists studying the effects of pollutants and in this case endocrine disruptors. Toft and Guillette (2005) found that mosquitofish exposed to water from Lake Apopka had significantly lower sperm counts than fish exposed to water from two other non-polluted lakes and one fresh spring. The Lake Apopka male mosquitofish also experienced a decrease in sexual behavior after their exposure to the contaminated water. The changes in sperm count and sexual behavior were attributed to endocrine disrupting compounds found in Lake Apopka water including a high instance of DDT.
Endocrine disruptors were shown to have dramatic effects on the levels of two very important pituitary sex hormones, namely, growth hormone and prolactin. Growth hormone is important for a wide range of activity in the body, including the lengthening of bones, and stimulation of other organs. Prolactin is also an important hormone, especially for females during and after pregnancy. Elango, Shepherd, and Chen (2006) found that exposing rainbow trout (Ooncorhynchus mykiss) pituitary glands to various levels of EDCs resulted in the disturbance of normal hormonal function. DDT, an estrogenic pesticide caused a major increase in the production of prolactin and growth hormone in trout pituitaries. Treatment with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) a dioxin group contaminant used in Agent Orange, was found to cause an increase in the mRNA coding for growth hormone and prolactin.
Another type of fish, the Japanese medaka (Oryzias latipes) was experimented on by Zha, Wang, and Schlenk (2006). The fish were exposed to pentachlorophenol, a known endocrine disruptor for one month, and then were allowed to reproduce until the F1 generation. Several negative effects were observed, including the decrease in length and body weight of exposed fish, a reduction in the number of eggs produced by the females, as well as an overall decrease in sexual behavior. Most startling was the fact that forty percent of male fish exposed to higher levels of EDCs had an incidence of testis-ova, an inter-sex condition in which oocyte-like cells appear abnormally. Degeneration of the ovaries was observed in female fish in the lower treatment levels, while 66.6% of female fish exposed to the highest level of pentachlorophenol experienced an absence of ovaries altogether.
Endocrine disruptors have been found to dramatically affect both reptiles and amphibians. In one study, conducted by Bogi, Schwaiger, Ferling, and others (2003), water tainted with environmental pollutants from a sewage treatment plant was applied to two different species of frogs, Xenopus laevis and Rana temporaria. Hermaphroditism was observed in both frog species upon exposure to the endocrine disrupting chemicals. Hermaphrodites are often seen in R. temporaria, even during regular undisturbed development, but the phenomenon has not been known to occur in Xenopus, up until the conduction of the experiment. Also noted was an abnormally high female to male ratio, likely to have been due to the endocrine disrupting properties of the chemicals in question. Juvenile alligators from three different Florida locations were experimented on. One location, Belle Glade was considered a higher contaminant site due to its position near sugar cane farming grounds. Lower levels of plasma hormones were found in female alligators from Belle Glade when compared to the other two sites, but was not seen in males. However, reductions in mean phallus tip length and cuff diameter were observed in male alligators living in Belle Glade as compared to those found in the other locations. Other possible causes of these trends were proposed by the scientists, Gunderson and Bermudez and others (2004), who carried out the research, including the exposure to stressful situations, changes or variations in diet, or genetic differences between locations.
EDCs are discovered in higher organisms
As previously described, endocrine disruptors are hypothesized to be entering the environment via aquatic ecosystems. This truth leaves marine mammals especially vulnerable due to the facts that they live in or around the water, they feed on organisms tied to the water, and they are higher up in the food chain, rendering them more susceptible to bioaccumulation. Perched high atop the marine food web are polar bears, (Ursus maritimus). These animals are top predators who have very high levels of body fat, the major contributing factor to bioaccumulation of EDCs. This is why researchers have focused on polar bears a great deal when conducting experiments on endocrine disruptors. One study, by Dietz, Riget, Sonne, and others (2004), researched concentrations of EDCs in the adipose tissue of 92 polar bears from East Greenland. The scientists discovered the presence of several types of endocrine disruptors including PCBs, chlorobenzenes, dieldrin, mirex and DDT in polar bear adipose tissue. It was noted in the study, which was conducted over a period three years, that concentrations fluctuated depending upon the season, sex of polar bear, and period in time which the bears were sampled. Tissue samples from 1999-2001 were compared with those from 1990. The more recent samples had lower concentrations of chlorobenzenes, DDTs, mirex, dieldrin and some other EDCs, but no firm conclusions could be made regarding the actual reduction in environmental pollutants over time due to the variation that occurs between years.
Verreault, Muir, Norstrom, and others (2005) carried out a similar study of polar bear adipose tissue using 107 female polar bears from Alaska, Canada, East Greenland and Svalbard, a small island north of Greenland. These scientists also found that levels of EDCs have been declining over the past decade, but they noted that polar bear adipose tissue sampling might not be a reliable method of studying endocrine disruptors because the tissue is highly influenced by other biological factors. More importantly, the scientists outlined the lack of sufficient research in regards to the effects of endocrine disruptors on polar bears, since most studies have focused simply on the presence of the compounds in the animals. Understandably, this may come as no easy task since polar bears are hard to come by in captivity, and performing experiments on the animals using toxic substances would be considered highly unethical. It is possible that science may not learn of consequent endocrine disruption until irreversible damage has been done. For this reason, the author stresses the importance of further research on EDCs and the eventual decrease or restriction of these harmful substances.
PCBs, pesticides, and DDT breakdown products were discovered in Canadian Arctic beluga whales (Delphinapterus leucas) during an eight-year research project carried out by Stern, Macdonald, Armstrong and others (2005). The blubber of beluga whales from 15 sites was obtained and analyzed gravimetrically to determine the levels of EDCs concentrated in the lipids. The scientists reported finding significant levels of all compounds tested for with notable variation between testing sites. In the discussion, the researches concluded that the age and sex of the animal play a key role in determining contaminant concentration in beluga whales. It was discovered that male belugas had higher levels of EDCs in their blubber. The scientists hypothesized that females have lower contaminant levels because they transfer much of their lipids to their young during pregnancy and lactation. Marsili, D’Agostino, Bucalossi, and others (2004), also mentioned the possibility in their study on striped dolphins, in which they noted that females specimens lose 90% of the organochloride chemicals found in their bodies throughout their pregnancy and during lactation. This study on belugas focused on the actual occurrence of these substances in the blubber of the animals in question. Although Stern, Macdonald, Armstrong and others noted that the compounds they studied have been linked to endocrine disruption and diseases in marine mammals, they did not study endocrine effects on belugas.
Dolphins are another type of marine mammal in which endocrine disruptors have been discovered. One study, performed by Fossi, Marsili, Lauriano, and others (2004), tested the reliability of using non-lethal skin biopsies to determine the concentrations of several different chemicals in striped dolphins (Stenella coeruleoalba). The scientists were successful and named skin biopsy a suitable way to evaluate the chemical contamination of striped dolphins. This comes as good news because skin biopsies are easier for scientists to perform than the extraction of blubber, they are non-lethal and non-stressful to the dolphins, and are still apt for studying bioaccumulation. In the study, gas chromatography was used to detect the incidence of harmful chemicals including DDT and its derivatives, PCBs, organochlorides and others in the skin tissue of the dolphins. Nearly all groups of compounds were detected by the biopsies at levels higher than recommended for marine mammals by the World Health Organization toxic equivalency factors (TEF), which facilitate risk assessment associated with exposure to the chemicals being studied. This research focused mainly on the development of suitable techniques used to investigate the incidence of EDCs in marine mammals such as the striped dolphin.
The Mediterranean striped dolphin was the central organism in another study by Marsili, D’Agostino, Bucalossi, and others (2004), which was carried out to determine the hazard associated with the numerous chemicals detected in their tissues. Using chromatography methods, combined with knowledge of toxic properties of compounds, the scientists were able to create parameters of toxic stress levels. These levels; low, moderate and high, will help to guide future research in evaluating the hazard associated with stress caused by endocrine disrupting substances. The scientists studied striped dolphins in two groups. One group, the stranded dolphins, consists of dead or living specimens who have washed ashore for any number of hypothesized reasons. The other group is the free ranging or swimming dolphins found in open water, which were assumed to be healthy. The tests results found that levels of all organochlorine compounds were higher in stranded dolphins than those of the free ranging group. In the early 1990s, a massive die-off of occurred in which Mediterranean dolphins were killed by the virus Morbilivirus. The scientists used their findings and the toxicological findings from a study on stranded dolphins at the time to confirm that EDCs were instrumental in causing the die-off. Polychlorinated biphenyls were one of the toxic substances found in the dolphins, and PCBs are known to cause immune system disruption, harm to the liver, and to advance and promote disease. It was emphasized that the findings could only be applied to Mediterranean striped dolphins, but even so, the results are alarming.
EDCs omnipresent in environment
In addition to studies on specific species, there has been research conducted on groups of animals in an area, which helps scientists to understand the collective toxicological status of food webs. Hoekstra, O’Hara, Backus, and others (2005) gathered different tissues from dozens of different species in Alaska including beluga and bowhead whales, ringed and bearded seals, and five types of fish. The researchers found that the concentrations of EDCs in tissues were dependent upon physical and chemical properties of each compound, the lipid content of each tissue, and the dietary habits of each species. This is consistent with the findings of other previously mentioned studies, and reiterates the validity of the process of bioaccumulation. Health Canada, the Federal department responsible for helping maintain and improve the health of Canadian citizens, has set up guidelines for assessing safe concentrations of contaminants in meat, poultry and fish. In the results section of this study, these parameters were used as a guideline to determine the health risks for the animals experimented on. It was found that the PCB levels in the blubber of bowhead whales, beluga whales, bearded seals, and ringed seals, all exceeded the recommended safe level for PCBs in meat proposed by Health Canada. This is not only startling for the health and safety of the affected animals, but it should also be noted that they are used as a food source for many peoples living in northern Alaska, where the animals were sampled. In their conclusion, Hoekstra, O’Hara, Backus, and others (2005) suggested the attainment of further data in regards to EDC concentrations in animals used for consumption, as well as more information on the diet of northern Alaska communities in order to determine the possible health risks to humans.
Vorkamp, Riget, Glasius, and others (2004) conducted another encompassing study, which included several types of terrestrial animals, freshwater fish, marine invertebrates and fish, and marine mammals. The purpose of the experiment was to outline the incidence of chlorobenzenes, pesticides, PCBs, and other endocrine disrupting chemicals in a range of different Greenland biota. The research was very extensive and quite complicated due to the many types of animals and various tissues analyzed. The results from the analysis of chlorobenzene concentration in terrestrial animals were quite interesting. Contrary to nearly all other studies mentioned here, there was no observable correlation between the lipid content and the contaminant concentration. Also, the herbivorous animals had concentrations of EDCs below those found in marine mammals. At first, the results seem puzzling, but they are easily explained by the herbivorous diet kept by the terrestrial organisms being studied. The presence of EDCs was detected in these animals, but they were more likely accumulated into the animal through drinking water rather than food consumption, unlike the marine mammals that feed on organisms such as fish, which leaves them subject to bioaccumulation. In their summary, the scientists explained that all suspected compounds appeared in the various organisms from Greenland, which is a clear indication of the omnipresence of EDCs in the environment.
EDCs are found in various organisms throughout the world, they cause many detrimental effects and they must be stopped
EDCs span the globe and the food web
It is impossible to deny the devastating effects of the persistent compounds causing endocrine disruption in the environment. Organisms are being affected throughout the entire span of the food web. EDCs have been discovered in everything from algae, krill and plankton to alligators, dolphins and terrestrial mammals. After learning of the attempted cover-up by the EPA, it is imperative that information on these controversial substances be brought to light. The chemical structure and biological persistence of EDCs has been well studied and well described through several bioaccumulation studies including those conducted by: Walker, Bush, Puritz, and others (2005), Hohenblum, Gans, Moche and others (2004), and Chiuchiolo, Dickhut, Cochran and others (2004). The ubiquitous presence of endocrine disruptors is demonstrated by the fact that the substances have been found in every corner of the globe. The numerous studies summarized by the author had a wide range of locations throughout the world.
EDCs have affected countless organisms
More importantly, it should be kept in mind that the negative effects of EDCs have been determined in countless organisms. EDCs were shown to adversely affect crustacean development in the study by Roepke, Snyder, and Cherr (2005), in which sea urchin embryonic development was disrupted. The effects of EDCs on fish have been studied a great deal by researchers such as Toft and Guillette (2005), who observed decreased sperm count and sexual behavior in mosquitofish. Zha, Wang, and Schlenk (2006) discovered reduced fertility in Japanese medaka upon application of pentachlorophenol, a pesticide and known EDC. Elango, Shepherd, and Chen, (2006) found that 17-beta estradiol induced significant increases in both pituitary growth hormone and prolactin mRNA in male rainbow trout pituitary glands. Reptiles and amphibians have been found to be responsive to endocrine disrupting substances. Bogi, Schwaiger, Ferling and others (2003) studied two species of frogs in which they discovered induced hermaphroditism and unnatural sex ratios. Variations in sex steroids and decreased phallus size in juvenile alligators are two of the effects observed by Gunderson, Bermudez, Bryan and others in 2004.
EDCs require further investigation
The effect of EDCs on marine mammals is continually being investigated. The presence of these substances has been discovered in species of dolphins, such as the striped dolphin in the studies by Marsili, D’Agostino, Bucalossi and others (2004), and Fossi, Marsili, Lauriano, and others (2004). Various levels of several contaminants were also discovered in Arctic beluga whales by Stern, Macdonald, Armstrong and others (2005). Research projects uncovered the incidence of EDCs in polar bears including those conducted by Verreault, Muir, Norstrom and others (2005), and Dietz, Riget, Sonne and others (2004). Vorkamp, Riget, Glasius and others (2004) discovered EDCs in several marine mammals during their Greenland based study. Though the effects EDCs are having on higher organisms remain under examination, knowledge of endocrine disruption in lower organisms are a good indicator that continuing down this road will end in disaster. Several researchers involved in a variety of studies mentioned the dire need for further investigation, most notably those studying higher organisms that require many expensive resources.
A call to action
Observed effects, and the discovery of EDCs in such a wide variety of organisms should be reason enough to begin establishing restrictions, bans, and other preventative measures. The EPA is currently researching endocrine disruptors in order to determine which substances are most harmful to humans and wildlife. This research could be very lengthy, and by the time conclusions are reached, immeasurable amounts of irreversible damage may already be done. The author proposes placing temporary restrictions on the use of known and suspected endocrine disruptors until conclusive results are obtained. This may seem drastic due to the financial implications, but the possible repercussions of taking no action are priceless. This proposal may seem unrealistic, but the reader can do his or her part to help speed up the process of restricting harmful endocrine disruptors. Ceasing use of products suspected to cause endocrine disruption is one way to help, and writing letters to government officials and EPA members is another. Another important way to promote the cause is to get the word out. Informing friends, family, and anyone who will listen can help to bring a stop to the disruption of the delicate balance found in nature.
References
Bogi C, Schwaiger J, Ferling H, Mallow C, Steineck F, Sinowatz W, Kalbfus RD, Negele I, Lutz and Kloas W. 2003. Endocrine effects of environmental pollution on Xenopus laevis and Rana temporaria. Environmental Research [serial online] 93:195-201. Available from (http://www.elsevier.com/locate/envres) Accessed 25 May 2006.
Chiuchiolo A, Dickhut R, Cochran M Ducklow H. 2004. Persistent organic pollutants at the base of the Antarctic marine food web. Environmental Science and Technology 38:3551-7.
Dietz R, Riget, FF, Sonne C, Letcher R, Born EW, Muir DCG. 2004. Seasonal and temporal trends in polychlorinated biphenyls and organochlorine pesticides in East Greenland polar bears (Ursus maritimus), 1990-2001. Science of the Total Environment 33:107-124. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 25 May 2006.
Elango A, Shepher B, Chen T. 2006. Effects of endocrine disruptoers on the expression of growth hormone and prolactin mRNA in the rainbow trout pituitary. General and Comparative Endocrinology 145:116-127. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 25 May 2006.
Fossi M, Marsili L, Lauriano G, Fortuna C, Canese S, Ancora S, Leonzio C, Romeo T, Merino R, Abad E, Jimenez B. 2004. Assessment of toxicological status of a SW Mediterranean segment population of striped dolphin (Stenella coeruleoalba) using skin biopsy. Marine Environmental Research 58:269-274. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 25 May 2006.
Gunderson M, Bermudez D, Bryan T, Degala S, Edwards T, Kools S, Milnes M, Woodward A, Guillette L. 2004. Variation in sex steroids and phallus size in juvenile American alligators (Alligator mississippienis) collected from 3 sites within the Kissimmee-Everglades drainage in Florida (USA). Chemosphere 57:335-345. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 25 May 2006.
Hoekstra PF, O’Hara TM, Backus SM, Hanns C, Muir DCG. 2005. Concentrations of persistent organochloride contaminants in bowhead whale tissue and other biota from northern Alaska: Implications for human exposure from a subsistence diet. Environmental Research 98:329-340. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 25 May 2006.
Hohenblum P, Gans O, Moche W, Scharf S, Lorbeer G. 2004. Monitoring of selected estrogenic hormones and industrial chemicals in groundwaters and surface waters in Austria. Science of the Total Environment 333:185-193. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 29 May 2006.
Malec, R. 2005. Library of molecular structures. New York University ScientificVisualization Center. Available from (http://www.nyu.edu/pages/mathmol/library/Overview.html) Accessed 25 June 2006.
Marsili L, D’Agostino A, Bucalossi D, Malatesta T, Fossi MC. 2004. Theoretical models to evaluate hazard due to organochlorine compounds (OCs) in Mediterranean striped dolphin (Stenella coeruleoalba). Chemosphere 56:791-801. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 29 May 2006.
McCormick S, O’Dea M, Moeckel A, Lerner D, Bjornsson B. 2005. Endocrine disruption of parr-smolt transformation and seawater tolerance of Atlantic salmon by 4-nonphenol and 17 beta-estradiol. General and Comparative Endocrinology 142:280-288. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 25 May 2006.
Roepke T, Snyder M, Cherr G. 2005. Estradiol and endocrine disrupting compounds adversely affect development of sea urchin embryos at environmentally relevant concentrations. Aquatic Toxicology 71:155-173. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 29 May 2006.
Rosser, S. 2006. Marine Food Web. ManaakiWhenua Landcare Research. Available from (http://www.landcareresearch.co.nz/research/biodiversity/penguins/food_web.asp). Accessed 20 June 2006.
Stern GA, Macdonald CR, Armstrong D, Dunn B, Fuchs C, Harwood L, Muir DCG, Rosenberg B. 2005. Spatial trends and factors affecting variation of organochloride contaminants levels in Canadian Arctic beluga (Delphinapterus leucas). Science of the Total Environment 351-352:344-368. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 20 May 2006.
Toft G, Guillette L. 2006. Decreased sperm count and sexual behavior in mosquitofish exposed to water from a pesticide contaminated lake. Ecotoxicology and Environmental Safety 60:15-20. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 29 May 2006.
Verreault J, Muir D, Norstrom R, Stirling I, Fisk A, Gabrielsen G, Derocher A, Evans T, Dietz R, Sonne C, Sandala G, Gebbink W, Riget F, Born E, Taylor M, Nagy J, Letcher R. 2005. Chlorinated hydrocarbon contaminants and metabolites in polar bears (Ursus maritimus) from Alaska, Canada, East Greenland, and Svalbard: 1996-2002. Science of the Total Environment 351-352:369-390. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 20 May 2006.
Vorkamp K, Riget F, Glasius M, Pecseli M, Lebeuf M, Muir D. 2004. Chlorobenzenes, chlorinated pesticides, coplanar chlorobiphenyls and other organochlorine compounds in Greenland biota. Science of the Total Environment 331:157-175. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 29 May 2006.
Walker A, Bush P, Puritz J, Wilson T. 2005. Bioaccumulation and metabolic effects of the endocrine disruptor methoprene in the lobster Homarus americanus. Integrative and Comparative Biology 45(1):118-126 Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 25 May 2006.
Zha J, Wang Z, Schlenk D. 2006. Effects of pentachlorophenol on the reproduction of Japanese
medaka (Oryzias latipes). Chemico-Biological Interaction:161:26-36. Available from (http://proquest.umi.com.wizar.umd.umich.edu) Accessed 25 May 2006.
Sunday, July 02, 2006
Motorcycle Dealths higher in States without Helmet Laws

By JP Saleeby, MD
No doubt the scariest emergency room scene is that of a car versus motorcycle accident. I have been witness to more than my share as a full time ER doctor. The outcome? Almost always the same, with motorcyclist never the winner. I am (as many warm blooded American men are) a true fans of the motorcycle as a true American icon and an art form. Yes, I watch Discovery Channel’s “Biker Build Off” and “OCC” and Speed Channel’s “Build or Bust” programs. Yes, I traveled to Marietta, GA to see the custom motorcycle exhibit “Wind Blown: American Motorcycle Fine Art” at the Cobb/Marietta Museum last year. The exhibit featured works by luminaries in the field of custom bike building: Arlen Ness, Indian Larry, Billy Lane & Hank Young. Yes, I recently traveled to the Orlando Museum of Art to take in the traveling Guggenheim Museum Exhibit, “The Art of the Motorcycle”. I have even paid homage at Billy Lane’s shop in Melbourne, Florida. Wonderful exhibits, great works of art. Interesting history and trends for this mode of transportation.
I will say with a big resounding “NO” (to emphasize) that I don’t own a motorcycle. And NO I don’t intend to ever get on the back of one. The motorcycle is a dangerous piece of art. Never to be underestimated in the devastation they can cause the human body if one is careless. Protective clothing is a must and the helmet can be a live saver.
I have seen too many horrific crashes that present to the ER to want to ride a motorcycle. I even was witness to a motorcycle crash that occurred in front of me on the highway in 2004. Motorcycle crashes are never good. And the mantra of many a cyclist: “It is not a matter of if you will ever wipe out, but rather when you will wipe out.”
People are buying more and more motorcycles in record numbers nationally. In Florida motorcycle registration has increased by 87% over the last six years. Motorcycle deaths have also risen in the state that repealed their helmet law in 2000. Estimates from the National Highway Traffic Safety Administration show a rise by some 67% in motorcycle related deaths between 2000 and 2004 in Florida alone.
It cannot be argued that helmets save lives. That is a priori. What baffles me is the drive by some motorcycle advocates to push for states to repeal their helmet laws. Not only does a helmet save the rider significant head injury, it also lowers insurance premiums for all vehicle drivers in the state.
Indian Larry died at age 55 in August of 2004 due to injuries suffered in a motorcycle stunt that went bad. He was well known in the custom bike circles as an outspoken opponent to wearing helmets. While performing a standing maneuver on his bike in a motorcycle show in Concord, NC, he lost control and fell sustaining fatal head injuries. He well may be alive today if he had adequate head protection. His own foolish act not only caused his own death but he did not set a good example for all the young bike riders that looked up to him as a role model.
Recently Pittsburgh Steelers football quarterback Ben Roethlisberger an outspoken advocate for helmet free riding had a devastating accident where he broke his jaw, nose and several teeth. He had to undergo several hours of surgery to repair his injuries. He is now quoted as saying if he ever gets back on a motorcycle it will not be without a helmet.
For me I will watch motorcycles on display. I am committed to climb into my steel caged, seat belted and air-bag protected car for transportation. To get the thrill of the wind in my hair, I will roll down my windows.
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JP Saleeby, MD is assistant medical director of the emergency department at LRMC, Hinesville, GA.
References: http://motorcycles.about.com/b/a/108958.htm http://www.sun-sentinel.com/news/local/southflorida/sfl-0618helmetlaw,0,5575536.story?coll=sfla-home-headlines
Sunday, June 25, 2006
Play the Didgeridoo and Quit Snoring

Interesting study on snoring and alternative treatments. The Didgeridoo is an Aboriginal wind instrument from Australia. This may be appealing to those who don't want to consider surgery [Uvulopalatopharyngoplasty (UPPP)] or drastic weight loss surgery (Gastric Bypass).
Reference:
Puhan, Milo A., Alex Suarez, Christian Lo Cascio, Alfred Zahn, Markus Heitz, Otto Braendli, Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ. 2006 February 4; 332(7536): 266–270
Objective To assess the effects of didgeridoo playing on daytime sleepiness and other outcomes related to sleep by reducing collapsibility of the upper airways in patients with moderate obstructive sleep apnoea syndrome and snoring.
Design Randomised controlled trial.
Setting Private practice of a didgeridoo instructor and a single centre for sleep medicine.
Participants 25 patients aged >18 years with an apnoea-hypopnoea index between 15 and 30 and who complained about snoring.
Interventions Didgeridoo lessons and daily practice at home with standardised instruments for four months. Participants in the control group remained on the waiting list for lessons.
Main outcome measure Daytime sleepiness (Epworth scale from 0 (no daytime sleepiness) to 24), sleep quality (Pittsburgh quality of sleep index from 0 (excellent sleep quality) to 21), partner rating of sleep disturbance (visual analogue scale from 0 (not disturbed) to 10), apnoea-hypopnoea index, and health related quality of life (SF-36).
Results Participants in the didgeridoo group practised an average of 5.9 days a week (SD 0.86) for 25.3 minutes (SD 3.4). Compared with the control group in the didgeridoo group daytime sleepiness (difference -3.0, 95% confidence interval -5.7 to -0.3, P=0.03) and apnoea-hypopnoea index (difference -6.2, -12.3 to -0.1, P=0.05) improved significantly and partners reported less sleep disturbance (difference -2.8, -4.7 to -0.9, P<0.01). p="0.27).">
Conclusion Regular didgeridoo playing is an effective treatment alternative well accepted by patients with moderate obstructive sleep apnoea syndrome.
www.andygraham.net
www.gabriellereillyweekly.com
Tuesday, June 13, 2006
New Vitamin (PQQ) in Green Tea

