Anthony Lee's Blog

Posted by Anthony Lee

In the last several years, proton beam radiation therapy has come along, claiming to be the next best thing in cancer treatment. Instead of x-rays, which can burn the target tumor but also surrounding healthy tissue, proton beam radiation therapy using an accelerator device to deliver a beam of positively-charged subatomic particles (protons), which destroys the tumor but spares the surrounding normal tissue. Such a theoretical benefit has gotten the attention of so many patients, including those with prostate cancer, lung cancer, brain tumors, and other types of cancer.

Even so, the majority of doctors are skeptical. The scientific evidence is currently insufficient to conclude that proton beam radiation therapy is superior to conventional x-ray therapy. Furthermore, the technology is very expensive. Implementation of proton beam radiation therapy costs at least $100 million, including expenses to build a facility that will accommodate the device. There are only a couple of centers around the world that offer this treatment. The United States alone has less than ten facilities offering proton beam therapy, including Loma Linda University (Loma Linda, CA), M.D. Anderson Cancer Center (Houston, TX), and Massachusetts General Hospital (Boston, MA).

Given the lack of evidence and the cost, it is too early to tell whether this technology will become standard of care for treating cancer. Efforts are underway to develop smaller and cheaper devices, even as more medical centers plan to adopt the device in the years to come. Will proton beam radiation therapy supplant conventional radiation therapy? Only time will tell.

Posted by Anthony Lee

Medicine is an imperfect science. If all medical tests and treatments are supposed to be completely free of side effects and do their job every single time, then healthcare would not be allowed to exist. Yet, we do have many things available to us from the field of medicine. That's because the rule that physicians follow isn't absolute but reasonable. Basically, tests and treatments can be used if their benefits outweigh their risks.

It applies to a test or treatment receiving approval from the United States Food and Drug Administration (FDA) or other regulatory body. It also applies to the individual level between a doctor and a patient. If, let's say, the patient had a condition that would lower the benefit and/or increase the risk of a test or treatment, then the doctor might not consider that option. This is why medicine is always an individualized service.

By knowing this clinical rule of thumb, things can make a lot more sense. One can understand why drugs may be prescribed despite a long list of side effects, even though they are, for the most part, uncommon. It can also explain why someone else could benefit from a test or treatment but another person might not. Remember, medicine is an imperfect science whose application to healing is tailored to each individual.

Posted by Anthony Lee

I like to first take this opportunity to mention a particular book. Nancy L. Snyderman, M.D., has written Medical Myths That Can Kill You and the 101 Truths That Will Save, Extend, and Improve Your Life. It has her insights into some incorrect medical assumptions and some useful medical advice, covering the strange but amusing and the serious and potentially harmful. The book is a worthy read, especially in this age where false medical information runs rampant on the Internet. In case you don't immediately recognize Dr. Snyderman, she is an otolaryngologist (ear, nose, and throat surgeon) at the University of Pennsylvania and the chief medical editor for NBC.

As someone who also comes with a medical background, here's my take on medical myths. They can be a major problem. People following wrong and unsubstantiated information will only do themselves harm. It's disheartening for doctors, who have studied evidence-based medicine, to see this happen. It's even more sad when such actions are taken out of distrust in the medical profession.

When I look at the issue, I can agree with both sides. It's ideal to trust doctors because they have expertise, but we also want to have control over our own health. I think the best way to reconcile the two is this. When looking up health information, take everything with a grain of salt and stick with trusted sources. Remember that many diseases cause the same symptoms, so it's easy to stay too focused on one diagnosis. That's where your doctor can sort it all out for you. Be open to what your doctor says. And if necessary, you have the right to additional opinion from another doctor.

Remember, this is your health we're talking about. You need the right information to live long and healthy.

Posted by Anthony Lee

Coronary artery disease (CAD), which can result in a heart attack (either unstable angina or myocardial infarction), is treated with medications, with or without the revascularization methods of angioplasty (an invasive nonsurgical procedure, also called percutaneous coronary intervention or PCI) or coronary artery bypass grafting (an open surgery). How far the cardiologist goes with treatment depends much on the severity of the individual patient's condition.

The August 14, 2008, issue of The New England Journal of Medicine published the results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. The study randomized 2,287 patients with coronary artery disease to receive either PCI with drug therapy or drug therapy alone. Clearly, PCI with drug therapy has significantly greater benefit than drug therapy alone, at least for the first 36 months. Otherwise, the benefit appears to be similar after that point. Furthermore, patients with the most severe angina (chest pain) resulting from their CAD do better after PCI with drug therapy than after drug therapy alone.

The study has two implications:

1. Patients with the most severe CAD should have PCI with drug therapy.
2. Patients with otherwise less severe CAD can do just fine on medications alone without PCI, given that the benefit is similar between the two in the long run.

Whether these are valid statements is still debatable. In medicine, it's always best for both doctor and patient to opt for the least costly and risky treatment that can achieve the greatest benefit. At the same time, one should approach it cautiously, especially with something serious like heart disease. With time, the best approach should become more clear.

Source: Weintraub, William S., et al. "Effect of PCI on Quality of Life in Patients With Stable Coronary Disease." The New England Journal of Medicine. 2008 Aug 14;359(7):677-687.

