Philip S. Chua M.D

Philip S. Chua M.D (15)

Health@Heart

Silent heart attack

Many patients with coronary heart disease have no chest pains or other symptoms indicative of ischemia (diminished blood flow and oxygen to the coronary arteries that supply the muscles of the heart). As such, this silent (asymptomatic) type of ischemia is treacherous and increases the risk of sudden and unexpected death and other cardiac events. Symptoms, in any illness, are the body’s defense alert system, a good warning sign that allows the affected individual time to do something pre-emptive to protect itself and prevent serious complications, like in seeking prompt medical help. Silent ischemia could strike an individual surreptitiously, causing heart attack or even cardiac arrest. These are the sudden deaths we all hear about every now and then, where the victims do not even know or realize the dangerous situation they are in.

The Mechanism

The muscles of the heart require oxygen and nutrition to function properly. These vital ingredients are in the blood which is supplied to these structures by the coronary arteries. If the blood supply is diminished because the coronary arteries are narrowed or blocked by arteriosclerosis (hardening of the arteries that reduces the luminal diameter of these arteries), the muscles are deprived of vital oxygen and nutrition. As a result, theoretically, angina pectoris (heart pains) ensues. But a significant number of heart patients, even with their coronary arteries narrowed, some of them blocked severely, somehow do not develop chest pains. These are the asymptomatic or silent ischemia patients who could be a walking time bomb.

Why “Silent”?

When there is myocardial ischemia, it is logically expected that the individual will have chest pains, much like lack of blood to the leg will cause “Charlie Horse”-type pains, medically termed claudication (pain and spasm of leg muscles) and even gangrene. The explanation for silent ischemia of the heart muscles (asymptomatic patients) is not fully understood. Some of the theories include: the patient may have a high threshold for pains; the size of the affected muscles in the heart may be small; there may be some collateral circulation to the ischemic area; the ischemia may be of short duration; some persons may have self-denial; the person may have a defective “warning system,” related to some past brain injury, past heart attack (known or unknown), diabetes, past heart bypass or transplantation.

Etiology

The etiology or cause of narrowing of the arteries is multi-factorial. While heredity plays a role in the pathogenesis of arteriosclerosis, lifestyle appears to be the major culprit. This includes a high-cholesterol, high-fat, high-carbohydrate, low-fiber diet of red meat, eggs, dairy products, bread, potato, rice, pasta, cakes, and sweets, instead of fish, vegetables, fruits, nuts and grains. The other important factors are smoking, the lack of daily regimented physical exercises, excess body mass index (weight), and poor stress management. Alcohol abuse, inadequate treatment of existing or undiagnosed hypertension (high blood pressure) and diabetes mellitus are aggravating conditions that hasten the build-up of cholesterol plaques in the inner walls of the arteries that lead to blockages and resultant ischemia.

The Minimum Test

Obviously, the early detection of myocardial ischemia, especially among those asymptomatic (silent) cases, is essential. This can prevent sudden cardiac death. Since many of these persons have no indication whatsoever about the state of their coronary arteries and they all may be feeling “100% healthy,” the only prudent strategy is to do prophylactic (preventive) investigation. Based on medical statistics, the minimum test recommended is a stress electrocardiogram (Stress EKG) for those with chest pains or other symptoms suspicious of coronary heart disease. Those with a strong family history of coronary heart disease or heart attack and/or hypercholesterolemia and diabetes, regardless of age, should also have Stress EKG every 2 to 5 years, depending on the severity of their hypertension, hypercholesterolemia, diabetes or hyperthyroidism. For those with none of these illnesses and with no familial history of coronary heart disease, Stress EKG is nonetheless advisable when they are 45 and older, especially for those who smoke, and a mandatory test for pilots and some giant corporate executives. There are other more sophisticated tests available.

The Supreme Court of Heart Tests

To arrive at the final confirmatory diagnosis, a cardiac cath is performed. This is the “court of last resort,” the “supreme court” of heart tests, that will tell us, once and for all, with 100% accuracy, if there are stenoses (blockages) in the coronary arteries or not, how powerful or weak the ventricular contraction is, the integrity of the heart muscles, in segments and as a whole, and if there are any other cardiac abnormalities present, like heart valve disease, etc. If there are coronary artery stenoses present, this angiogram, which is recorded in a video film(movie of the heart in action), will also show which arteries are blocked, how many percent obstruction there is (are) and the exact location of the blockage(s). The findings will also help the cardiologist and the cardiac surgeon make a final decision if heart surgery is needed or not, and if it is, what procedure to do, which arteries to bypass, blocked arteries) will be, the percentage of risk of the surgery, and the prognosis.

Clinical Highlights

Various investigative studies have been done to address this particular issue on silent ischemia, its diagnosis and treatment. To of these trials are the ACIP (Asymptomatic Cardiac Ischemia Pilot) and the ASIST (Atenolol Silent Ischemia Study). The findings are as follows: (1) Silent cardiac ischemia could lead to sudden cardiac death; (2) In the ACIP trial, it has been shown that revascularization, using coronary angioplasty or bypass surgery provided more effective relief of the ischemia than medical (pill) therapy alone; (3) In the ASIST study, those treated with Atenolol showed great reduction of ischemia and the risk of future events compared to those who were given placebo (“sugar” pills, in the controlled group); (4) the prevalence and risk of cardiac events have been much less where ischemia has been treated with revascularization; (5) that risk factor modification (lifestyle and behavioral changes: cessation of smoking, abstinence from red meat and eggs, a diet of fish, vegetables, fruits, nuts and grains, daily exercises), together with aggressive treatment as in numbers 2 and 3 above, reduces or eliminates myocardial ischemia, left ventricular dysfunction, and the incidence of sudden cardiac death. It is obvious that a pre-emptive strike, a prophylactic strategy, on everyone’s part is the only way to beat sudden cardiac death.