In 1979 the latest vitamin was discovered. Researchers in Japan discovered this compound which has been classified as a B-complex vitamin due to it's water soluable properties. The compound's scientific name is 2,7,9-tricarboxy-pyrroloquinoline quinone or PQQ for short. This discovery made it the first new vitamin isolated since 1948.
Ref:
www.brain.riken.go.jp
Saturday, June 10, 2006
Physician Shortage
In the struggle to keep pace with ever growing patient load in the Emergency Room there is discouraging news. A national trend to require emergency room residency trained board eligible or board certified physicians exclusivity to practice the specialty of emergency medicine is gripping the country. Years ago most Level I regional trauma centers or large high volume inner city emergency rooms required EM boarded physicians on staff, but of late we are seeing this trend take hold in small low volume rural hospitals through out the USA. In a time where predictions of physician shortages as high as 85,000 by 2020 there is a movement to limit credentialing of qualified and experienced physicians who are not boarded to fill the ever increasing holes in Emergency Department coverage. What is the driving force behind this new and detrimental trend?
My hunch is there are three powers influencing the practice of emergency medicine. First and most horrific is the Joint Commission on Accreditation of Healthcare Organizations.
In 1951, The American College of Physicians (ACP), the American Hospital Association (AHA), the American Medical Association (AMA), and the Canadian Medical Association (CMA) join forces with the American College of Surgeons (ACS) to spawn the Joint Commission on Accreditation of Hospitals (JCAH), an independent, not-for-profit organization whose stated primary purpose is to provide voluntary accreditation to hospitals at a tremendous financial cost. They became a monopolizing self-righteous institution dictating what hospital had to do to conform to obtain managed care contracts. They were redundant in nature in so far as there were Federal and State organizations that oversee such things to make a hospital safer for patients and healthcare workers in the first place. Compliance with JCAHO recommendations does nothing but increase healthcare costs to all. They make it increasingly difficult for small, just getting by financially hospitals to keep up with their absurd requirements. They have been pushing for over zealous and unrealistic credentialing standards in the ER for years.
Second on my list are insurance companies. Those fat cats in the insurance business influenced by share-holder bottom line profits and overly concerned about liability medical malpractice awards insist that BE/BC physicians will incur fewer lawsuits than non-boarded physicians. This has yet to be proven in my eyes.
Thirdly, pressure is coming from the American College of Emergency Physicians (ACEP) who are flexing their political power for self promotion stating that only a emergency medicine residency trained board certified physician is capable of treating patients in the ER. They have recently been going head to head with the American Academy of Family Physicians about the legitimacy of this claim, as AAFP physicians are having doors slammed in their faces as they apply for ER staff positions.
Hospital authorities and administrators afraid of losing valued managed care contracts are jumping on the bandwagon and entering into the hospital bylaws requirements for BE/BC EM trained physicians to staff the ED. This poses a problem however as there are not enough residency trained physicians to even keep up with the demands of Level I inner city trauma centers let alone tiny rural hospitals. And the problem will worsen each year that passes.
Hospitals in this country have to come up with the courage to thumb their noses at JCAHO and extend their middle fingers at the insurance industry and open their doors to well qualified, experienced physician from all disciplines who’s only fault is not having a slip of paper hanging on their walls proclaiming them residency trained EM boarded physicians.
For more information visit: http://www.iom.edu/?id=35025
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http://www.iom.edu/?id=35025
Friday, June 02, 2006
Pu-erh Tea & SARS
Drink Rooibos and save your Liver
Drinking Rooibos tea (Aspalathus linearus) the "Red Tea" from Africa has properties of healing a sick liver.
Ref:
Kucharska J, Ulicna O, Gvozdjakova A, Sumbalova Z, Vancova O, Bozek P, Nakano M, Greksak M., Regeneration of coenzyme Q9 redox state and inhibition of oxidative stress by Rooibos tea (Aspalathus linearis) administration in carbon tetrachloride liver damage. Physiol Res. 2004;53(5):515-21.
Tuesday, May 30, 2006
Wu-long (oolong) Tea helps reduce fat
Appearing in Tea Experience Digest's Fall Edition:
Q: An ad said I could lose weight by drinking wu-long tea because it burns fat. Is this true?
A: A thorough examination of the published medical literature reveals that this is true. Wu-long or oolong tea, which is a partially fermented tea, has been reported in laboratory animals as well as in human subjects to have anti-obesity effects. Wu-long tea in fact lessens absorption of fats, increases the body’s metabolism and is responsible for noradrenaline-induced lipolysis (breakdown) of adipose tissue. Wu-long tea also exhibits cholesterol-lowering effects and reduces blood glucose. This does not appear to be a by a caffeine effect, for wu-long tea contains half the caffeine of green tea, but double the polymerized polyphenols. When teas are compared, wu-long tea trumps pu-erh tea, black tea and green tea in suppressing body weight.
Ref:
Int J Obes Relat Metab Disord. 1999 Jan;23(1):98-105.
Diabetes Care. 2003 Jun;26(6):1714-8.
J Med Invest. 2003 Aug;50(3-4):170-5.
J Agric Food Chem. 2005 Jan;26:53(2):480-9.
Mol Nutr Food Res. 2006 Feb;50(2):211-7.
Friday, May 26, 2006
JAMA reports negative findings on Policosanol

Reprint of Letter to Editor (JAMA) submitted 5-26-2006
Regarding: Effect of Policosanol on Lipid Levels Among Patients With Hypercholesterolemia or Combined Hyperlipidemia: A Randomized Controlled Trial, Heiner K. Berthold, et. al., JAMA. 2006;295:2262-2269.
Dear Dr. Golub,
With the plethora of well designed positive studies published in peer reviewed medical journals on the use of Policosanol in the treatment of dislipidemia why is it that JAMA chooses to publish this single negative study? I can find no other reference in past JAMA issues of any studies either positive or negative regarding Policosanol.
Even the authors of this contribution are quoted in the conclusion that "more independent studies are required to counterbalance the vast body of available positive trials." Could this be a bias to publish the "negative" related to pressures from the pharmaceutical industry? To be fair, JAMA should review and publish one of the many positive trials on this rather safe lipid lowering substance.
JP Saleeby, MD
jpsaleeby@aol.com
docsaleeby.blogspot.com
Ref:
1. Lijec Vjesn. 2005 Nov-Dec;127(11-12):273-9
2. J Pharmacol Exp Ther. 2006 May 22;
3. Arch Med Res. 2005 Sep-Oct;36(5):441-7.
4. Drugs R D. 2005;6(4):207-19.
Sunday, May 21, 2006
Saturday, May 20, 2006
Bird Flu Alert

Avian Influenza
By JP Saleeby, MD
Influenza is a real threat each and every year during the winter months. The influenza viruses that are different from the common cold viruses inflict significant morbidity and even mortality and should be taken seriously. The Influenza virus of which there are generally three types (A, B & C) causes the Flu. Type A is the most common and it is the subtypes of A and B that cause the seasonal outbreaks. The constant mutations of these viruses make it necessary to vaccinate annually with updated strains.
Everyone is affected, from the very young to the older adult. Most outbreaks or epidemics occur in late fall and early winter. It has been reported that as many as 20,000 deaths and over 100,000 hospitalizations occur each year in the USA due to the flu. Those deaths are highest in the elderly (over 65), folks with diabetes, HIV, nursing home residents, pregnant women and those with chronic diseases of the lung, heart and kidneys.A person is contagious for up to 5 days after onset with symptoms that include high fever, aches in joints, muscles and around the eyes, weakness, headache, dry cough, sore throat and watery discharge from nose and eyes.
Annually, there are many that miss considerable time from work in the winter months due to infection with this virus.You acquire the flu virus through contact with contaminated aerosols or droplets found on surfaces referred to as fomites (such as doorknobs, countertops and telephones.) So prevention is crucial. Of course maintaining a health lifestyle (not smoking, eating right, plenty of exercise & sleep) is important as is taking care not to come in contact with potential contaminants (good hand washing, not sharing cups with others, etc.) And vaccinations are of critical importance especially to those high-risk individuals. They may even be considered as lifesaving therapy.The flu vaccine (shot) is unique each year, being made up of inactivated A & B viruses. It is injected into the upper arm and should be taken in early fall (from October to mid-November) because it takes two weeks to confer immunity. But once injected (it is considered 70 – 90% effective), it can protect you from the symptoms of the flu, lost work, hospitalization and even death.
Who should get the flu shot? Anyone over 50, those with chronic diseases, those with HIV/AIDS, women over 14 weeks pregnant, residents of nursing homes, health care workers, bank tellers, waitresses, students especially those living in dormitories, and those people interested in reducing risk for the flu. Side effects to the shot are rare but include soreness and mild muscle aches or low-grade fever for only a couple of days. These untoward effects are most often noticed in children. Life threatening allergic reaction and something called Guillain-Barre syndrome are extremely rare reactions to the vaccine. But those allergic to eggs should probably avoid the shot.
Myths about the flu shot such as getting the flu from it are unfounded. Since it contains the killed form of the virus, it is impossible to actually acquire the syndrome. Another myth is that one shot in you life will do, but since the virus mutates from season to season, revaccination with new strains must occur each season. For those needle-phobes, there is an investigational nasal spray "inoculation" is available under the name FluMist. The nasal-spray flu vaccine (called LAIV for Live Attenuated Influenza Vaccine) was licensed in 2003. It is different from the typical flu shot because it contains weakened live influenza viruses instead of killed viruses and is administered by nasal spray instead of injection. Only indicated for health folks from 5 to 45 years of age.
There is a lot of talk about a particular virulent type of emerging flu called Avian Influenza. Other animals can become infected with flu viruses such as birds and pigs (remember the swine flu?) but zoonotic viruses (or species-jumping viruses as they are called) are usually restricted to a few bad players that may mutate and infect humans. While avian viruses can attach easily to bird cells they must first genetically mutate before becoming able to attach and thus infect human cells. The A (H5N1) Strain (Avian Flu) is designated because it comes from the "A" type virus and there are subtypes defined by the proteins that constitute the outer layer. The two outer proteins "H" (of which there are 16 subtypes) and "N" (of which there are 9 subtypes) are used to identify a specific virus.
Scientist are concerned that a human form of H5N1 will cause a pandemic like flu virus in the 1918 world wide epidemic that killed 25 to 50 million people. The flu of 1918 was identified using DNA technology as being a mutation of the avian virus. We can never be sure if the mutation will ever occur, but some experts believe it will within the next 2 years and could spark a pandemic. To date there are about 200 reported human cases and those being from China, SE Asia and Turkey. Transmission has only been from bird-to-human and occurred mostly in those that handle poultry or live in close proximity to birds. The cases have been quite virulent with mortality approximating 50%. A vaccine that protects birds is in use in high-risk areas but to develop a vaccine for humans can take up to 6 months.
What happens should you get the flu? Well, there are standard medications that should be started within 24 hours of symptoms such as Amantadine, Rimantadine (Flumadine), Zanamivir (Relenza) and Oseltamivir (Tamiflu). The prescription usually lasts 5 to 7 days and it may cut short the course of infection and prevent serious complications such as pneumonia. Currently H5N1 is sensitive to these drugs, but mounting evidence has shown some resistance developing to these drugs. Availability of these drugs in a pandemic may also be problematic.
Decongestants such as phenylephrin and pseudoephedrin are helpful with symptoms. Antibiotics are not indicated unless there is a secondary bacterial infection. Antibiotics are useless against the flu virus.Nutritional medicine offers high doses of vitamin C, and Zinc. Herbal remedies include Echinacea (E. purpurea root extract) and Goldenseal (H. candadesis root extract). Other immune boosting compounds are extract of maitake and reishi mushrooms, garlic extracts, and olive leaf extract. Effects remain to be seen by a direct hit by the avian flu.
A powerful tool in the early treatment of the flu is something called the Myers’ Cocktail. This is a rapid intravenous infusion of high dose vitamins and minerals given over 10 minutes. It has proven effects in reduction of symptoms, viral spread and getting you back on your feet quickly after being infected.
Myers’ cocktails must be administered in the doctor’s office and depending on how severe the illness, one to three treatments during a course may be indicated. If caught early, a Myers’ Cocktail may be the most effective remedy in the treatment of the flu. The Myers’ Cocktail is also useful in many other maladies, but for acute respiratory and viral infections, it stands heads above other treatments. I am currently working on an Oral/IM combination to make this therapy more accessible and easily to administer without IV access.
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JP Saleeby, MD is co-director of the ER at LRMC, adjunct professor at GSU in Statesboro, GA and a medical / health writer for several regional and national journals. He maintains a blog at: www.docsaleeby.blogspot.com.
Reference:
http://www.cdc.gov/ncidod/eid/vol4no3/murphy.htm
http://docsaleeby.blogspot.com/2005/11/preparing-for-flu-season.html
http://www.patientcareonline.com/patcare/article/articleDetail.jsp?id=319724
www.defra.gov.uk/science
http://www.thehealthierlife.co.uk/article/3424/pathogen.html
Monday, May 15, 2006
A Not So Nice Bug
I used to think those tiny cute little ladybugs were quite harmless. I used to let them land on my shoulders while hiking in the woods and carry them along as friendly hitchhikers. I read with glee about these insects being used by farmers as "natural" ways to control pests. However, my eyes were opened quite recently after hearing about several studies presented at the American Academy of Asthma, Allergy & Immunology’s 2006 Annual Meeting with regard to an invading species. There is a very real ladybug threat in a matter of speaking.
The little monsters causing havoc are Asian Ladybird (Ladybug) beetles (Harmonia axyridis) and they can be quite nasty. In America the name "ladybird" has been popularly Americanized to "ladybug", although these insects are actually beetles (Coleoptera), and not bugs (Hemiptera). Furthermore the Asian beetles should not be confused with the European Coccinella septempunctata which is the friendlier seven-spotted ladybug.
These ladybugs from Asia are multi-colored and a bit larger (5 to 8 mm in length) than most native American species. In Japan they are used intentionally to control arthropod pests and quite by accident they found they way to American throughout the 20th century. By the mid-1990’s they could be found from the Canadian boarder to Florida and from coast to coast.
Most Asian beetles tend to be yellow to red in color and have a varying pattern and size of spots from no spots to around nineteen. Unlike our native ladybug these Asian beetles can inflict a rather painful bite. Additionally, H. axyridis will exude a foul-smelling, viscous yellow defensive chemical (when disturbed) that may be an allergen to may people. And this is where the problem lies.
When the weather gets cooler ladybugs come into homes and are usually found in attics, within walls and around windowsills. Homes that are infested with this beetle often reveal tiny yellow dots (the defensive compound they release) on the walls as a tale-tell sign of a problem. There can be hundreds or even thousands in your house when there is a significant infestation. This species of ladybug are of special consternation to people who suffer with entomophobia (whose with a fear of insects) as you can imagine.
H. axyridis adults deposit their eggs in or near prey infestations. They prey upon many species of injurious soft-bodied insects such as aphids, scales, and psyllids and that is why many farmers and gardeners don’t mind them so much. Eggs take about 4 days to hatch while the larva stage lasts about 2 weeks. Adults amazingly can live up to 2 to 3 years in optimal conditions. The larvae are larger than most native ladybird larvae and are especially fond of crapemyrtle aphids, found only on crape myrtle. Many of our native beneficials (those bugs that eat pests) also feed on crapemyrtle aphids.
It is suspected that H. axyridis may be responsible for reduction in the numbers of native beneficial beetles including other ladybug species through cannibalism and by competing for prey. They tend to take over and kill off more tame species, much like the what the killer bees of Africa (Apis mellifera scutellata) do to other subspecies of honey bees. Another example of this unhealthy competition is the Snakehead fish (another Asian import) which some experts worry will have an untoward effect on native fish in our lakes. The Snakehead has a veracious appetite, is resilient and can live out of water for hours. This fish is a menace because it has few natural predators and can deplete lakes of indigenous fish. The same rule may hold true for H. axyridis.
Besides sustaining a painful bite H. axyridis is more worrisome to those prone to allergic reactions. Allergic reactions to these ladybugs are rather common and can result in sneezing, rhinorrhea, itchy eyes as mild reactions to those of cough and shortness of breath with wheezing as more serious reactions. Rashes have also been reported. To an asthmatic with sensitivity to this beetle’s antigen this can spell some real trouble. Researchers have found that up to 21% of people tested (especially in rural areas of the country) exhibit sensitivity. That is similar to cat (24%) and cockroach (27%) sensitivity. Mild reactions are not great problem, but should a hypersensitive asthmatic get exposed the reactions may have more serious consequences.
JP Saleeby, MD is assistant medical director of the ER at LRMC, Hinesville, GA. He is also adjunct professor at GSU, Statesboro, GA. He has recently published a book on herbs entitled: Wonder Herbs: A Guide to Three Adaptogens and can be reached for comment at jpsaleeby@aol.com
Reference:
Clinical Rounds, Family Practice News, April 15, 2006
http://creatures.ifas.ufl.edu/beneficial/multicolored_asian_lady_beetle.htm
http://www.nysaes.cornell.edu/ent/biocontrol/predators/harmonia.html
http://allergies.about.com/od/bugs/a/blaaaai030406a.htm
http://www.insecta-inspecta.com/bees/killer/
http://fishing.about.com/cs/fishfactsinfo/a/aa092703a.htm
Sunday, May 14, 2006
John Kenneth Galbraith (1909 - 2006)