Posted by Anthony Lee

The cellular phone is such a useful and ubiquitous tool that we forget about the electromagnetic waves transmitting the signals for communication. Obviously, they don't cause immediate harm or discomfort, but considering how certain types of radiation can cause cancer, it's natural to wonder if cell phone radiation can do the same with tissues in the head, including brain tissue.

Studies have attempted to link cell phones to brain tumors and other conditions, including cancer of the salivary gland. Collectively, results appear to be mixed, either denying any association or stating that they can cause cancer. Regardless of what you believe, there are two important things to consider. First, because the effects of cell phones, if any at all, are not immediate, such studies would have to follow cell phone users over several decades, much like studies linking cigarette smoking to lung cancer. Second, studies of cell phones have to minimize confounding variables by look at cell phone users with similar phones, manner of using the phone, frequency of phone use, and location of phone use. It's difficult given how people use their phones freely in so many different ways.

Nevertheless, if you are afraid of the risks of cell phone radiation, there are steps you can take. You can minimize use of the phone overall. If you do use your phone, use a headphone/microphone apparatus to distance the phone away from your head. Using the phone in more wide open spaces may be helpful, too. It'll be years before we truly know whether cell phones are the next cigarettes, but it doesn't hurt to take precautions.

Posted by Anthony Lee

Decades ago, the public expressed high regard for the medical profession. Now, there is a shift in the public's attitude towards doctors, one learning on suspicion, frustration, and sometimes anger.

Patients are now researching medical information on the Internet, which can be a problem if the information is incomplete and not taken with a grain of salt. They are also bringing journal articles to their doctors. It's almost as if clinic visits are for questioning the doctor, not trusting the doctor's advice. Such patients often have expectations that their disease is perfectly curable with no side effects from treatment. On the other side, physicians are forced to see more patients in less time. Some also admit that their rigorous medical training focuses too much on technical details and little on interpersonal contact.

There is no doubt a rift in the doctor-patient relationship. There are many possible causes, but I like to point out one specifically: the media. I know from experience that medicine is an imperfect science. One should not assume disease to be 100% curable or treatments to be 100% safe and effective, but standard treatments still have a good chance of success. However, with news stories that tend to highlight the worse medical scenarios and the neatest medical breakthroughs, it's easy to forget that medicine is an imperfect science.

The solution to this is for all of us to work together. If doctors and patients take the time to understand the other side, then there won't be any needless tension. I myself am playing a role by constantly sharing with you what I know about medicine.

Posted by Anthony Lee

If there is one thing I see frequently in our current age of digital technology, it's MP3 music players. I cannot ride the train to and from work without seeing at least one person listening to music on headphones. There are times, however, when I could hear the song through the headphones.

I would like to take this opportunity to remind everyone about excess noise. Our ears and sense of hearing are things to be grateful for. Therefore, we should make sure we don't damage them with unnecessarily loud noise.

This is not anything new, of course, especially with certain workers who wear protection with regular exposure to loud noise. The message may be important for young people who listen to music that is too loud, whether through headphones or at a concert. Just because one's sense of hearing is good early in life does not mean it will definitely stay that way decades later.

When I listen to music through headphones, what I like to is to set the volume level to the minimum necessary to hear the music. It's loud enough to hear it but I could still converse with people if I want to. If you want to protect your ears, this is one thing you can do. And, of course, if you can avoid being near speakers at a musical event or anything that is a source of potentially deafening noise, then why not?

Posted by Anthony Lee

Sleep is necessary for optimal function of the human body. You have probably heard the recommendations about how much sleep is necessary. They say that seven to eight hours of sleep each night is best for adults.

Yet, the time for sleep can be a challenge in an industrialized society. With duties that include employment from early morning to late afternoon and raising families during the remaining hours, some people don't get enough sleep. Furthermore, they attribute this problem to their busy lives and may not consider sleep as important as making money. Of course, I'm not suggesting that one should quit his or her job to sleep more, but the need for sleep should not be ignored.

First off, sleep deprivation leads to interruptions in concentration, which is dangerous for driving or other tasks that require alertness for safety. However, there may more to sleep deprivation than just daytime drowsiness. Sometime back, I saw an episode of the news program 60 Minutes where healthy volunteers were forcefully deprived of sleep. One of them had elevated blood sugar, a finding that suggests the possibility of sleep deprivation leading to diabetes. Then there are things people do to fight sleep, such as drinking coffee. While caffeine acts as a stimulant, it is no substitute for rest. Plus, coffee may have their own long-term health effects, like contributing to obesity.

This may be a good time to stop and ask ourselves this question: is sleep such a bad thing that we must have as little of it as possible? Rather than go against nature, it may be best to accept how we function. If we need eight hours of sleep each night to be healthy, then we need to schedule that into our lives.

Sleep does not hinder life. Rather, it's the reverse.

Posted by Anthony Lee

Medicine is an evidence-based profession. Everything we know about diagnosis and treatment is based on research. These days, a patient may print out a study related to a specific disease or treatment and bring it to their doctor. There's nothing wrong with doing so, unless one fails to understand how much it takes to convince a healthcare professional.