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Red Meat and Cancer

A diet high in processed meat (sausages, luncheon meats, etc.) may increase the risk of carnivores developing pancreatic cancer by almost 70%, reported a recent major study that was published in the Journal of the National Cancer Institute.
The report showed “an average of 41 cases of pancreatic cancer were diagnosed per 100,000 people each year among those who ate the most processed meat compared with 20 cases among those who ate the least.”
This research, which included 180,000 individuals, also found that individuals who ate even non-processed red meats, including pork, beef, and any other red meats, had a 50% higher risk of having cancer of the pancreas. While this is 20% lower compared to those who ate processed meats, 50% increase in the risk is still too high for comfort, since pancreatic cancer is a very painful and fatal disease, with no known cure.
Scientists think the culprit-carcinogen (cancer-causing agent) may not be the saturated fat in red meats but the nitrate-based preservatives and the cooking method, like charcoal-grilling and broiling. Apparently, the cooking method and the nitrate preservatives each play a great role as carcinogens.
While the saturated fat in fresh (no preservative) red meat appears not to be linked to pancreatic cancer in this study, other studies have shown that people who eat red meat regularly have a higher risk for developing cancer of the colon, breast, and other cancers in general, compared to those who minimize eating red meat. Red meat also causes a quick rise in the cholesterol blood level, a condition that increases the risk for the development of heart attack and stroke.
In 2005 alone, 32,180 Americans and 60,000 Europeans were found to have pancreatic cancer, a disease that is often diagnosed late because they are not readily obvious clinically. Less than 5% of these patients live for more than five years after the cancer is first detected.
Other risk factors include smoking, family history of cancer of the pancreas, obesity, diabetes, age (older ones), gender (male), ethnicity (African), exposure to certain dyes, pesticides, and chemicals related to gasoline. Helicobacter pylori infection that causes the common ulcer of the stomach is also a predisposing factor. African Americans appear to have higher incidence of pancreatic cancer and poorer prognosis than Whites.
Abdominal ultrasound, CT scan, and Endoscopic ultrasound are some procedures, together with some blood and liver function tests, that aid in the the diagnosis of pancreatic cancer.
The treatment of pancreatic cancer varies according to the stage of the malignancy. The management includes surgery, radiation, chemotherapy alone, and chemotherapy with a targeted treatment. The Whipple Procedure is the most popular surgery for cancer of the head of the pancreas. Modern advances in surgery today have allowed resection of pancreatic cancers which were considered unresectable in the past. Completely resected pancreatic cancer provides the best opportunity for a longer term survival, albeit still not a cure.
The most common drug used is gemcitabine (Gemzar), but recently this drug, in combination with erlotimib (Tarceva), has proved useful in advanced cases. Chemotherapy may be used in combination with radiation, which uses high energy x-rays to shrink the tumor or slow its growth.
The other option is biological and targeted therapies, which “enhances the body natural immune system to stop tumor growth, changing cellular signals that permit tumor growth, making tumors more susceptible to an immune system attack; and blocking the process that change normal cells into cancer, thereby stopping the abnormal growth behavior of a tumor.”
Smoking is one of the most significant risk factors, besides eating red meat. For prevention, minimizing red meat ingestion, abstinence from cigarettes, maintaining a normal body weight, daily exercises, and eating a lot of vegetables, fruits and whole grains have all been found to significantly lower the risk of the development of pancreatic cancer, not to mention heart disease, stroke, other forms of cancer, and even Alzheimer’s.
In contrast, those with untreated Obstructive Sleep Apnea (OSA) have higher risks for those illnesses mentioned, including cancers. Those who snore and wake up at night gasping for breath, especially those who are overweight, who do not have a restful sleep, feeling tired and sleepy during the daytime, should have a life-saving Sleep Study to confirm or rule out OSA.
In cardiovascular illnesses, like heart attack and stroke, in metabolic diseases, like type 2 diabetes, and in most cancers, lifestyle and personal behavior are the greatest factors in the causation of these maladies, and these killers are, therefore, preventable.
As always, as far as our health is concerned, the ball is in our court. How we play it will determine the quality of our life, our future, and our longevity.
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Metformin: The truth

One of the most popular and very useful medications today worldwide is Metformin (Glucophage). This drug, whose molecular formula, C4H11N5, was first synthesized in 1929 and clinically introduced in the late 1950s by Jean Sterne, a French physician, who named it Glucophage, meaning glucose eater. In the United States, this drug was approved for type 2 diabetes by the FDA in 1994 and was marketed as Glucophage on March 3, 1995.

Evidence based clinical practice of today uses Metformin as the first-line oral drug for the treatment of type 2 diabetes mellitus, especially those who are overweight, according to the American Diabetes Association and the American College of Physicians.

In spite of its widespread global use and hundreds of millions benefiting from it, there are misleading and egregious assertions by some manufacturers of alternative herbal preparations for diabetes that Metformin is useless and dangerous. These are irresponsible claims in order for the uninformed and the gullible individuals to buy and use their products instead. These products, which have not been studied by the food and drug administration of the United States, the Philippines, or other countries, could be untested, unrefined, adulterated, contaminated, and are unsafe and possibly toxic in the long run.

How does Metformin work?

Contrary to some understanding, Metformin does not directly lower blood sugar like insulin does. Metformin acts to reduce the insulin resistance of the body cells to allow our own natural insulin to enter the cells to enable normal sugar metabolism. A significant number of type 2 diabetes suffer from insulin resistance that prevents insulin from entering the cells and doing its normal job, so the blood sugar goes up. Metformin reduces the resistance and improves the sensitivity of our body tissues in order for insulin to work more effectively. It also lowers the production of blood sugar in the liver. Again, on its own, Metformin does not cause hypoglycemia (low blood sugar).

Are ampalaya preparations as effective?
No. Ampalaya (bitter melon), a vegetable-fruit dish commonly prepared in Asian countries, has been found to lower blood sugar level a little, not significantly enough to be effective in controlling blood sugar level among diabetics. In spite of this limitation and lack of efficacy, ampalya preparations (pills, potions, lotions, teas) are on the shelves of many stores, claiming to lower blood sugar level, aimed at scamming the ignorant and gullible public. This is fraudulent because there have been reports of diabetics who stopped their prescribed medications and took these ampalaya preparations instead and have gone into diabetic comma. While eating ampalaya, a succulent dish, is a good idea for everyone, especially for diabetics, the use of the ampalaya preparations on the market as a substitute for (instead of) the prescription medication for diabetes is very dangerous and could be fatal.

What are the other uses of Metformin?

An amazing versatile drug, Metformin is also used for the treatment of polycystic ovary syndrome, and there are some limited suggestions that it may prevent cardiovascular disease and cancer complications of diabetes. More clinical studies are needed to confirm these. Its use is not linked to weight gain and higher risk of low blood sugar in contrast to the use of sulfonylureas for diabetes. Metformin also modestly reduces LDL (bad cholesterol) and triglycerides. Among obese non-diabetics, Metformin has been observed to be induce some weight loss. There is also a study that suggests Metformin be used as a second-line drug if clomifene treatment fails in the management of infertility among women.

Can Metformin prevent diabetes?