"The only function of economic forecasting is to make astrology look respectable." - John Kenneth Galbraith
[Yes, I also think those silly little "experts" on Radio and TV news programs that laugh and joke their way through predicting stock prices and making economic predictions are over-animated and over-paid putzes]
Mr. Golbraith also coined the term "Conventional Wisdom".
Thursday, May 11, 2006
Dr. Saleeby on AM Talk Radio with Dr. Jordan
http://www.healthradionetwork.com/index.php?option=com_remository&Itemid=32&func=fileinfo&parent=category&filecatid=5226
Monday, April 24, 2006
Monday, April 17, 2006
RLS
I have run this mile countless times, not around the neighborhood nor the local track, but simply in my bed each night as I try to fall asleep. The nagging need to move my legs beneath the sheets is overwhelming. I get out of bed. I walk through the house. I try running water over my feet and legs. I hang my legs over the edge of the bed and dangle my feet. Pacing the floor again, I try sleeping on the sofa. I have tried a variety of medications and have avoided certain foods and drinks prior to bed. My symptoms go away for a while. Some nights I simply fall asleep due to exhaustion. This scene repeats itself and to varying degrees of aggravation.
What is this sleep malady and why am I affected by the inability to relax and fall asleep peacefully? I am not alone in this affliction. It is called Restless Leg Syndrome or simply RLS. Approximately 10% of the population is affected. The syndrome is characterized by the urge to move the legs and usually manifests during periods of inactivity and at night prior to falling asleep. Women are affected nearly twice as often as men. Women who are multiparous (who have had more than one child) are primarily affected and the symptoms tend to worsen with subsequent pregnancies. The syndrome often becomes worse with age and is frequently diagnosed in middle age. RLS often can be a secondary symptom of conditions that cause iron deficiencies. This is perhaps why RLS presents itself during pregnancy when iron deficiencies can occur. End stage renal disease and neuropathies can also cause RLS symptoms. The severity of symptoms range from mild to uncomfortably irritating to painful. Management of RLS, depending on the severity, can involve simple lifestyle changes, such as diet and exercise or in severe cases medications that can be prescribed by a family physician.
Diagnosis usually is based on the subjective information of the recipient. Are the symptoms alleviated by moving the limbs? Is there a family history of RLS? Do certain types of medications help to alleviate or aggravate symptoms? When are symptoms most noticeable? Are there problems with falling asleep and staying asleep? Is there an anemia or an iron deficiency present? Is there an underlying disease present that would cause RLS? The answers to these questions help make the diagnosis.
Often times the victim may present with a normal physical exam. Typically the patient’s main complaint is fatigue and lack of sleep. Their sleep problems are often described as an uncomfortable, creeping, nagging sensation in their legs that does not allow for falling asleep. The feeling is uncomfortable enough to cause the person to “have to” move their legs in order to rid themselves of the sensation. The arms can sometimes be involved as well. The symptoms are alleviated as long as the legs continue to move. Once movement has stopped the uncomfortable sensation begins again. So goes the pattern. The severity varies from night to night and the symptoms may dissipate for several weeks to several months and then return. The symptoms can also occur during any period of inactivity, whether it is sitting down to read, watch TV, or travel or any time the body is required to sit still. Eighty percent of those affected experience Periodic Limb Movement Disorder or PLMD. This is a jerking motion of the limbs that occur throughout the night and disrupts the sleep cycle. PLMD is different from RLS in that the movements are totally involuntary. The diagnosis of PLMD is made by a sleep study at medical facilities that do sleep monitoring. In either case, the cause of the disorder is not known. It is believed that the chemical neurotransmitter dopamine, which carries information to the nerve cells, is possibly not functioning correctly and therefore an imbalance of this substance contributes to the development of RLS.
Interestingly enough, although it is diagnosed frequently in middle age there are those who are affected early in life. Genetics definitely is a factor in determining early onset of the syndrome. Those with family members affected can have symptoms present as infants. In my particular case, my mother suffers from RLS and my symptoms appeared
in my early teens. The fact that I have had four children has made the symptoms even more pronounced. It is estimated that 50% of those with RLS have a genetic predisposition. Others develop RLS as a secondary symptom of other disorders. Again, those with anemia or low iron levels can develop RLS. It is important to have your physician perform a serum ferritin and iron level to determine if iron deficiency exists. Once anemia is corrected the symptoms of RLS are usually alleviated.
Those suffering from kidney failure, diabetes, Parkinson’s disease and peripheral neuropathies often exhibit RLS. Again treating the underlying condition will usually resolve the RLS. Pregnancy is a tremendous contributing factor particularly in the last trimester. Once delivery has occurred the symptoms lessen. However, as mentioned previously multiple pregnancies tend to cause the symptoms to remain. Medications also can be a contributing factor. Antinausea, antipsychotic, and some cold and allergy medications can reek havoc on the RLS sufferer. At one point my sleep was so disrupted that I resorted to nightly sleep aids containing diphenhydramine. Little did I know this was contributing to my RLS. Once I stopped the over the counter sleep aid, my nightly occurrences of the “jimmy legs” stopped as well.
RLS can affect our daily productivity. Lack of concentration, lack of motivation and memory loss are all byproducts of sleep disruption. RLS is often underdiagnosed or misdiagnosed. Common misdiagnoses are depression, insomnia, arthritis, neuropathies and night cramps. Discuss your symptoms with your physician. Identifying a problem is often half the battle. If there is a positive family history, if you experience the urge to move your limbs voluntarily or involuntarily throughout the night and are experiencing sleep interruptions its quite possible that RLS is present. If involuntary, periodic limb movement disorder is suspected, be aware that there are lifestyle changes that can help tremendously.
Pharmacotherapy includes dopaminergic drugs. Levodopa is a first line standard therapy for this disorder. Pergolide (Permax®) is another medication that is used. The FDA has approved the drug Ropinirole (Requip®) as a treatment for RLS. The drug Cabergoline (Dostinex®) is yet another agent but less is know about it. Other pharmaceuticals used with varying affect are opiates, tramadol (Ultram®), benzodiazepines and anticonvulsants. There is even a drug called Rotigotine (NeuproTM®) in the form of a patch that is in trial.
Some non-pharmaceutical treatments include exercise. Reduction in caffeine consumption, particularly in early afternoon and early evening. It is not necessary to eliminate caffeine but reduce its use and never late in the evening. Eliminate the use of tobacco, that’s a no brainer. We are fully aware of the detrimental effects of tobacco. Reduce the stress in one’s life, for example try meditation or yoga to keep the mind and body in tune. Strive for a healthy diet. Obesity is rampant in our society and makes management of this disease difficult. Manage your medications. If you feel that certain medications may be triggering your RLS discuss the problem with your physician. There are also drugs out in the market that help in the treatment of RLS. Lastly, once it has been determined that anemia is present ask your doctor about vitamin supplements.
Reference:
Allen, RP., et. al., “Restless Legs Syndrome: A Kickoff”, The Movement Disorder Society, Feb. 2006.
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Sharon K. Coopersmith, RRT is a pediatric respiratory therapist at MUSC in Charleston, SC. She suffers periodically from RLS.
JP Saleeby, MD is co-director of the ED at LRMC in Hinesville, GA. He is adjunct professor at GSU in Statesboro, GA.
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Further References:
1. Allen RP, Picchietti D, Hening WA, et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology.A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med.
2003;4:101–119. 2. Hening W,Walters AS,Allen RP, et al. Impact, diagnosis and treatment of restless legs syndrome (RLS) in a primary care population: the REST (RLS epidemiology, symptoms, and treatment) primary care study. Sleep Med. 2004;5:237–246.
3. Hening WA,Allen RP, Earley CJ, et al.An update on the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep. 2004;27:560–583. 4. Trenkwalder C, Seidel VC, Gasser T, Oertel WH. Clinical symptoms and possible anticipation
in a large kindred of familial restless legs syndrome. Mov Disord. 1996;11:389–394. 5. Lazzarini A,Walters As, Hickey K, et al. Studies of penetrance and anticipation in five autosomal-dominant restless legs syndrome pedigrees. Mov Disord. 1999;14:111–116.
6. Desautels A,Turecki G, Montplaisir J, et al. Identification of a major susceptibility locus for restless legs syndrome on chromosome 12q. Am J Hum Genet. 2001;69:1266–1670. 7. Bonati MT, Ferini-Strambi L,Aridon P, et al.Autosomal dominant restless legs syndrome
maps on chromosome 14q. Brain. 2003;126:1485–1492. 8. Chen S, Ondo WG, Rao S, et al. Genomewide linkage scan identifies a novel susceptibility locus for restless legs syndrome on chromosome 9p. Am J Hum Genet. 2004;74:876–85. 9. Allen RP,
Earley CJ. Restless legs syndrome: a review of clinical and pathophysiologic features. J Clin Neurophysiol. 2001;18:128–147. 10. Allen RP, Earley CJ. Defining the phenotype of the restless legs syndrome (RLS) using age-of-symptom-onset. Sleep Med. 2000;1:11–19.
11. Milligan SA, Chesson AL. Restless legs syndrome in the older adult: diagnosis and management. Drugs Aging. 2002;19:741–751. 12. Bara-Jimenez W,Aksu M, Graham B, Sato S,Hallett M. Periodic limb movements in sleep: state-dependent excitability of the spinal
flexor reflex. Neurology. 2000;54:1609–1615. 13. Bucher SF, Seelos KC, Oertel WH, Reiser M,Trenkwalder C. Cerebral generators involved in the pathogenesis of the restless legs syndrome. Ann Neurol. 1997;41:639–645. 14. Turjanski N, Lees AJ, Brooks DJ. Striatal
dopaminergic function in restless legs syndrome: 18F-dopa and 11C-raclopride PET studies. Neurology. 1999;52:932–937. 15. Ruottinen HM, Partinen M, Hublin C, et al. An FDOPA PET study in patients with periodic limb movement disorder and restless legs syndrome.
Neurology. 2000;54:502–504. 16. Garcia-Borreguero D, Larrosa O, Granizo JJ, de la Llave Y, Hening WA. Circadian variation in neuroendocrine response to L-dopa in patients with restless legs syndrome. Sleep. 2004;27:669–673. 17. Earley CJ, Connor JR,
Beard JL, et al.Abnormalities in CSF concentrations of ferritin and transferrin in restless legs syndrome. Neurology. 2000;54:1698–1700. 18. O’Keeffe ST, Gavin K, Lavan JN. Iron status and restless legs syndrome in the elderly. Age Ageing. 1994;23:200–203.
19. Sun ER, Chen CA, Ho G, Earley CJ,Allen RP. Iron and the restless legs syndrome. Sleep. 1998;21:371–377. 20. Allen RP, Barker PB,Wehrl F, Song HK, Earley CJ. MRI measurement of brain iron in patients with restless legs syndrome. Neurology. 2001;56:263–265.
21. Earley CJ,Allen RP, Beard JL, Connor JR. Insight into the pathophysiology of restless legs syndrome. J Neurosci Res. 2000;62:623–628. 22. Erikson KM, Jones BC, Hess EJ, Zhang Q, Beard JL. Iron deficiency decreases dopamine D1 and D2 receptors in rat brain.
Pharmacol Biochem Behav. 2001;69:409–418. 23. Phillips B,Young T, Finn L, et al. Epidemiology of restless legs symptoms in adults. Arch Intern Med. 2000;160:2137–2141. 24. Rothdach AJ,Trenkwalder C, Haberstock J, Keil U, Berger K. Prevalence and risk factors of
RLS I an elderly population; the MEMO study. Neurology. 2000;54:1064–1068. 25. Lavigne GJ, Montplaisir JY. Restless legs syndrome and sleep bruxism: prevalence and association among Canadians. Sleep. 1994;17:739–743. 26.Wetter TC,Winkelmann J, Eisensehr
I. Current treatment options for restless legs syndrome. Expert Opin Pharmacother. 2003;4:1727–1738. 27. Earley CJ. Restless legs syndrome. N Engl J Med. 2003;348:2103–2109. 28. Clark MM. Restless legs syndrome. J Am Board Fam Pract. 2001;14:368–374.
29. Winkelman JW, Chertow GM, Lazarus JM. Restless legs syndrome in end-stage renal disease. Am J Kidney Dis. 1996;28:372–378. 30. Ondo WG,Vuong KD, Jankovic. J Exploring the relationship between Parkinson disease and restless legs syndrome. Arch Neurol.
2002;59:421–424. 31. Littner MR, Kushida C,Anderson WM, et al. Practice parameters for the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep. 2004;27:557–559. 32. Happe S,Trenkwalder C. Role of dopamine
receptor agonists in the treatment of restless legs syndrome. CNS Drugs. 2004;18:27–36. 33. Trenkwalder C, Hening WA,Walters AS, et al. Circadian rhythm of periodic limb movement and sensory symptoms of restless legs syndrome. Mov Disord.
1999;14:102–110.
34. Allen RP, Earley CJ.Augmentation of the restless legs syndrome with carbidopa/levodopa. Sleep. 1996;19:205–213. 35.Wetter TC, Stiasny K,Winkelmann J, et al.A randomized controlled study of pergolide in patients with restless legs syndrome. Neurology.
1999;52:944–950. 36. Stiasny K,Wetter TC,Winkelmann J, et al. Long-term effects of pergolide in the treatment of restless legs syndrome. Neurology. 2001;56:1399–1402. 37. Trenkwalder C, Hundemer HP, Lledo A, et al. Efficacy of pergolide in treatment of restless
legs syndrome: the PEARLS Study. Neurology. 2004;62:1391–7. 38. Ondo W, Romanyshyn J,Vuong KD, Lai D. Long-term treatment of restless legs syndrome with dopamine agonists. Arch Neurol. 2004;61:1393–1397. 39. Montplaisir J, Nicolas A, Denesle R,
Gomez-Mancilla B. Restless legs syndrome improved by pramipexole.A double-blind randomized trial. Neurology. 1999;52:938–943. 40. Montplaisir J, Denesle R, Petit D. Pramipexole in the treatment of restless legs syndrome: a follow-up study. Eur J Neurol.
2000;7(Suppl 1):27–31. 41. Trenkwalder C, Garcia-Borreguero D, Montagna P, et al. Ropinirole in the treatment of restless legs syndrome: results from the TREAT RLS 1 study, a 12 week, randomised, placebo controlled study in 10 European countries. J Neurol
Neurosurg Psychiatry. 2004;75:92–97. 42. Walters AS, Ondo WG, Dreykluft T, et al. Ropinirole is effective in the treatment of restless legs syndrome.TREAT RLS 2: a 12-week, double-blind, randomized, parallel-group, placebo-controlled study. Mov Disord.
2004;19:1414–23. 43. Allen R, Becker PM, Bogan R, et al. Ropinirole decreases periodic leg movements and improves sleep parameters in patients with restless legs syndrome. Sleep. 2004;27:907–14. 44. Zucconi M, Oldani A, Castronovo C, Ferini-Strambi L.
Cabergoline is an effective single-drug treatment for restless legs syndrome: clinical and actigraphic evaluation. Sleep. 2003;26:815–818. 45. Stiasny-Kolster K, Benes H, Peglau I, et al. Effective cabergoline treatment in idiopathic restless legs syndrome. Neurology.
2004;63:2272–9. 46. Stiasny-Kolster K, Kohnen R, Schollmayer E, Moller JC, Oertel WH. Patch application of the dopamine agonist rotigotine to patients with moderate to advanced stages of restless legs syndrome: a double-blind, placebo-controlled pilot study.
Mov Disord. 2004;19:1432–1438. 47.Walters AS,Wagner ML, Hening WA, et al. Successful treatment of the idiopathic restless legs syndrome in a randomized double-blind trial of oxycodone versus placebo. Sleep 1993;16:327-332. 48. Garcia-Borreguero D,
Larrosa O, de la Llave Y, et al.Treatment of restless legs syndrome with gabapentin: a double-blind, cross-over study. Neurology. 2002;59:1573–9. 49.Walters AS, Mandelbaum DE, Lewin DS, et al. Dopaminergic therapy in children with restless legs/periodic limb
movements in sleep and ADHD. Dopaminergic Therapy Study Group. Pediatr Neurol. 2000;22:182–186. 50. Silber MH, Ehrenberg BL,Allen RP, et al.An algorithm for the management of restless legs syndrome. Mayo Clin Proc. 2004;79:916–922.
Saturday, April 08, 2006
Wonder Herbs: A Guide to Three Adaptogens
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Wednesday, March 15, 2006
Coffee vs Tea

The last 15 years has brought to light a significant amount of medical research correlating coffee consumption to an increased risk for non-fatal myocardial infarction (MI) or heart attack. Several of the studies had varying range of outcomes with some showing very strong correlation and others weak. That variability was not understood until researchers looked into how the body metabolizes caffeine. The March 8th 2006 issue of JAMA featured a contribution on coffee, caffeine and risk of MI. The researchers in this particular study took a look at a genotype (CYP1A2) of the polymorphic cytochrome P450 system of enzymes that detoxify and breakdown caffeine in the body. They found that particular individuals who have the variant CYP1A2*1F allele were “slow” caffeine metabolizers and were thus subject to the untoward effects of high doses of caffeine. Those folks can see a 60% increase in risk for heart attack by drinking 5 or more cups of coffee a day. Those subjects with CYP1A2*1A are considered “fast” metabolizers of caffeine and are much less at risk for heart attack. Obviously the dose of caffeine plays an important role in risk.
A 5-oz cup of coffee contains on average 80mg of caffeine (the range is typically 40 to 170 mg depending on the type of brew). Whereas Black tea contains on average 40mg, Oolong tea 30mg, Green tea 20mg, and decaffeinated tea only 2mg of caffeine. Herbal teas usually don’t contain any caffeine.
There are several methods in which to decaffeinate coffee and tea. The chemical methods involve the use of methylene chloride (not considered a natural means by which to do the job) and ethyl acetate (considered natural due to the presence of this compound in many fruit). Other non-chemical methods involve the use of water and compressed CO2. There are losses in flavor and nutrient value so some degree with almost all the methods of decaffeination and that is their downside. For a simple in-your-own-home decaffeination process with tea follow these simple steps. Let the tea leaves steep from 45 to 60 seconds in hot water. Discard the water and steep the tea in a fresh pot of hot water until ready to consume. Since caffeine is very water-soluble it will be “drawn out” with the first treatment of hot water. Some of the beneficial flavor compounds, polyphenols, catehcins, epigallocatechin esters (EGCG), theasinensins, and dimeric proanthocyanidins will be washed out in this process but you are likely to end up with only 10% of the original caffeine content. This is a plus for those individuals sensitive to caffeine or for that late night cup of tea.
While there are scattered references to health benefits of coffee drinking in reducing kidney stones and possibly reducing colon cancer there is by far not the plethora of scientifically proven health benefits found in drinking tea. At present it is rather clinically impractical and fiscally unreasonable to genetically test an individual for the type of allele he or she carries. So the best advice for reducing MI risk is to avoid large doses of caffeine. So skip the Starbucks double espresso and have a cup or two of tea instead.
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JP Saleeby, MD is co-director of the Emergency Department at LRMC in Hinesville, GA. He is adjunct professor in health sciences at Georgia Southern University and lectures on the benefits of tea drinking. His book Wonder Herbs: A Guide to Three Adaptogens covers the medical and health benefits of Jiaogulan tea. He is the medical / health writer for the Tea Experience Digest magazine. Dr. Saleeby can be reached at jpsaleeby@aol.com
Reference:
Cornelis, M. El-Sohemy, A, et. al., Coffee, CYP1A2 Genotype, and Risk of Myocardial Infarction, JAMA. March 2006;295:10:1135-1141.
http://www.teatalk.com/science/chemistry.htm
www.stashtea.com/caffeine
© 2006
Tuesday, March 14, 2006
Human Papillomavirus (HPV) & Disease
There are many different types of Human Papillomavirus (HPV) with some rather benign types causing the common wart, plantar and filiform warts. Other types are a bit more serious causing genital warts in men and women of which a million cases are reported each year in the USA. Most HPV infections clear on their own, are often asymptomatic and are spread unknowingly. There are however some 20 types of HPV that are classified as oncogenic (or cancer causing) viruses. Infection with one of these types is not a simple self-limiting infection, but one that has some serious outcome. HPV is transmitted sexually so it is considered a Sexually Transmitted Disease (STD) and has an incubation period of 1 to 6 months before signs of infection are evident. This delayed incubation period allows for the infection to spread from one person to another unwittingly.
HPV is the culprit behind Cervical Dysplasia with 330,000 new cases of high grade (classified as CIN (Cervical Intraepithelial Neoplasia) II & III) and 1.4 million cases of low grade (classified as CIN I) being diagnosed each year in the USA. The high risk types of HPV (types 16, 18, 31, & 45) cause changes in the cells of the cervix. Some changes will resolve spontaneously, but other go on to cause dysplasia and if left untreated these dysplastic cells develop into cancer.
Almost all cases of cervical cancer are linked to oncogenic types of HPV (especially types 16 & 18). Ten women every day in the USA die from cervical cancer. That approximates 3700 women a year. By fifty years of age 80% of sexually active women in this country will acquire genital HPV. Epidemiological statistics show that 1 out of 4 sexually active young adults between the ages of 15 and 24 will be infected with this virus.
Genital warts usually can be identified by their appearance (a cluster of cauliflower like lesions) but must be differentiated from the flat-topped condyloma lata of secondary syphilis. Biopsies of atypical and/or persistent warts may be necessary to exclude carcinoma. Endocervical warts can be detected only at colposcopy, a magnified type of pelvic examination done when some women receive their Pap smears.
A HPV test should be done when a woman has her annual female exam and Pap smear. It is done to detect any HPV infection and determine the type of HPV present. This type of test checks the DNA of the virus using modern technology. Like a Pap test, it is a sampling or scraping of the epithelial cells of the cervix.
There are several treatment options but none is completely satisfactory and relapse is frequent. Genital warts may be removed by electrocauterization, laser, cryotherapy, or surgical excision. Topical antimitotics drugs such as Podophyllin, or 5-fluorouracil; caustics such as Trichloroacetic acid; or interferon inducers such as Imiquimod are widely used but usually require multiple applications and have high failure rates.
Interferon, either intralesionally or by intramuscular application, has been shown to clear intractable lesions of the skin and genitalia. Its optimal dose and long-term effects are still not very well understood.
GlaxoSmithKline and Merck pharmaceutical companies are working on a vaccine for HPV. This vaccine may hold promise for reducing the morbidity and mortality of these viral diseases. Annual examinations and good follow-up examination for women is important (as well as for their sexual partners) especially when HPB type 16 and 18 are found because of their high risk of invasive carcinoma.
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JP Saleeby, MD is co-director of the Emergency Department at LRMC, Hinesville, GA. He holds faculty position in the Department of Health Science at Georgia Southern University, Statesboro, GA. He can be reached for comment at jpsaleeby@aol.com.
References:
http://www.merck.com/mrkshared/mmanual/section13/chapter164/164l.jsp
http://www.questdiagnostics.com/kbase/topic/medtest/tu6451/descrip.htm
http://www.newscientist.com/channel/sex/mg18624954.500
Merck Literature
The word on Codex Alimentarius - Does it threat our Supplement Industry
For years I preached that the supplement industry needs to police itself or it will be done for us. Don't like the idea of the Government stepping in too much. DSHEA has given the industry too much in the way of freedom to say whatever with regards to supplements. This is a call for some regulation but not in the form of a Big Pharma controlled solution.
From Health Freedom USA (www.healthfreedomusa.com):
The first step to understanding Codex Alimentarius is to realize that it has absolutely nothing to do with "consumer protection". That's propaganda for the sake of getting people and Congress to yield to its implementation.
"Codex Alimentarius" means "food rules" in Latin. The organization was born in 1962 when the UN established the Codex Alimentarius Commission (CAC) as a "Trade Commission". It was created to regulate, and thus control, every aspect of how food and nutritional supplements are produced and sold to the consumer. It is solely about trade and the profits of multi-national corporations.
The more natural health products people use, the fewer drugs they use. Millions are turning to natural health. Big Pharma fears this as it would diminish profits. Codex is designed to protect Big Pharma profits by eliminating natural health products and treatments. Health food stores and wellness companies would be hit hard.
Codex is unscientific because it classifies nutrients as toxins and uses "Risk Assessment" to set ultra low so-called "safe upper limits" for them. Risk Assessment is a branch of Toxicology, the science for assessing toxins. The proper science for assessing nutrients is Biochemistry. Codex does not use Biochemistry.
Codex is based on the Napoleonic Code, dating back to Bonaparte. Under this code, anything not explicitly permitted is automatically forbidden. Under Common Law (our system), something does not have to be explicitly permitted to be legal. The tyrannical Napoleonic Code allows the banning of natural health options by default.
Codex will go into global effect on December 31, 2009, unless we, the People, take action and avert it. Right now, we are like a frog boiled slowly, the heat raised gradually so we won't jump out of the water. The media is used to make us believe that Codex is about "consumer protection". Part of the media strategy is to tarnish the image of natural health options, through for-hire studies.
One-time defenders of supplements and nutritional products, such as the National Nutritional Foods Association (NNFA) and Council for Responsible Nutrition (CRN), have fallen prey to new pharmaceutical members and are spreading disinformation saying that Codex is "consumer protection". Their boards used to be run by health freedom fighters.
Codex is made up of many standards for every aspect of food. One of these standards was ratified (approved) in July 2005: the destructive Codex Alimentarius Vitamin and Mineral Guideline (VMG). The VMG can ban all high potency and clinically effective vitamins & minerals. For example, Vitamin C would be restricted to only a few milligrams per dose. Other nutrients, such as amino acids, are also under threat.
The U.S. has a powerful legal tool for health freedom: the Dietary Supplement Health and Education Act (DSHEA), passed in 1994 after massive grass-roots action. DSHEA scientifically classifies nutritional supplements as food and prevents dosage restrictions; Codex unscientifically classifies them as toxins and sets ultra-low doses. The VMG violates U.S. law because it violates DSHEA. We must unite to protect DSHEA, our best legal defense against Codex.
The pharmaceutical industry works through irresponsible/corrupt politicians to do their bidding. The path to institute Codex in America is to "influence" Congress to pass laws friendly to drugs and unfriendly to nutritional supplements, so that slowly everyone comes to believe that nutrients are "dangerous", and drugs are "proper medicine". Susan Davis (D, CA) and other politicians are helping Big Pharma by supporting bills designed to destroy DSHEA.
The U.S. Codex Office (the U.S. Codex "point of contact") is unfortunately highly supportive of Codex. So is the rest of the government, including the pharmaceutical-friendly FDA. They should not be. DSHEA and other U.S. law means their support is in direct violation of the laws of the U.S.A.! They are breaking our laws and they know it.
Congress has the power to keep America Codex-free. It can defeat bills designed to destroy DSHEA, support health freedom bills, and reprimand the U.S. Codex Office and the FDA. Using the Internet we can reach Congress directly to create a lobby of the people, for the people. Families of Congress would suffer too, if Codex is not averted.
To sign a citizens petition against Codex go to: http://www.healthfreedomusa.org/action/step3.shtml
Wednesday, March 01, 2006
USA loses Medals due to Bad Attitudes
Let's talk attitude for a minute. A lot can be said about attitude. In my field if a person is diagnosed with cancer and assumes a negative or bad attitude about his or her predicament then the outcome is poor. A good prognosis falls on those with a positive attitude and a fighting spirit. This has been reported time and again.
After watching the 2006 Torino Winter Olympic Games night after night, I kept shaking my head. It seems there was this dark cloud of negativism amongst some of the athletes and it cost us in the medal counts and in the eyes of the world. Athletes must remember that in the Olympic Games they are as much a representative of their home country as they are for themselves. Everyone tunes in on this stage. Antics don't go unnoticed.
While I tend to be a participant in sports and not an armchair athlete the one exception is the winter and summer Olympic Games where I find myself glued to the TV set. As a casual observer of sports I find better sportsmanship and attitude in the amateur athletic programs. Professional sports are typically a turn off for me. Huge egos, unjustified star status and unbelievable remuneration for playing a sport for goodness sake. Then you have these celeb athletes private lives forced down your throat. Doesn't add to the game and I really don't care as I am not into tabloids. Then there is that NASCAR character who does a back flip in the pits after he wins a race. Just waiting for the idiot to slip on some motor oil and smash his face into the asphalt. Oh and when the amateur athlete has an agent and a spokesperson they no longer can claim amateur status.... are you listening Michelle Kwan.
I want to highlight some "good" attitudes and recognize some athletes who did outstanding jobs. Now I cannot mention everyone but will focus on one of my favorite sports. I am a big fan of Luge, having attended some start camps at the Lake Placid training center some years ago, I have always watched this sport with great interest. I am pleased to say that four of our outstanding American athletes in this winter sport can walk with heads held high not only for their individual performances but for their attitudes and spirit. Women's slider Courtney Zablocki attained a fourth place finish. Yes, out of medal contention but non the less she was the first American female in the sport of Luge to place this high at a Winter Olympic game.
In an interview reported in USA Luge's Online Newsletter Zablocki is quoted as saying: "I thought that I had four awesome runs, I was happy with what I did. I really convinced myself that I could finish up there. Fourth -- even though it's an awesome finish, the truth is I'm a little disappointed, but I'm also happy at the same time." She went on to say: "My goal now is to become the first singles slider to win an Olympic medal for the United States and that will be my focus over the next four years."
Tony Benshoof tied Adam Heidt's (one of my coaches in Lake Placid) fourth place finish in the Salt Lake City Games of 2002. While Tony brought home Silver in the World Championships he was a bit disappointed in Torino, missing the podium by 0.16 of a second.In an interview after his last run Benshoff said: "I thought that after my fourth run I would pull it off. I didn't think that Martins (Rubenis) would hold on under the pressure, but he did, and I have to give him credit." He went on to say: "My third run is what cost me the race. Two things happened, my start was slow and curve-14 was a little rough, which probably cost me a tenth of a second, and in the end, it was the difference."
Tony stated later: "Am I disappointed. sure I'm disappointed, I certainly had hopes of coming away with an Olympic medal. It hurts being fourth, but I have to remind myself that I'm the fourth best slider in the world and I'm extremely proud to say that. I plan on being back for Vancouver (Canada)." That is the Olympic spirit. In an email to me on Feb. 13th he stated that he appreciated my keeping track of him through the years and that although he was not entirely happy with the result, he did do his best. That is all we can ask of our athletes. To do their best. Never to give up or mope around, especially in an international theatre.
In the doubles event, Preston Griffall and Dan Joye finished eighth. The Olympic first timers came back from an 11th-place opening run time with the fourth fastest run of the second heat. "We were not happy at all after that first run and we knew that we needed to bounce back during the second," stated Joye. "We were able to do that and we closed out the Olympics in the right way." That is the fighting spirit.
Now for the bad and the ugly. This negative vibe seemed to permeate the games more this year than I can ever remember. Maybe it was the media. They tend to hype up athletes and their issues to build viewership in the ratings game. Despite all the hype about Bode Miller, he had a painfully poor performance and nonchalant attitude about competing. I just don't understand. He was the defending World Cup overall champion but you would not have guessed it by his performance or his attitude. He seemed out of focus. Maybe his only excuse could be that he is such a rebel he was rebelling against the media and all the pressure placed upon him. However, much of it was self-inflicted. He remained unrepentant at interviews and said he was not there to win medals, but rather "experience the Olympic Spirit". That is a defeatist attitude and truthfully I don't buy it.
Remember Americans love the come from behind victor, the underdog, and the non-braggart who wins in the end. Americans prefer the meek hard working dedicated athlete to that of a boastful, arrogant low talent. And that is how I see the playing field today in both amateur and professional athletics.
A look at our medal count from the Salt Lake games yielded 10 gold, 13 silver and 11 bronze with at total of 34 medals. We ranked second only to Germany in the medal count. This year our totals dropped to only 25, with 9 gold, 9 silver and 7 bronze. I attribute it not to lack of a home field advantage but rather to some very poor attitudes. How a nation performs at the games is a reflection of the health of that country. We are the premier world power, but you would not have come away with that impression watching NBC Sports.
Another attitude or ego that got in the way was the loss of a first place finish in the woman's snowboard cross where Lindsey Jacobellis with a commanding lead over her competitors pulled a stunt on the course that cost her the gold. Her arrogant showboating before the fans did not make her a winner of a silver, but the loser of the gold in many eyes. Her coaches could have died. She should have been scolded and berated more than what was obvious. For God sake, you celebrate after you win the medal. My six-year old son knows that rule of the game. Not only did she lose a first place personal finish, she cost her team and country the top slot. Shame on her. Had she taken a spill at the start of the race and overcome the odds to finish second she would have been heralded a hero. But no, she had to be a smart ass. What of her teammates response? They were all supportive and remarked that was what snowboarding is all about. Well maybe in the X-Games, but not in the Olympics, they need to take a reality pill and "get real" as they say. Thank gosh for the good showing of White, Kass, Wescott, Teter and Bleiler on their boards. Hey didn't we invent the snowboard anyway?
Another malady of the games highlighted by the media was the on and off ice antics of some speedskaters. Not entirely sure of what all was going on, but I really don't care. What matters is professionalism and sportsmanship on the playing field. Apolo Ohno lived up to what was expected of him and came away with some medals in the short track speedskating events. It was good to see him win gold in the 500 against the Koreans without all the controversy of their last encounter. However overshadowing the medal wins by Joey Cheek, Chad Hendrick and Shani Davis was Chad and Shani's off ice war of words. In an immediate live TV interview after Davis won his gold in the 1000-meter event he came across as a rude punk with no respect for his country or himself. In later interviews he put on a better face, but surely after someone told him what an ass he was.
Oh and hey we won a bronze in Curling this year. The first ever medal awarded to the US for Curling and also a bronze medal to the oldest US athlete in the games. Curling team member Scott Baird is 54 this year. How cool is that.
So I certainly hope our young American athletes represent themselves and our country a bit better in Canada in four years. And for Pete sake will the media give them some room to breathe.
Sources:
USALuge Newsletter 2-26-06 report from Cesana Pariol, Italy
http://sports.yahoo.com/olympics/torino2006/medals
http://en.wikipedia.org/wiki/2002_Winter_Olympics_medal_count
USA Today Feb. 27, 2006, Section D
Friday, February 03, 2006
Diet Pill Phenom

