Dr Bob's Newsletter September 2004

Additional Treatment for Prostate Cancer May Enhance Improved Outcomes

A recent article in the Journal of the American Medical Association showed improved survival in men who underwent a combination of androgen suppression and radiation therapies. In the study of 206 men who had localized prostate cancer. This study is significant because of the shortened time of male hormone sup- pression. There are numerous side effects with long term suppression. When compared with radiation alone the combination therapy improved survival from 78% to 88%.
Dr Bob's Take: this was a well conducted study and may be a landmark study. It may be the basis of a new treatment method for men with prostate cancer which is localized. A larger study though is still needed to be sure these results can be duplicated.

MRI Screening for Breast Cancer

A recent article in the New England Journal of Medicine showed that MRI screening for women who are at high risk for breast cancer was much better. High risk was defined as those women who had family history of breast cancer and those who are genetically predisposed with positive BRCA tests. In the study 1900 women the study picked up 51 women with breast cancer of which 20 were not detected by routine mammograms or breast examinations. The women were followed on average for 2.9 years.
Dr Bobs Take: This is both good news and bad. The good news is that another diagnostic method is starting to be used for high risk women. The bad news is there are many false positive results. False positive is where there is an abnormality thought to be a tumor but turns out it wasn't. Routine mammograms have much less false positives. Also, the MRI techniques vary widely from center to center.

Drug + Therapy Combo Best for Teen Depression

A major study has proved that a combination of counseling therapy and anti depressants are much better than either alone. This was a study done through Duke University. There were 439 children age 12 -17 y.o. There was less suicide tendency with the combination. Dr Bobs Take: I would agree in my experience the combined counseling and medication work best for teens in the high risk for suicide.

Flu Vaccine Will Be Late

About half of the flu vaccine will be late reaching doctors offices. One of the two manufacturers, Chiron Corp, has had contamination problems and is destroying about one million doses.
Guidelines for receiving Flu vaccine are:
1. People 65 years and older;
2. Those with chronic lung (including asthma), heart, diabetes, HIV/Aids or undergoing chemotherapy;
3. People in nursing homes;
4. Children 6 months or older who have chronic heart or lung conditions;
5. Children or adults who have been hospitalized during the previous year;
6. Children 6 months to 18 years of age who are on long-term aspirin therapy;
7. Women who will be pregnant during flu season;
8. All children 6 month to 23 months of age;
9. People 54 ? 64 y.o.;
8. People living with those with the chronic diseases listed above.

Dr Bobs Take: those who are at high risk (# 1 to 4) should be vaccinated early (October). For those you should make an appointment with your physician NOW. By end of November or mid December everyone who needs it should be your vaccinnated.

Causes of Heart Attacks
In a study presented by Dr Yusuf to the European Cardiology Conference showed that up to 90% of all heart attacks can be found to be caused by one or more of these factors.
1. Smoking
2. Abnormal cholesterol
3. Diabetes
4. High blood pressure
5. Stress
6. Abdominal obesity
7. Sedentary lifestyle
8. Eating too few fruits and vegetables
9. Abstaining from alcohol
Dr Bobs Take: we finally have a study that gives us the reasons for 90% of heart attacks. Until now it has been thought that these factors only accounted for about 54% of heart attacks. We can now take control of these factors and work on reducing them.

Full Body CT Scans

I am sure you have all heard the advertisements, get your full body CT scan and catch diseases early?. Well the American College of Radiology has stated that these not be done on healthy individuals because there is a significant risk of creating cancer from the radiation given during the test. Having one screening probably does little to add to this risk but multiple ones definitely do.
Dr Bobs Take: It has been thought that one full body ct scan can be equivalent of getting between 1000 and 2000 chest x-rays. We need to know that each does of radiation is additive throughout our lifetime.

Stents for Arteries to the Brain

The FDA approved a stent for people who have had strokes or those with symptoms of pre-stroke (TIA?s). A stent is a wire mesh which goes inside blocked arteries to keep them open. You have heard of stents used for people with heart blockages. The new stents will be used right now for patients who cannot tolerate surgery on the carotid arteries (blood vessels leading to the brain). Within 30 days of undergoing the procedure, patients were less likely to die, or suffer a stroke or heart attack than patients who had undergone surgery, the studies indicated.
Dr Bobs take: This is a brand new device and there needs to be more experience gained with the use of it. I would not advise rushing into this unless this is the only alternative. And be sure that your surgeon has had experience in using this first. You don?t want to be the first patient to be operated on.

Increased Death Rate With Antibiotic

A study in the New England Journal of Medicine has shown an increased risk of death associated with the antibiotic Erythromycin when taken with certain cardiac and high blood pressure medications. A review by a team of researchers looked at more than 4,000 people which then was narrowed to 1,476 records. The associated medications included Verelan and Isoptin for verapamil, Cardizem and Tiazac for diltiazem. Dr Bobs Take: this is a preliminary study which needs more studies to verify it. The reason suspected for the deaths was that the concentration of erythromycin was elevated when these medications were used. Until studies prove out this study I would simply talk with your doctor if your are on any of the cardiac medications listed above.

Some Good News For Chocolate Lovers

Another report from the European Cardiology meeting has shown that eating dark chocolate creates more flexibility for the blood vessels. Hard or stiff blood vessels make us more prone to heart attacks. The study was done on a small group of 17 young adults but adds to growing literature on the benefits of chocolate. The bad effects of this are the potential for people to gain weight and lose the benefits of the chocolate. Dr Bobs Take: Although I am chocolate lover myself the studies to date are not well controlled or large enough to make any solid recommendations like we have for wine.