Among those with pre-diabetes, who are at risk of developing full-blown type 2 diabetes, treatment with Metformin has been found to reduce the chances of developing this metabolic disease. The same may be achieved with intensive regimented physical exercise done religiously, at least 20 minutes 5 days a week, as shown by the US Diabetes Prevention Program of lifestyle modification. This non-medication, exercise strategy, could lower the incidence of diabetes by 58 percent. Medical research on this continues to confirm these findings.

Does Metformin improve longevity?

This wonderful drug appears to increase longevity, at least in mice in the experimental laboratory, by a mean life span of 37.8 percent. Findings like this are extrapolated to be applicable among humans. There is scientific evidence that hyperglycemia (high blood sugar) and hyperinsulinemia (high insulin levels) are significant factors both in aging and development of cancer. The life prolonging effects of dieting (caloric restriction) has been attributed to decreasing IGF-1 (insulin growth factor-1), so eating less than maximal will reduce the need for the body to secrete more insulin and its level would go down, including body weight, and eventually in the long run slowing down aging and cancer risk. As my late teacher, Dr. Fe del Mundo, an internationally renowned pediatrician-scientist who lived to almost 100, still treating patients at age 94, stated, her secret to longevity was to push herself “away from the dining table less than full.”

What are the side-effects of Metformin?

Metformin is well-tolerated by most. Mild diarrhea is the usual initial side-effect that is transient, which stops after a day or so. Nausea, abdominal pains, flatulence have been reported but they are mild and temporary. If taken in overly large doses, it causes high blood lactic acid level. This drug is contraindicated among those with kidney or liver disease. Long term use of Metformin leads to vitamin B-12 deficiency, and increase in the homocysteine level, which increases the risk for hardening of the arteries. Vitamin B-6, B-12, and Folic Acid might be considered by the attending physician for these. Among pregnant women with gestational diabetes, insulin is the preferred treatment, although there is no clear evidence that Metformin causes harm among these patients. If the side-effects continue for days, which is not common, a medical consultation is advised.

Is it safe to self-medicate with Metformin?

As a rule, it is never safe to self-medicate or share medications with anyone, even with over-the-counter drug, unless prescribed by a physician. Allergy and unexpected untoward reactions, side-effects, and unforeseen complication, sometimes fatal, can occur in some individuals. Metformin and all other medications must be taken under the guidance of a physician, who knows your personal circumstances and health.

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Debunking Diet Myths

In today’s health-oriented world, the four major players – diet, exercise, smoking and alcohol abuse – are in the spotlight. Diet weighs heavily on this equation and has also been a subject of a lot of pervasive myths and misinformation. Today, we shall review some of the most popular misconception about diet.

Fasting is the best way to start.

Fasting is the wrong way to start, or even “punctuate,” your dieting schedule.  Fasting has no place at all in controlling weight or quality of nutrition for our body. The temporary weight loss resulting from fasting is thru water loss (dehydration). The best way to maintain your weight is to burn the calories your take in daily (example: if you take in 2000 calories, you should exercise off 2000 calories that day). It is a matter of intake and output, an obvious common sense approach. If one is overweight and wants to lose weight, then the calories burned should be higher than the calories ingested, until the goal is reached…and at that point, the maintenance intake and output formula should prevail. Those who want to gain weight to reach the ideal weight, obviously, should have more intake than output of calories.

 

Low carb - hi protein diet is best

Not true. Those on low carbohydrate diet alone, but on high protein (meats, egss, etc) had good initial weight loss, but regained the weight after six to 12 months, as shown by some studies. They faired better than those on low fat diet, which is actually more healthy as far as cardiovascular diseases, metabolic illnesses and cancers are concerned. However, low carb diet, combined with low fat diet and exercise, has been found to be the best regimen. This means the diet mainly consists of fish and bean curd, beans, grains and nuts (as the main source of protein and oil) and a lot of green leafy and other vegetables, and fruits. Among diabetics, fruits should be included in the calculation of the total daily restricted calorie intake.

 

Enemas aids in dieting

False! This is a myth that is unhealthy. Enemas for cleansing “to get rid of toxins in our body,” is not medically accepted as a means of detoxification and weight control. To detoxify our body, the best way is to abstain from smoking, minimize alcohol intake and exposure to other toxic agents, eat a lot of vegetables, nuts, some fruits, and to exercise daily. There have been reports of deaths with frequent self-prescribed enemas. They could lead to diarrhea, nausea, vomiting, electrolyte imbalance, heartbeat irregularity, and bowel perforation. The so-called designer coffee enema for colon cleansing is not only expensive but also useless and very dangerous.

 

Eating late at night leads to more weight gain and fats

This is no more true than the myth that Elvis Presley is alive. Of course, it is best not to have a full stomach close to bedtime. Going to bed 3 to 4 hours after a meal is fine. The calories taken at night have the same effect as those taken during the daytime. While you burn less calories while sleeping, you lose these when you get up in the morning and start your daily routine, especially if you exercise every day. 

 

“Slimming Tea” works

This is a myth. “Slimming Tea,” or other drinks that are advertised as effective for weight reduction, are per se, useless and a waste of money.  Any beverage, so long as they are zero calorie drinks, can help in weight reduction, if taken in lieu of a ton of calories. And I repeat, in lieu of. Not together with thousands of calories. If you drink them and still eat more calories than you burn, then you will gain weight, regardless of what fluid you drink. There is absolutely NO beverage on the market that will lead to weight reduction, per se. There is no easy solution to overweight; it takes education, discipline, determination and hard work. But the dividends are worth the sacrifices. 

 

Drinking a lot of water leads to weight gain

Only if you heart or kidney is not healthy. Heart or kidney failure patients tend to retain water, so water restriction is part of the treatment among many of them. However, for someone who is otherwise healthy except for excess body weight, drinking two glasses of water before each meal is a great strategy in appetite and calorie control (it “fools” the brain into thinking the stomach is already full), which reduces the food intake, and, subsequently, the weight. The recommended fluid intake is at least 8 glasses of water a day. However, if the beverage ingested is loaded with a lot of calories (like regular cola drinks, fruit drinks, smoothies, etc.), then rapid weight gain results. Fruits juices (fresh fruits are better than the juice) should be limited to 4 oz a day since it has a high concentration of added sugar. Sugar-loaded pop beverages are among the top culprits in the calorie explosion of today, and should be avoided. Purified water is the healthier and cheaper universal beverage for all seasons.