By JP Saleeby, MD
Americans love to stuff their mouths. Lately it has been with a lot of fast food. The national girth has proven in recent years that we are a nation of fat people. Those of us that actually care about our appearance and our general health often times want a quick fix. Heaven forbid we actually shut our pie-holes to the offerings of McDonalds and Burger King. Oh no, we need some painlessly easy means of fixing things. Both big pharma and the nutritional supplement industry provide us with the means. Yes just one more thing to cram into our over stuffed mouths. Diet pills have been around for years, but there are a few new agents on the market and Americans are cashing in on them.
Meridia is one of only two FDA approved long-term medications for weight loss. It is a sister drug to Prozac and Zoloft and alters the feel-good brain chemical serotonin in our brains. This can be a rather useful start to a weight loss program if used in conjunction with proper diet and exercise. However, some side effects include a rise in blood pressure. Not a good idea for the obese hypertensive.
Xenical came out a few years ago. It is the other FDA approved drug for weight loss. Was the FDA on crack? Does the drug company that manufactures Xenical have a very evil sense of humor? This drug from day one was on my shit list (no pun intended). Besides commanding a price tag of over $100 per month it is dangerous if you ask me. Xenical inhibits the absorption of fat in the digestive tract. As a consequence it blocks absorption of the very good fat-soluble vitamins (A, D, E and K) as well as some rather important Omega-Fatty Acids. If that ain’t enough, it can cause severe bloating and diarrhea. OK, you are at a dinner party and sample the duck pate and bang you have created a very embarrassing moment.
There is a new drug in the wings called Acomplia, currently under FDA review. This drug turns off the eating pleasure sensors in the brain lowering the urge to overeat. Preliminary studies show side effects from dizziness to diarrhea. There is even some reports that this drug may be useful in smoke cessation. Jury is still out on this one until the studies are published.
Then there are those late night infomercials that boast “too good to be true” weight loss promises. Most are untested, most are absolutely false in the claims they make and they hide under the skirt of the Dietary Supplement Health and Education Act (DSHEA) of 1994, so the government can’t touch them. Shame on them. Oh come on guys, do some real research to prove these supplements effective. If they are you will make four-fold in profits on what you spend on R&D. They are worth mentioning here because you are bound to come across them at the supermarket checkout line next to issues of tabloids the Star and National Enquirer. There are quite a number out there, but a popular supplement is Zantrex-3. Alleged to boost metabolism with caffeine and guarana. Same effect as a double expresso from Starbucks and side effects are about the same: increased heart rate, jitters and some serious insomnia.
Hoodia is all the rage these days. Like an old Arab saying goes “There are those that cannot find a miracle at their local church”. The exotic herb from far off lands may yield the answer. Hoodia originates from a cactus-like plant in South Africa and Namibia, and was used by natives for stamina. Rumors leaked out that the cast members of “Desperate Housewives” used the stuff and sales have gone nuts. Once again no peer-reviewed articles that show if this really works to reduce weight. So in conclusion, Americans need to put less in their mouths including diet pills and muster up enough will power to get off their fat rear-ends, make a trip to the gym and not stop at the Krispy Kreme on the way home.
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© 2006
Sunday, January 29, 2006
Red Wine and Resveratrol

Interest in wine’s health benefits in the last two decades may have been sparked by a desire to establish a reason for the so called “French Paradox”. There is a where a lower incidence of heart disease is found in the French. The French have a diet rich in fat and it is rational to think this antagonistic diet would be incompatible with good health. The French are known to eat more beef, cheese and butter than their European neighbors. Several researchers concluded that along with their rich fatty foods they also have a significant intake of red wine when compared to other Europeans and even Westerners. Thus the door was open for many researchers to study the health effects of wine (especially red wine) as a possible solution to this quandary. There is research supported information that moderate red wine consumption (that is one glass for women and one to two for men) can protect you against heart disease, hypertension and cancer. It also has been shown to have a positive effect on cholesterol levels. Of course moderation is key here. This is certainly not an example of where a little is good a whole lot is better. Therefore, the medical community is very cautious to recommend routine use of red wine for obvious reasons.
Some studies in women regarding the consumption of alcohol and risk of breast cancer found an increase of this type of cancer in women who consume at least one drink daily. According to a report by the American Cancer Society in 2004 there was an increase of 30% in the death rate from breast cancer in women who would drink alcohol daily. This confounding information aside consumption of one or two drinks per day is associated with a reduction in risk of approximately 30 to 50 percent in coronary heart disease. Heart disease being the overwhelming number one killer of woman annually makes it the major target. So wine consumption has an overall positive effect on death rates in the female population.
The compounds responsible for the protective powers of wine are a class of compounds called antioxidants. Red wines contain several antioxidants the key isolate being the polyphenol compound called trans-Resveratrol or Res for short. Res is found in other fruit besides grapes including mulberries, raspberries and muscadine grapes (indigenous to the Americas). And in this particular grape Res is reported to be seven times as concentrated. Resveratrol is also encountered in peanuts and other nuts. Researchers at University of North Carolina-Chapel Hill and the University of Illinois found that Res has both anti-inflammatory and anti-cancer properties. A paper published by the UNC researchers in 2000 in the journal Cancer Research reports that Res inhibits the activity of a protein called NF-kappa B which attaches to DNA inside human cells. This protein acts like a switch turning certain genes on and off. Cancer cells propagate and continue to survive by means of NF-kappa B and thus under controlled settings researcher introduce Res which turns off this protein and thus causes the death (apoptosis) of cancer cells.
In 1992 Harvard Medical School researchers included moderate alcohol consumption as one of eight ways to reduce coronary heart disease risk. The cardioprotective effect is attributed to the antioxidants found in wine grape skins and seeds. These antioxidants (flavonoids) are found in higher concentration in red as opposed to white wine. As part of the red wine making process grape skins, stems and seeds are kept in contact with the juice for a long period of time imparting not only the “red” color but also these health-benefiting flavonoids. It should also be noted that certain flavonoids found in oak wood are conveyed, as many red wine spends much time “aging” in oak barrels.
Coronary heart disease reduction by Res and other antioxidant flavonoids occur in part due to a reduction in the production of low-density lipoprotein cholesterol (LDL-C) and the increase of the good high density lipoprotein cholesterol (HDL-C). Additionally these agents reduce blood-clotting factors limiting thrombus from causing “clots” in the coronary arteries. Some of these properties may be attributed to the fact that Res has mild estrogenic properties and estrogens as a class of hormones seem to be cardioprotective. Still another study indicated that Resveratrol aided in the formation of nerve cells. There are those experts that believe this may be helpful in the treatment of neurological diseases such as Alzheimer’s and Parkinson’s in the near future. There is even one study out there claiming that daily moderate wine consumption will result in weight loss.
Not all wines are created equally. Studies from the University of California at Davis conducted studies on several varietals. They determined that higher concentrations of flavonoids are present in Cabernet Sauvignon, followed by Petit Syrah and Pinot Noir grapes. Merlot and Red Zinfandels have far fewer flavonoids. Whites once again came out short, as the bigger bolder more tannic wines seemed best for high flavonoid yields.
Resveratrol has been used in Traditional Chinese Medicine for centuries in the form of a plant called Polygonum cuspidatum for the treatment of liver and heart conditions. Why take a bitter herb when you can sip a fine wine?
According to recent statistics, year 2002 wine volume in the United States was approximately 595 million gallons. Up 34 million gallons of annual wine production when compared to 2001 records and the trend continues. California remains the largest wine producing state in the US with 90 percent coming from this state alone.
With wine sales in the United State reaching $21.1 billion in 2002, it has helped push the US to fourth in world wine production and third in consumption. The Greek philosopher Plato is quoted as saying "Nothing more excellent or valuable than wine was ever granted by the gods to man." And this may be true beyond his imagination given the stated health benefits. The questions remains, with the increased consumption in recent years, will it have a noticeable impact on the health of Americans? Cheers.
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JP Saleeby, MD is co-director of the Emergency Department at LRMC in Hinesville, GA. He is a strong advocate of nutritional medicine and an oneophile of sort founding the Savannah Wine Club. He maintains a blog at http://www.docsaleeby.blogspot.com/ and www.members.aol.com/savannahwine.
References: (upon request to jpsaleeby@aol.com)
Monday, January 09, 2006
Dr. Steve Fagan
Dr. Steve Fagan is one of my favorite high school teachers and mentor. He tuned me into the sciences. I took basic biology, chemistry and botany with him and this directed my career into medicine and research. In 1991 Dr. Fagan attended my hooding ceremony for my doctorate degree. He is pictured here with another SHS classmate (Sally Miller) at the 2005 reunion.
Take link to picture: http://www.gshutter.com/gallery/902741/1/41051923/Large
Sunday, January 08, 2006
Quote from the monk & mystic Thomas Merton

"The least of learning is done in the classrooms."
- Thomas Merton
While pursuing my minor in Philosophy at Georgia State University in the late 1980's I read Thomas Merton's Seven Story Mountain and became a big fan.
I can certainly appreciate this quote as it applies to physicians. I would rather have my medical care from a seasoned and wordly clinician than one adorned with paper certificates from some ivory tower institiution.
Wednesday, January 04, 2006
Essential Oils as Effective Anti-microbials
Essential Oils as Effective Anti-Antimicrobials JP Saleeby, MD
To stay healthy one must be ever on guard against those nasty little bacteria that wait to infect us. Everything from counter tops to doorknobs, a simple handshake and even the droplets left in the air after an innocent sneeze are a constant threat to our well being. Those who pay due diligence by being careful to avoid being inoculated by harmful bacteria avoid those cumbersome ear and throat infections, skin infections (referred to as cellulitis) and even the make-your-life-miserable bronchial or lung infections.
Teaching children to cough into the crook of their elbow rather than their hand is a first step in prevention of spreading harmful bacteria and viruses. Using good hand washing techniques as in a scrubbing action for 15 to 20 seconds and when warm water and soap are available. Those convenient alcohol-containing hand-rubs are another way to keep germs at bay when soap and water are not available. They should be applied and rubbed until the gel is dry. Probably not know to many are the antibacterial effects of some essential oils. Essential oils have been around for hundreds of years and used medicinally in many cultures. Today they are used as fragrance and by massage therapists in their massage oils. They can be aerosolized or provided as an inhalant in techniques termed aromatherapy. In 2001 fourteen such essential oils were studied scientifically in the laboratory to determine if they harbored effects against pathological bacteria and to what degree if any.
Dr. Inoyue at the Tokyo University Institute of Medical Mycology in Tokyo, Japan studied the effects of essential oils on bacteria such as Haemophilus influenzae, Streptococcus pneumonia, Streptococcus pyogenes, and Staphylococcus aureus. These are just a few bad actors out there responsible for infections of the respiratory tract and skin. Essentially they exposed bacteria in culture to vapors of several essential oils using different concentrations and exposure times. Those essential oils that were the most effective were cinnamon bark, lemon-grass and thyme oils being the most potent of the fourteen tested. The most susceptible organism was H. influenzae with even penicillin-resistant S. pneumoniae falling victim. Perilla and peppermint oils were also moderately effective against those bacteria. Essential oils containing terpene ketones, ether and hydrocarbon required higher concentrations and longer exposure times. The best results were with high vapor concentrations for as short a time as one to two hours. Incidentally shorter exposures were comparable with similar vapor concentrations with longer overnight exposures. So selected aromatherapy can play a part in preventing or even treating mild respiratory and skin infections.
The best way to apply essential oils in your germ-killing program is to use it in a couple of different applications. It can be added to rinse waters and liquid soaps. It can also be added to cleaning sprays used to wipe down surfaces (called fomites) where bacteria like to lay in waiting (countertops, tables, doorknobs and desks). A few drops of a standard preparation of essential oil on a cotton ball placed near the spout of a steam humidifier will distribute the oil’s vapor as the humidifier expels a steam mist.
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Reference: Inoye S. et. al., Antibacterial activity of essential oils and their major constituents against respiratory tract pathogens by gaseous contact. Journal ofAntimicrobial Chemotherapy, 2001 May;47(5):565-573.
Published March 3, 2005 Enigma Magazine
http://www.enigmaonline.com/gbase/Expedite/Content?oid=oid%3A1225
© 2005
Monday, January 02, 2006
Something ALL Physicians should live by.....

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.
I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.
If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.
Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.
Sunday, January 01, 2006
The World we Live In - Happy New Year
Should we shrink the earth’s population into a village of precisely 100 people with all the existing human ratios remaining the same, this is what we would see:
- 57 would be Asians
- 14 would be from the Western Hemisphere
- 8 would be Africans
- 52 would be female
- 70 would be non-white
- 30 would be Christian
- 6 would possess 59% of the entire world’s wealth
- All 6 would live in the US
- 80 would live in substandard housing
- 70 would not be able to read
- 50 would suffer malnutrition
- 1 would be near death
- 1 would be near birth
- 1 would have a college education
- 1 would own a computer
Source: Volunteers in Medicine (2005)
Saturday, December 10, 2005
A Fishy Story: Catfish Trauma

A Fishy Story: Catfish Trauma
JP Saleeby, MD
The summer of 2005 brought my Emergency Department a rather unusual case. It is quite a fishy story, as a young boy of 12 years presents with chest wall pain and dyspnea after being hit with a fish. The onset of symptoms came shortly after being "hit in the back with a catfish". The patient reported that he was riding his bicycle along the banks of a small pond in his neighborhood when a 14-year-old boy in a group fishing for catfish flung one of the catch at him. While not initially in distress within thirty minutes the boy became quite short of breath and uncomfortable with pain radiated from the site of injury along all his chest wall.
The apparently innocent prank of hitting someone on the back with a dead fish had rather grave consequences in this case. In fact the channel catfish (Ictalurus punctatus) a common sport-fish and one sought after for its flesh in southeastern Georgia is laden with defensive spines. These spines are found along the dorsal and pectoral fins. Depending on the size of the catfish these spines can be quite nasty weapons. There are even some species of catfish that have venomous spines. But in this instance it was not venom but rather the sharp penetrating spine that caused this patient's morbidity.
In this particular case the adult sized catfish hit the young boy square between the shoulders with one of the pectoral spines pierced his skin just under his left shoulder blade. The child as well as some bystanders reported that they had to actually remove the catfish from the victim as it was "hung-up on him". This resulted in a seemingly innocent and small puncture wound just under his left shoulder blade. What was not appreciated immediately was the fact that the spine had penetrated the lung pleura and into the lung itself. When the child returned home moments later his mother was alarmed to find him in an uncomfortable state. Relief of the chest pain was achieved by lying in the fetal position. When she lifted his shirt to examine his back she noted some soft tissue swelling and what was later described as a "spongy area" around the puncture wound. This fact as well as the boys continued complaints of chest wall pain and difficulty catching his breath prompted the mother to bring the child into the ER for evaluation.
On physical examination vital signs were normal (blood pressure, pulse and respiratory rate were within normal limits. Oxygen saturation by pulse oximetry was 99%. There was evidence of a very small puncture wound under the left scapula area, with pronounced soft tissue swelling, mild erythema and subcutaneous air noted. A stat PA and Lateral Chest X-rays revealed a 10% apical pneumothorax. The child was placed on pain medication, antibiotics and referred for follow up care at our regional Level I trauma center.
When I consulted the accepting trauma surgeon, he remarked that this was the first case of "Catfish Trauma" he had ever accepted in transfer. The patient did rather well as he had subsequent chest x-rays that showed resolution of the pneumothorax without the need for tube thoracostomy.
A survey of the medical literature reveals two cases of rather serious infection following catfish spine-related injuries. Besides the obvious mechanical injury one must be cognizant of subsequent infection of the soft-tissue with microorganisms such as Vibrio species, Aeromanas hydrophila, Enterobacteriaceae, Pseudomonas species as well as those commonly found on the human skin. Those who present with chronic illness, immunocompromised states or late presentation after an injury should be aggressively treated with antimicrobials. Empirical antibiotic regiments should include tetracycline and a broad-spectrum beta-lactamase-stable beta-lactam drug or tetracycline, beta-lactamase-stable penicillin and an amino glycoside.
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JP Saleeby, MD is assistant medical director of the Emergency Department at Liberty Regional Medical Center in Hinesville, GA. He may be reached by email at jpsaleeby@aol.com.
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Reference:
Murphey DK, Septimus EJ, Waagner DC. Catfish-related injury and infection: report of two cases and review of the literature. Clin Infect Dis. 1992 Mar;14(3):689-93.
Andrews CJ, Morris A, Pearn JH. Related Articles, Catfish trauma. Med J Aust. 1991 Jul 15;155(2):130.
Catfish Species, http://www.dlia.org/atbi/species/animals/vertebrates/fish/Ictaluridae/I_punctatus.shtml(December 20, 2005)
www.wemjournal.org/.../request=getdocument&issn=10806032&volume=016&issue=04&page=0204(December 20, 2005)
For another story: http://www.sptimes.com/2005/07/01/Northpinellas/Flung_catfish_lands__.shtml
Submitted for publication December 10, 2005 to Cortlandt Forum Magazine at http://www.cortlandtforum.com/
Monday, December 05, 2005
Friday, December 02, 2005
Keeping the Lung Healthy
By JP Saleeby, MD and Sharon Coopersmith, RRT
(submitted to AFAA's American Fitness Magazine for publication)
Very often we take for granted our lungs. No thought has to go into breathing. The drive to breathe is located in a rudimentary part of our brain. From the moment out of the womb to the last truly overt sign of life our lungs play a critical role however unrecognized or under-appreciated.
The lungs are a pair of conical shaped, elastic and spongy organs located in our chest wall or thorax. Stretching from the collarbone to the bottom of the rib cage, the lungs are grouped into lobes. The right lung has three lobes, while the left lung has only two major lobes because of the leftward position of the heart. The ribs, the sternum and the vertebrae protect the lungs, heart, stomach, spleen and the liver. The chest wall also acts as a bellows to allow air in and air out of the lungs. The muscles of respiration are the diaphragm, the external intercostals, the internal intercostals, and accessory muscles, like the trapezius. There are muscles involved in exhalation, though usually passive, and they are the internal obliques, external obliques, rectus abdominus and the transverse abdominus.
The respiratory tract starts at the nose and mouth. With each inhalation through the nose air is filtered, warmed and humidified. The next area on the tract is the pharynx, which is behind the nose and mouth. This area contains the tonsils, adenoids and the eustachian tubes (which lead to the ears). If the tonsils and adenoids are swollen, this can often lead to middle ear infections, snoring and obstructive problems. Below the pharynx is the larynx, which is responsible for phonation and is commonly referred to as the “voice box”. The trachea follows the pharynx and bifurcates into the right and left bronchus, which of course, leads to the right and left lung. Interestingly enough, the right bronchus is at a greater angle and therefore any object that is accidentally inhaled, typically food, will usually lodge right into the right bronchus. Knowledge of the Heimlich maneuver is crucial in just such instances. This maneuver can force air out of the lung rapidly and propel the obstructing body out of the airway. The smallest anatomical part of the lung is the alveoli or air sacks, where most of the gas exchange occurs in the lower respiratory tract.
What has become a very popular device in recent years is the nasal dilator strips (Breathe Right®), believed to enhance performance in the athlete. The belief is that dilation of the nasal passage allows more air in during exercise. At rest 80% of air passes through the nose, but during vigorous exercise (where device marketers state efficacy) the majority of the volume of air entering the lungs come via the mouth. Only 25% of air enters through the nose during even a light jog. After several scientific studies into the use of nasal strips were completed, the consensus that they were ineffective was unanimous. Another popular image in professional sports is the use of oxygen masks on the bench for players coming in off the field of play. In a healthy athlete oxygen saturation in hemoglobin is close to or at 100%, so supplemental oxygen cannot force more oxygen than the hemoglobin can carry. This practice does little to aid in performance and should be reserved to those with sick lungs who cannot maintain adequate oxygen saturation levels. The athletes who testify that these aids work are not speaking from scientific fact but rather what can be based on the placebo effect.
As we know the lungs primary duty is gas exchange. There are, however, specialized cells contained in the lungs that aid our immune system. These cells help synthesize interferon. Interferon is a protein that helps the body fight off viruses, bacteria, parasites, and inhibit the growth of tumors. Other cells in the lungs are responsible for mucus production. Mucus is essential to the filtering and clearing of the airways. We can help the process at peek function by keeping up with our fluid intake. Drinking plenty of water, particularly in the throngs of a respiratory infection are essential to keeping the flow of mucus in the respiratory tract. We commonly refer to this in the medical community as pulmonary toilet. Other cells that aid in our immune system are referred to as mast cells and they are responsible for antigen-antibody responses. In an allergic response to allergens in the air such as pollen or cigarette smoke, the lung cells release histamine, leukotrienes, serotonins and eosinophils. We are all familiar with histamine blocking agents such as Benedryl® and Allegra® or Claritin® during cold and allergy seasons. Lastly, there are cells in the lungs that produce surfactant. Surfactant is a compound that contains both a lipid (fat) and a protein that maintain the structural integrity of the alveoli. Without surfactant the lungs would collapse.
The discovery of surfactant was crucial in the management and survival of premature infants. In medical facilities nationwide, premature infants are given natural surfactants in their airways immediately at birth to help replace the surfactant that they lack. It is an amazing process and it has markedly increased the survival rate in many infants born at such a fragile stage of development. Embryologically, the lungs begin to form within the first five weeks of fetus development. It is not until the twenty-fourth week of gestation, however, the lungs actually begin to produce surfactant, increase its surface area and increase the number of alveoli and capillaries present. Also at this stage of pending premature birth, is the administration of the drug Celestone®. This drug is a corticosteroid that helps to speed the development of their surfactant.
The lungs are designed to let oxygen dissolve into the blood and carbon dioxide to dissolve out of the blood very quickly. To help make this happen, the lungs have a huge surface area, the alveoli where this exchange occurs has the surface area of a tennis court. When resting, the entire blood volume of the body (five liters on average) passes through the lungs each minute. With exercise the capacity to exchange good gasses (oxygen) for waste gasses (carbon dioxide) is made more efficient. The lung functions, total lung capacity (TLC, the amount of air the lung can hold) and forced vital capacity (FVC, the amount of air forced out in a given period of time, both indices of lung function) do not become larger. The pulmonary (lung) system is also unique in that pulmonary veins carry oxygenated blood to the heart and pulmonary arteries carry deoxygenated blood. This contrasts the typical description of our circulatory system.
Non respiratory functions of the lung as just as important as it’s function in gas exchange. Some of the more important functions include the concentration of biologically active substances and medicinals. It is also the site of some hormone conversions for a presser agent. A very important function is that of a “clot” filter. The lung “catches” small blood clots that form on the venous side of our circulation. Should these clots be allowed to pass to the arterial side, we would suffer hundreds of emboli damaging almost every organ in our body. The lung, because of its spongy nature acts as a shock absorber protecting the heart of which the lung nearly entirely encloses.
The peptidase hormone Angiotensin Converting Enzyme (ACE) is a very important hormone related to blood pressure control. ACE was discovered in the late 1960’s in high concentration in the vascular beds of lung. ACE and Endothelin, another lung peptide, are involved in the conversion of angiotensin I to angiotensin II in pulmonary artery endothelial cells. These agents are referred to as pressors. Angiotensin II is a very potent vasoconstrictor (causing a rise in blood pressure) and the use of ACE-inhibitors is a common class of drugs that help lower blood pressure in hypertensive patients. This is another example of the non-respiratory function of the lung that affects a non-gas exchange related issue such as blood pressure control.
To maintain health and have a good quality of life you must have healthy lungs. When we think of aerobic exercise the focus is on the heart (cardiac) and thus the creation of the colloquialism “Cardio” in our vernacular. Aerobic exercise technically should refer to both the cardio-and pulmonary components. Without properly functioning lungs you cannot obtain good aerobic exercise. This is seen in those who have underlying asthma or exercise induced asthma (EIA). These folks are severely limited in their “aerobic capacity” to perform exercise. Asthma is one of many diseases that affect the lung and it’s function. Know also as reactive airway disease, it is an inflammatory process that constricts airflow out of the alveoli and thus produces the classic “wheezing” noise. The prevalence of asthma is about 9.6% in the USA. There are 26.7 million people who suffer with this illness in this country. In 1999 there were almost five thousand deaths nationwide related to asthma. Exercise induced asthma (EIA) is a common issue faced by aerobic instructors. Those that are affected usually benefit from pre-treatment prior to the aerobic activity with a bronchodilator drug such as Albuterol. Albuterol know by the brand name Proventil® is Beta2-agonist class drug that helps open up the bronchial tubes and allows for the quicker exhalation of air out of the lungs by relaxing the smooth muscle surrounding the air sacks.
Another disease that fitness instructors should be aware is emphysema (known more formerly as chronic obstructive airway disease (COPD)) that is typically caused by smoking or inhalation of industrial pollutants. Rare examples are found due to a deficiency of a protein called alpha-1 antitrypsin (A1AT). Folks that lack this protein are at a higher risk of developing severe emphysema. Alpha-1 antitrypsin deficiency (A1AT-D) is an inherited condition and occurs in varying degrees. But by far the most common cause is modifiable and it requires the cessation of tobacco smoking.
Other diseases cause the destruction of the elasticity of the lung and are called restrictive airway diseases. Several disorders cause restrictive airway disease and they are categorized into two groups. The first is intrinsic lung (lung parenchyma) diseases. The diseases cause inflammation or scarring of the lung tissue (interstitial lung disease) or result in filling of the air spaces with exudate and debris (pneumonitis). These diseases can be characterized according to etiological factors. They include idiopathic fibrotic diseases, connective tissue diseases (such as lupus), drug-induced lung disease, and sarcoidosis.
The second is extrinsic (extraparenchymal) diseases. The chest wall, pleura (lung lining), and respiratory muscles (intercostals and diaphragm) are the components of the respiratory pump, and they need to function normally for effective ventilation. Diseases of these structures result in lung restriction and impaired ventilatory function.
Finally we will discuss lung cancer. There are 2 main categories of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). In the United States people diagnosed with lung cancer, 75% to 80% have non-small cell lung cancer, making it the most common type of lung cancer.
There are three major subtypes of NSCLC. These subtypes are based on the appearance of the cells and are adenocarcinoma, squamous cell carcinoma and large cell undifferentiated carcinoma. Adenocarcinoma represents about 40% of lung cancers and is more common in women (with larger numbers of cases being diagnosed each year). It can also be seen in non-smokers. Squamous cell is seen in mostly men and older people. It is strongly associated with smoking and tends to be a late metastasizer.
Small cell lung cancer also referred to as “oat cell” is a more aggressive type of cancer than NSCLC. It less commonly tends to spread to other organs quickly through the lymphatics. This is usually diagnosed in smokers or former smokers. Since it spreads so quickly it has usually metastasized through out the body by the time the diagnosis is made. Surgery is rarely used because of the expansive spread but this type is more responsive to chemotherapeutic drugs.
Mesothelioma is worth mentioning here because it affects the lung. Although mesothelioma is not formally a type of lung cancer, it is a rare type of cancer of the mesothelium (lining of the chest). There are about 1200 cases diagnosed each year in the United States. Men are stricken four times as much as women. Especially white men over 50 years of age. The major risk factor for developing this cancer is exposure to asbestos. Smoking and asbestos exposure raises the risk. Surgery is the most common treatment. Radiation and chemotherapy may also be used.
Peter Jennings the ABC news anchor (from 1983 until his death in August of 2005 at the age of 67) was diagnosed with lung cancer. Even though he had quit smoking some 20 years before he was diagnosed, he was know as a rather heavy smoker, and those years of insulting his lungs finally impacted his life.
Dana Reeves, better know as the wife of "Superman" star Christopher Reeve, was diagnosed with lung cancer in August 2005, at the age of 44. At the time of this writing she is reported to be responding well to chemotherapy. Reeves is typically 30 - 40 years younger than most women diagnosed with this type of cancer. While lung cancer (not breast cancer) is the number one cancer killer of women, doctors still don't understand why female non-smokers are more likely to develop lung cancer than men who don't smoke. Non-smokers make up only 10% of men with lung cancer, but make up 20% of women with the disease. These celebrities have brought recent focus to lung cancer and will hopefully make the public more aware, drive others to quit smoking, and have those at high risk obtain lung cancer screenings.
Protecting the lung against exposure to toxins (smoking, air pollutants, and radon gas) can insure a healthy lung. Most but not all lung disease is preventable. Exercising the lung with cardo-pulmonary exercise should also be a part of any healthy lung program. It is extremely important to be cognizant of utilizing modern medicine and early diagnostics to identify a disease process before it gets out of hand.
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JP Saleeby, MD is assistant medical director of the Emergency Department at LRMC in Hinesville, GA. Dr. Saleeby is an integrative practitioner with a focus on prevention. He writes regularly on topics of health for regional and national journals. Dr. Saleeby can be reached for comment at jpsaleeby@aol.com.
Sharon Coopersmith, RRT is a pediatric respiratory therapist at the Medical University of South Carolina. She has over 20-year experience treating disease of the lung in the adult and pediatric populations. Ms. Coopersmith can be reached for comment at cooperss@musc.edu.
Reference:
http://www.talktransplant.com/Lung/Anatomy.aspx
http://www.psychcentral.com/psypsych/Lung#Nonrespiratory_functions_of_the_lung
Kawaguchi H, Sawa H, Yasuda H., J Mol Cell Cardiol. 1990 Aug;22(8):839-42. Endothelin stimulates angiotensin I to angiotensin II conversion in cultured pulmonary artery endothelial cells. Department of Cardiovascular Medicine, Hokkaido University, School of Medicine, Sapporo, Japan.
www.nature.com/nm/journal/v5/n10/full/nm1099_1110.html
http://respiratory-lung.health-cares.net/emphysema-causes.php
http://www.emedicine.com/med/topic2012.htm
http://www.thewellnesscommunity.com/programs/frankly/lung/understanding/what_is_lung.asp
Strom, Wm. W., Asthma therapy: Changing perspectives, Journal of Respiratory Disease, 2005 Oct.: 26(10):S5-S7, University of Colorado Health Sciences Center.
http://en.wikipedia.org/wiki/Peter_Jennings
http://medicineworld.org/cancer/lung/lung-cancer-blog.html
Interview with Dr. Bruce Johnson, director of thoracic oncology at Boston's Dana-Farber Cancer Institute. http://www.usatoday.com/news/health/2005-08-09-reeve-cancer-cover_x.htm
Harwood, Robert, Perinatal / Pediatric Respiratory Care, F. A Davis Co. 1999
Deshpande, VM, Pilbeam, SP, Dixon, RJ, A Comprehensive Review in Respiratory Care, Appleton & Lange, 1988
http://www.truestarhealth.com/members/cm_archives06ML4P1A7.html
http://www.thefitmap.com/mens_health/features/nose_strips.htm
http://www.sciam.com/askexpert_question.cfm?articleID=00024444-FB67-1284-BB6783414B7F0000
Sunday, November 20, 2005
Introduction to Three Adaptogens (1st Chapter)


