Dr Christine Cheng

Obesity is a huge problem for doctors, not just in terms of the health implications. Diagnosis is also more difficult. Physical examination is hampered by the think layer of fatty tissue. Now even radiological diagnosis is said to be less accurate.

I had a few “memorable” encounters with morbidly obese patients when I was an Anaesthetic Senior House Officer in Wales.

 The first was a lady who suffered from severe depression and ate herself to the point where she could not get out of bed. She ended up breaking her leg (can’t remember how) and needed surgical fixation.

She was too large to fit onto the standard operating table. Fortunately the obstetric delivery bed was able to take her weight. She was admitted to the intensive care unit after the operation so as to ensure she didn’t stop breathing when she was asleep.

The other lady needed an epidural for labour. When I saw how huge she was, I freaked and ran for a consultant’s help. I was in Swansea’s Singleton Hospital then, and I had only just started doing labour epidurals.

My consultant struggled to get an epidural in, and eventually succeeded. The midwives spent ages after that trying to find the foetal heart again. They eventually got worried and decided to call the obstetricians in to do a caesarean section.

The baby was stillborn.

No one knew when the baby had died. Monitoring was just so difficult because of her weight.

Morbid obesity is just such a disaster. Find the help. Lose the weight. Regain health. Your life depends on it.

Aspirin is back in the news again. Researchers have finally revealed that very low doses of Aspirin are enough for cardio-protection, without putting the patients at risk of strokes.

This is good news, as recent reports suggested that prophylactic Aspirin intake in asymptomatic elderly can increase their risk of haemorrhagic strokes. This means that taking low doses of Aspirin can protect us from heart attacks without increasing our risk from strokes caused by bleeding in the brain.

High doses of Aspirin can also cause bleeding in the gastro-intestinal tract.

The latest evidence shows that a daily dose of aspirin of 75 to 81mg is the best for the long-term prevention of heart disease and strokes, without causing any serious side effects.

There is no evidence that taking higher doses has any increased benefits.

Source: Forbes

Malignant melanomas account for more than 75% of deaths from skin cancer. Some cases are missed because of common myths regarding the disease.

1) Non-Caucasians can develop malignant melanoma with excessive sun exposure
2) Atypical melanomas can be mis-diagnosed as benign (not all melanomas have variation in colour, asymmetrical borders or size greater than 6mm)
3) Some hair-bearing moles can be cancerous

Caucasians are 10 times more likely to develop melanoma than other races.

African-Americans often develop melanoma in non-sun-exposed parts of the body: nails, soles of feet, palms of hand, mouth, nasal passages and genitals!

Only 33% of African Americans develop melanoma in sun-exposed areas!

The development of melanoma in non-exposed areas of the body results in spread of the cancer before diagnosis, and a high fatality rate. One American dies of skin cancer every 65 minutes. Appropriate lifestyle behaviour and vigilance plays a large part in the prevention and early detection of this disease.

Source: PR Inside

International obsession with health and weight management has led to a reduction of salt and fat in processed foods.

Low fat foods are guilty of having a high sugar content. The high glycaemic index and high level of processing is already contributing to escalating obesity.

Now even “healthy” foods have much more sugar in them than original recipes! Breakfast cereals, soups and wholemeal bread have up to twice as much sugar as 30 years ago!

A high sugar intake contributes to tooth decay and insulin resistance. Insulin resistance, if not controlled, results in type 2 diabetes mellitus. Type 2 diabetes is linked to heart disease and obesity.

Sugar Content: 1978 vs 2007

I’m astounded that Kellog’s Special K now has 17g sugar/100g compared to a mere 9.6g/100g in 1978. If the sugar content is that high, I’ll have an ice cream for breakfast, thank you!

I’ve always regarded cereals, wholemeal breads and tomato soup as healthy diet options. I guess we can’t trust anything that’s processed nowadays. And it’s not just the additives and trans fats that we need to worry about.

Source: Daily Mail

Wearing sunprotective clothes and a hat and reducing sun exposure to a minimum should be preferred to sunscreens.

Often this solution is deemed to be unacceptable and sunscreens are usually the predominant mode of sun protection.
Sunscreens had been shown to protect against sunburn and less serious forms of skin cancer, said the experts. However, there was no conclusive proof that they prevented the potentially deadly melanoma skin cancer.