 

Eating grapefruit will help burn body fats

A caveat to remember: there is no food known to man today that can burn or “melt” body fats, or that can reduce weight without proper dieting. Eating grapefruit is good, if done (again) in lieu of eating tons of calories. Grapefruits, like many fruits and multi-colored and green leafy vegetables, are loaded with good anti-oxidants that protect our body from the ravages caused by free radicals. So, eating them daily is healthy for us, but for fat and weight reduction, the only guaranteed formula is our basic common sense principle: output must be equal to intake (calories taken in = calories burned) in order to maintain a certain weight.  And you can extrapolate from there to suit your personal goal.

 

Soft drinks is safe?

Soft drinks, regular or diet, cola or uncola, caffeinated or not, are not only unhealthy but toxic to the body, especially for children. They increase the risk for the development of metabolic syndrome, number one killer among diseases. For those on a diet, drinking soft drinks is like pouring water on someone who is already drowning. Taxes for soft drinks, like taxes for cigarettes, are being increased through legislation to discourage people from using these toxic agents.

 

Diet without exercise

While dieting or watching our diet, pushing ourselves away from the dining table less than full to maintain a healthy weight, body, and mind, doing this disciplined strategy, adding exercise to this healthy lifestyle regimen, more than triple its beneficial effects as far as boosting our immune system, our physiology, disease prevention, and overall well-being for health and longevity.

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Facts about coconut water

Facts about coconut water

Coconut water (buko juice) is a popular drink in Asia and South America. The top ten countries on the list of world-leading coconut producers according to volume are: Indonesia, Philippines, India, Brazil, Sri Lanka, Vietnam, Papua New Guinea, Mexico, Thailand, and Malaysia. The Philippines export more than $1 billion worth of coconuts to the United States alone.

What actually is coconut water?

Coconut water is the clear liquid inside coconuts which, in early development, “serves as a suspension for the endosperm of the coconut during its nuclear phase” of growth. The endosperm matures into “cellular phase and deposits into the rink of the coconut meat.” The coconut water and the soft meat of young coconut is a delicacy, popular among locals and tourists in those tropical countries and others where coconuts thrive. They are sold fresh on the street by vendors with machetes who cut a hole at the top for drinking, with or without a straw. They are also available bottled, soft-packed, and canned, usually consumed chilled.

What are the other coconut products?

Besides its water and meat, other coconuts products include copra, coconut oil and coconut milk (gata) for cooking and for cosmetics, palm sugar, flower syrup, butter, desiccated coconut, powdered sugar, jelly, cream, kefir (probiotic), flour, vinegar, nata de coco fruit jelly, etc. Indeed, coconut is a versatile fruit, nut, and seed, all in one.

Can it reverse Alzheimer’s?

The popular claim that coconut oil products can reverse Alzheimer’s disease is baseless and unfounded. There is no scientific evidence to this effect. The same is true with the other medicinal claims for other illnesses, like depression, diabetes, obesity, high blood pressure, allergies, As a matter of fact, there is a controversy that coconut oil and products can be detrimental to the consumer’s blood cholesterol/lipids levels and cardiovascular health, if consumed regularly. Fresh uncontaminated coconut water is deemed acceptable and safe. Scientifically, the use of coconut oil for hair, skin, and lips, as conditioner-moisturizer has been proven to be of good cosmetic value.

What are the nutritional values of coconut water?

Coconut water is 95 percent water and 100 ml provides only 19 calories, 4 percent carbohydrates, under 1 percent protein and fat. It does not contain any vitamin or dietary minerals of any significant value. Unless contaminated by a handler, fresh coconut water is sterile, free of microbes.

While this has been marketed as “natural energy drink or sport drink,” claiming it has significant electrolyte content, this is not true. The potassium, magnesium, calcium and sodium in unprocessed coconut water per 100 ml are insignificant and not balanced. The health benefit claims, that it is antiviral, that it lowers cholesterol and regulates blood sugar, are false, and the US Food and Drug Administration has warned producers against misleading marketing.

Various firms have faced class action lawsuits over false advertisements that coconut water was “super-hydrating,” nutrient-packed,” and “mega-electrolyte” source. The suit was settled with a US$10 Million award in April 2012.

Was coconut water used as IV fluids?

During World War II, coconut water was used as intravenous fluids for rehydration when medical fluids was not available during emergencies. It is actually not similar in composition as our plasma. Intravenous coconut water is not accepted as within safe standard of care today and must not be performed at all as it would be malpractice. Drinking it occasionally is the safer way to take coconut water.

Is excessive consumption safe?

No, drinking a large amount of coconut water is unsafe. As a matter of fact, coconut water is used in southern districts of Tamil Nadu, India, for senicide of the elderly, a traditional accepted practice performed by family members called thalaikoothal, an involuntary euthanasia for those incapacitated and seriously ill, where “the elderly is made to drink an excessive amount of coconut water, eventually resulting in fever and death.” Besides pulmonary (excess water in the lungs, as in drowning) due to fluid overload, the exact mechanism causing the demise is not clear.

Are coconut food products healthy for us?

Olive oil is preferred over coconut oil for cooking and overall use. The virgin variety of each is considered better than their regular form. While olive oil is universally recommended as a healthy oil, there is a lot of controversy about coconut oil because of its high saturated fat content (albeit from non-meat source). The use of virgin coconut oil in cosmetics (skin moisturizer and hair conditioner-shiner, lip balms, etc.) has been proven beneficial, but not as a food or as a cooking ingredient for DAILY consumption. Advocates, including some physicians, think differently. While the controversy lingers, occasional indulgences and in moderation are safe. For many, the great unique appetizing taste of coconut milk (gata) in main courses (red meat/chicken/vegetables) and in desserts is hard to resist. I confess, I am one of them.

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National smoking ban

 

Providing a smoking area within

the same building with one ventilation system

is like designating a urinating area

in a swimming pool.

 

HealthJustice Philippines, a vigilant think tank and advocacy group with legal expertise in tobacco control and health promotion and a Bloomberg Awardee for Global Tobacco Control, sent out a press release May 12, 2017 praising “Davao City Vices Regulation Unit for its strict enforcement of smoking ban and apprehension of 4,487 violators since its formation last month.”

“We commend the local government of Davao City and its Vices Regulation Unit for strictly enforcing the provisions of its pertinent local ordinances and national and international laws banning smoking in public spaces. Davao City has been recognized by no less than the World Health Organization for its landmark tobacco control ordinance, and since then it has continued setting a sterling example in crafting and implementing tobacco control measures for cities across the country and the whole world to emulate,” said Mary Ann Fernandez-Mendoza, president and trustee of HealthJustice.