Introduction to Three Adaptogens
JP Saleeby, MD
In humanities never ending search for the magic cure-all, many a snake oil salesman in modern times has become wealthy. Attempting to separate the chaff from the grain, searching for the panacea of health, the consumer is bogged down in a quagmire of products most of which do not work. Take for instance supplement infomercials that run for a couple of months then all of a sudden disappear after accomplishing the goal of stuffing the bank accounts of their promoters. The supplement industry is a billion-dollar a year business. To this day after starting my nutritional medicine practice in 1998, I have been deluged with email and junk mail from companies wanting me to “sell” their products by whatever scheme (usually multi-level-marketing) to the consumer (my patient).
The Dietary Supplement Health and Education Act of 1994 often referred to as DSHEA took the FDA out of the business of policing the dietary supplement industry. This law has its ups and downs. On the downside for consumers there is no governing body to regulate what a product promoter can claim about a particular supplement. So caveat emptor, let the buyer beware. The Internet offers the lay public the opportunity to research the subject, but alas the Internet is infested with misinformation. The upside to DSHEA is lower prices for consumers. No need for tremendous expenditures for Research & Development in “proving for the FDA” the efficacy and safety of supplements, thus the cost to consumers is very low compared with many pharmaceuticals. Also this serves the supplement industry with great profits. That is what prompted me to research and formulate a supplement line for use with my patients following many of my protocols for wellness. The result was a safe pharmaceutical-grade bioavailable nutracutical at low cost to the consumer. Something I could recommend and sleep well at night knowing I had done good for my patients.
It must be human nature to be easily swayed by fancy advertisers and convincing charismatic spokesmen that deliver a message of the miracle potion to ensure health, wellness or weight loss. So I do my part as a physician to inform my patients what is correct and backed by scientific research, not by whimsical belief. Time and time again I am assaulted by late night infomercials that boast the latest trend or “hot” supplement to bestow good health. It is this reckless and un-policed forum that has prompted me to put some of my thoughts to paper for those who don’t have the luxury of sitting across from me in consultation. This remains the reason I maintain an online blog and have written this book.
As I spent the last few years researching and writing for this book, I considered writing the world-renowned herbalist and integrative practitioner Dr. Andrew Weil for a forward to this book. I later decided against this move, as there is really no need for any forward and certainly not a need for an Imprimatur. No need for any sanctioning individual, body or colleges to lend credence to what I have done. What gives me license to write on this topic? Well there is no residency training or credentialing process that affords legitimacy here in this country, so the reader must take into account my many years of self-study and personal research in the field as well as my fifteen years of practicing clinical medicine. I a certain this is enough to produce credible text. Enough to offer the reader comfort in what is expressed within these pages is evidenced-based fact rather than fiction. This represents the work of a scientist unlike the un-credentialed talking heads on those late-night infomercials. This remains an easy to read, moderately technical (but not overwhelmingly so) book so the casual lay reader may enjoy it as much as the medical upper or mid-level practitioner who is attempting to gain an entry level understanding of these remarkable herbs for their practice of medicine.
As a medical practitioner my allopathic training in traditional western medicine taught that healing or curing came about by identifying the root cause of a disease and eliminating it. This is more commonly known as the “doctrine of a specific etiology of disease”. In the East another approach was developed thousands of year ahead and is centered on the disruption of the balance within and the assistance with herbals or other remedies to restore balance. This practice allows the body to cure itself.
For over a decade and a half I have witnessed first hand the ravishes of disease, obesity, lack of exercise, and poor nutrition. I have seen what the effects of a stressful lifestyle can have on the body. I have treated many successfully. Those that are disciplined and listen and follow appropriately mapped out programs reap the best results. Those that grow tired of the rituals of good health fall to the wayside and eventually live a lesser quality of life, or even succumb to a premature death.
Obviously there is no substitute for proper nutrition & hydration, adequate sleep, aerobic and resistance exercise and a balanced neuro-endocrine system. I am not going to elaborate on this subject as much research has proven its effectiveness. Many books and articles belabor the benefits. Rather I am going to focus on a more esoteric subject, that of a select subset of medicinal herbs that will embellish and enhance an already well oiled machine. Once a person has committed to proper diet, exercise and rest; once a person has committed to selected dietary supplements it is time for the next step. As you cannot put the cart before the horse here, I do not advise continued cigarette smoking with the use of herbs as a quick-fix to lowering lung cancer risk. Smoke cessation first, then consider this as the next step.
There is a class of herbs that aid our bodies in adapting to environmental changes. Whether the environmental changes are emotional stress, physical stress, toxins, or a drastic change in our exercise program or work schedule, these herbs exert a balancing effect. They are known collectively as adaptogens or adaptogen herbs. Only about one in every 300 herbs is considered an adaptogen. The most commonly recognized adaptogen herb has to be Panax ginseng. This is the benchmark herb that all other adaptogens are compared.
The term adaptogen was coined in 1947 by a Russian toxicologist and pharmacologist named Dr. Nikolai Vasilyevich Lazarev. As the father of modern day research into adaptogen herbs, Dr. Lazarev set up some basic criteria that must be met in order for consideration in this very special class of herbs:
1. It must cause only minimal disruption in the body's physiological functions;
2. It must increase the body's resistance to adverse influences not by a specific action but by a wide range of physical, chemical, and biochemical factors;
3. It must have an overall normalizing effect, improving all kinds of conditions and aggravating none. And it must restore balance to the system regardless of the direction of the illness (for example, an adaptogen would work equally well in a depleted condition as it would in a condition of excess).
Herbalists believe adaptogens work by supporting adrenal function, enabling cells access to more energy and helping them eliminate toxic metabolic byproducts. Adaptogens also help the body use oxygen more efficiently and improve the regulation of the body's natural rhythms. Though they all work in these similar ways, each adaptogen has a distinct personality and unique medicinal qualities. We will visit what I consider three rather remarkable yet generally lesser known of adaptogen herbs. They are, in no evident order: Rhodiola rosea, Eleuthero (Eleutherococcus senticosus) and Jiaogulan (Gynostermma pentaphyllum).
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This is the introduction to the soon to be published book (available via Xlibris.com, Amazon.com and Barns&Nobel online in March 2006 on Three Wonder Herbs (Adaptogen Herbs). Hope you enjoy and have a chance to read what follows. For a personalized-signed copy please email Dr. Saleeby at jpsaleeby@aol.com
Thursday, November 10, 2005
Preparing for the Flu Season

By JP Saleeby, MD
As the Flu season approaches, we need to be prepared. The Flu, which is different from the common cold, inflicts significant morbidity and even mortality and should be taken seriously. The Flu is caused by the Influenza virus of which there are three types (A, B & C). Type A is the most common and it is the subtypes of A and B that cause the seasonal outbreaks. The constant mutations of these viruses make it necessary to vaccinate annually. Everyone is affected, from the very young to the older adult. Most outbreaks or epidemics occur in late fall and early winter. It has been reported that as many as 20,000 deaths and over 100,000 hospitalizations occur each year in the USA due to the flu. Those deaths are highest in the elderly (over 65), folks with diabetes, HIV, nursing home residents, pregnant women and those with chronic diseases of the lung, heart and kidneys.
A person is contagious for up to 5 days after onset with symptoms that include high fever, aches in joints, muscles and around the eyes, weakness, headache, dry cough, sore throat and watery discharge from nose and eyes. Annually, there are many that miss considerable time from work in the winter months due to infection with this virus.
You acquire the flu virus through contact with contaminated aerosols or droplets found on surfaces such as doorknobs and telephones. So prevention is crucial. Of course maintaining a health lifestyle (not smoking, eating right, plenty of exercise) is important as is taking care not to come in contact with potential contaminants (good hand washing, not sharing cups with others, etc.) And vaccinations are of critical importance especially to those high-risk individuals. They may even be lifesaving.
The flu vaccine (shot) is unique each year, being made up of inactivated A & B viruses. It is injected into the upper arm and should be taken in early fall (from October to mid-November) because it takes two weeks to confer immunity. But once protected (it is considered 70 – 90% effective), it can protect you from the symptoms of the flu, lost work, hospitalization and even death. Who should get the flu shot? Anyone over 50, those with chronic diseases, those with HIV/AIDS, women over 14 weeks pregnant, residents of nursing homes, health care workers, bank tellers, waitresses, students especially those living in dormitories, and those people interested in reducing risk for the flu. Side effects to the shot are rare but include soreness and mild muscle aches or low-grade fever for only a couple of days. These untoward effects are most often noticed in children. Life threatening allergic reaction and something called Guillain-Barre syndrome are extremely rare reactions to the vaccine. But those allergic to eggs should probably avoid the shot.
Myths about the flu shot such as getting the flu from it are unfounded. Since it contains the killed form of the virus, it is impossible to actually acquire the syndrome. Another myth is that one shot in you life will do, but since the virus mutates from season to season, revaccination with new strains must occur each season.
What happens should you get the flu? Well, there are standard medications that should be started within 24 hours of symptoms such as Amantadine, Rimantadine (Flumadine), Zanamivir (Relenza) and Oseltamivir (Tamiflu). The prescription usually lasts 5 to 7 days and it may cut short the course of infection and prevent serious complications such as pneumonia. Decongestants such as phenylephrin and pseudoephedrin are helpful with symptoms. Antibiotics are not indicated unless there is a secondary bacterial infection. Antibiotics are useless against the flu virus.
Nutritional medicine offers high doses of vitamin C, and Zinc. Herbal remedies include Echinacea (E. purpurea root extract) and Goldenseal (H. candadesis root extract). Other immune boosting compounds are extract of maitake and reishi mushrooms, garlic and transfer factor (an extract of colostrum). A very powerful tool in the early treatment of the flu is something called the Myers’ Cocktail. This is a rapid intravenous infusion of high dose vitamins and minerals given over 10 minutes. It has proven effects in reduction of symptoms, viral spread and getting you back on your feet quickly after being infected. Myers’ cocktails must be administered in the doctor’s office and depending on how severe the illness, one to three treatments during a course may be indicated. If caught early, a Myers’ Cocktail may be the most effective remedy in the treatment of the flu. The Myers’ Cocktail is also useful in many other maladies, but for acute respiratory and viral infections, it stands heads above other treatments.
JP Saleeby, MD is medical director of the Saleeby’s Consultations. He oversees administration of Myers’ Cocktails in a clinical practice and is researching the effects of this treatment on several illnesses. He can be reached at jpsaleeby@aol.com or on www.saleeby.net.
Tuesday, November 08, 2005
Quote by Charles T. Spradling
"Knowledge consists in understanding the evidence that establishes the fact, not in the belief that it is a fact." -Charles T. Spradling
Saturday, October 22, 2005
Will they ever stop?
My personal fight against medical charlitans continues. They will only get crushed with the FDA walks in and polices the industry. For now the consumer must beware.
Once again I have been contacted by yet another unscrupulous "vitamin salesperson"... this guy should go back to selling used cars and leave the practice of medicine and health to the experts trained in the field. He boasts how my "negative campaign" is HELPING his product sales. Hogwash, unless he is selling to the gullible and easily swayed.
Recently TIME magazine featured Andrew Weil (on the cover) and parts of his latest book exposing the scams that the unregulated supplement industry has. For more you can read about it at: http://www.time.com/time/archive/preview/0,10987,1115695,00.html
The last exchange from this greedy little salesman was a pesty Instant Message exchange on AOL:
This fellow writes:
"DDellorso: I find it hard to believe how many read it [my blog] by Google.com, but its a strange twist how it worked in the opposite manner....and yes please write more!!!!! Thanksyou again..."
My response was that I would certainly write more and expose these people for what they are. Out to dupe the public into purchasing overprices "cure alls".
Please feel free to write ddellorso@aol.com and tell him just how wrong he is....
For safe physician formulated and economically priced supplements visit www.vitasanus.com
JP
Sunday, October 02, 2005
Body Modification and Suicide

Body Modification and Suicide
By JP Saleeby, MD
Body Modification includes tattoos, body piercings and branding or scarification. For the purposes of this article I will not be discussing the body dysmorphic disorder (BDD) that some have which takes them to extremes of body modification with plastic surgery (i.e. Michael Jackson, the cat woman, etc.) This discussion will be limited to those that seek tattoos and piercings in general. The findings referenced in this article were presented at a recent American Association of Suicidology conference.
While in recent years body modification has been more socially acceptable for a tattoo or two and maybe a selected piercing (of the belly button for example) there is still a stigma associated with those having body art. A 2003 Harris Poll shows that approximately 16% of Americans have one or more tattoos. This is a three-fold rise from a 1936 Life Magazine poll. It is estimated that 36% of those between the ages of 25-29 have had a tattoo. More body modifications seems to occur on the West Coast of the United States than the East and it is highest amongst gays, lesbians and bisexual populations. According to an online survey the average number of tattoos for a male subject is three to four. Seems as if after one tattoo most people return for another. The same can be said for piercings and scarification.
Dr. David Lester, Ph.D. professor of psychology at Richard Stockton College in Pomona NJ (and a suicidologist with the Center for the Study of Suicide) in a recent presentation to peers on the subject showed a strong link between body modification and suicide. In Dr. Lester’s study only 34% of some 4,700 individuals who responded to an online survey on a hard-core body modification web site admitted to not considering suicide. Two-thirds had suicidal ideation at one time or another or attempted suicide. Thirty-nine percent admitted that they only contemplated suicide while 27% stated that they made one or more attempts. The survey also identified participants by sexual preference. Fifty-six percent were heterosexual, 38% bisexual and 5% homosexual. Eighty-eight percent were white and 45% were students. Most survey participants had a medial age of 21 years.
The type of body modification as well as the anatomic location also lends itself to the suicidality. Eyebrow piercings show a rather high suicide attempt rate with 46% of women admitting. Among men with tongue piercings 24% reported previous suicide attempts. Some of the highest suicide rates occur with those that engage in scarification. The survey reports that 39% of men and 48% of women with scarification of the upper arm or shoulder area reported one or more prior suicide attempts. As Dr. Lester reports self-mutilation may be an indicator for high risk for suicide accordingly, but further studies are needed for clarification since the online survey tends to be somewhat skewed. Certain types of body modification may also be another cry for help to some degree as we see with hesitation marks or wrist slashing.
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JP Saleeby, MD is co-director of the Emergency Room at LRMC in Hinesville, GA. He treats and stabilizes those who present to the ER with suicide attempt or ideation. For comments sent to jpsaleeby@aol.com
Reference:
David Lester, Ph.D.
Center for the Study of Suicide
RR41, 5 Stonegate Court
Blackwood, NJ 08012-5356
Jancin, Bruce, "Body Modification: Personal Art or Cry for Help?", Family Practice News, Vol. 35, No. 16, August 15, 2005, p. 33.
http://www.tattoo.dk/questionnaire/eng-cyberresults.htm
http://www.vanishingtattoo.com/tattoo_facts.htm
Oct 8, 2003 /PRNewswire via COMTEX/ (Harris Poll in Tattoos)
Sunday, September 11, 2005
WTC (Ground Zero) Site Memorial Competition

