October 12th, 2007 by Dr. Val Jones in News
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The short answer is: yes. The longer answer is that Tasmanian devils (TDs), those feisty black and white Australian marsupials, are the first to suffer from it. In an enlightening story about the plight of these little guys, I learned that they are prone to a certain type of mouth cancer that they pass to one another through biting. Now, since biting is part of their mating rituals, this cancer has spread through the TD population like wild fire, even putting them at risk for extinction.
Why am I telling you this? Because it’s quite fascinating that cancer can be contagious. Sure we know that the human papillomavirus (HPV), for example, can be spread through sexual contact and may stimulate the body to produce cervical cancer cells eventually, but this is a more direct and faster method of transmission. Researchers have found that cancer cells in the mouth of the animal doing the biting slough off in the wounds on the other animal, and the cells grow into a new cancer in the injured animal.
So you may ask – can I get cancer from a TD? Not unless YOU’RE also a TD. The reason why the cancer cells can survive in the victim is because TDs have become so genetically similar to one another that foreign cells from another animal are not recognized and attacked by their immune systems. Human immune systems would recognize the TD cells as foreign and attack and kill them quite quickly.We humans can’t even accept an organ transplant from a family member without being on strong immunosuppressive medications.
Nonetheless, this case of contagious cancer is interesting – and makes me wonder if immunosuppressed humans could one day be vulnerable to developing cancer from another person’s cells. But that risk seems rather remote. For now, we should just feel sad for our furry friends down under. I know that at least Dr. Rob, the llama lover, will understand the grief.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 9th, 2007 by Dr. Val Jones in News
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I was intrigued by a news story all over the wires today and yesterday – that blood transfusions may do more harm than good. Over 4.5 million Americans receive blood transfusions for one reason or another each year in the US. Two new studies have been published in the Proceedings of the National Academy of Sciences, suggesting that blood can get “stale” much sooner than we think. Although we’ve known for a while that blood transfusions should be given only when critically needed, this news is interesting in that it may explain why blood transfusions are not a panacea.
Blood contains nitric oxide – a gas that is used as a signaling molecule in humans. It can trigger the relaxation of blood vessel walls, which is important in getting blood flow and oxygen to areas of the body that need it. Nitric oxide exists in small amounts in the bloodstream, but it can evaporate rapidly once outside the body (such as in a transfusion bag). So the question is: how critical is it to have nitric oxide dissolved in the blood given via transfusion?
The Red Cross keeps blood for up to 42 days after it is donated (though nitric oxide depletion may occur within hours) and will continue to do so until it is clearly shown that the expiration dates should be shortened. Further research is underway to test whether or not infusing nitric oxide back into blood is a viable option to improve its ability to oxygenate the recipient. It’s not easy to do this, since nitric oxide is a very tricky gas that can become a free radical or an acid in the presence of certain oxygen species. So the exact proportion of nitric oxide is critical – a little does just the right thing, but too much can be harmful or even fatal – which is probably why we haven’t tested this in humans yet, only dogs.
Still, many have high hopes for adding nitric oxide to the blood supply – Dr. Jonathan Stamler of Duke University appears to have applied for more than 50 nitric oxide associated patents and, not surprisingly, is taking the lead on various research studies, including the two new ones mentioned in my first paragraph.
My personal take on this? Blood transfusions are a serious treatment that can save lives, but should not be given willy nilly to “boost” people’s hematocrits. I’ve witnessed physicians giving their patients an extra unit of blood “just to perk them up a bit” prior to discharge from the hospital. That behavior is not safe or appropriate. So before you undergo a blood transfusion, make sure you really need one. Until we figure out how to replace nitric oxide safely in the blood supply, the life-saving potential benefits of a transfusion must outweigh the risks of stroke and heart attack from nitric oxide-depleted blood.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 8th, 2007 by Dr. Val Jones in Health Tips
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You’d think that all my friends were participating in breast cancer awareness month – first the abnormal mammogram scare, now a new email from a young, worried friend: “I found a lump in my breast. What should I do?”
My friend is 28 years old, with no family history of breast cancer. However, I take all lumps seriously because my husband’s sister was diagnosed in her early 30’s, after complaining of some hip pain followed by an x-ray which revealed diffuse metastases. Nonetheless, it bears repeating that a breast lump in a woman in her 20’s is highly unlikely to be cancer. For those of you out there who have found a lump in your breast, here are the statistics:
- An estimated 90% of breast lumps are benign (and that includes lumps in significantly older women).
- The number one risk factor for breast cancer is age. The risk of a woman in her 30’s having breast cancer is <0.43%. The National Cancer Institute doesn’t have per cent risks for women in their 20’s but I’m sure it’s even lower.
- Fibrocystic breast tissue occurs in up to 60% of all women, and has a lumpy texture.
- Breast cysts are fairly common, up to 7% of western females have a breast cyst at some point in their lifetimes.
- Breast lumps often occur in response to normal hormonal fluctuations in the menstrual cycle
So if you find a breast lump, you should have it evaluated, but please keep in mind that there’s a 60% chance that it’s due to harmless fibrocystic changes, and (if you’re in your 30’s) a 0.43% chance that you’ll develop cancer. Indeed, most lumps are benign at all ages.