“We hope that President Duterte will soon sign the ‘smoke-free’ Executive Order that will not only strengthen the enforcement of existing smoking bans, but also direct local governments to pattern their anti-smoking ordinances after that of Davao, which includes a ‘no smoking indoors’ policy,” she added.

*        *        *

Cebu in the 1990s, expanding on its existing ban on smoking in public establishments then, proposed its laudable goal to make Cebu city a smoke-free city by year 2006. I was among its staunchest supporter and stated then that achieving this would earn Cebu the enviable distinction of being one of the healthiest cities and tourist spots in the world. Unfortunately, wisdom, health, and medical science were no match to the power of money and political correctness.

I remember that there were some brainless city legislators who wanted to amend the ordinance to allow smoking after 9:00 P.M. and for the creation of smoking areas in shopping malls, restaurants, etc.

Did these obviously ignorant officials think that active and passive smoking would only cause cancers, cardiovascular illnesses, and lung diseases before 9:00 P.M., and that smoking after 9 PM would be safe? Did they honestly think that the smoking areas (within a building) will prevent the 4000 harmful (200 of them cancer-causing) chemicals in tobacco smoke from getting into the ventilation system and expose and hurt everyone in the premises, including non-smokers and children?

What in this issue was NOT clear?  I bet even the kids in the kindergarten can see how ludicrous these proposed amendments are. 

Unless the designated room is air-tight and totally excluded from the main building (of shopping malls, restaurants, stores, hospitals, public libraries, theaters, the workplace, etc.), and has a ventilation system of its own, it would be ineffective and useless. Providing a smoking area within the same building with one ventilation system is like designating a urinating area in a swimming pool. This is the same scientific and medical principle why the smoking ban in commercial airplanes also includes the toilets, besides all the cabins and the cockpit. A simple common sense.

The issue is crystal clear. Smoking and second hand-smoking or passive smoking maim and kill millions in countries around the world, the Philippines included. Spraying poison in the air, as in passive smoking, adversely affect everyone in the area. 

The simplest, totally cost-free, and medically effective solution is to allow smoking ONLY outside of, and a distance from, public buildings. What could be more obvious? A national smoking ban, while unpopular and controversial, would provide an immeasurable boost to people’s and the nation’s health.

While I abhor smoking and inhaling secondhand tobacco smoke for health reasons, I defend the right of smokers to smoke. That is their constitutional right…so long as the exercise of that right does not offend or hurt the people around them and infringe upon the rights of others. After all, non-smokers have rights too: not to be exposed to the dangers of secondhand smoke. Where there is a conflict, the right of the non-smoker prevails. This is an accepted legal tenet.

What is secondhand smoke?

Secondhand smoke is the fume that one involuntarily inhales after someone who smokes exhales it (called mainstream smokes), or the fume that goes directly to the atmosphere from the burning tobacco (cigarette, pipe or cigar) called side stream smoke. When non-smokers breathe in these smokes or fumes from other people’s cigarettes, cigars or pipes, this is involuntarily inhalation called passive smoking. As stated earlier, tobacco smoke contains about 4000 chemicals, 200 of them known poisons and carcinogens. Smoking around people is similar to spraying known poison gases into the atmosphere, victimizing and posing even greater health hazards to non-smokers.

Does passive smoking cause cancer?

Yes, active and passive smoking cause cancers, besides bronchitis, premature births, smaller babies with higher risk for impaired mental development, respiratory illnesses among children, emphysema, heart attack, and stroke. In the United States, cancer victims of smoking, and family members of smokers who died from cigarette-related illness, have sued cigarette manufacturing companies, and have won millions in awards. While they vehemently denied it before, cigarette companies today have admitted in public that tobacco causes cancers and other lung illnesses. The courts have likewise ruled in a similar fashion in favor of victims of passive smoking (as in the airline stewardess’ case). In 1986, the Surgeon General of the United States reported that involuntary (passive) smoking can cause lung cancer in healthy non-smokers. In fact, the U.S. Environmental Protection Agency (EPA) has now classified secondhand smoke as a known carcinogen (cancer-causing agent).

If we, as a people and as a nation, are really serious in eliminating all the smoking-related killer diseases that snuff out more than 240 lives a day, yes, a day, not a month, causing the loss of loved ones and family devastation, promulgating a national smoking ban truly makes sense.

But don’t hold your breath. History shows that majority of our elected politicians, leaders we voted for to protect us, do not have balls and the wisdom and the will to eliminate this vicious serial killer amidst us. The illnesses and deaths from tobacco far exceed the morbidity and mortality from illegal drugs.

Let’s see if President Rodrigo R. Duterte can extinguish this political insanity that is holding the people’s health hostage. 

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Depression is great risk factor in suicide

Depression is a most significant risk factor in suicide. In today’s busy, impatient, materialistic, and fast-paced society, people are subjected to various stressors in life everyday. Encumbered by their personal circumstance, some are unable to adjust and cope, and develop depression. Suicide is a senseless option and a preventable alternative.

What is depression?

Depression is a state of emotion where the individual has some or all of the following senses, feelings, or moods: downhearted, unhappy, anxious, irritable, unable to concentrate, socially withdrawn, empty inside, has inordinate fatigue and reduced interest in activities which used to be fun, hopelessness, indecision, impaired sleep, misery, helplessness, confusion, monosyllabic speech or abnormally quiet.

What is the prevalence of depression?

In the United States, about 9 percent, or 28 million American adults “have feelings of hopelessness, despondency, and/or guilt that generate a diagnosis of depression,” according to the US Centers for Disease Control and Prevention. Three percent or 9.6 million of adults have major depression, a chronic and severe form of depression. In the Philippines, the rate is about 5.3 percent. Worldwide, the rate is between 2.6 percent to 29.5 percent, a pandemic, actually, according to an international study conducted by the World Health organization. In general, women are 70 percent more prone to develop depression, in part due to hormonal changes, especially during menstruation, after pregnancy, and menopause. In the past 50 years, the rate has catapulted from 3.33 percent to 7.06 percent, from 1991 to 2002. The rate for the various types of depression in the United States are: Postpartum – 10 to 15 percent; SAD (Seasonal Affective Disorder) – 4 to 6 percent; Bipolar – 2.6 percent; Dysthymia (minor depression that lasts 2 years or longer) – 1.5 percent; Psychotic depression (most severe form) – 5 percent.

Are there screening tests for depression?

Yes, there are. Mental health specialists can administer preliminary tests such as the BDI (Beck Depression Inventory), or the HRS (Hamilton Rating Scale), which is composed of 20 questions to screen the patient. Today, computerized phone interviews are gaining effectivity as a screening tool. These tests are only a small part of the evaluation process, because the specialists have the symptoms of the patient and other criteria to aid them make the correct diagnosis.