For one thing, a study involving many patients has more power than smaller studies. Case reports and small case series usually won't do. If something about a disease or treatment can be proven, it should be seen on a large scale.

For treatments, studies have to show statistically significant difference between the new treatment and the standard one. Therefore, patients receiving the new treatment should be compared with patients receiving the standard one. After all, if the two treatments are equivalent in safety, efficacy, and price, what would be the point of the new treatment? This is why doctors like comparative studies, especially randomized controlled trials.

The last thing to consider is the number of studies. Even if a great randomized controlled trial demonstrates success with a new treatment, the study should be repeated in a similar fashion. If the same results can be replicated, then the medical community would have further promising evidence for this treatment.

These are the main things doctors look for when reviewing clinical research. It takes a lot to convince the medical community of any new fact about a disease or treatment.

Posted by Anthony Lee

We like to think that any test ordered by a doctor is perfect. If it can reliably detect the presence of a certain disease and it's always right, it's something to be thankful for. In reality, no test is 100% perfect. Good tests are sensitive and specific, though not absolutely.

The following are quick statements about the sensitivity and specificity of tests.

• Sensitivity means how well the test finds that someone with a disease indeed has it. Ideally, all patients with a disease are tested positive for it. Otherwise, there would be false negatives from failed detection.
• Specificity means how much the test result depends on the presence or absence of that disease. Ideally, all patients without the disease are tested negative for it. Otherwise, there would be false positives from the presence of other diseases.
• A test that is sensitive but not specific is problematic, because a positive test result could come from many different things.
• A test that is specific but not sensitive is problematic, because the condition the test is for may not be detected.
• Although nothing is 100% sensitive and specific, tests that are standard of care still have enough sensitivity and specificity to be worth using, and it sometimes helps to use tests in combination.

Keep these things in mind when your doctor discusses test results. Also, if you wonder why a certain diagnostic test isn't used, ask yourself if it's more sensitive and/or specific than the existing one.

Posted by Anthony Lee

Alzheimer's disease is a heartbreaking burden for patients and their families. It is more than a gradual decline of memory and cognitive functions. It is a loss of one's sense of self and the world. For any caregiver or loved one, the thought of being alive with no meaningful awareness and only a sense of confusion is saddening.

Given that no cure exists for Alzheimer's disease, the focus is to maximize their quality of life and recognize them as individuals. To help achieve the latter, a non-profit organization called Project StoryKeeper is aiming to preserve the life stories of people with Alzheimer's disease. The organization does not necessarily limit itself to this population, because it does the same for veterans, Native Americans, and other groups of people who deserve to have their stories told to the world. Project StoryKeeper is also partnered with LifeLenz, an online social network that provides the means for families to share text, images, and video to record life's memories.

Whether or not you are with Project StoryKeeper, anyone can play a role in helping those with Alzheimer's disease be recognized as people. For that matter, this goes for all people regardless of what medical conditions they face. Everyone deserves the best care in the remaining years of life.

Posted by Anthony Lee

Antibiotics are a type of medication used to treat infectious diseases. If you break the word "antibiotic" down into its individual parts, you have the prefix "anti" that specifies antagonism and the suffix "bio" that refers to life. Literally, an antibiotic would suggest that it's a medication that kills any living thing. Of course, that is not entirely true. People do understand that antibiotics acts against microorganisms.

But do they target all microorganisms? Not quite. Microscopic pathogens include bacteria, viruses, fungi, and parasites, but antibiotics work against bacteria. Viruses are treated with antiviral medications, fungi are treated with antifungal medications, and parasites are treated with other medications. The term "antibiotic" might be used a little incorrectly because it actually refers to an antibacterial medication.

It's especially confusing for people with minor infections. For example, a patient may have a sore throat that a doctor concludes is from a virus, not a bacterium, based on certain physical findings. In such a case, the patient may expect to be given antibiotics and even assume the doctor does not care when he or she tells the patient that no medications are needed. However, antibiotics are for bacterial infections, not viral infections. Viral upper respiratory infections are usually self-limited in their natural course.

In any event, asking a doctor or consulting a medical dictionary may resolve such situations, even if one may think he or she knows the definition already.

Posted by Anthony Lee

Some people may be intimidated by the doctor and too embarrassed to talk about certain things. The doctor, of course, does his or her best to elicit from the patient what needs to be done. After all, a doctor uses interpersonal skills to show that he or she is just as human.

Sometimes, the fear to speak up is too strong. The worst thing that could happen is that the patient finally has the courage to bring up what he or she wanted to tell the doctor all along and does so just as the doctor is leaving the room. This is sometimes called "doorknob syndrome" because the doctor is ready to open the door when the patient speaks up.

It's a problem for both sides. The patient still doesn't get his or her real problem addressed while the doctor realizes that it's now too late to even do so. There's always a future clinic visit, but it's something important, it becomes frustrating to wait even longer.

A useful tip for patients would be to have a list of questions and issues ready before the doctor comes in. It's easier on everyone when the agenda is laid out from the start. When time is used efficiently, the doctor can surely deliver the best care possible.