My effort to memorialize those who lost there lives on 9/11/2001. The first casualties in the civilized world's "War against terrorists". They may be missed but they will not be forgotten. For more information visit the link: http://www.wtcsitememorial.org/ent/entI=790337.html
Free Radicals and Disease
How a byproduct of oxygen can harm our bodies
by JP Saleeby, MD
Free Radicals are not some '70 peace-loving group of some 21st century right-wing religious fanatic fighting for the freedom to take over the world. Rather free radicals are tiny little devils that can impact our health in a very negative way. The theory of free radicals and their place in human disease was first theorized by Dr. Denham Harman of the University of Nebraska in the 1950s. By experimentation with synthetic antioxidants (BHT, 2-MEA) which combat free radicals he extended the life of laboratory mine up to 61%. This theory is one of several that help to explain the aging and degenerative process. Free radicals are molecules that contain one or more unpaired electrons. They are highly reactive substances and destroy human tissues and DNA. They play a part in heart disease, stroke and cancer.
Oxygen (O2) is a di-radical molecule and contains two unpaired electrons (with opposite spin) and thus generates free radicals. Cellular respiration (which occurs in the mitochondria) during aerobic metabolism is a major source of endogenous free radicals. We must breath air (containing oxygen) to live and in doing so we produce free radicals at the molecular and cellular level which is potentially harmful to us.
Three types of O2 based free radicals are produced. Superoxide radical (O2-), hydrogen peroxide (H2O2), and Iron catalyzed hydroxyl radical (OH-). Spontaneous reduction (donation of another electron) of oxygen does not occur in nature randomly. This is fortunate because the human body might otherwise react explosively. The reactions take place in a well-controlled environment in the mitochondria of each cell. The mitochondria is essentially the power plant of each cell. The enzyme cytochrome oxidase is responsible for this "cellular" respiration. Oxygen has its electrons transferred "safely" with the generation of adenosine triphosphate (ATP) which the cells use for energy. Unfortunately noting is perfect in nature and there is a "leak" of free radicals from this exchange at about 2%. Not too bad, but 2% over a lifetime can have an impact on our health.
From animal studies we know that superoxide radical and hydrogen peroxide molecules are produced thousands of times over in each cell each day. This accounts for an estimated 10,000 oxidative DNA hits for each cell everyday. If one of these hits on DNA causes damage that is not repaired by the redundancy of repair mechanisms that our cells have, then cancerous cells can be generated.
The body’s aerobic metabolism has significant advantages for energy production, but the disadvantage is the generation of highly reactive free radical molecules. In theory, one reason for the rising incidence of cancer with advancing age is due to the body’s increasing level of free radical reactions and diminished protection provided by the immune system as time passes. Less protection from free radicals, more DNA mutations, hence more cancer, and degenerative diseases such as arthritis.
In 1969 the hypothesis of a balance between free radicals and "antioxidants" came about with the discovery of superoxide dismutase (SOD). This enzyme catalyzes a radical-radical annihilation that removes O2 - derived radicals from cells. One tends to view free radicals as "bad" and antioxidants as "good," but it is the balance of oxidants and antioxidants that is important.
Exogenous sources of free radicals are air pollution, processed foods, ambient ionizing radiation from the sun and atmosphere, chronic infections, chronic inflammation, and cigarette smoking to name a few. Higher lung cancer rates are found in smokers due to free radical damage to lung tissues. Studies have shown that alveolar fluid levels of Vitamin E (a natural antioxidant) are considerably lower in smokers than non-smokers. And even with Vitamin E supplementation of up to 2400 IU/d (a huge dose), smokers still lag behind in this particular antioxidant. Smoking eats up antioxidants at an alarming rate.
Heart disease is the number one killer in America. By now most everyone knows the relationship between Coronary Artery Disease (CAD) and hyperlipoproteinemia (high cholesterol). Elevated lipids in conjunction with hypertension, tobacco use, Diabetes, male gender, age and family history make up the major risk factors. In Japan, for example, where hypertension and tobacco use are high, CAD is paradoxically low secondary to lower cholesterol levels in the general population.
Low-density lipoprotein (LDL) is atherogenic (causes plaques in the coronary arteries) as we are told by our doctors. How does this occur? Circulating macrophages in the bloodstream adhere to the arterial endothelium with greater affinity when bathed in cholesterol rich serum either from increased liver production (genetically) or from our diet (self-induced). These cells, laden with lipid droplets develop into "foam cells" which create the fatty streaks or plaques on vessel walls. A buildup of these plaques and the arteries narrow and are susceptible to blockage with clotted red blood cells and platelets. When this process happens we have a Myocardial infarction or heart attack. Pretty much the same process is responsible for strokes (brain attacks).
One very important fact regarding this process remains. Native or natural un-oxidized LDL does not form foam cells. Only oxidized LDL does. So for hear disease to occur you need elevated levels of the bad cholesterol AND free radicals.
Oxidized LDL is chemotactic, attracting them to developing fatty streaks. Oxidized LDL inhibits motility of macrophages, hence trapping them in the fatty streak, and it is cytotoxic, it augments atherogenesis by cell injury and death and promotes transition from fatty streak to fibrous plaque. Furthermore, oxidized LDL inhibits the ability of endothelial cells to release endothelium-derived relaxing factor (nitric oxide) which can cause vasospasm around the lesion. Vasospasm around a narrow coronary artery spells trouble. The combination of all of these results in eventual Myocardial Infarction. It is therefore very important to block this process of LDL oxidation. The means by which this is done is the appropriate use of antioxidants. Too much emphasis these days is on LDL reduction with statin drugs and such. This happens to be only half of the solution. The problem should be approached bi-directionally.
For the aging patient who’s stores of antioxidants are lower, as well as the young who’s physical activities (athletics) can cause tremendous surges in oxidative load, antioxidant supplementation is vital.
What can we do?
A single antioxidant supplement is not usually enough. Choosing the right combination is crucial; it should be well balanced. Taking a variety in lower doses is better and just one or two in high doses. Antioxidants have been scientifically proven to slow the aging process. This fact is just now being embraced by modern conventional medicine. Everyone is unique and may require a different "mix" of antioxidants.
Partial list of antioxidants.
Vitamin C & E
Vitamin A (as beta-carotene)
Selenium & Zinc
Glutathione
CoEnzyme Q10
Melatonin
Bilberry (Blueberry)
Ginkgo Biloba
Oligomeric Proanthocyanidins
Green Tea
Superoxide Dismutase (SOD)
Alpha-Lipoic Acid
Inositol
Fish oils (Omega-3 FA)
Grape seed oil
There are literally hundreds of natural antioxidants, too many to list here.
© 2005
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References:
Harman D. Free Radical Theory of Aging: The free radical diseases. Age 1984;7:111-131.
McCord JM. Human disease, free radicals, and the oxidant/antioxidant balance. Clin Biochem 1993;26:351-357.
Garrett, D. Guy Free radicals and antioxidants: What is their clinical role?
JAAPA Archive 1997;J6A.
Balch J.F. Nutritional Healing, 2nd edition, 1997.
Monday, September 05, 2005
Friday, August 26, 2005
Pharming Parties (A New Trend in Drug Use in our Youth)
By JP Saleeby, MD
With a raging war against terrorists, our children being abducted left and right, and the daily news broadcasts of violence against our children no wonder the beginning of the 21st century is a hard time to raise and care for our kids. Parents should also be concerned with our pathetic public school system that is fighting to just make the mark and seems to be slipping each year. Both public and private schools are spending tremendous resources combating everything from disruptive and violent behavior, to drug use, to bullying issues. Our kids sit in chaotic classrooms devoid of learning. We also have to contend with having toxic kids with poor fast-food and junk diets, obesity as a national epidemic, and a pervasive lack of good exercise habits. To add another concern to our national conscience, TIME magazine published an article in a July 24th, 2005 issue about the rise of "Pharming Parties". This is yet another sub-set of illicit drug use on our youth.
In a 2004 government study it was reported that in the course of 12 months there was use of marijuana in 34.3% of high school seniors. Between 1992 and 2004 past-month use of marijuana increased from 12% to 20% among high school seniors. Amongst 10th graders a jump from 8% to 16% was seen. High school seniors in a 12-month period admit to the use of stimulants (10%), opiates (9.5%) and tranquilizers (7.3%). While there was a drop in the use of cocaine in our youth from the mid-1980's to the lowest reported usage in 1992, the trend is upward again by 2005 statistics.
Because of the increase of stimulant drugs such as Ritalin and Adderall for the treatment of ADD/ADHD and the availability of drugs like opiates, benzodiazepines in the family medicine cabinet, access to prescription drugs is at an all time high. This is causing a surge among young kids who are hosting parties to "exchange" their drugs. These parties are taking place while parents are away and it is a forum for kids to exchange their favorite prescription drugs with each other as if they were exchanging baseball cards, only with devastating outcomes. Pharming parties so named after the word pharmaceutical are the most recent trend in youth drug use. Since the use of illegal substances such as marijuana, speed and heroin have declined over the past ten-years according to a study published by Columbia University's Center for Addiction and Substance Abuse, prescription drugs use has sharply increased. According to this study, some 2.3 million children from the age of 12 to 17 have taken "legal" prescription drugs illegally in 2003. That amounts to 1 in 10 teens and that figure is three times the number seen in 1992.
Legal medication is easier to obtain and plentiful. In an interview with a 17-year old who hosted a pharming party recently in New Jersey, Carolyn Banta, who wrote the TIME magazine article quotes her as stating, "If you have something good, like Oxycontin, it might be worth two or three Xanax." This teen also goes on to say that the kids will hoard prescribed medications for legitimate medical conditions such as wisdom teeth extractions and bring them to their next party. They also tend to swipe "left overs" in the family medicine cabinets that include opiates, sedatives, tranquilizers, and stimulants (either their own ADD drugs or that of a sibling).
With the abuse of "legal" medication there is a national trend to go beyond that to abuse illegal substances. The CASA report showed that 75% of prescription drug abusers were also abusing other drugs and alcohol. Such abuse is called polysubstance abuse. The combination of several drugs taken in this manner is extremely dangerous. Many of these kids are swilling back pills with beer or other alcoholic beverages, or even Red Bull which is a popular beverage at these parties for the extra kick the higher caffeine gives them.
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© 2005
Dr. Saleeby, MD is assistant medical director of the Emergency Room at LRMC, Hinesville, GA. Also held faculty position at Georgia Southern University in the Graduate School of Nursing. He treats daily young Americans involved in drugs and polysubstance abuse. Dr. Saleeby maintains a blog at www.docsaleeby.blogspot.com.
References:
http://www.missingkids.com/en_US/documents/nismart2_overview.pdf
http://www.ericdigests.org/pre-9213/promise.htm
http://www.veronaschools.org/Cit-e-Access/news/index.cfm?NID=4235&TID=21&jump2=0
http://www.ojp.usdoj.gov/bjs/dcf/du.htm#use
http://www.ojp.usdoj.gov/bjs/dcf/du.htm
TIME Magazine (August 1st, 2005 issue)
Sunday, August 14, 2005
Fast Food - Slow Food
Fast Food, Slow Food.
By JP Saleeby, MD
As I was about to offer up kudos to the McDonalds corporation for introducing some healthy food the other day to an associate of mine, I managed to snap back to reality before those words of praise left my lips. The dangers of letting good marketing, and a fast food giant’s attempt to attract new customers, suck you in. I am speaking of the introduction of the new McDonalds fruit and walnut salad. Yes, this “healthy choice” was introduced in May of 2005 with much hoopla. Having snared spokespersons as tennis star Venus Williams and the music group Destiny’s Child into promoting this new product. Well, after all, this fast food empire had to take steps to repair some damage to its name. After law suites filed against several fast food chains with charges of being responsible for people’s obesity and morbidity. With movies like Morgan Spurlock’s “Super Size Me” that clearly linked how the food industry in this country is contributing to the epidemic of obesity, some damage control maneuvers had to be undertaken. The new product is actually quite a departure from McDonalds usual menu items. This is a mix of grapes, apple slices, candied walnuts and low-fat vanilla yogurt. Walnuts and all it has a total of 330 calories. An independent website www.calorie-count.com ranks this product as taking home some good marks. It’s good points are that it is low in cholesterol, low in sodium and high in vitamin C. The only bad point is its sugar content. While this product is a boom to the US apple growers who expect to supply the 54 million pounds of apples McDonalds needs each year, McDonalds is also salivating over projected profits and reputation salvaging. McDonalds expects to sell this new salad in its 30,000 restaurants (in 119 countries) serving some 50 million people worldwide each day.
Flashback three weeks ago. There I was at 10:00 PM in San Francisco and most dining establishments were closed except for a neighborhood McDonalds. Reluctantly I forced myself up to the late night drive-through window, placed an order for food that is so foreign (repulsive may be too harsh a word) to me. And, oh look… the McDonalds apple and walnut salad all light up so pretty on their colorful drive-through display. A must have I thought. Well, after eating only half the salad it sat for 2 days in the hotel room a sort of trophy of how I managed to eat “healthy” from a fast food joint. Yeah, only half the salad, because I was stuffed by the barely palatable cardboard-like burger [704 calories & 43 grams of fat] and fries [540 calories]. Have to admit the fries are pretty damn good. Don’t they say McDonalds has the best tasting French fries in the business? Word on the street is before they go into the fryer they are coated with sugar and special seasoning. Anyway back to the story. What amazed me was that the apples once exposed to air and room temperature did not brown one bit, not even a yellowing in the 48 hours after purchase. Boy I remember biting into a fresh apple and watching it brown or at least yellow before my eyes. What had McDonalds done to my apples? Come to find out after some Internet researching that the wizards at corporate have been playing games with the fruit. After they are sliced they are dipped into the preservative calcium ascorbate, hence their high vitamin C content. Actually calcium ascorbate is non-toxic and a rather decent source of calcium and vitamin C. A nod to the folks at McDonalds for that one. That question answered lead me to another. Just how old were those apples to begin with? With what other preservatives are they not going public? And the big question, how will American’s deal with being good and just ordering the salad when they get a whiff of those darn fries.
So as I was about to sing praises to this forward thinking fast food titan, it dawned on me that most people will not just order a salad and diet drink, but rather supplement their quarter-ponder with cheese or their Big Macs and large fries with this salad. So nothing is really accomplished in the realm of calorie curbing. It is just a marketing gimmick to make average Joe American think they are eating healthier. Doing some damage control against the countless obese that eat out every day. Other fast food franchises have followed suite and are now offering “healthy menus”. But the bottom line is total sales for these companies and their intent is not to change the way people eat for the better, but acquire a greater piece of the market share.
Another assault on the poor belt-line-widening consumer is an all out war on organizations who educate against the perils of eating wrong, smoking too much and drinking too much. Born in 1995, the brainstorm of Richard Berman a food and tobacco industry marketing guru is an outfit called Guest Choice Network. Berman & Co. is a public affairs company, a big lobby group out of Washington, DC. This organization now renamed Consumer Freedom, with its slogan “Promoting personal responsibility and protecting consumer choice” is using high profile television ads to downplay the true consumer advocate groups preaching on healthy eating habits. Right, this group is all about protecting the consumer from the meddling of government agencies such as the FDA and private sector groups and industry watchdogs that are bashing the fast food and tobacco industry. Oh, give me a break. Since when is a group that was initially funded solely by money from Philip Morris Tobacco Co. (and in recent years many food corporations, restaurant giants and alcohol producers) out for your best interest. This organization that has spiffy Madison Avenue ads and a website that spins nutritional research towards their own agenda is a front for all that is wrong in the food, tobacco and alcohol industry.
I suppose it is good to have open debate about our nations eating habits and who should be responsible for our health. But maybe the big fast food industry should take off the sheep’s clothing and expose itself for what it really is. A big for profit industry looking for big dividends for their shareholders, much like the tobacco industry that laid waste to many lives for that almighty dollar. I foresee a day when class action law suites against the food industry will grow and not be limited to just the fast food chains. Coca Cola will be targeted for promoting to our youth by cutting deals with school boards to allow them small profits in exchange for placing soda machines in the hallways of our public schools. Those empty calories that fatten our kids, phosphates the give us bubbly pleasure while sucking the calcium out of our bones, the artificial sweeteners that poison our tissues are turning our kids into sick brittle-boned diabetics. The blatant marketing to children by the soda pop industry may be skeletons in their closets ready to reap havoc on their future profits. Don’t think I will be putting anymore McDonalds Waldorf Salad in my mouth any time soon.
The solution to fast food and a nose thumbing to those marketing their wares is Slow Food. While I am generally opposed to organizations of most any sort, as they tend to be self serving once they are established and grow in size. I hold one exception and can say that the Slow Foods group is a worthy organization that is all about real food, eating health, protecting our indigenous food sources and bringing mealtime back into our culture as an important daily event. An international organization first organized in 1986 in Italy, Slow Food (www.slowfood.com) has grown in size and numbers promoting dining as a source of pleasure. The United States has several “conviviums” in larger cities all over the country. There is even a University of Gastronomics in Italy where attendees earn college credits in the culinary arts. Meetings are usually around the dinner table where local foods are relished, cooked slowly and enjoyed over good conversation. So when I dine I try to take the time to enjoy a healthy cooked meal in an unrushed setting with good friends abound. And I can really mean it when I say, “I’m lovin’ it”.
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JP Saleeby, MD is co-medical director of the Emergency Department at LRMC, Hinesville, GA. He also held faculty position at GSU School of nursing. He is co-founder and former VP of the Slow Food Savannah Convivium. He offers consultations on healthy living at www.saleeby.net
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Reference:
www.wikipedia.org
www.calorie-count.com
www.consumerfreedom.com
www.mcdonalds.com
www.supersizeme.com
www.slowfoodusa.org
www.slowfood.com
www.bermanco.com
www.rense.com/general7/whyy.htm
© 2005
Sunday, July 31, 2005
Headaches
- Steady pain that doesn't pulse
- Tightness, fullness or pressure over the top of the head or back of the neck
- Occasional nausea or vomiting
In summary, the vast majority of headaches are not medical emergencies. Most can be controlled by the use of over-the-counter medications, and in some cases by altering the lifestyle of the sufferer. An organization dedicated to educating people about headaches is the American Council for Headache Education. You can learn more by going to www.achenet.org or by calling their toll free number: (800) 255-2243.
American Council for Headache Education
19 Mantua Road
Mt. Royal, NJ 08061
www.achenet.org
Telephone: (856) 423-0258 1-800-255-2243
National Institute of Neurological Disorders and Stroke. NINDS Headache Information 8-1-00.
American Family Physician. 11-15-97 issue.
(c) 2005
Tuesday, July 26, 2005
Testicular Cancer