Don’t we all get depressed sometimes?

To some degree, some situations in life trigger depression, and normal people develop a mild form of depression, which is transient, self-terminating, and not a disease. As long as the resultant symptoms are trivial and temporary, and do not debilitate the person, the condition is not clinical illness and does not need any medical treatment

What foods relieve depression?

Foods that are high in tryptophan, an amino acid involve in serotonin production, provide relief to some people with depression. Niacin (Vitamin B3), which is essential in the production of tryptophan, can be found in dried peas, beans, whole grains, dried fortified cereals, and especially in oily fishes like salmon and mackerel. It is reported that Omega-3 polyunsaturated fatty acids in fish oil may actually reduce depression. PMS Escape, a high carbohydrate drink, was claimed to increase tryptophan level and would control the depression related to pre-menopausal syndrome has been found to have impurities by the FDA and subsequently withdrawn from the market. Calcium supplements and Vitamin B-12 have been reported to reduce pre-menstrual depression. Also, some studies showed that among depressed people who drink caffeinated beverages have a lower incidence of suicide, which seems to suggest that coffee or tea reduces depression.

How about exercises?

Believe it or not, physical exercises may be as effective as psychotherapy in the management of mild to moderate depression. Prolonged aerobic workouts lead to higher levels of serotonin, adrenalin, endorphins and dopamine in the brain (producing the popular term “runner’s high”). Physical exercises, brisk walking, ballroom dancing, yoga, tae-bo, etc. lead to better emotional health. As an extra bonus from physical exercises, weight loss and improved muscle tone lead to the sense of well-being and higher self-esteem. Those individuals with strong spiritual faiths have a relatively lower predisposition to depression. These people might benefit from meditation, yoga, and other techniques for obtaining spiritual security, inner peace and happiness. Severe depression need medical treatment.

Does depression play a role in suicides?

Yes, very significantly. Depression is present in about 90 percent of the more than 40,000 suicides that take place in the United States annually, and for every two homicides, there are 3 suicides. Suicide is the 10th leading cause of death in the United States overall and the second leading cause of death in the age group 10 to 34. According to CDC, 1.3 million adults attempted suicide in 2014. About 78 percent of them are men, more than 4 times the rate for women. Depression lowers the mental threshold for self-destruction.

Do you have depression?

If you do, it is most prudent to seek medical help, not necessarily psychotherapy. The first thing to do it to consult your family physician, who can help guide you. With early proper medication and/or advice, depression in most cases can be managed effectively and eliminated faster than one can imagine. Physicians today have invaluable tools in their armamentarium for the diagnosis and treatment of depression. Many individuals with depression, who have sought medical care, are so “cured” with simple oral medications that they look, behave, function and live as normally and happily as anybody else, lost in the sea of anonymity.
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Wisdom Capsules

Veggies Protect the Stomach

Those taking NSAID drugs like ibuprofen, and other anti-arthritis pain medications regularly, can be victims of stomach irritation which could result in ulcers and bleeding complication, that is why medical guidance is essential, even for these over-the-counter pills. To prevent stomach ulceration, ingesting 8 to 10 ounces of vegetables a day can work wonders by protecting the stomach wall lining, according to a researcher at Sweden’s Uppsala university.

Crackling Brain Food

If you want a healthy snack, one that keeps your brain sharp and reduces your risk for the development of Alzheimer’s, nothing beats crunchy celery, cucumber, carrot, broccoli, cauliflower, olives, bell peppers, and other veggies. Eating them uncooked preserve all the phyto-chemicals in them, like luteolin, which prevents brain inflammation, a common condition linked to ageing, chronic brain syndrome, multiple sclerosis, etc. So, to stay young, with a sharper mind, stay away from the high carbo snacks, including (especially) soft drinks, and savor the benefits from these crunchy veggies. And nuts also, like walnuts, pecan, pistachio, almonds, macadamia, and peanuts. Even your looks and your complexion will shine, with your favorite moisturizer, and without the use of glutathione or other expensive herbal products, which may even be dangerous after chronic use. Veggies and nuts are in, especially among teenagers. We, adults, should learn from the younger generation.

Healthy Dish

Omega 3 Fish Oil (Omega 3 fatty acids DHA and EPA) is a popular supplement to eating fish for its cardio-protective benefit. It can lower blood pressure, help new brain cells regenerate and reduce the risk of the development of Alzheimer’s, minimize inflammation, and is a great aid in the management of cholesterol and arthritis. It also boosts the immune system. When digested, fish oil breaks down to hormone0like ingredients called prostaglandins, which reduced inflammation, like in arthritis (inflammation of the joints). This leads to lesser need for pain medications, as it also lubricates the joints. Fish oil is also good for auto-immune diseases. Indeed, a versatile supplement. Daily exercises, eating fish and vegetables at least 3 times a week, and abstaining from red meat and egg yolk is the healthy way to go, for children and adults alike.

Viagra, Cialis, Levitra

There are so many sex aids which come in herbal potion, pills, lotion, gel, and juices including ginseng and similar herbs, but studies have shown that the best results for those with erectile dysfunction among men, young or old, were obtained by taking Viagra, Cialis or Levitra. These drugs should be taken only after consultation with a physician, because some prescription medications may interact with any of these three pills and cause serious problems. Data today show that these pills, which have been prescribed for millions of times around the world, are effective and safe for ED in men, used under medical supervision. The fake ones from Pakistan, India, and other countries, which are being sold in the Philippines for a very cheap price, are deemed crude formulas and very dangerous.

Sex Could be Deadly

Sleeping around indiscriminately, or having multiple sex partners, can be hazardous to health and deadly. A perfectly healthy-looking person could be walking around with HIV, Chlamydia, Gonorrhea and other STDs (sexually transmitted diseases), including Syphilis. And no matter how normal looking the sexual organs of the women or men are, they could be harboring bacteria, fungi, viruses, and sometimes, even parasites, not obvious to the naked eye. Only a medical check-up and laboratory tests could confirm their presence or absence. STD infections in general, affecting the sexual organs, the eyes and mouth, are common. Be smart. You do not want a few minutes of pleasure to risk your health and life for weeks, if not years, of agony and shame. A internet message said, “unlike love, herpes is forever.” That may sound funny but herpes is really for keeps. Sex is a major and serious responsibility, not only to our body and health but to our family and friends, to all our loved ones, and to society in general.

