Quotes of the Month
When I first started writing this edition of the Webletter, I wondered if winter would ever come to North Texas. The artic air that blew in last week answered my question. Brr it was cold but not like the weather in the Northeast. The Holidays, together with a little procrastination, are responsible for my tardiness.
In this Webletter I am going to depart from my usual practice of paraphrasing articles from medical journals and, instead, discuss e-mail "Medical Pearls" from Dr. Stephen Eppstein. Dr. Eppstein is a locally renowned retired internist who organizes Continuing Medical Education for the Medical Clinic of North Texas. Dr. Eppstein and I go back a longtime. We started our early medical practices at the late Lorimer Clinic which merged with other physicians into the Medical Clinic of North Texas.
We don't have to worry about this problem now but when warmer weather heats the water of the Gulf of Mexico, we should all be aware of the threat of Vibrio infections. Last year the Texas Department of Health confirmed 43 cases of Vibrio Fulnicus infections along the Gulf Coast. Seven of the patients died and one required a leg amputation. These infections can occur when a person allows contaminated Gulf or bay water to contact a sore or cut. It would seem that salt water bathing would promote healing but such is not necessarily so. The presence of Vibrio fulnicus and Vibrio parahaemolyticus in tepid salt water poses a threat to susceptible individuals, both by direct exposure and through the ingestion of contaminated uncooked shellfish (most commonly raw oysters). Contact does not automatically ensure an infection but if a cut or sore is exposed to coastal waters, the following precautions should be taken: 1. Wash the lesion with soap and water and rinse thoroughly with fresh water. 2. Individuals who have diabetus, liver problems, or compromised immune systems should not eat raw shellfish.
ED: You are not aware, by taste, if oysters are contaminated with the Vibrio organism. Several years ago I attended a surgical meeting where one of the speakers gave a paper on Marine Medical problems. I thought he was going to talk about shark bites or such things as sting ray injuries. Instead, he said, in Florida, the major cause of death (7) from marine life was due to the ingestion of raw oysters. I love raw oysters. If you are going to eat them, you should make sure you know the restaurant or seafood market obtained them from a controlled source and only eat them in cold weather. In the Gulf States the oyster industry is a major economic source of income so the commercial beds are carefully monitored for contamination. The old adage of only eating oysters in the "R" months was because of older refrigeration methods but the Vibrio threat makes that advice mandatory.
Breast cancer in men is uncommon but the rate increased 26% in the years 1993-98, according to The National Cancer Institutes SEER program. Men had a higher proportion of ER/PR (hormone dependent) malignancies when compared to a group of women and, also, the men's 5 yr. survival rate was lower.
ED: The lower survival rate was probably related to delay in diagnosis. Since it is uncommon in males the significance of a tumor is not immediately recognized and is commonly thought to be gynecomastia which is a benign physiological enlargement of the male breast occurring in older men.
Morphine is commonly used for palliative care in terminally ill patients. There has always been a question whether the amount used affected the patient's longevity. In a study of Hospice patients in Israel, Dr. M. Berkovitch concluded that high doses of morphine did not adversely influence the patient's life expectancy.
ED: This should be welcome news for providers of homecare Hospice patients.
Drs. Boles, Pelletier, and Lynch from the Portland State University School of Community Health studied a group of employees to determine the relationship between health risks and work productivity. I will quote Dr. Eppstein's assessment of this study, "In 2,264 employees of a single employer, absenteeism and presenteeism (health related on the job decreased productivity) was evaluated and correlated with 11 specific health risk factors. 90% of the employees had 2 or more risk factors and 50% had 4 or more. Absenteeism was related to high stress, physical inactivity, and diabetus. Presenteeism was related to physical inactivity and lack of job satisfaction. The rate of absenteeism was 1.8% and presenteeism was 6.6%. The combined impact on productivity was a loss of 3hours/week/employee. Financially, this added to $67/week/employee or $153,000."
ED: This is valuable information for the small business owner and should be correctable with appropriate workplace changes and employee education.
C-reactive protein and inflammation's relationship to cardiovascular disease is a hot topic. An article in The New England Journal of Medicine studied the risk of heart attack and stroke after acute infections and vaccinations. They found that both increased after systemic respiratory infections and urinary tract infections but not after vaccinations.
ED: No "blow" to Preventive Medicine.
As a surgeon, I found this study from Canada to be particularly interesting and again I quote from Dr. Eppstein's e-mail "pearls." "The study looked at weight loss, morbidity, and health care costs in 2 cohorts of morbidly obese (100 lbs. over ideal wt.) individuals. The treatment cohort (1035 patients) underwent gastric bypass surgery in a single institution and the control cohort (5746) individuals were identified as being morbidly obese but had no weight loss surgery. These latter individuals were drawn from the Quebec Provencial Insurance data base. Patients with co-morbid conditions at the study's inception were excluded. Patients in the surgery group experienced a 35% reduction of BMI and lost 67% of excess weight. At 5 years, when compared to controls, surgery patients had risk reductions in malignancies, cardiovascular disease, endocrine, infections, and respiratory conditions. Surgery patients had an increase in GI disorders. The mortality rate in the surgical group was 0.68% and in the control group it was 6.17%. The surgery group had fewer hospitalizations and lower health care costs."
ED: The significant difference in mortality rate is impressive. They didn't break the surgery group into the variety of procedures done. The newer "lap band" technique is easier and has fewer complications but the long term effectiveness is not quite as good as a stapled bypass.
Dr. Eppstein reported a study from an unknown source on the value of radiation plus androgen (testosterone) suppression in men with prostate cancer. The 5 year survival for radiation alone was 78%.The survival rate for radiation plus androgen suppression was 88%.
ED: The figures speak for themselves. The treatment for prostate cancer continues to be age related.
There was an interesting abstract from the Journal of the American Medical Association on the risk of herbal medicine products from India and South Asian Countries. They are known as Ayurvedic herbal medicines and were found to contain lead, mercury, and arsenic and therefore could be associated with heavy metal toxicity. These herbal medicines are marketed in the U.S. as nutritional supplements and they are regulated under the Dietary Supplement Health and Education Act. There is no requirement for proof of efficacy, safety, or content.
ED: Buyers beware. They aren't necessary anyway-another fad.
QUOTES FOR THE QUARTER
Nature, time, and patience are the three great physicians.
Take care until next time,
Richard J. Turner, III, M.D., F.A.C.S.
To ask questions or submit comments, please fill out and submit the contact form.
Fall 2004 - Women's Health
Summer Trip to Russia
Miscellaneous Medical One Liners
Trip to Ireland
Texas Surgical Society Meeting Notes
The Malpractice Crisis
Treatment and Prevention of Malignant Disease
West Nile/Cancers/Discontent with American Healthcare/Prescriptions
History of Preventive Medicine
Smoking Risks/Depression/The Western Diet
Food Consumption/Cancer and Treatment Relationships
Notes from the Spring Texas Surgical Society Meeting