Nina Goad, of the British Association of Dermatologists, said: “Sunscreen is an effective tool, but it should not be used as the single method of sun protection.

Researchers have revealed that adequate protective clothing is more reliable at protecting against melanoma than sunblock alone.

Many people are lulled into a false sense of security and abuse low SPF sun protection during periods of sun exposure. The sensible use of sun block includes:

1. Choosing the right SPF level for the sun exposure level. SPF 15-30 is needed for normal indoor use.
2. Application 15-30 minutes before sun exposure.
3. Liberal even application over all sun exposed areas.
4. UV-A and UV-B protection. UV-B rays cause burning, but it is UV-A rays that cause skin cancers and premature ageing.
5. Reapply if exposure is prolonged and if you sweat or swim.
6. Choose a product that you can apply with ease. There are some that are non-greasy, absorb easily and smell wonderful!

Physical protection used in conjunction with a good sun block is ideal. Once again, sensible barrier choices are essential. I had a client who wore hats everywhere and was convinced she was protecting herself against the sun. However, the hats she preferred either had tiny rims so most of her face was not covered, or had large holes in the rim. Very pretty, but useless as far as sun protection is concerned.

Clothes can offer protection too. Again, clothes made of tightly weaved material is a more sensible choice.

Ultimately, common sense is essential. Some exposure with adequate protection and avoidance of prolonged exposure, particularly at the hottest times of day are vital.

Source: Telegraph.co.uk

A 20 month old girl presented with cracked upper front incisors after being dropped by her elder brother. The elective operation to repair the broken teeth was set for the morning following a public holiday. She fell ill the night before the holiday, and had rhinorrhoea on the day of the operation. She was otherwise well and afebrile, so the operation went ahead as planned.

A gas induction was performed. A size 2 disposable laryngeal mask was inserted. IV access was obtained subsequently. The laryngeal mask was secured with the tube anchored to one side to improve surgical access. Cardiovascular parameters were stable at this stage, with good tidal volumes and normal saturation as measured by pulse oximetery.

Upon start of surgery, the child was noticed to be “moving”. There was loss of capnograph trace and it was clear the observed movement was from the child struggling to breath against an obstructed airway. 100% oxygen was administered, with positive pressure ventilation. The larynx relaxed fairly rapidly, with return of normal saturation. The airway was suctioned and large amounts of mucoid secretions were removed. The layungeal was was removed and re-positioned to entire an optimal position. Once secured in place, the capnograph trace disappeared again. The decision was made to proceed to relaxation and insertion of an oral endotracheal tube. A size 4.5 RAE (S) was inserted after the administration of 5mg of Atracurium.

The gas flows were altered to 35% oxygen in nitrous oxide with sevoflurane for maintenance of anaesthesia. Surgery continued. Within a few minutes, she started to desaturate again. The FiO2 was increased once again to 100%. The was eventually reduced to 70%, with maintenance of oxygen saturation at 96%.

The rest of the operation and extubation was uneventful. The child was well, but fretful in recovery. She was coughing a lot, with some stridorous sounds on deep inspiration. She was unco-operative with monitoring attempts.

Comments:

1) URTI is common and usually has little negative sequelae in elective surgery, especially if the atient is feeling well & afebrile, with no respiratory compromise.
2) An armoured laryngeal mask would have provided better positioning, but this was not available at this centre
3) Crying, a common scenario in paediatric anaesthesia, increases airways secretions
4) Dry anaesthetic gases with endotracheal tube irritation of the laryngeal area can increase coughing/produce stridor after general anaesthesia

Conclusion:

Anaesthetists should be at increased vigilance when giving anaesthesia to people with URTI in view of increased airway sensitivity during this time. Most cases proceed uneventfully, but they must be ready to respond should an airway event occur. Ideally, elective procedures should be postponed. However, most children start a new infection soon after they recover from one. The advised 6 weeks after recovery from URTI rule may not be practical.

By Dr Christine Cheng

The aim of acne treatment is not just to reduce outbreaks, but the prevention of permanent scars. For adults whose acne has been quiescent for years, the scars often remain. Such permanent facial scarring, especially if prominent and deep over the cheek area, can have a major negative impact on the individual’s self confidence.