Laughter/Singing: A Healer

Living a healthy lifestyle includes laughter. The more we laugh in life, the healthier we are. Indeed laughter is the cheapest and best medicine. Laughing (like singing or listening to romantic soft music and inspiring classical ones) increases our T-cells in the body which boost our immunity. Laughing also lowers the cortisol (stress hormone) level allowing us to minimize stress and its adverse effects on our system. It also blocks out bad emotions within us, giving us a better outlook and perspective in life. Even nothing is funny, even while alone in a room, laugh anyway, because even the simple act of laughing (and/or singing) in itself confers all those benefits. And don’t worry if people think you are crazy and laugh at you. You are doing them a favor anyway, by helping them get healthier as they laugh at you for yur insane laughter or off key singing.

Great advances

Instead of the cumbersome, uncomfortable diagnostic procedures now available for detecting lung cancer, the University of Texas researchers have developed a new lung cancer test that allows the use of “a simple mouth tissue sample, which compares the changes that takes place 95% of the time in both mouth and lung cells” among those individuals with lung cancer. This is a fantastic progress in our fight against lung cancer and cancers in general. As always, as with any other illnesses, prevention is the key, the best option, even compared to the greatest remedy or cure.

A non-invasive “virtual biopsy” technology (using harmless electrical current to better detect skin and cervical cancer (and eliminate need for surgical biopsy) has been developed by an Australian scientist.

A new ultrasound, “which can catch tiny tumors earlier,” has been evaluated for clinical use in Norway. Second to prevention, catching any cancer in its early stage can lead to complete cure, among most cancers.

Progress in science, in every sphere of human endeavor, benefits mankind as a whole. We are indeed lucky to be living in this world of today, in spite of all its imperfections and problems, most of which are man-made. For world peace and prosperity, where there is no war, poverty and hunger, all we really need is love, tolerance, and respect for each other. And the best place to start is at our own home.

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Is CPAP for you?

(Correction: In my previous column on sexually transmitted diseases, I inadvertently equated Human Papilloma Virus (HPV) to genital herpes virus. HPV is an entirely different virus than genital herpes virus.)

What is CPAP?

CPAP stands for Continuous Positive Airway Pressure, the best treatment, the accepted evidence-based standard of care, for persons with confirmed Obstructive Sleep Apnea (OSA).

What is OSA?

OSA is a condition where the individual takes very shallow (ineffective breaths during sleep, or even holds his/her breaths for an abnormally prolonged period of time (apnea) for dozens of times during the night, depriving the person of oxygen, which could lead to arrhythmias (heart irregularity) and in some cases, heart attack and even death. Unfortunately, not every healthcare provider, even today in the United States, recognizes OSA as a significant factor in the causation of metabolic (diabetes-T2 and other endocrine) illnesses, cardiovascular and respiratory diseases, and alarmingly, even of various cancers.

What causes OSA?

There are some individuals whose anatomy of the throat allows the soft palate (roof of mouth at the back) to fall back and block the upper airway passage while asleep. This obstruction is commonly seen among those who snore, but not all who snore has OSA. This obstruction makes the diaphragm and the chest muscles work a lot harder to bring air into the lungs, momentarily waking up the person, on and off, jerking, choking, and gasping for breath several times during sleep.

What are the dangers of OSA?

Besides the arrhythmias and possible heart attack, OSA also deprives the person of a restful, satisfying sleep. As alluded to above, OSA has been linked to increased risk for metabolic and cardiovascular diseases and to elevated risk for cancer. Lack of sleep also decreases the sense of well-being, mental acuity, concentration, work performance, and all these expose other people, society in general, to the danger of driving accidents. Those with untreated OSA are also less efficient, more forgetful, and cranky members of the work force. They are always tired, have excessive daytime sleepiness (EDS), and doze off frequently. They lack stamina and their sex life is also affected. Almost all of these individuals do not realize OSA is the cause of their problem. Actually, even among physicians, OSA, while common, is still an under-recognized and under diagnosed medical entity.

How common is OSA?

One in five Americans, or about 60 million, have obstructive sleep apnea, 4 percent among males and 2 percent among females. Extrapolated figure for the Philippines would place the incidence at about 4-5 million Filipinos suffering from OSA. In Hong Kong, the prevalence is about 7 percent, in India, 13.7 percent. Its only in the past 2 decades or so that physicians have been more aware of OSA and CPAP therapy and have been referring more and more patients to Pulmonologists for Sleep Studies. The “epidemic” of OSA is more common than we think.

What are the associated predictors?

The typical associated predictors for those who are prone to develop OSA are: male more than female, older age group, usually above 40, greater BMI (Body Mass Index, obesity), larger neck circumference and waist to hip ration, smoking, snoring, high blood pressure, longer time to fall asleep, and higher Epworth Sleepiness Scale score. To some extent, family history of OSA.

How is the diagnosis confirmed?

When the physician suspects a person to have OSA, the diagnosis is confirmed by a Sleep Study (Polysomnography). This study, which requires sleeping overnight in a sleep clinic or hospital, where the person is connected to various devices to monitor, among others, the brain activity, oxygen level, EKG, heart rate and breathing rate, while a video records movements and snoring, etc., while asleep. When positive for OSA, the diagnosis is confirmed, and a second night needs to be spent in the sleep clinic to titrate the CPAP parameters needed for actual CPAP therapy, like how much pressure is needed to keep the airway open (which differs per person), etc. These parameters are used when prescribing the CPAP therapy. The machine will be calibrated and set according to the person’s needs for an effective use every sleeping hour each day.

How comfortable is CPAP use?

Contrary to what might think as “obvious,” the use of CPAP mask or nasal pillows (depending on the user’s preference after trying them) at bedtime is surprisingly comfortable. After getting used to it within a week or so, the user might even miss it or might not feel secure without it. The CPAP machine has a controlled water heater reservoir which provides warm humidified air. Using it religiously provides a sense of safety from lack of oxygen and from developing a heart attack. CPAP use among those with OSA assures them a more restful and satisfying sleep every day. Many prefer the nasal pillow, but if one is a mouth-breather, the mask is recommended.

Is CPAP use for life?

Yes, since OSA is only treatable but not curable, one has to use CPAP for life. But as I have alluded to, once one is used to it, CPAP use could be 
“addicting” (reassuring is the more appropriate term) because of its life-saver reputation and all the benefits CPAP provides, including a satisfying restful sleep.

Are other gadgets any good?