Posted by Anthony Lee

In my days of clinical medicine, there were times when I would ask a patient what allergies does he or she have, and the patient would tell me medications that produce side effects. It's enough to let me know that people may think they know what an allergy is but they might not. More precisely, they know what an allergy is but they think it also includes things that are not.

Therefore, I shall define what an allergy is: an adverse reaction to a medication, food, or other substance that is mediated by the immune system and occurs only with exposure to the offending substance. People experience runny nose, itchy eyes, and sneezing with pollen exposure or more serious symptoms with consumption of certain foods. These are allergies because they involve IgE antibodies and immune cells like eosinophils, basophils, and mast cells. Other conditions may involve other components of the immune system with allergen exposure, like celiac disease with gluten consumption. Such conditions are technically allergic conditions because they involve adverse effects produced by the immune system.

What is not an allergy is everything else. If an adverse effect is not produced by the immune system itself, it's not an allergy. Of course, it's OK to tell your doctor that you once tried this medication and couldn't tolerate it because of a certain side effect. It may be an adverse reaction, but it doesn't necessarily mean it's allergic. Doctors ask patients about their allergy history because they don't want to put the patient at risk for severe allergy, the life-threatening type known as anaphylaxis.

Basically, any unwanted and/or unpleasant reaction to a food or drug is an adverse reaction. An allergy is just a specific type of it.

Posted by Anthony Lee

In the last several years, one observation struck me. There is a word that people like to use that doctors rarely use: "cure." Every medical resource I've ever consulted doesn't use that word as often. Rather, they use the word "treatment." Both words deal with how to manage a disease, but I'm starting to realize that they might correlate with expectations of prognosis.

The word "cure" suggests that a disease can be completely eradicated. We all love the idea of something that could get rid of a disease once and for all. In reality, however, some diseases are not likely to be completely eliminated, like autoimmune diseases. Rather, they are reduced in severity as much as possible. This is why doctors use the word "treatment." It encompasses any means to combat a disease regardless of how much they can do.

This difference in terminology and connotation may lead to problems. If a patient expects a miracle cure but the doctor knows that the best treatment may not be a complete cure but is still beneficial, the patient's expectations may be too high and will not likely be met. It can lead to unnecessary distrust in medicine.

Remember, medicine is an imperfect science. Some diseases, especially those originating from inside the body, just cannot go away. Options to manage a condition may not be 100% efficacious, but the chances are good enough to give it a shot. That's why some diseases are not curable but are still treatable. This is the reality we should accept.

Posted by Anthony Lee

LASIK eye surgery to correct nearsightedness and other eye conditions can be a hot topic. The idea of a procedure that does not use a scalpel or other sharp instrument sounds appealing. That and the benefit of not having to wear glasses or contact lenses anymore.

But don't forget that LASIK surgery has risks. The condition may be inadequately corrected or overly corrected. There can be debris left behind by the procedure. It is risks like these that should remind you that LASIK is not 100% guaranteed.

For that matter, every single medical treatment has risks. Even though they may be small risks, being aware of them can help you make a more informed decision about your health. If there is one good rule of thumb to follow, it's that treatments are worth considering when the benefits outweigh the risks.

Doctors live by this rule all the time. It wouldn't be a bad idea for patients to do the same.

Posted by Anthony Lee

For decades, the physician has had a fascination among the public, which is why fictional television shows about medicine, like Marcus Welby, St. Elsewhere, ER, Grey's Anatomy, and House, have been successful. There's nothing wrong with emotional stories surrounding doctors, patients, and health care. People have a right to be creative with any subject matter.

However, medicine may involve some shaky ground. I myself don't watch medical shows, because I know from experience that medicine's portrayal in entertainment is either not completely realistic or presents inaccuracies that people may think are true. For example, patients on House present with rare diseases, all concentrated in a single hospital, but in real life, the rare is spread out amidst the common and uncommon. Also, real-life doctors, being the busy professionals they are, do not have sex lives as liberal as those on Grey's Anatomy.

Medical fiction can be entertaining, but don't expect it to be a source of medical education or a 100% portrayal of the profession. Nothing can substitute for consulting trustworthy medical references or speaking with your physician about certain medical facts, no matter how convincing it looks on TV.

Posted by Anthony Lee

With so much research going on in medicine, there are endless causes to raise money for, like AIDS and heart disease. There are many ways to do it, too, such as marathons and bicycle races. There is reward in doing something you enjoy while helping other people. Best of all, anyone can do it.

A great example of this is Climb Against the Odds, an upcoming mountain climb for the Breast Cancer Fund. From June 15 to 21, 2008, about forty people, including actress Sarah Carter (whose credits include the CBS television series "Shark" and the movie "Final Destination II"), will climb Mt. Shasta in Northern California, a tall mountain with glaciers. This is another expedition that follows past mountain climbing events for the Breast Cancer Fund.

So if you can, find an activity you can be proud of doing and a cause to be proud of contributing to. Those in need will certainly thank you for it.

Posted by Anthony Lee

People have a right to privacy for medical information for the same reason as privacy for other personal information. Such information could be used in a way that ultimately affects the person negatively. It does not have to be intentional. One may view someone's personal information just out of his or her own curiosity, but the information could unknowingly fall into the hands of others.