Various treatments have been used in an attempt to reduce the appearance of acne scars. Microdermabrasion is popular as it is relatively non-invasive. Multiple sessions (20-25) are needed for optimum results. The scars depth is reduced and a glow is more visible. Microdermabrasion is useful in shallow, rolling scars and has little impact on the deeper ice pick scars.

Subcision has been employed to cut the fibers under the scar tissue, in an attempted to release the scars from the underlying tissues. This is useful for ice pick scars. Further filling with a temporary or permanent dermal filler may be needed for an even skin surface.

The best treatment to date has been laser resurfacing. This destroys the skin surface. When the epithelium grows back, the skin is smooth and unscarred. However, this is a traumatic procedure with a prolonged recovery.

A new roller device with rows of tiny microneedles is now available for the treatment of acne scars. When the needles penetrate the skin surface, micro-channels form. This allows product penetration past the skin barrier. The physical minute breaks in the skin surface stimulates the skin to produce collagen naturally (Collagen Induction Therapy). New skin forms under the dead scar tissue, hence the skin naturally becomes smoother once it regenerates.

Up to three treatments, six to eight weeks apart (length of the skin growth cycle), are needed for optimal results. Depending on the device and protocol chosen, downtime can be minimal. The results are progressive. As the skin remains intact, there is no increased sensitivity to the sun. The micro-channels close within minutes, and the skin continues its normal barrier function.

This simple mechanical device produces results equivalent to laser therapy, without the prolonged recovery or expense. It is rapidly gaining popularity worldwide as a useful part of the Aesthetic Physician’s tool kit in the treatment of acne scars and general rejuvenation.

Collagen Induction Therapy is the new buzz word in anti-ageing and aesthetic therapy.

Dr Christine Cheng is an Aesthetic Physician at Simply Aesthetic Rejuvenation & Contouring Clinic (http://www.simply-aesthetic.com) in Singapore. She runs an effective slimming program combining the Food Intolerance Test with Mesotherapy and Advanced Contouring techniques to speed up the fat melting process. She is the Aesthetics Contributor for Gethat Magazine.

Simply Aesthetic Rejuvenation & Contouring Clinic provides non-surgical solutions to enhance physical beauty. Treatments available include mesotherapy for fat melting, cellulite, stretch marks, alopecia and rejuvenation, botox, fillers and chemical peels. Their cellulite program (http://www.we-treat-cellulite.com) shows reduction after 3 sessions, with elimination of moderate cellulite after just 5 sessions.

Article Source: http://EzineArticles.com/?expert=Christine_Cheng

Healthy older people who take regular aspirin to prevent stroke may actually be increasing their risk. A UK study has revealed that the number of strokes associated with blood-thinning drugs such as aspirin or warfarin has risen seven-fold in the last 25 years.

An article in The Lancet reports that the risk is particularly high in the over 75s and aspirin may do more harm than good in healthy older people.

Researchers at the University of Oxford compared figures on intracerebral haemorrhagic stroke - a type of stroke caused by bleeding in the brain - from 1981-85 and 2002-06.

They found that the number of strokes caused by high blood pressure had fallen by 65%, which in the under 75s meant the overall rate of strokes had halved.

But in the over 75s the stroke rate remained the same over the 25-year period. There has been an increase in the number of strokes in patients taking blood thinning drugs: the proportion of patients on antithrombotic drugs was 4% in the initial study period, but two decades later this had risen to 40%.

People with cardiovascular disease, who have a high risk of blood clot, are prescribed drugs like aspirin to thin the blood and reduce the risk of a heart attack or stroke. But many healthy older people also take a regular aspirin in an attempt to ward off a stroke.

Study leader, Professor Peter Rothwell, said the increasing use of drugs such as aspirin may soon take over high blood pressure as the leading cause of intracerebral haemorrhagic stroke in the over 75s. He warned than in healthy older adults the risks of taking aspirin may outweigh any benefits.

“GPs have been treating high blood pressure very aggressively and that is bringing dividends but there are other causes of stroke in the elderly which have become important.