By JP Saleeby, MD
What better a spokesman for the fight against cancer than Lance Armstrong. In particular this seven time Tour de France winner is a reminder of how we can beat cancer and move on with our lives. In 1996 Lance Armstrong was diagnosed with testicular cancer and if that were not bad enough for an athlete, his disease spread (metastasized) to his brain and lungs. He was given a 50% chance for survival. Because Lance was unfamiliar with the way the disease presented itself, he chalked it up to side effects of his intense training regimen.
"Of course, I should have known that something was wrong with me. But athletes, especially cyclists, are in the business of denial," Armstrong writes in his bestseller, It's Not About the Bike. "Everything hurts. Your back hurts, your feet hurt, your hands hurt, your neck hurts, your legs hurt, and of course your butt hurts. So no, I didn't pay attention to the fact that I didn't feel well in 1996. When my right testicle became slightly swollen that winter, I told myself to live with it, because I assumed it was something I had done to myself on the bike, or that my system was compensating for some physiological male thing."
Finally after 6 months of severe headaches, visual disturbances, coughing up blood, and worsening testicular pain he sought medical attention. The cancer, an aggressive type called choriocarcinoma that is difficult to arrest, had spread. Tests revealed 40 tumors in his lungs and two in his brain.
"I was given less than a 40 percent chance of surviving," Lance wrote. "And frankly, some of my doctors were just being kind when they gave me those odds."
After researching the disease Lance sought the best in the field to treat him. The one name that kept coming up was Dr. Larry Einhorn at IUMC, who in the mid-1970Âs pioneered the use of three chemotherapeutic drugs to treat testicular cancer. Dr. EinhornÂs work saved hundreds of lives. Lance also learned that the Indiana University Medical Center was the world's leader in treating testicular cancer, so he flew out to met with Dr. Einhorn and his associates the following day.
After brain surgery to remove the tumors and an intense course of chemotherapy Lance Armstrong returned to the arena of competitive cycling a year later and went on to win seven consecutive Tour de France victories a challenge in and of itself making him the athlete of the decade or maybe the century.
Dr. Lawrence Einhorn states in an interview with reporter Patrick Perry that: "Thirty years ago, if you took every single patient with testicular cancer, about 50 percent of them survived their disease. Ninety percent of patients in whom the cancer had metastasized, or spread to distant parts of the body, died. Today, 95 percent of all patients with testicular cancer and 80 percent of patients with metastatic disease are cured."
Lance is not alone. Another well-known athlete who conquered this disease is Scott Hamilton the champion figure skater. There was even an MTV personality who went on TV with his diagnosis and video taped his surgery. All for the ratings I am sure, but none-the-less gave great exposure to the disease. Dr. Einhorn warns that there are about 8,000 new cases each year, affecting one man in 400.
Testicular exams should be a part of every young man's annual physical exam. Early detection increases the chances for cure. It is one of the many cancers that can actually be cured with very good long-term survival rates. Self-exams should be done each month from the age of 15 to 35 just as a woman would examine her breasts for breast cancer. A lump with or without pain should be brought to the attention of your physician for further work-up.
Cisplatin was the chief drug used to treat testicular cancer but when it was combined with other drugs the success rate of cure went up drastically. The "Einhorn Regiment" nicknamed PVB for the three chemo drugs used (cisPlatin, Vinblastine, & Bleomycin ) had huge success and was the treatment that Lance Armstrong received. Another type of testicular cancer responds to radiation. After surgery and chemo there are blood tests that are used (HCG and alpha-fetoprotein) as markers to monitor for cure.
The Facts about Testicular Cancer:
1. Number one cancer killer among young men in their 20Âs and 30Âs.
2. More common cancer in white males than in blacks and Asians.
3. Men with history of undescended testicles (cryptorchidism) are at higher risk.
4. Early detection and treatment enacts a 90% cure.
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© 2005
JP Saleeby, MD is the co-director of the emergency department at LRMC in Hinesville, GA. He also holds a faculty position at GSU department of nursing. He practices integrative and preventive medicine in South Carolina and Georgia and maintains a blog at www.docsaleeby.blogspot.com He can be reached for comment at jpsaleeby@aol.com
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Reference:
An interview with Dr. Larry Einhorn: champion in the war on cancer. By Patrick Perry of the Sunday Evening Post, Jan-Feb., 2002
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=cmed.table.22420
Monday, July 25, 2005
Are Oxygen Bars Really Worth It?
Oxygen for Sale
Angela Kaylor, RN, MPH and JP Saleeby, MD
Whoever said nothing is free, wasn’t kidding. One of the latest trends in upscale health promoting establishment is the selling of oxygen. One can now pay to sit at a bar and order oxygen. Isn’t oxygen in the air we breathe? Yes, it is, but apparently some feel this is not good enough. In our consumer-driven society if a little is good, more is better. But unfortunately there is little science behind this new craze.
There is about 21% oxygen in the atmosphere that we breathe. In 1774 Joseph Priestley discovered oxygen when he noticed a candle would be extinguished under a bell jar once a certain component of air was “used up.” Further testing determined what kept the flame going and what also kept mice alive under an airtight jar. With further experimentation he was able to calculate quite accurately the percentage of oxygen in air. Without oxygen aerobic organisms would not be able to survive from bacteria to highly complex mammals. But the question remains; do health individuals need more than the 21% oxygen that our atmosphere offers?
Oxygen bar fans tout the benefits as reducing stress, increasing energy and alertness, lessening the effects of hangovers and headaches. They even promote the use as helping with sinus problems and as an agent to relax a client. In an interview Mary Purucker, MD, PhD a pulmonologist at the FDA’s Center for Drug Evaluation and Research, she is quoted as saying there are no long-term well-controlled scientific studies to support these claims.
How many times do we see football players coming off the field and donning oxygen masks? It is a rather common practice and according to Dr. Conrad Earnest, director of exercise physiology at the Cooper Institute in Dallas it is basically a placebo effect. Adding extra oxygen for such as short time does not make a measurable difference in performance for a physiological perspective. Mentally it may be different. Those who support this practice are putting “sales before science.”
As organisms we evolved for millions of years breathing 21% oxygen and doing it quite nicely. Breathing moderately increased levels of oxygen through nasal cannula at an oxygen bar on the other hand has not been shown to be harmful. At least in an individual with normal lung function. This may be different in someone with obstructive lung disease or other health problems. The chemotherapeutic drug bleomycin that is used to treat some types of cancer can react badly with high levels of oxygen and those taking this therapy are advised to avoid oxygen bars.
The process usually involves an oxygen concentrator that will bring the content of the gas to about 95% oxygen (100% oxygen is considered a drug and many states require a medical license to administer it). The gas is then bubbled through aromatic oils or fluids that sent the oxygen. It is then piped though tubing into the client’s nose. Nasally inhaling oxygen further dilutes it with ambient air to bring the final inspired concentration down to about 50% or so.
Besides offering a higher concentration of oxygen, these bars also “flavor” the oxygen. There are concerns about the “flavoring” methods. Quality and sterility of the fluids is not regulated and thus the client could be inhaling bacteria or fungus spores in poorly maintained equipment. Also there is the risk of developing a condition called lipoid pneumonia from inhalation of vapors containing oily substances.
Oxygen bars were spawned in the late 1990’s and became hip places to hang out and “get healthy” with choices like peppermint, bayberry, cranberry and wintergreen used to flavor oxygen. It has risen in popularity around the country with oxygen bars popping up in all sorts of places, predominantly sports clubs and wellness centers. The experience can last from just a few minutes to about 20 minutes depending on the customer’s bank account. Typically, oxygen bars charge around a dollar a minute. So a long session can really take your breath away when you get the bill.
Be wary of such claims of curing cancer or AIDS or helping with arthritis that you see being advertised and remember it may not be worth the theoretical risk of injury to yourself. My advice, avoid the oxygen bars and take a trip out into nature and breathe the fresh air while you work on a power walk.
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(c) 2005
Reference:
US Food and Drug Administration
http://www.brlsi.org/notable/Priestley.htm
http://www.fda.gov/fdac/features/2002/602_air.html
Sunday, July 10, 2005
Prostate - Part II - Prostate Cancer
Prostate: Part II - Prostate Cancer
by JP Saleeby, MD
This is the second in a two part series on the male gland called the prostate. In the first article we discussed the anatomy and physiology of the gland as well as the benign process of the enlargement called BPH. This article is devoted to cancer that can occur in this gland. We will discuss topics important about early detection, confirmation of the tumor and staging the extent of disease and it’s aggressiveness. Lastly we will discuss treatment options.
As a part of a man's annual physical exam after the age of 45 it is necessary to include a digital rectal examination and a prostate specific antigen blood test (PSA) as part of prostate cancer screening. It is much better to have a tumor of the prostate gland (which originates in the peripheral zone of the prostate) to be confined to the capsule of the prostate when diagnosed early. Once the tumor spreads past the prostatic capsule treatment take on a new dimension. During the late 1970's 54% of men diagnosed with prostate cancer in the US had their cancers confined to the gland itself. Forty-six percent had more advanced disease as it spread outside the capsule. Between 1986 and 1992 as screening became more commonplace 67% of white men and 63% of black men were diagnosed with localized and curable disease. Early detection lead to better cure rates and a 5 year survival rate that jumped from only 59% in the mid 1980's to 89% in the 1990's. This suggests that early detection methods are helping to impact survivability of this cancer.
Once a DRE and PSA are preformed and there is an abnormality noted, say a lump in the gland or an elevated level in the serum test other diagnostics are necessary to determine if in fact this is cancer. We look not only at the raw PSA number (abnormal levels are those above 4.0 ng/ml) but also PSA velocity (the rate of rise from a previous recorded level). Other sub-tests are the FreePSA (which is the non-protein-bound portion of the PSA molecule) and the %FreePSA. Values of %FreePSA can indicate the evidence of cancer or other diseases that elevate PSA (trauma, prostatism, BPH). The lower the ratio the more likely that the rise in PSA is due to cancer.
There are other blood assays such as RT-PCR, Porstatic acid phosphatase, and a cancer marker called Anti-malignin Antibody in Serum (AMAS test). PT-PCR stands for reverse transcriptase-polymerase chain reaction and it can detect prostatic enzymes outside the prostate as in the case of metastasis. The PAP test has been used for some time but is making a comeback as it measures prostatic acid phosphatase in the blood and again helps with the diagnosis of distal metastasis. A rather new test called the Anti-malignan antibody screen (AMAS) has not been widely adopted. However this cancer marker is probably a more sensible and dependable way to screen for prostate cancer. This marker actually measures the level of cancer cells in the body and can be used to diagnose or screen for other cancers as well. No single test should be used to either confirm or refute the presence of cancer. Rather a combination of tests is always the best bet. There are also imaging studies such as the ultrasound, endo-rectal MRI and CAT Scan of the pelvis and abdomen. Other studies in late disease may include a bone scan and chest x-ray for metastatic disease.
The disease can also be scored or graded which is a way to express the severity and aggressiveness of a tumor. This allows for the discussion of treatment options and prognosis. There are histological examinations of biopsy results that confirm the diagnosis. There is the DNA polidy analysis as to diploid, aneuploid or tetraploid. There is the more common Gleason Score and the Partin Table Score that are helpful when discussing treatment options with your doctor.
Treatment options are many. They range from watchful waiting (monitoring by a physician) to radical prostatectomy (removal of the prostate gland). Another surgical treatment includes cryo-surgery. Additionally, used alone or with surgery, there are hormonal therapies (blocking testosterone and androgenic hormones), chemotherapy with and without hormonal blockage, radiation seed implants (brachytherapy) and conformal beam radiation therapy. These are rather complicated procedures with their own untoward effects and outcomes and should be entered into discussion in great detail. Open and detailed consultation between a patient, his primary urologist, oncologist and radiation oncologist is always a good idea.
It has been calculated that in 1985 there was one death in every 3 men diagnosed with prostate cancer. Compare that with the much better statistics of only one death in 8 men diagnosed today. So the point to be driven home here is that early detection can lead to cure and a better outcome, so don’t be shy get in there and get screened.
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© 2005
Thursday, June 30, 2005
Skin and Skin Aging
Cheating Skin Aging
J.P. Saleeby, MD
The skin, which is our largest organ and is most often ignored or abused, serves many functions. It is our first line of defense, a protective barrier to disease and injury, a temperature regulator, a means by which some toxins are eliminated by perspiration and the means by which endogenous Vitamin D is produced. It also happens to be the first thing another person notices about us. Our appearance can speak volumes about our general health, attitude and lifestyle. Protecting our skin against harm is very necessary for overall good health. Avoiding exposure to UV rays while outside playing golf or those present in tanning beds is a must. While tanning beds are said by some to be safer than the sun, UVA and UVB will cause photo-aging and skin cancer nonetheless.
Sunscreens should be applied to all exposed parts of the body (SPF 15 or better) and reapplied often as they wash or wear off. Also the use of light colored clothing and headgear is helpful. Avoiding tobacco products, excessive alcohol and poor nutrition (fast foods) are also very important. Environmental toxins, ionizing radiation and letting certain medical conditions go unchecked will also affect skin health and aging.
Plastic surgery and aggressive laser treatments are the answer some seek for reversing the signs of aging skin. While this treatment is pursued by some, it should not circumvent the idea that prevention comes first. Skin modification by surgical procedures will only make improvements which are "skin deep" while a non-surgical holistic approach has many more benefits to a persons overall well being. Some natural considerations pertaining to nurturing and protecting the skin from aging are as follows. Adequate oral hydration is crucial. Essential fatty acids such as evening primrose oil, borage oil and black currant seed oil have gamma-linolenic acid (GLA), which appears beneficial in some research studies. Some eczema and dry skin suffers benefit from fish oils containing eicosapentaenoic acid (EPA). Vitamin E (orally) appears to be helpful.
Antioxidants such as Green Tea extract and coenzyme Q10 taken orally or topically help with slowing the aging process. Another potent antioxidant, Vitamin C in higher doses (2 to 3 grams daily) has been shown effective in controlling skin aging and disease. Vitamin C along with the mineral Zinc (Zn) make up the two co-factors in the enzymatic protein process of skin and soft tissue repair. Deficiencies in either or both of these substances will result in poor wound healing. Traditional Chinese herbal preparations of licorice root, chamomile, calendula and chickweed have reported benefits, and the anti-inflammatory properties of Sarsaparilla and mint extract seem useful as do creams containing witch hazel and phosphatidyl choline.
So remember avoid the harmful skin aging effects of too much sun, tobacco and alcohol. Eat a well balanced diet with whole grains, fresh veggies and fruit, and "good" fats. Take in the proper daily supplements and plenty of water. Apply preparations to the skin that are formulated for the purpose of anti-aging in conjunction with regular facials and even gentle exfoliative treatments with proper skin care preparations. Remember participation in non-surgical therapies will benefit internal organs as well. And for those who have spent small fortunes on plastic and reconstructive surgery it is of utmost importance to consider an anti-aging skin treatment program for maintenance. Something can be said about the saying that you are only as young as you feel …. or look.
Wednesday, June 29, 2005
San Francisco, California
Having a blast in SF this day. For more on my travels with Sharon visit www.our-odyssey.blogspot.com
Friday, June 24, 2005
Vaccines
Vaccines: A Principal Tool in Preventive Medicine
JP Saleeby, MD
Vaccines have had their controversies and problems recently, but they remain a very important part of preventive medicine. There are dozens of anti-vaccine Internet sites (www.thinktwice.com for example) that carelessly disseminate dis-information regarding vaccines and immunizations. According to an article authored by Dr. Robert Wolfe in the June 26th, 2002 issue of the Journal of American Medical Association, twenty-two such sites were investigated and shown to contain material unproven or false. An unfortunate consequence of this is the drop in MMR immunizations by 65% in the UK, with a rise in outbreaks of measles in certain areas last year. The USA has not been impacted as hard and the CDC reports that 90 – 95% of children are still being vaccinated.
Immunization by vaccine is an acquired immunity achieved from modified antigen from a disease-causing organism that allows the body to fight further exposures to prevent disease. The benefits of vaccines have been proven in epidemiological data to outweigh non-use due to side effects. Like any intervention in medicine, immunization is not without some untoward effects. But the benefits are immense. For example, can you imagine what our world would be like if Small Pox were not eradicated or if the Polio virus was still infecting and crippling thousands of people? A chiropractor acquaintance of mine once commented that he was never immunized against childhood illnesses, nor were his parents (both chiropractors) because "they did not 'believe' in immunization." He went on to state that he never was infected with mumps or measles or polio for that matter. My retort to that statement was that he and his family should be grateful and thank all the other children in his school and folks they interacted with in their community for being immunized. That sort of rational or argument is faulted, for his reduced risk is relative to those he comes into contact with. Trust me, he would be singing a different tune if those around him were not immunized. Small Pox would not have been eradicated if not for the vaccine discovered in the 1700's by Dr. Edward Jenner. Without a vaccine for Polio, we would not see the numbers who fall victim continue to drop worldwide.
Since the discovery of a Polio vaccine in 1954 by Dr. Jonas Salk, we have seen a steady drop in rate of infection. The WHO reported back in 1980 that 500,000 children were paralyzed by polio annually, which has steadily dropped to only 480 reported cases globally in 2001. On July 21, 2002, Europe was proclaimed Polio-Free and only 10 countries are considered endemic (down from 20 just last year). This was the fruit of global vaccination programs that like Small Pox are on the brink of eradicating this horrible virus from humankind.
The flu virus kills many people annually, usually our older citizens and influenza vaccine saves lives, this is a proven fact. The occasional morbidity of taking an annual flu vaccine pales in comparison to lives saved. Tetanus toxoid vaccine that prevents a neurotoxin secreting bacterium prevents a potential illness that has a 50% mortality rate. Rabies vaccine and immunoglobulin therapy prevents a disease that is near 100% fatal.
Today however, the detractors of childhood and adult immunization and vaccines state several issues. Some argue that MMR causes Autism and Crohn's disease, which was reported in a single British study from 1998. But several large well-designed studies since have not shown an increased incidence of Crohn's or Autism with MMR vaccine. Sudden infant death syndrome (SIDS) was blamed on whole-cell DTP, but large clinical trials have actually found a lower incidence of SIDS within the vaccinated population of children. In 1998, France suspended Hepatitis B vaccines, because of a reported risk associated with Multiple Sclerosis (MS). But again, this was proven false with several large international studies showing no correlation between Hep. B vaccine and MS. Detractors also imply that immunization weakens the immune system and may cause allergies. Again well-designed scientific studies came to the rescue to refute these claims and actually show the converse. There is a lower incidence of allergy and weakness to the immune system with vaccinated children. Medical science is never perfect and I will outline three examples and what medicine has done to rectify its problems.
First is the use of oral polio vaccine (which had an occurrence of polio in 1 in 2.4 million doses). A couple of years ago, pediatricians were instructed to use only the injectable and not the oral polio vaccine. Problem solved. The issue of mercury toxicity with the use of a mercury containing preservative (thimerosal) in many vaccines has caused the industry to produce a supply of vaccines that are mercury free. And then there was the rotavirus immunization program. This would have helped combat a viral gastroenteritis children often acquire which causes dehydration and the discomfort and morbidity associated with hospital admissions, IV fluids and medication. The vaccine was stopped when reports of 15 children (in 1.5 million immunized) suffered a rather rare bowel obstruction called intussusception. A search for a new type of vaccine is ongoing.
Again, science wins over hysteria and the irrational. My recommendations to my patients are to immunize your children and keep you adult immunization up-to-date. Just be judicious, keep informed, don’t believe everything you read on the Internet, and ask for mercury free preparations.
Wednesday, June 22, 2005
Tuesday, June 21, 2005
The Prostate - Part I - BPH
The Prostate: Part I – BPH
By JP Saleeby, MD
What is situated below a body of water, has four zones and is commonly associated with venial pleasures. No it is not some romantic European city, but rather a walnut sized male organ that serves important procreative functions. It also happens to be an organ that plagues men as we age. This organ or gland is the prostate. This is the first of two articles on the male prostate. This article will focus on a disease process that affects older men, something we refer to as benign prostatic hyperplasia (BPH). BPH is a non-cancerous growth in the size of the prostate gland that impairs the flow of urine out of the bladder. The second article will focus of prostate cancer.
But first a little about the small yet important male organ. The gland is located just below the bladder. It usually measures one inch by one-and-a-half inches (approximately the size of a walnut). It surrounds the urethra (the tube that takes urine out of the bladder). It is responsible for producing a fluid important in male sexual function.
In the past the prostate was described as having “lobes”, but today we refer to it as having concentric zones. These zones are important both on an anatomical as well as histological level. We can separate pathology along these zones as well. For instance most all cancers occur in the peripheral zone while the benign process of enlargement occurs almost exclusively in the transitional zone (which only occupies about 5% of the total prostate volume).
The prostate gland is also made up of different cell types. Cancer cells develop from the epithelial cells, but it is the interaction with stromal cells that is important in the behavior of the cancer. BPH develops from an interaction between these cells as well, but it is complex and poorly understood. Testosterone and other hormones and their interactions with this gland are hot topics of research in understanding prostate disease.
The prostate gland produces most of what is found in the male ejaculate. The average volume is about 3 mL. This is less than a teaspoon and only 1% of it is sperm. The majority of the semen volume is made of products of the seminal vesicles and the prostate. The male ejaculate is very rich in potassium, zinc, citric acid and fructose. Along with these substances it also contains prostaglandins. There are many other unusual substances found in the semen. Not all is know about their function or purpose.
This important male organ is a complex mix of anatomical structures and cell types that make it possible for human reproduction. However beyond the reproductive years of men, this organ becomes one of burden rather than usefulness. We will discuss the finer points of BPH and how to best avoid it and if plagued with it, treatment options.
BPH typically affects men from their fourth to fifth decade of life and beyond. Several hormones come into play that have a drastic effect on the transitional zone (the zone that is most central and surrounding the urethra). Namely a metabolite of the male androgen Testosterone called Dihydrotestosterone (DHT) plays a big part on the enlargement of cells of the prostate and the encroachment on the urethra. There are several signs and symptoms that correlate with BPH and they are: slow urinary flow, the urge to urinate all the time, nighttime urination, enlargement and distension of the bladder with continuous urine leakage (incontinence) and urinary obstruction. Autopsies suggest that more than 90% of men older than 70 years have BPH. The average age for symptomatic development is about 65 years for white Americans and about 60 years for African-American men.
Ways to prevent the effects of DHT on the prostate gland and the ensuing enlargement are via medications that block the enzyme 5-alpha-reductase, which converts Testosterone to DHT. Proscar is such a drug commercially available through a pharmaceutical company. Proscar works on blocking the effects of androgens on the epithelial cells and can actually shrink the size of the prostate making some of the symptoms of BPH resolve.
Alternatively two FDA approved drugs that aid in symptoms of BPH (but act differently than Proscar) are Hytrin and Cardura. Both Hytrin and Cardura are drugs in the alpha1-blocker class. Originally researched as a centrally acting blood pressure reducer for patient with hypertension, it was discovered that this drug would actually relax the prostate tissue surrounding the urethra making symptoms of BPH resolve. Side effects generally include low blood pressure, dizziness, and nasal stuffiness. While neither of these two drugs will “cure” or reverse the process, they certainly do provide symptom relief for the patient plagued with BPH.
Another way to treat this disease and a more natural approach is the use of herbs know for their anti-androgenic effects on the prostate. These include the well-studied Saw Palmetto herbal extract that blocks 5-alpha-reductase in the same manner as the prescription drug. Saw Palmetto taken in a standardized dose of 160mg twice daily has shown increased urine flow, with minimal side effects. Saw Palmetto is an herb indigenous to the Lowcountry of Georgia and South Carolina. Pygeum Africanum is shown to do the same yet it is not as effective and there is a fair degree of stomach symptoms. Pygeum is derived from an African evergreen tree. Stinging Nettles (Radix urticae) is another herb used widely in Europe for prostate health that has been shown to lower the residual urine volume in men with enlarged prostates. These phytotherapeutics (plant derived medicines), used and described by the Egyptians as far back as the 15 Century B.C., have a common compounds called phytosterols. The most effective phytosterol is beta sito sterol for BPH.
None of the medications or herbs has been shown to prevent prostate cancer. These prescription medications and herbs are for the treatment, reduction in size or prevention of the benign process of enlargement of the prostate. Prostate cancer prevention and treatment is by other means and the subject of the next article.
Besides the herbal and drug therapies there are a few surgical therapies worth mentioning. These include the most common transurethral resection of the prostate or TURP. This is where under the care of an urologist the constricted urethra within the prostate gland is “reamed out” thus mechanically or surgically widened the opening. A variant of this is the transurethral incision of the prostate (TUIP) where an incision rather than resection of the tissue is performed. A suitable procedure for patients with prostates <30>100 mL in volume. This involves an abdominal operation and removal of the whole prostate. Of course symptoms mentioned above for TURP are of greater frequency with this more radical procedure. There is also thermotherapy (a type of microwave treatment) that alleviates irritative symptoms, but not much is available in long-term results in the medical literature. And finally stent placement is an option. This can be used in selected cases of patients with a poor general condition and in the non-operative candidate.
Symptoms of BPH include:
Obstructive symptoms:
Hesitancy in initiating voiding (trouble getting started)
Weak urinary stream, prolonged voiding
Post-voiding dribbling (mild incontinence)
Sensation of incomplete emptying
Nocturia (night time urination)
Overflow incontinence
Acute urinary retention (very painful condition)
Irritative symptoms:
Dysuria (discomfort in urination)
Frequency
Urgency
Scoring BPH:
The American Urological Association Symptom Index (AUASI) and International Prostate Symptom Score (IPSS) are now considered the gold standard measurement tools for the assessment of BPH symptoms and response to treatment. Both questionnaires can be used by a physician in a clinical practice to quantify the subjective symptoms of BPH and monitor therapies.
Part II in this series will cover annual examination of the prostate, blood testing, prostate cancer. It will also cover prevention and treatment of prostate cancer.
Reference:
http://www.prostatehealth.com
Lowe, FC. Et al, Phytotherapy in treatment of benign prostatic hyperplasia: a critical review. Urology 48:12-19, 1996
Dreikorn, K. et al, Stellenwert von Phytotherapeutica dei der Behandulng der benighnen Prostatahyperplasia. Urologe (A)34:119-129, 1995
Fitzpatrick, J.M. et al, Phytotherapeutic Agents in Management of Symptomatic Benign Prostatic Hyperplasia. Urological Clinics of North America. 22:407-412, 1995
Wilt T, Ishani A, Mac Donald R.. Serenoa repens for benign prostatic hyperplasia. The Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD001423. DOI: 10.1002/14651858.CD001423.
[Research by Sagalowski and Wilson, 1998]
© 2005
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Sunday, June 19, 2005
New Medicine Paradigm for the 21st Century
New Medicine for a New Century
By JP Saleeby, MD
Be warned, this article is not for the squeamish. Within this editorial I express my world-view of the state of health care in America in the 21st century. There are some harsh realities that remain hidden to the masses of consumers by the status quo healthcare industry. These are dangerous times in which we live and quick action must be taken to fix a hemorrhaging system. First is the problem of our aging society. Baby Boomers now represent 28% of the US population. The fastest growing group of people in most countries of the world is the 80+-year-old bracket and by the year 2025 those over 80 years old will represent 30% of the world population. These statistics are frightening when one considers the cost of caring for older Americans by today’s standard of care.
With medical science advancements those born today will live on average 30 years longer than those born in the early 1900s. Longevity will continue to rise exponentially as the years go by. The economic burden to an aging society with disregard to preventive medicine is incredible. By 2025 we will spend 50% more than what was spent in 1998 in the healthcare arena. Will there be enough funds to take care of the sick and aging? Will we be able to afford good quality of care? Those who do not take care of themselves and ignore the "preventive medicine" physician will suffer from multiple chronic end-organ disease, this is a given. The result is that a growing number of these patients find themselves in total care facilities. These facilities are the decubitus ulcers of the healthcare industry; nobody really cherishes working them and certainly nobody wants to end up there.
My years working the emergency departments in southeast Georgia have taught me a great lesson. I see daily the ramifications of poor preventive medicine care, and care daily for large numbers of people suffering from debilitating disease. Less than five percent of people today consume greater than ninety percent of the healthcare dollar. Will there be enough funds in the future if the sick population grows? Effective January 1, 2002 Medicare will reduce reimbursements to physicians by a little over eight percent.
As everyone knows the rest of the industry follows the example of government reimbursements. What does that mean? Less money to care for the sick will lead to lesser quality of care, that is a known fact. True there are many abuses in the system, but socialized medicine is certainly not the answer. Look a the UK, our lines for access to healthcare pale in comparison to the delays seen in those systems. It is without argument that it is less expensive and more efficient to spend time and money early on in life to avoid degenerative end stage diseases than to manage them later in life. Ignorance is by far the greatest common denominator for those who wind up in the ER or the nursing home with congestive heart failure, lung disease, heart attach, cancer or stroke. A lifetime of abusing the body or not realizing an underlying destructive process will cause the body to succumb to degenerative disease and organ failure.