In past weeks, the public have been paying attention to pop singer Britney Spears and her psychiatric issues as well as actress Farrah Fawcett and her battle with cancer. For both of these celebrities, at least one employee at the hospital snooped into their records without a justifiable need to know. Such actions destroy the trust that patients have in their health care providers. It is no surprise that these employees were fired.

Given the seriousness of medical confidentiality, the Health Insurance Portability and Accountability Act (HIPAA) was written to minimize breaches in privacy. It can be summed up with a rule of thumb: you may review a patient's medical record only if you absolutely need to know the information to do your job successfully. If you work in health care, this is something that should not be forgotten.

Posted by Anthony Lee

Although medications are available to treat many conditions, one obstacle can still stand in the way: lack of medication adherence. There's no point in any medication if the patient is not even taking it.

People can refuse to take medications for a variety of reasons. They may feel better already, dislike the side effects, or don't see the point. While these reasons are understandable, it's important to know that certain chronic conditions require ongoing medications, like high blood pressure (hypertension). Not everything is a temporary condition requiring only a one-time treatment.

Some people my have a hard time keeping track of medications, another hindrance to medication adherence. This is especially true for the elderly and those with cognitive dysfunction. One solution is to arrange the medications in pill boxes labeled by time of the day and day of the week. Physicians can also help by prescribing only what is necessary instead of piling medications in the patient's list.

Whatever the reason may be, not taking medications as prescribed presents challenges for everyone. Most importantly, it jeopardizes your health. If you have concerns about your medications, your doctor can address them.

Posted by Anthony Lee

High blood pressure has always been treated in a stepwise fashion. Patients newly diagnosed with hypertension are given one medication to see if the blood pressure can be lowered adequately. If that is not enough, additional medications are added. There are many classes of antihypertensives for a doctor to choose from, including diuretics, ACE inhibitors, beta-blockers, and several others.

However, a new study called ACCOMPLISH (Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension) reports that antihypertensives in combination reduce blood pressure dramatically, suggesting that they are beneficial from the start. In other words, doctors may soon prescribe at last two antihypertensives or a combination antihypertensive pill for a patient newly diagnosed with hypertension. They may not need to wait to see if additional medications should be added. However, the drug company Novartis sponsored this study. so whether this study has any merit may be debated.

One thing may still hold true: the sooner you take care of your blood pressure, the better off you'll be.

Posted by Anthony Lee

Cardiopulmonary resuscitation (CPR) traditionally involved two components: mouth-to-mouth breathing to exchange any oxygen possible and chest compressions to get blood moving when the heart is not beating. It's not a substitute for urgent hospital care, but it provides a couple of extra seconds or minutes of life. It can sometimes mean the difference between life and death.

When I first learned CPR, I was taught to provide 2 breaths for every 15 chest compressions. Later, the guidelines were change to 2 breaths per 30 compressions. And now, you don't need to give breaths, because chest compressions alone have been shown to be just as effective.

It's probably because giving breaths takes a few seconds. You could be spending that same amount of time doing chest compressions. Perhaps it's not the air you're giving that's potentially life-saving. It's the blood flow. You can try to oxygenate the blood, which may provide minimal benefit, but it's no good if that blood is not moving without your compressions. After all, the organs need perfusion, especially the brain since it's most sensitive to oxygen deprivation.

So if someone needs CPR and you're comfortable with chest compressions only, take comfort in that you can still be a hero doing this.

Posted by Anthony Lee

In the old days, people would completely trust doctors with all of their medical care. This may still be true today, but more and more, patients are looking up stuff on the Internet for information related to the conditions they have or might have. In my opinion, it may help you understand your condition better, if you do it carefully. Otherwise, it's a double-edged sword with pitfalls:

• You might focus on one diagnosis without looking at the other possibilities, which a doctor can do.
• You might see another condition whose clinical presentation seems to better match yours but miss an important fact about it that makes it unlikely to be your condition.
• You might focus on another treatment for your condition without understanding why your current treatment is just fine.
• You might get overly anxious about drug side effects, particularly uncommon and rare ones.
• You might read about stuff that is wrong or biased.
• You might refuse a doctor's recommendations because of something you read.

Just remember that nothing substitutes for talking to your doctor, who can sort it all the diagnostic possibilities and treatment options plus answer any questions you may have. If you don't agree, get a second opinion.

Posted by Anthony Lee

Zach Dunlap had been in a terrible vehicle accident. While in the hospital, doctors had pronounced him brain dead. Even a brain scan indicated no activity. Yet, to everyone's surprise, Zach woke up and later went home to his family. He has talked about it on NBC's Today show.

I will say that there is nothing wrong with medical miracles. They can be uplifting. Medicine is a science, basing clinical decisions on facts backed by evidence, but it's also an imperfect science. Now and then, a patient can surprise people. He or she may be an outlier whose symptoms, signs, and prognosis do not fit the textbook expectations.

Of course, doctors should still rely on their knowledge to guide their decisions, just as long as they don't forget the importance of time. A physician should not give up treatment prematurely, even if it seems like much time has passed. For any condition that requires a gradual recovery, the best thing for doctors, patients, and families to do is to allow plenty of time, hope for the best, and prepare for the worst.