“There are good reasons for taking aspirin or warfarin but there are elderly who take aspirin as a lifestyle choice and in that situation the trials have shown there’s no benefit.

“And what our study suggests is that, particularly in the very elderly, the risks of aspirin outweigh the benefits,” he said.

This new evidence indicates that if you are healthy and have a low risk of heart disease or stroke and unless advised by your GP to take aspirin on a daily basis then the increased risks from the side effects of aspirin are likely to outweigh the benefits of preventing a stroke.

People can lower their risk of stroke by having regular blood pressure checks, eating a healthy diet, quitting smoking, drinking alcohol in moderation, reducing salt intake and taking regular exercise.

It might be time to get a little more natural light in your life as researchers suggest that vitamin D, which is produced by sun exposure, has a number of profound health benefits.

U.S. researchers have found a direct link between vitamin D and cancer prevention. Their four-year clinical trial found that women taking the vitamin had a 60-per-cent reduction in cancer incidence compared to those not taking it.

Reports that vitamin D deficiency have been linked to cancer, multiple sclerosis, juvenile diabetes and osteoporosis should have people rushing to change their lifestyle. Supplementation is particularly important in temperate climates.

Optimise Your Vitamin D Levels:

1) Have a blood test to determine, then monitor, your vitamin D levels three or four times a year. Check for 25 Hydroxy Vitamin D levels, which should be between 125 and 150 nanomoles per litre.

2) Sunlight is the best source of vitamin D. How long you should stay outside depends on how much sun block your skin creates naturally. Fair-skinned people, especially blonds and redheads, need only about 20 minutes a day to produce the recommended levels. Those with darker skin could need five to 10 times longer. Never allow the skin to burn, Dr. Cannell advises. Vitamin D production is maximized before skin turns pink, and further exposure does not increase levels.

3) Only a few foods have naturally occurring levels of vitamin D, and usually in insignificant quantities. An adult would have to drink about 40 glasses of milk a day to get the recommended dose of vitamin D. Milk is a more adequate source for children.

Fatty fish like salmon, sardines and herring contain vitamin D, as do egg yolks, shiitake mushrooms and reindeer meat. Some juice and cheese companies also fortify their products with vitamin D. It is more effective for adults to go outside than to modify their diet.

4) Vitamin D3 cholecalciferol pills are available over the counter in most pharmacies and health-food stores. Take 2,000 international units of the supplement per day, and no more. It is possible to have too much vitamin D.

Drinking alcohol, even moderate amounts, is a well-established risk factor for breast cancer in women. A recent study found that 60 percent of breast cancer cases in women worldwide were attributable to alcohol consumption. But the mechanism(s) of alcohol-induced breast cancer are poorly understood.

Drinking just two alcoholic drinks a day when you have breast cancer fuels the growth of tumours. Cancer patients are often just told to moderate drinking.

A University of Mississippi team found giving mice the equivalent of two to four drinks a day doubled the normal growth of a tumour after four weeks. The growth and progression of breast cancer by fueling the development of new blood vessels — a process called “angiogenesis.” It does this by boosting expression of a key growth factor known as vascular endothelial growth factor or VEGF.

Dr. Jian-Wei Gu and colleagues from the University of Mississippi Medical Center in Jackson examined the effects of alcohol on tumor growth and progression of breast cancer in mice.

For 4 weeks, 6-week old female mice consumed regular drinking water or water containing 1 percent alcohol, which is equivalent to about 2 to 4 drinks in humans. In week 2, the animals were inoculated with mouse breast cancer cells.

“We found after about 4 weeks that breast tumor size almost doubled in mice that drank alcohol compared to control mice given plain water,” Gu noted in a telephone interview with Reuters Health. Moderate alcohol intake also caused a noteworthy increase in tumor blood vessels compared with no alcohol intake.

The team also observed a significant increase in VEGF levels in the tumors of mice consuming alcohol compared to the tumors of control mice.

Lead researcher Jian-Wei Gu said: “The vast majority of tumours result from over expressed VEGF. Every day, we produce a lot of cancer cells, but they don’t become bigger. But if the cells establish blood vessels, the tumour grows and strengthens, a process known as angiogenesis. Alcohol can induce tumour angiogenesis.”