I hope you are enjoying lots of good summer fun. The change of season brings many different opportunities to get outside and explore this beautiful area. Don’t have so much fun that you forget to relax, as some of us tend to do. One of my best vacations was on a sailboat I rented with some friends. Sure, the area in which we sailed for a week was incredibly gorgeous and I saw many beautiful sailboats, but part of why it was so great was that there was so little I could do. I had to relax. I highly recommend such R&R whenever and wherever you can find it.

In today’s newsletter:

PSA Breakthrough?
Don’t Get Hot About Fevers
Junk Food Practically Normal
Superbugs Step Out Into The Community
Worm Whips Inflammatory Bowel Disease

Next time - some thoughts about weight loss and body composition inspired by the recent first meeting of the International Society of Sports Nutrition.

Best, Michael Carlston, M.D.
www.carlstonmd.com 
707-545-1554

After many years of frustration and confusion over the screening blood test we have for prostate cancer, the pieces may be falling into place. Prostate cancer is an extremely common cancer, with as many as 30% of 80 year-old men having it. As you can figure out from that number, it is a widely variable disease, killing some young men and not really impacting most older men who have it. The PSA (Prostate Specific Antigen) test gives us a level of a marker antigen in the blood. When it first appeared we hoped it would help us diagnose this cancer. The problem is that it turned out to have a high rate of false positives, quite a few false negatives, and even when truly positive, the men diagnosed had non-aggressive forms of prostate cancer. This situation led to many men having additional testing (biopsies for example) and the testing gave them lasting problems with urination and sexual dysfunction. Many physicians specializing in care of this part of the body (urologists) proclaimed their own personal refusal to have the PSA test done on themselves because of these problems.

Now we have learned something which seems to change everything, and why I am going to have my PSA checked soon. A recent large study of men with prostate cancer found there was a very strong connection between how aggressive their prostate cancer was and how quickly the PSA test levels rose. Men whose PSA levels rose 2 points in a year had a death rate ten times that of other men. That is pretty impressive.

The lead investigator, who had long been critical of the PSA test, recommended that we begin to use the test in a different way. He suggested that we test men in their 30’s to establish a baseline PSA level and then recheck it annually. My only question is whether these data apply as well to men who have not already been diagnosed with prostate cancer; in other words, the men who we would be screening. As I wrote, though, I am convinced enough that my first PSA will be part of my next blood test.

Unfortunately, many people, patients and doctors are misinformed about fever. I was lucky because way back in medical school I was taught how the body created fevers to fight off infection.

In a recent survey of two urban hospital-based clinics, 92% of caregivers incorrectly believed that fever was harmful, with 24% fearing brain damage. Another study of 151 members of the American Academy of Pediatrics found that 72% often or always recommended treating feve,r and 65% believed fever itself could be dangerous.

Dr. Lewis First, who is the chief of pediatrics at Vermont Children’s Hospital, commented on these studies: “Parents seem to think their child will self combust …. We need to remind them that fever is a symptom, not a disease……Truly, fever is our friend”.

For decades, studies have shown that ill effects associated with fever are the result of a serious illness (e.g., meningitis) and not the fever itself. In fact, “treating” a fever with medicine to reduce it can cause problems for several reasons. First, these medicines have been shown to prolong the illness, which seems obvious if you think about the body’s wisdom in making the fever to fight the illness in the first place. Second, aspirin and the other drugs used have been linked with fatal Reyes Syndrome occurring in children with viral illnesses. Many of the medications themselves cause liver damage and studies show parents usually give incorrect dosages and often don’t know they are giving excessive doses because of confusion about the chemical name of the medicine. Also, attention to the fever distracts from the real issue, that is, what is the illness and then what should be done about it.

A study published in June found that 30% of the food consumed by Americans is officially “junk”. Sweets, desserts and soft drinks make up 25% of all the calories eaten by Americans. Sodas alone were over 7% of ALL calories consumed. Most Americans are undernourished in vitamins and minerals, but gorge on empty calories. If you think about how so many Americans have their backsides glued to the couch in front of the TV, we seem a bit like confined and force-fed veal calves or foie gras ducks, only we do it to ourselves.

As part of my discussion about the hygiene hypothesis (how certain infections and micro-organisms make us healthier) many of you have had to endure the story about a small study of patients with inflammatory bowel disease successfully treated with worms. Now I will jump to the topic again, because the same investigators conducted a larger, and so more impressive, study. They studied 200 patients, half with ulcerative colitis and half with Crohn’s disease (the two forms of inflammatory bowel disease). These diseases are very serious chronic illnesses, can be fatal and often shorten people’s lives. This solution of pig whipworm eggs sent 70% of the Crohn’s patients and 50% of the ulcerative colitis patients into remission. Food for thought?