I don't know the details of Zach's case to see if this miracle can be explained. In any event, Zach and his family have much to be grateful for.

Posted by Anthony Lee

Diabetes mellitus type 2 and high blood pressure, or hypertension, are risk factors for other conditions later, and yet they are preventable with healthy lifestyle habits. These two conditions are so common that I often repeat myself when spreading the word about taking care of yourself.

Today is no exception. Both diabetes and hypertension can ultimately lead to blindness. Over time, uncontrolled elevations in blood glucose and blood pressure cause changes in the retina, the layer of tissue in the back of the eye that enables vision. Sometimes, patients notice abnormalities in vision, like floaters. Others may not be aware of any retinopathy until they are screened by an opthalmologist.

People may know about worsening vision by reading too closely on a regular basis, but diabetes and hypertension should also be concerns if you value your eyesight. Blindness is one disability resulting from diabetes and hypertension, aside from stroke, kidney failure, and several others. But even blindness alone is life-changing.

Your eyes, and the rest of your body, are precious. Take good care of them now and be healthier later.

Posted by Anthony Lee

Patrick Swayze now has it. Luciano Pavarotti and Michael Landon died from it. About 30,000 people in the United States are diagnosed with it, and sadly, most of them are expected to die from it.

Pancreatic cancer is a disease that is hard to detect early and treat fully. It's not entirely a silent condition. There are symptoms early on, but they are nonspecific and are often attributed erroneously to other causes. In situations of unexplained symptoms, a doctor must be vigilant to even consider pancreatic cancer as a diagnosis. Even with that, pancreatic cancer may have already spread by the time it's diagnosed, making treatment difficult. The five-year survival rate for this disease is about 5%.

The reality is that there are still some conditions where no definitive screening and/or treatment exists. In medicine, there is always uncharted territory. Not everything has an answer, but every answer has a chance to be found. It is still important to hope for the best, but don't forget to understand the facts grounded in reality.

Still, smoking and chronic pancreatitis, particularly from long-term alcohol consumption, are risk factors for pancreatic cancer. There is at least some reassurance in prevention.

Source: eMedicine - Pancreatic Cancer

Posted by Anthony Lee

If you read my profile, you will find that my job involves researching new medical technologies. Normally, I do not talk about what I have been reviewing lately. For this blog post, however, I'm making an exception. In fact, I may consider using this blog more often for reports of major technological breakthroughs.

Transcranial magnetic stimulation (TMS) is a noninvasive magnetic therapy for major depression. Instead of electrical shocks through the brain to induce a seizure, as with electroconvulsive therapy (ECT), the treatment delivers magnetic pulses to the brain. I have mentioned this briefly in my article on depression treatments. So far, TMS has not yet received approval from the U.S. Food and Drug Administration, but if it is accepted as safe and efficacious, TMS may be an alternative to ECT if antidepressants fail.

I am not here to say what I think of the technology. I am simply informing you what you might hear about in the near future. Based on the interest it has been generating among some psychiatrists, TMS is something that could make the headlines pretty soon. Whether this treatment will have a positive or negative impact on depression is something that only time will tell.

Posted by Anthony Lee

There's a reason why medical records exist. Nobody can remember what kind of health care you received so far, especially with the level of extensive detail that doctors require. A doctor taking care of a patient, whether in a hospital or a clinic, must review the patient's care thus far before launching into treating the current condition. You cannot have any good care without tangible records.

Some people may forget, however, that records should also be complete in one location. If you change doctors for whatever reason, you need to make sure that the new doctor has your records. Starting a new record from scratch may be OK if you're very healthy with a thin medical chart. Otherwise, it is much easier to contact the previous health care facility and having the records copied and forwarded to the new provider.

Then there are patients who see multiple doctors at once, like a primary doctor for general care plus an outside physician for additional opinion. Make sure the primary doctor knows all aspects of care you're receiving, even those related to providers outside the usual facility. Information that is important but missing may disrupt smooth delivery of your care.

The point is that the best medical care comes from all parts of your medical records accessible from one place. Unless in a medical emergency where you end up in an unfamiliar hospital, don't expect a physician to know all about your care when some of your records are elsewhere and hard to obtain immediately. Physicians need details of your medical history to give you the best care. Only complete records can provide the information.

Posted by Anthony Lee

One of the great medical technologies of today is imaging, allowing physicians to look inside the body noninvasively. Medicine would not be the same without x-ray, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear imaging.

We often forget that these imaging modalities involve radiation, which is harmful to the body's tissues at an adequate dose. Efforts are always made to minimize the dose, and if the necessary dose for good imaging is actually dangerous, it wouldn't even be in clinical practice. But one factor is sometimes overlooked: a patient may have multiple studies, and the total cumulative dose may no longer be safe.

Some people believe in good health so much that they're willing to have a CT or MRI scan of the whole body just to screen for whatever is there. Certain diseases have great benefit in screening, like colon cancer. But why undergo high doses of x-ray with a CT scan, now believed to boost cancer risk with multiple uses, when many other diseases manifest with symptoms, if they occur at all? You may argue that certain conditions are deadly without early warning signs. Unfortunately, the disease must be common enough to be worth screening a population.