Countless “non-CPAP” gadgets advertised on various media are useless and not scientifically based. They market the items to stop snoring, but snoring is not the cause of OSA. The CPAP stops snoring also. Snoring is only a symptom. Even if you stop snoring, the blocked airway is still there. The treatment should be directed to the collapsing airway passage, by “filling it up” with continuous high pressure (enough to keep the airway open for effective respiration) so oxygen can get into the lungs. Without exception, all those “non-CPAP” marketed items are useless and a waste of money. They are also dangerous because they provide a false sense of security, which could delay or preclude proper and prompt medical consultation and avoid a medical disaster.

More and more physicians, other healthcare providers, and the public are becoming aware and acutely conscious about OSA, its diagnosis, and the wonderful CPAP treatment. This trend is gratifying because the earlier the diagnosis is confirmed and the CPAP therapy is instituted, the sooner the incidence of all OSA-linked diseases listed above will be minimized through prevention around the world.

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Sexually Transmitted Diseases

It is quite alarming that forty-five to fifty percent of men and women in the United States have HPV – genital Human Papillomavirus – infection. This information was recently reported by the Center for Disease Control’s National Center for Health. It is, indeed, the most common sexually transmitted disease in the country. Here are the details, which are conservative statistics since this does not include institutionalized higher risk individuals, like prisoners, addicts, and the homeless:

“Using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014, researchers found the following:
Oral HPV prevalence was 7% for adults under age 70. The prevalence of high-risk oral HPV was just 4%.
For adults under age 60, the prevalence of genital HPV was 43% in 2013 to 2014. It reached 64% among black adults. Non-Hispanic Asian adults had the lowest prevalence at 24%.
Roughly 23% of adults had high-risk genital HPV, with the highest prevalence among black males (40%).

HPV and cancer
There are more than 108 different types of genital HPV, more than 30 of these are sexually transmitted, causing infection involving the skin of the penis, vagina (vulva), cervix, and even the anus and rectum.
US government statistics show that 25 percent of men and 20 percent of women have the strain of human papilloma virus or human wart (virus) that causes cancer. To protect individuals who are 25 and younger from acquiring this HPV-related cancer, the vaccine listed below is available today.
Cervical cancer
Cervical cancer is malignant tumor of the cervix (mouth of the womb). It is the second most cancer in women and the third most common gynecologic cancer, the second being cancer of the ovary. The most common gynecologic malignancy is endometrial (inner wall of womb) cancer, which is the fourth most common cancer in women. The first being cancer of the breasts, followed by colorectal cancer and lung cancer. Cervical cancer develops in women at the mean age of 50 years old, although it can occur in women as young as 20. In the Philippines it is the number 2 most common form of cancer among women. In the United States it accounts for least 3000 deaths, and globally, about 300,000, annually.
How prevalent is cervical cancer?

More than 20 million of Americans have HPV infection. In the Philippines, there are about 5000 new cases of cervical cancer each year. By age 50, about 80 percent of American women will have acquired genital HPV. However, more alarming than that is the fact that there are between 10,000 to 25,000 women walking around (not seen by physician) who have undiagnosed pre-invasive lesions in their cervix. If diagnosed early, these women could be saved. For every four survivors of breasts cancer, there are less than 3 women who survive cervical cancer, which shows how virulent cervical cancer is.

What causes cervical cancer?

Human Papilloma Virus (HPV, also known as genital herpes virus) accounts for most, if not all, cervical cancers. At least 50% of sexually active men and women are infected with genital HPV, especially those with multiple partners. There are about 20 million American men and women infected with HPV, many linked with abnormal pap tests, genital warts and cervical cancer. It is estimated more than 10,000 new cases of cervical cancers are discovered annually. Between half a million to a million Americans have genital warts, transmitted thru sexual contacts. The so-called high risk HPV may cause positive Pap test, and it could cause cancer of the cervix, vulva, vagina, penis, anus or rectum. The low-risk , milder form, causes single or multiple bumps of genital warts (kulugo) and could be cauliflower shaped.

Is the cure for cervical cancer?

Better than the cure! A vaccine that prevents cervical cancer has been in use since it was introduced in June 2006 and found to be “effective 100%, in the short term, at blocking the cancer and lesions likely to turn to cancer” (like the pre-invasive lesions), according to drug manufacturer, Merck & Co.

The vaccines, which are genetically engineered, Gardasil and Cervarix, which block infection caused by two of the more than 108 types of human papilloma virus (HPV), strains 16 and 18. These two sexually transmitted viruses are responsible for about 70% of cervical cancers. HPV, in one form or the other. The other strains of the virus cause painful genital warts, and sometimes, cervical cancers too. The newer versions of these vaccines are effective for more strains of HPV.

How early should the vaccine be given?

Students in grammar school, middle school and high school should be vaccinated before they become sexually active, because once they catch HPV infection, there is no cure; herpes is for life. This was the recommendation of Dr. Gloria Bachmann, director of The Women’s Health Institute at Robert Wood Johnson Medical School in Brunswick, NJ., who said this vaccine is a “phenomenal breakthrough. This is, today, the standard of care.
Can oral sex cause cancer?
The most common cause (70 percent) of throat cancer is oral sex with a partner who has active HPV infection. About 4 percent of adults who practice oral sex will have oral infection with a high-risk form of cancer-causing HPV. Experts say head and neck cancer will surpass cervical cancer as the most common cause of HPV-related cancer by 2020. Without being flippant, the use of seran wrap or plastic film to cover the female pelvis (similar to the use of condom for males), if oral sex is to be practiced at all, could be of some protection against HPV contamination. However, the CDC review of 138 peer-reviewed scientific studies showed that the use of condom is not effective in reducing the risk of STDs. Out of 100 women who used condom religiously, 37 of them still developed HPV. At least 1 percent of condoms are defective.
Syphilis higher among homosexuals
While society regards syphilis as an STD of the past, it is actually still very much with us, domestically and globally. Rarer than it was a century ago, syphilis remains a much dreaded disease.
Men who have sex with men have much higher rates of syphilis infection, according to a study. The rate is 106 times more than the rate of syphilis among heterosexual men, and 167 times higher than the rate of infection among women.
Homosexuals had a rate of 309 cases per 100,000 population for a primary and secondary syphilis, compared to 2.9 and 1.8 cases per 100,000 for heterosexual men and women, respectively. The region with the highest rates are located in the Southern region, with a rate of 748 per 100,000 in North Carolina.
This may sound like over simplification and quite obvious, but the best way, the surest way, to prevent getting any sexually transmitted diseases is not to have sexual contact with someone infected, or possibly infected, with HPV/HIV/Syphilis/Gonorrhea.

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