Secondly, even before the tragedy of 9/11 and it’s effect on the economy there were problems brewing within the insurance industry. Take a close look at the insurance industry today; there are critical issues that will impact the solvency of that industry. Already there is a crisis among underwriters of medical malpractice and the state of Georgia has seen at least one major carrier pull out and end coverage for hundreds of physicians. It does not stop there. The cost of caring for the ill is very expensive and either one of two things must occur. Premiums will rise sharply and coverage may reach a point that may be prohibitive for individuals or employers to purchase, or the industry will demand health care professionals do "less" to save money. Neither scenario is appealing.
Will I be able to purchase medical insurance in the future? With rising cost of healthcare will I be able to afford it in the future? I don’t wish to be an alarmist, but time is of the essence for a proactive approach to staying well and free of disease. By reducing cancer and heart disease by just 20% a savings of $10 trillion annually in this country can be appreciated. The average 65 year old today takes nine different prescription drugs yearly with an average monthly cost of $38 each. This all adds up quickly. Add in the cost of doctor visits and hospitalizations which may quickly see a rise in out-of-pocket cost and it could spell disaster.
The only way to avoid this dilemma on a personal level is quite simple. You must rely on a different paradigm of healthcare. The emphasis is on early education, preventive oriented evaluations and selected interventions that will assure better quality of life in the future. Even if this is totally an out-of-pocket, non-reimbursable expense the future payoff is tremendous for our overall well being. Take our automobiles for example, Americans will spend on average $24 a day on there cars, but we grumble about spending less on our health. Think for a moment here, our car is a replaceable, depreciating entity, our bodies are not. Eating well and exercising correctly are two simple "no-brainers." Participation in annual preventive medical examinations needs a bit more motivation and foresight. Frankly no one really wants to visit a doctor when they are "well". This mindset must change.
This new age of medicine demands a "new" doctor, one who is unhampered by the restrictions and decay of what the managed care system in America has made of today’s physician. Long lines to access care, long waits in the doctor’s office and short visits with physicians without attention to detail and the "whole patient" concept are unacceptable, but apparently tolerated by most Americans today. The intentional destruction of the patient-physician relationship by the current health care system is chiefly to blame for the dissatisfaction in the care many receive today.
So what can I do? Do not take this sitting down. There are alternatives to the status quo offered by today’s sick and dying health care industry. What is offered today is fast-food (to use as a metaphor) medicine, and it is not good for the body. Alternatively there are programs to delay or reverse the aging process preventing permanent damage to the body at a relatively young age. Just think about enjoying the latter years of you life traveling, remaining active and able to partake in leisure activities, versus spending the last 20 plus years of your life confined to a bed, swallowing a collection of pills to treat a myriad of diseases and spending your last dollar of savings on hospitals or nursing homes. Given the options, there is no hesitation in the path I would choose.
Thursday, June 16, 2005
Glucophage (Metformin) as an Anti-aging Drug
Metformin (An Anti-aging Drug)
by JP Saleeby, MD
For more than forty years the drug named Metformin (Glucophage® manufactured by Merck, but now available generic as the patent has expired) has been used to treat Type II diabetics with great success. Unlike other medications used to lower blood glucose levels, Metformin will not cause hypoglycemia because it acts quite differently than other classes of diabetic medication.
Observing the nearly 4 decades of Metformin use in overweight diabetics with cardiovascular disease, hypertension and dyslipidemia brought to light the amazing transformation this drug has on this group of patients with this insidious and life-shortening (and quality-of-life diminishing) disease. Metformin happens to be one of the only drugs used to treat type II diabetes that has an impact on reduction of death by heart attach and stroke. While other agents raise the insulin levels, Metformin's mechanism of action work to make endogenous insulin levels more effective on a cellular and molecular level. What is more, the ideal anti-diabetic drug should exhibit enhanced cellular sensitivity to insulin (reducing insulin resistance and glucose intolerance), inhibit excessive intestinal absorption of sugars, reduce excessive liver production of glucose (gluconeogenesis), promote weight loss and correct lipid abnormalities.
With the CDC’s predictions that one of every three children born after 2000 will develop type II diabetes, this is certainly a topic of paramount importance. Metformin answers the call. Now here is where we have some fun. Take these well documented finding and apply them to the non-diabetic patient. Several studies have done just that, and a growing number of anti-aging physicians are prescribing this drug as a part of their regiments for patients over 40.
Three placebo-controlled trials using Metformin in non-diabetics reported a reduction in fasting insulin and c-peptide levels, normalization of serum glucose and harmful low-density cholesterol (LDL-C) and apo B levels. One of the three even reported lowering of blood pressure and fasting triglyceride levels. It is shown time and again that Metformin is able to assist patients with weight loss.
Metformin has also been used to treat women with polycystic ovary disease (Stein - Leventhal syndrome) and infertility or menstrual irregularities. There are also studies published in the medical literature showing Metformin's activity against cancer and enhancement of cellular immunity. Metformin has been found to suppress growth of some tumors and enhance the activity of anti-cancer drugs. In one such study it reduced the incidence of chemically induced cancer in laboratory rats.
As with all medication there are some patients who should not take this drug and there are some side effects one should be aware. For example, people suffering from sever liver and/or kidney disease should not take this medication. Those with a history of alcohol abuse should avoid this because of an associated lactic acidosis when the two are taken together. Additionally, people who are to take an Iodine-based intravenous contrast agent for special radiological examinations need to stop the medication a couple of days prior. There is an associated risk of kidney damage when Metformin is onboard.
Finally, continuous use of Metformin will predispose a person to vitamin B12 malabsorption. So people taking Metformin for prolonged lengths of time need to supplement with vitamin B12. By and large this is a very safe drug and the benefits attained from its use outweigh the relatively small number of untoward effects.
The multiple positive effects of this single drug (for its ability to reduce development of diabetes, cardiovascular problems, endocrine disorder, nephropathies, retinopathies, decreased immune function and cancer, as well as weight loss) make it a top disease preventing & longevity medication. There are special doses recommended for the use of this medication for anti-aging purposes and it is best prescribed by physicians with this as their focus of practice.
Friday, June 10, 2005
Avoidance of MLM in Dietary Supplements
Avoidance of MLM in Dietary Supplements
The following was a recent exchange from a detail person from an MLM scheme with an outfit called Oasis Life Science. The ploy... come across as BIG, name drop and claim to have heavily researched products. The downsides are obvious but I will point them out:
1. Name dropping is as bad or worse then a plethora of testimonials (non-scientific). Who really cares if a billionaire is involved. Would I buy vitamins sponsored by Bill Gates??? Probably not. Would I buy software... well yes as most of us have.
2. Much more money is devoted to marketing and sales than is to the research and improvement of the products.
3. Where is there any "good" and "credible" information on the products... such as a label with ingredients, standardization, independent laboratory testing, etc. Don't really see evidence of this on their website.
4. Multi Level Marketing Scheme... a great tool for making some people very rich... should you get involved... NAH!!! Not very reputable and reminds me of Amway. Before long they will want you to sell product for them to pad their bank accounts. Major ethical dilemma here.
5. Get a load of those prices.... astronomical. Again the cost is to support the huge infrastructure of marketing, commissions, etc. Very little goes back into R&D and product improvement.
FINAL COMMENT: Stay away from these outfits... if you really want a good dietary supplement go with a small independent no-nonsense company such as VSN. www.vitasanus.com.
--JP Saleeby, MD
***Late Entry: 3/24/2009: For those reading this blog entry. I must say for clarification that my opinion has changed with regard to SOME network marketing (MLM) companies in so much as I have researched and found a very credible company and product worthy of my endorsement (not only do I back this up without being a paid spokesman per se, but I take it myself). By and large I am not a MLM person, but when I came across this product, I was a convert if only for this ONE dietary supplement. Kudos to Beachbody to formulating and TESTING Shakeology and investing in a very good product. Again this is the one and only exception I take to my world view on network marketed OTC dietary supplements.***
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| From: | |
To: | |
Cc: | |
| Subject: | Re: (no subject) |
| Date: | Fri, 10 Jun 2005 21:06:03 -0400 |
Mr. Dellorso,
I find that retort highly offensive. My product line was developed after 3 years of researching the best ingredients and delivery systems. The longevity pack system is updated every 2 to 3 years based on the latest scientific studies in the field of nutritional medicine. Another concern is cost to client/patient. While VSN carries Metagenics and Thorne Quality it can be obtained at WalMart prices. Also VSN is NOT a MLM scheme of which I find quite honestly unappealing and oftentimes with ethical shortcomings. You are not the first (nor I suspect the last MLM outfit) to try to "win me over" to sell a product line. Furthermore I plan on posting this exchange on my blog. Not a good mark for your company.
Respectfully,
JP Saleeby, MD
(800) 965-8482
www.saleeby.net
-----Original Message-----
From: DDellorso
To: JPSaleeby
Sent: Fri, 10 Jun 2005 2:31:23 PM Eastern Daylight Time
Subject: Re: (no subject)
Just a thought....which would be more important to you.....selling YOUR product, or giving something that would actually help them and is scientifically proven to do so????
www.oasisdr.com
516-521-6839
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| From: | |
To: | |
| Subject: | Re: (no subject) |
| Date: | Fri, 10 Jun 2005 12:07:16 PM Eastern Daylight Time |
My name is David Dellorso and I am working closely with billionaire Bill Lee of South Korea, seated on the "World Economic Forum" , and world famous Stephen Cherniske' author of "The Caffeine Blues", "DHEA Breakthrough" and most recently "The Metabolic Plan". We would like to overnight a sample of Oasis Life Sciences groundbreaking anticatabolic compound. We would value your opinion.
The corporate site is www.oasislifesciences.com. We will look for an email confirmation or a direct response via our toll free number and we will forward it to you immed.
best regards;
David Dellorso
1-877-668-1547
516-521-6839
---------------------------------------------
Tuesday, June 07, 2005
Say bye-bye to COX2 inhibitors and hello to Exercise
Addendum to OA Article
In a study by Dr. Steven Mazzuca presented at the 10th World Congress on Osteoarthritis in 2006 he showed that lower extremity strength training (resistance exercise) had a positive impact on reduction in joint space narrowing by 26% when compared to range-of-motion exercise. Therefore resistance exercise is one way to reduce the degenerative effects of OA in joints that suffer early signs of the disease.
Monday, June 06, 2005
Managing Osteoarthritis (OA)
Managing Osteoarthritis: Getting away from Vioxx
By JP Saleeby, MD
One in every seven adults in America suffers with arthritis or degenerative joint disease. The more common type of arthritis is Osteoarthritis (OA). The pain and disability it causes account for 46 million visits to physicians annually. The economic impact of this disease is quite significant in that the dollars in lost wages and medical bills exceeds $65 billion each year. Unfortunately, the current "standard treatment" for Osteoarthritis offers only temporary relief of symptoms, does nothing to address the underlying cause and oftentimes contributes to undesirable side effects and other disorders.
The medications that are usually prescribed by physicians are in a class called non-steroidal anti-inflammatory drugs (NSAID). Some common drugs in this class are aspirin, Motrin, Naprosyn, Vioxx, Bextra and Celebrex. In general these drugs inhibit prostaglandins that are responsible for creating substances that cause pain and inflammation. The drugs work by inhibiting a cycloxygenase enzyme or COX for short. Recently drugs have been designed to inactivate one subtype of this enzyme called COX2. These newer drugs have less of the undesirable effects on the stomach lining and the kidneys. The prostaglandins (PG) that are inhibited by COX inhibition are also necessary in protecting the stomach lining from the acid within and also the kidneys. Loss of this protective PG oftentimes leads to gastric ulcers and renal impairment. Other undesirable effects of NSAIDs are: elevated blood pressure, hepatic (liver) toxicity and further deterioration of cartilage in the joints. The new generation of drugs also carry an expensive price tag.
Until September 2004, COX2 inhibitor drugs like Vioxx and Celebrex were the standard treatments recommended by most allopathic physicians. Sales of Vioxx topped the list of prescribed arthritis fighting drugs in recent years. Recent discovery from investigational studies within the Food and Drug Administration (FDA) have caused quite a stir in the medical communities with the prompt removal of Vioxx from the market. There are also warnings on the use of long-term and high dose prescriptions of other COX2 inhibitor drugs and even an over-the-counter NSAID drug called Aleve (Naprosyn). Whether the drug companies knew of these untoward effects prior to FDA exposure is not clear, but that is a topic for another discussion. Point is that these new generation arthritis "wonder drugs" that were once touted as having additionally benefit in reducing heart disease and stroke and even preventing other inflammatory diseases may have actually been shown through scientific trials to be doing more harm than good.
The patient depending on COX2 inhibitor drugs must now search for a safe and effective way to treat symptoms and the underlying cause of degenerative arthritis. What is needed to treat OA appropriately is a means to reduce inflammation, reduce or eliminate pain AND reduce the degenerative and destructive process within the joints. The joints that are affected by arthritis are covered with cartilage on their articulating surfaces. By supporting the cartilage we combat osteoarthritis at the source. Cartilage is composed of specialized collagen fibers made up of large molecules called proteoglycans. The integrity of cartilage is in the hands of chondrocytes that produce collagen and the proteoglycan matrix. Since cartilage is in a state of constant repair it is important to supply the body with the substrate it needs to repair and rejuvenate the joints. What needs to be avoided is any medication that disrupts this process and favors the breakdown of cartilage. Unfortunately the majority of Americans with OA are being treated with the wrong medications for this purpose. Something is actually missing in the mix. Treating OA with NSAIDs alone will only solve the problem of pain and swelling in the short term, but will actually make the condition worse in the long-term. Today the thinking is the temporary short term use of NSAIDs anyway.
A very important "factor" in the treatment of OA is Glucosamine. This is a naturally occurring substance that is the substrate that chondrocytes need to rebuild health cartilage. While we produce Glucosamine in our bodies, age, trauma, malnutrition or other co-morbid factors will cause one to produce inadequate quantities to support our bones and joints. Therefore, exogenous Glucosamine is required to keep the balance.
Glucosamine (2-amino-2deoxy-D-glucose) is a naturally occurring cousin of the glucose or sugar molecule called an amino-sugar. As stated earlier, this substance is the building block of the proteoglycans used to make connective tissue such as cartilage. The benefits of using Glucosamine to treat OA are many.
Firstly, it provides the body with a means to repair the damage that is occurring to the joints and REVERSE the degenerative process. Secondly, it has anti-inflammatory properties in and of itself, which are appreciated with long-term use. Thirdly, it has no known toxicity (the drug Duract, a newer NSAID, by comparison was pulled by the FDA some years ago for its toxicity, now we see the same thing happening with Vioxx and possibly Celebrex). The only theoretical downside is that it may cause serum glucose levels to rise in a diabetic patient. Careful monitoring of glucose levels and management of diabetic medication would solve this problem if it were to arise.
Fourthly, there is no risk of gastric ulceration, renal impairment, hepatic toxicity (as seen with Bextra a new COX2 inhibitor), nausea or other side effects seen in NSAID use. Fifthly, the cost is much less in comparison to the new generation of COX2 inhibitors. Imagine paying less for a safer treatment regiment.
In controlled studies Glucosamine went head to head with ibuprofen. While patients receiving Motrin (ibuprofen) demonstrated more rapid relief at the onset of therapy, the degenerative process continued under long-term therapy. The Glucosamine treated patients saw relief of pain and inflammation equal to that of the ibuprofen group in eight weeks. Additionally, the Glucosamine group had no side effects and regeneration of cartilage was seen with continued use. For clinical application, NSAIDs can be used in conjunction with Glucosamine for symptom relief, but then should be discontinued once dual therapy has continued for 2 months.
Choosing a source of Glucosamine is important. It must be of quality and without contaminants. Doses that have been effective are in the range of 1500mg daily. It is usually administered as 500 mg capsules taken three times daily. There are delayed-release or time-released preparations in the pipeline. Oftentimes Chondroitin sulfate (polysulfated glycosaminoglycan) is used in conjunction with Glucosamine, as well as some other herbs that aid in joint health. Boswellis serrata, turmeric, quercetin and ginger are a few that offer anti-inflammatory properties. The amino acid L-Proline as well as the sulfur compound Methyl Sulfonyl Methane (MSM) are important in cartilage health as they provide necessary components for cartilage and synovial fluid.
Another important supplement is Omega-3 Fatty Acids. They hold mild anti-inflammatory properties acting by another mechanism than COX inhibition. They actually produce good eicosanoids or PGs. But one should also remember good nutrition as in fruits and vegetables and adequate hydration are also important.
Without the use of preventative measures and only the current "standard recommended treatments" it is predicted that OA will affect upwards of 59 million Americans by 2020. So if you suffer with arthritis or are at risk, do you joints a favor and protect them with Glucosamine, Chondroitin, MSM and EFA containing supplements. Whether Vioxx or other COX2-Inh. will be reintroduced into the market is neither here nor there. They will still remain drugs with side-effects, make an educated smart decision on how you want to treat your OA.
© Copyright 2005
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Dr. JP Saleeby is assistant medical director of the ER at LRMC, Hinesville, GA and formulator of the VSN Supplements. Joint Support is one of his arthritis formulations containing Glucosamine, MSM and other herbals. Dr. Saleeby’s Recommendation: Joint Support 3 to 4 tablests daily (2 tabs twice daily) as stand alone (or in conjunction with an NSAID [Motrin, Advil, etc.] initial short term only). He can be reached for comment at vitasanus@aol.com. or for consultation at (800) 965-8482.
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VSN Joint Support [SRP $19.95 USD]
90 Capsules
The Joint Support formulation is a combination of vitamins, minerals, herbs, amino acids and powerful antioxidants in addition to sulfur compounds which play an integral part in the formation of bone and cartilage matrix. The principals being Glucosamine Sulfate, which provides the raw material needed to manufacture the mucopolysaccharide glycosaminoglycan found in cartilage. The second is Chondroitin Sulfate a major constituent of cartilage and its matrix. Since cartilage is avascular (without direct blood supply) it depends on the synovial fluid for nutrition. The components in this formula give the best protection to cartilage against free radical damage and degenerative changes.
The Joint Support formula also contains Vitamin C a powerful antioxidant also necessary for collagen formation and repair. It has mild antihistamine properties, helps with wound healing and enhances athletic performance. Panotothenic acid (B5) is able to help reduce symptoms of Rheumatoid Arthritis (RA) and Lupus (SLE) in scientific study. Vitamin B5 is also an athletic enhancer. Niacin (B3) is present in this formula in a level that will not cause flushing, and is helpful in managing osteoarthritis (OA). L-Proline is an important amino acid found in the joint matrix. Manganese (Mn) found in cartilage and bone activates Superoxide Desmutase (SOD) and staves off OA. Iron (Fe) & Calcium (Ca) intake can reduce Mn, so women on Calcium and Iron are at risk for this deficiency. Bromelain, a digestive enzyme, also has powers of anti-inflammation (73% of RA patients reported improvements with this supplement alone in one study.)
Quercetin, a flavonoid, and Grape seed extract, a proanthocyanidine, help with antioxidation, reduce edema, and have been helpful with gouty arthritis (gout). The herb Turmeric, with active ingredient curcumin, is a potent antioxidant & anti-inflammatory, it reduces histamine, releases cortisols and helps with OA. Ginger is used in Ayurvedic and Tibetan medicine to treat inflammation is also present in this formula [it may react with some blood thinners (Coumadin.)] Finally, the herb Boswellia serrata (the active component is a terpenoid) is found in this formula and inhibits inflammation & leukotrienes. It has been used in Ayurvedic medicine for centuries to treat OA, RA and Bursitis. Dr. Saleeby recommends anywhere between 3 to 5 tables daily (divided doses) for control of arthritis or as a prevention of joint damage in his athlete patients.
3 Capsules contain:
Glucosamine Sulfate 1000 mg
Chondroitin Sulfate Complex 100 mg
Vitamin C 100 mg
Niacin 25 mg
Pantothenic acid (B5) 25 mg
Manganese 25 mg
Boswellia serrata extract 100 mg
Turmeric root extract 50 mg
Bromelain 25 mg
Grape seed extract 10 mg
Quercetin 10 mg
Ginger root powder 50 mg
L-Proline 50 mg
To order call (800) 965-8482 or visit www.vitasanus.com
Male Pattern Baldness (Herbs v. Drugs)
Male Pattern Baldness
By JP Saleeby, MD
I will depart from my usual topics on preventive medicine relating to cardiac disease, diabetes, and hormone replacement to address a topic very dear to many aging male patients. This topic, while not a life-threatening ailment, is often a major concern that plagues their every waking minute. I am talking about balding; male pattern baldness (MPB) is one of those inherited traits that can have devastating effects of how a man perceives himself, his sexuality and virility. Ninety-five percent of baldness is genetic, but there are other causes as well, which include, some medications (antihypertension and depression medication) and rare immunological hair loss. Balding actually starts at puberty and by 50 years of age greater than 50% of men will notice significant loss of hair. There are many means to attack this problem. The simplest is to ignore it and live with the fact that a chrome-dome isn’t all that bad a thing for some folks, just ask Michael Jordan or Telly Savalas (when he was around). You can cover it up with a rug - maybe not the most practical for the active man. You can even spray on some artificial stay-in-place by static "hair". You can have hair follicles (plugs) surgically implanted, which may or may not take… Ouch! Or you may approach it in a more proactive way and try to salvage what you have medically.
Rogaine (Minoxidil) hit the market a few years ago and what was once used as a powerful anti-hypertensive saw new use in balding men around the crown. Today they are even promoting it for women. How does Rogaine work? Maybe by increasing blood flow to the base of the hair follicle and thus increasing the thickness and health of the hair at that location.
Propecia which is a lower dose of an anti-BPH drug Proscar (Finasteride) is the most recent entry into the market place for hair salvaging medication. This apparently saves hair along the anterior frontal region. How does Propecia work? As in prevention of benign prostatic hyperplasia (BPH) it inhibits an enzyme that converts testosterone to DHT (a potent androgen) that is implicated in the enlargement of the prostate and in baldness. This enzyme is called 5-alpha-reductase. Actually there are two types of 5-alpha-reductase (type I is found in higher concentrations in the scalp (more along the frontal aspect), sebaceous glands and skin and type II which is found more abundantly in the prostate gland). What is worth noting is that Procecia has more of an effect on type II than type I reductase. There are actually several other compounds that have the same effect on 5-alpha-reductase and may do even a better job on prostate protection and MPB. While these drugs protect the hair that has not been lost, most will confess that it does not grow "new" hair; it just makes what you have thicker and retards further loss.
Lets look for a moment at some alternatives. There are some fatty acids that plants produce, namely Gamma Linolenic Acid (GLA), Oleic Acid and Alpha Linolenic Acid (ALA), that have activity in inhibiting both forms of 5-alpha-reductase and additionally have potent anti-inflammatory functions. Azelaic Acid which is a dicarboxylic acid found in grains has been used topically for years to treat skin ailments, but when combined with the mineral zinc and vitamin B6 in low concentrations it has an overwhelming effect on inhibition of 5-alpha-reductase. An article in the British Journal of Dermatology demonstrated inhibition of 90% of the enzyme. Probably the most popular herbal used for prostate health is Saw Palmetto extract, which is a liposerolic extract from the fruit of the Saw Palmetto plant indigenous to the Low Country. Once thought to only affect 5-alpha-reductase type II, recent studies of Permixon [a lipido-sterol extract of Saw Palmetto (Serenoa repens)] showed activity against type I reductase and surprisingly more effective and potent than the drug Propecia.
Finally like Rogaine there are compounds in nature that help nurture and stimulate hair growth. Japanese scientists have shown that Procyanidin Oligomers (Proanthrocynadines) possess this stimulatory activity toward hair epithelial cells. Used topically it has the same effect on hair as Rogaine. In my practice I use a pharmaceutically compounded topical mixture of Minoxidil and Finasteride. Additionally I use the natural compounds mentioned previously both orally and topically to treat patients at risk of balding.
(c) 2000
Herbal Drug Interactions
Herbal Interactions with Prescription Medication
In America today approximately 30% of the population take some form of herbal supplement in conjunction with prescription medication. Less then 2/3 of patients ever tell their physicians. This fact may lead to a rise in untoward effects. Herbals should be used judicially and be treated as a "drug" especially when combined with prescription medication. A few common interactions are: Ginkgo biloba with aspirin, Coumadin, Ticlid or Plavix can lead to bleeding and hemorrhage. St. John’s wort with a number of antidepressants can cause dizziness, confusion, and photosensitivity.
Ephedra (Ma-Huang) used with caffeine, decongestants and stimulant drugs can cause dangerous elevations of blood pressure and heart rate and has been reported in 12 sudden deaths, 16 strokes and 10 acute myocardial infarcts in a review of over 900 cases. Ginseng taken with Coumadin will cause a decreased response to that blood thinner and an increased chance of blood clotting. Kava combined with antipsychotics, alcohol and sedatives can potentate the depressant effects of those drugs. While there are thousands of herbs used today by herbalists and TCM practitioners these listed in this short article are the most common to Americans. There are also Herbal-Herbal interactions. Herbals certainly have their place in maintaining good health and disease prevention, but when combining their use with medication consult a knowledgeable physician and/or pharmacist.
(c) 1999
Sunday, June 05, 2005
Heart Disease Risk Factors
Topic: Cardiac Risk Factors
Author: J.P. Saleeby, MD
Published in Coastal Sports & Wellness Magazine
The leading cause of death in the United States is from cardiac (heart) disease. It is crucial that Americans of all ages be concerned about and identify their Cardiac Risks. In this article I will outline some modifiable and non-modifiable risk factors, certain tests which are important to obtain as a part of routine health screening & lastly some measures to take to reduce the risks. To define Cardiac Disease, we mean to say, atherosclerosis of the coronary arteries or the "hardening of the arteries that feed the heart muscle."
In general there are several established risk factors that include: Family History, Advanced Age, Male Gender, Postmenopausal Status in Women, Tobacco Use, Diabetes & Kidney Failure, Thyroid dysfunction, Hypertension, Elevated Cholesterol (LDL), Low HDL-C, Elevated Homocysteine, Lp (a), Sedentary Lifestyle, Increased States of Inflammation (elevated C-RP), Poor Nutrition, Elevated Fibrinogen, Low Socioeconomic status, and Low circulating Antioxidants.
Traditionally physicians have focused on family history, hypertension, tobacco use, gender, cholesterol, sedentary lifestyle & diabetes. It is becoming increasingly clear that there are other independent risk factors that should be assessed for the simple reason that coronary artery disease (CAD) can be found in people with negative family history and normal cholesterol levels. There is probably too much emphasis today focused exclusively on lowering total cholesterol and LDL-C when it is apparent from research and population studies that these risk factors are not impacting many of the patients with CAD.
Checking the oxidized-LDL may actually be more important as well as total oxidative load and total oxidative protection index, than just a standard lipid profile. Assessing Vitamin A, Beta-carotene levels, Vitamin C and Tocopherol (Vit. E) levels may also play an important role. Vitamins B-6, B12 and Folate should also be measured since they play a major role in metabolism and elimination of homocysteine. Another vitamin like substance known as ubiquinone or coenzyme Q10 has a tremendous role in cardiac health. Studies mostly out of Japan have shown that deficiencies in coenzyme Q10 can throw a patient into congestive heart failure. Certainly assessing serum levels of coenzyme Q10 may be important in certain individuals.
Those folks with elevated Lipoprotein (a) or Lp(a) have an increased risk of coronary artery disease, again that is something that should be checked as part of a comprehensive cardiac risk assessment. Elevated Fibrinogen, which can cause blood to clot abnormally, is also another testable independent risk factor. Homocysteine has come to the forefront lately after the publishing of studies and a text by Dr. Kilmer McCully as yet another important independent risk factor for heart disease. While this is now just becoming more routine in cardiac testing it certainly is a treatable risk factor that patients should be aware.
Unfortunately there are some non-modifiable risk factors that defy treatment such as family history (probably the strongest of all risk factors), advanced age (hormonal considerations), the male gender, and low socioeconomic status. But identifying modifiable risk factors and implementing changes will drastically lessen a persons risk for coronary disease and heart attack, especially if a person has one or more non-modifiable risk factors. These modifiable factors are the postmenopausal state in women, tobacco usage, diabetes (managing high glucose levels), maintaining proper thyroid function, controlling high blood pressures, decreasing elevated levels of cholesterol, decreasing elevated homocysteine levels, lowering circulating inflammatory mediators, improving nutrition, increasing circulating antioxidants and implementing an exercise program.
For you own good cardiac health it is important to seek out those proactive physicians who will order both the esoteric as well as the routine cardiac risk profiles. Also it should be established that the endpoint of all therapies to lower risk of coronary artery disease is the reduction of plaques on the arteries. Therefore, studies should be performed as a baseline and to determine if therapy is effective via non-invasive Electron Beam (or Siral) CT scan of the heart for calcium score. A score of 0 is ideal and means one has a very low risk for heart attack.
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JP Saleeby, MD is assistant medical director of the emergency room at LRMC, Hinesville, Ga. He also is adjunct professor of the graduate nursing program at GSU in Statesboro, GA. He maintains an online consulting practice at www.saleeby.net and hosts a medical information blog www.docsaleeby.blogspot.com.
Friday, June 03, 2005
Thursday, June 02, 2005
VSN
VSN (Vita Sanus Nutraceuticals) has products that range from vitamins, minerals, selected hormones to a proprietary skin rejuvenation anti-aging cream. They represent the best in the industry with the highest purity and bioavailability. All have been independent laboratory tested for levels and quality.VSN guarantees these unique formulations as the finest in the marketplace. We ship to retailers and customer locations in the USA and Canada.
VSN was founded in 1998 by Dr. J.P. Saleeby to provide his patients an affordable line of dietary supplements and skin care products. This line of supplements is manufactured by two pharmaceutical companies in the USA under the direction of Dr. Saleeby. VSN offers customer feedback within 48 hours by email. Dr. Saleeby will personally respond to dietary supplement questions about this product line. The flagship Longevity AM/PM Pack system is updated and reformulated no less than once every two to three years to keep up with cutting edge findings in nutritional medicine.
In September of 2006 VSN was sold to a physician in Michigan. Customers can order by visiting www.vitasanus.com















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