Then there is imaging without any medical necessity, like vanity ultrasound. For pregnant women, ultrasound is used to evaluate the condition of the fetus. It is not for taking pictures to keep in a photo album, as some women may consider. Whether ultrasound waves are truly harmless is unknown, but it's better to play it safe.

The bottom line is that the radiation per imaging study may be within safety limits, but it can add up with multiple studies, especially unnecessary ones. Reserve this technology for medical necessity, where the consequences of no imaging are far greater than the risk of radiation.

Posted by Anthony Lee

We have many choices of things to drink: water, soft drinks, coffee, tea, fruit juice, milk, beer, wine, and whatever else I haven't listed. If I were to ask you which one of these is healthy, you may easily tell me the correct answers. Does that mean you necessarily drink them regularly?

Let's talk about what's supposed to be healthy. Water is the healthiest drink there is. It has no calories but is essential for life. Fruit juice, like orange juice and grape juice, provides some nutrients and not too many calories. Keep in mind that the juice is all natural, so fruit-flavored artificial drinks like punch don't count. Milk is also good because of its calcium content, if you can reduce the fat with 2% or fat-free milk.

But there are some people who don't drink much of these liquids. It seems more common for individuals to consume coffee and soft drinks. Both are known to have caffeine, which some may consider a good thing in a busy society where one must stay on top of things. However, you have to consider the sugar content. It can add up and contribute to gradual weight gain. I'm not going to comment much on tea and alcohol because there are pros and cons of each. If you choose to drink them for benefits you believe are true, just don't overdo it so that the risks outweigh the benefits.

You may know that what you eat and how active you are can determine your health, but don't forget that what you drink can make a difference, too.

Posted by Anthony Lee

Doctors always advise against using alcohol, tobacco, and drugs. The medical community considers them to have virtually no health benefit. This is not anything new, but it wouldn't hurt to remind everyone of this.

People say that alcohol helps one relax. That may be true in moderation, but if you overdo it, expect to have impaired consciousness and judgment. If you drink for many years, your liver could become cirrhotic and your heart may become weaker from the direct effects of alcohol. Of course, you might argue that alcohol is good for the heart. Keep this in mind, however. Alcohol can raise the good HDL cholesterol, but only when it's not too little or not too much. There is a certain amount that produces this sole benefit. Otherwise, alcohol doesn't do anything else to outweigh the risks.

Tobacco is no better, either. It destroys lung tissue and leads to chronic obstructive pulmonary disease (COPD) and increases the risk of lung cancer. As for drugs, they harm the body in so many ways that I won't bother listing their effects. I'll give you this tidbit, though. Cocaine can cause a heart attack. The drug speeds up the heart but also clamps down on the blood vessels, so the heart can be deprived of blood. Yes, it can happen, even in younger people.

The bottom line is that these three groups of substances do no good for the body. You are doing yourself a favor if you avoid them. If you are using one of these but are working on quitting, that's also good. Everyone wants to live long happy lives, but the only way to do that is to take good care of yourself. That means not indulging in harmful lifestyle habits.

Posted by Anthony Lee

The American Heart Association declared today to be National Wear Red Day as part of its Go Red for Women movement. By having many people wear red clothing, it helps spread awareness of heart disease in women.

This would be a good time to remind ourselves that a heart attack, or myocardial infarction as termed in clinical circles, does not always manifest itself as chest pain. The classic teaching is that you should call 911 if you have this symptom. While this may be true, it does not mean that you don't need to call for help if it's something else. Other symptoms can present as a heart attack.

Think about it. A heart attack occurs when a portion of the heart is deprived of blood, classically from narrow atherosclerotic arteries. Oxygen deprivation starts a process that leads to pain. Depending on the individual severity, the heart can also have trouble pumping blood. Blood may back up towards the lungs and make it hard to breathe. Blood to the brain may be inadequate, which can result in lightheadedness or fainting. Even nausea and vomiting can occur as a result.

And while we're talking about cardiac health, here's some advice for the rest of us. A study in Germany found that overly enthusiastic soccer fans during the 2006 World Cup had a higher risk for heart disease. It makes sense when you consider the alcohol, smoking, junk food, weight gain, and the stress of your favorite team losing. There's nothing wrong with enjoying a sporting event, but don't forget your health. It's something to keep in mind as Super Bowl Sunday is coming up.

If you have something to share about heart disease, feel free to post in the discussion forum.

Posted by Anthony Lee

The big news this week is that actor Heath Ledger was found dead in his apartment. As of this blog post, an investigation into the cause of death is still underway, but there is interest towards the possibility of accidental overdose with prescription drugs, specifically medications like Xanax, Valium, and Ambien. Such medications can be beneficial for problems like insomnia and anxiety. However, it's only true when the total dose is not too high.

Even though Ledger's death is likely accidental, we should still remind ourselves that more does not mean better. Any condition is an imbalance that needs correction. Acid reflux is balanced with proton-pump inhibitors. Airway constriction in asthma is corrected with bronchodilators. When you take enough of a medication to achieve balance, then you've met your goal. If you overdo it, you create an imbalance in the other direction. I once heard about a patient who took so many Tylenol pills per day for many days that she went into liver failure. Just like that. A normal liver that suddenly requires transplantation. This patient took Tylenol for pain but took it like candy.