The next step in a lump evaluation is to have an ultrasound and if you’re over 35 to also have a mammogram, and then if the clinical images warrant it, a biopsy to confirm the contents of the lump. Also keep in mind that once you’ve had a biopsy, you can expect some scarring which could be read as “abnormal” in future mammograms. So don’t be surprised if you get an abnormal mammogram later on after the biopsy.
Breast cancer awareness is very important and can save lives, but on the flip side it can also make us paranoid about our breasts. My advice would be to take any lumps seriously, but also know that it’s not cancer until proven so – and that most women have breasts with a somewhat lumpy texture, so if you don’t have any lumps, you’re technically in the minority.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 6th, 2007 by Dr. Val Jones in News
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Have you ever been singled out in a lecture and picked on? Or maybe at a comedy club? It’s somehow awkward when everyone is looking at you, and you can’t really defend yourself. That happened to me yesterday in a lecture about how email can transform medical practices. My friend Joe Scherger was talking about the beauty of asynchronous communication, and how much time it saves – when out of the blue, he said that Blackberries defeated the whole purpose of emailing, and that people who used them lead unbalanced lives. He then pointed at me and said, “See my friend Val Jones, there? She uses a Blackberry all the time!”
All eyes fixed on me with a sort of half pity, half “tisk, tisk” expression.
“She answers all her emails within minutes… She never unplugs.”
I shrugged and smiled sheepishly. Soon the conversation turned to other subjects, and I resisted the urge to pull my Blackberry out of my bag to check my emails.
Today I heard that Intel instituted email-free Fridays as a means to force their engineers to talk to others face-to-face. Apparently, the company was worried that interpersonal skills were being lost, and that people were not developing normal working relationships because of the artificial distance created by email-only communication.
“Well, at least I’m not alone,” I thought as I read the news story. “This is a serious problem across the country.”
There has been recent debate in the psychiatric community about whether or not video games could be considered an addiction (just as drugs and alcohol can be). Some have proposed that it be added to the DSM-V due out in 2012, others have said that compulsive video game playing is a sign of other underlying pathology (such as depression or social anxiety) but not a true addiction.
But the bottom line is that overuse of the Internet can disrupt a person’s time available for meaningful interpersonal relationships, be they with a spouse, a parent, a relative, or a friend. When your husband is sitting in the same room with you and has to get your attention by IM-ing or emailing you, you know there’s a problem.
And there doesn’t seem to be much of a break in sight – with Facebook, MySpace, Linked-In, YouTube, Pownce, Twitter, GTalk, blogs, podcasts, discussion boards, chat rooms, forums, etc. available as 24-7 forms of entertainment and communication, and companies like Intel trying to forbid this kind of stuff at least 1 day per week, Blackberries are the least of our worries. I wonder if these programs are like junk food for the brain? Will we soon suffer from cerebral obesity?
I’m afraid that I recognize that there is a problem, but I’m not sure what the solution is. “Just say no” to email doesn’t work for me… I like the fast-paced interactivity and connection I get from these activities. Maybe there’s a positive feedback loop at work, though – we spend a lot of time involved in online activities and become more isolated and lonely in our personal lives. In the end we become more and more engaged with the Internet to fill the emotional gap that we’re actually creating by overusing it.
I’ll ask my husband what he thinks… perhaps I’ll send him an email about it tonight.
What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 4th, 2007 by Dr. Val Jones in Announcements
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Well, I had a great time at the Revolution Health booth at the AAFP meeting today. Hundreds of people stopped by for a chat and to get to know what Revolution Health is about. I handed out golf towels (well, they were little white hand towels that I used to give out as gym towels, but with the doctor audience I changed the pitch to golf. How cliche of me. Ha!) Some of the notable guests included:
Bob Rakel, MD – author of my most favorite medical textbook in the world: Saunders Manual of Medical Practice
David Rakel, MD – Bob’s son, and the author of my second most favorite medical textbook: Integrative Medicine
Len Fromer, MD – past president of the California Academy of Family Physicians. His wife is an actor – and we had a great chat about how we both miss New York City.
John Pfenninger, MD – author of the coolest book for outpatient medical procedures
Todd Dicus, JD – deputy executive VP of the AAFP and a really friendly lawyer.
Marianne Walters, MD – an urgent care physician in California who taught me that surfers’ wet suits are like Petri dishes for MRSA (a really nasty bacterium). Ew.
Allan Harmer, ThM – from the Christian Medical Association, who told me that the story of how he accidentally attended a medical conference about HIV and ended up involved in medical groups for the rest of his career (even with no previous medical training).
Joe Scherger, MD – the hardest working man on the Revolution Health expert team. He gave a lecture about how to use email and online help as an integral part of one’s medical practice – and the audience was riveted.
Tomorrow’s going to be fun, I can just tell. And the best part is that I can wear sneakers with my business suits – all the family physicians are doing it themselves! I’ve never seen more Birkenstocks in one place before… I think Michelle Au might have been right about family docs – see her cartoon.
See you tomorrow at Revolution Rounds.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