Some people may be prescribed new medications on a regular basis that they end up with at least fifteen medications. Polypharmacy is a problem, especially for the elderly. Not only can one lose track of all the medications, but also the possibility of interactions between medications is greater. Sometimes, the patient can be better managed by discontinuing unnecessary medications and changing the doses of others.

When it comes to medications, take only what is necessary. The number of medications and the dose of each should not be excessive for your conditions. If there is any doubt about why you're taking each one, ask your doctor to sort it out.

Posted by Anthony Lee

The pharmaceutical companies Merck and Schering-Plough released the results of their ENHANCE trial: Zetia (ezetimibe) and Vytorin (ezetimibe/simvastatin) do not appear to lower cholesterol enough to lower the risk of heart attack and stroke. Statin drugs, like Zocor, have been proven to lower cholesterol by inhibiting the body's formation of cholesterol. Ezetimibe lowers cholesterol by blocking its absorption from the intestines, but this study demonstrates that it doesn't do much alone (Zetia) or together with a statin (Vytorin).

This may come as a shock to patients in the United States, where drug ads are rampant. You've probably seen the television commercial for Vytorin, pointing out that cholesterol comes from food and family and that Vytorin treats both sources. It sounds good, yet the ENHANCE trial is not supporting it.

Pharmaceutical marketing is a major issue, not just for patients who demand a medication they see on TV but also for doctors who are swayed by pharmaceutical sales representatives. I remember a lecture in my medical school's pharmacology course. It taught me one surprising fact: drug companies spend more money on advertising than the research and development of the drug itself.

I've seen these tactics in action. Drug reps will buy tons of free food for doctors in residency programs during their midday lectures. They will stop by clinics that do not restrict their visitation privileges. They will even take doctors out to dinner and a medical conference. Whatever they do, they throw in pens and other gifts with the drug name branded on them.

Patients and physicians need to step back and realize what's important: solid evidence. Regardless of what advertisements claim, only a well designed clinical trial can tell if the drug is efficacious and safe.

To sound off on this issue, visit the discussion and the poll for this topic.

Posted by Anthony Lee

As a medical student and briefly as an intern physician, I've seen many patients with diabetes, high blood pressure (hypertension), and high cholesterol (hypercholesterolemia). They're so common that I'm amazed to see any older patient with none of these three. What's more amazing is how these three conditions are fairly preventable with diet, exercise, and weight control.

Why are these three conditions so bad? Well, high cholesterol leads to atherosclerosis. High blood pressure injures the inner lining of the arteries, paving the way for atherosclerosis. Diabetes does it, too. When you have arterial plaques, you are at risk for at least several conditions.

Additionally, hypertension over many years puts a strain on the heart and can lead to congestive heart failure. If you leave it significantly uncontrolled long enough, like a blood pressure of 180/99, there is a risk of aortic dissection. In a severe case, like a blood pressure of 210//110, you enter the zone of hypertensive emergency with risks of mental status changes, stroke, or heart attack. Yes, there is such a thing as hypertension with symptoms.

As for diabetes, it leads to visual changes, blindness, chronic kidney failure, and foot damage, not just the problems stemming from atherosclerosis.

Patients may be passive about diabetes, hypertension, and hypercholesterolemia because they consider them to be just abnormal numbers. The medical community, however, takes them very seriously. Imagine having these so-called abnormal numbers and having one to ten additional medical problems later on. If you can prevent it all with a healthy lifestyle, don't lose your chance. If you have these conditions, change your lifestyle while taking any medications prescribed.

Quality of life is not just about indulging in life's pleasures now. It's also about living longer and healthier so that you can optimize your quality of life in your later years.

Posted by Anthony Lee

As the new Feature Writer for General Medicine. I would like to dedicate my first blog entry to something I see often: idealistic views of medicine. We all want the best doctors and the best care. We want it so much that not having an immediate diagnosis or being denied a test or treatment can be frustrating. However, are patients really aware of the other side?

With that, you may want to consider the following:

• Because medicine is still evolving, not all conditions have good screening tests and treatments.
• Sometimes, one condition is similar enough to another that even the best doctors can misdiagnose a patient.
• Some conditions are easily diagnosed without tests. Tests are only done when additional infomation is necessary and could ultimately change the treatment.
• Tests do not identify specific diseases, but they increase or decrease the probability of possible diseases.
• Tests are never 100% sensitive or specific to one disease, but good tests come fairly close.
• False positives and negatives are always a possibility with any test.
• Tests and treatments are accepted when proven, meaning the benefits must outweigh the risks.
• Advertisements for any treatment should be taken with a grain of salt.
• Good clinical studies, preferably randomized controlled trials, involve many people over a long period of time.
• Even with one good study, only multiple studies confirming the same results are truly convincing.
• Certain conditions are managed over several follow-up visits, not always in one visit.
• Doctors refer to specialists because no single physician can know everything.

Basically, understanding medicine involves not having idealistic expectations. The human body is not an artificial machine. Because we don't design people, patients aren't assumed to have the same inner workings that can be fixed based on a standard manual. Hopefully, with this perspective of medicine, you can be happy with your care no matter what happens.