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Wednesday, October 28, 2009

Policosanol vs Statin Drug

Policosanol is a wonderful alternative to prescription 'statin' drugs in the
treatment of elevated cholesterol.

The side effects of statin drugs [are]:

1. Changes in liver function. Liver 'transaminases' can become elevated,
indicating liver damage with the use of prescription statin medications. For
this reason, routine, periodic blood work must be performed to monitor for this
potential and fairly common problem.

2. Muscle cramping and muscle aches. Muscle symptoms are common Lipitor side
effects, but occasionally something called “myopathy” occurs, involving actual
damage to muscle tissue.

3. Altered Memory and Poor Concentration. Changes in memory, focus,and/or
concentration can occur in patients receiving statin medications. People may
develop difficulty finding the right word. Lose items, and have memory issues
that can be disturbing. .

4. Depression and Irritability. Depression and mood changes are common
side-effects associated with statin use.

5. Headaches, Joint and Abdominal Pain.

6. Peripheral Neuropathy. Peripheral neuropathy, perhaps due to CO-Q10
depletion may occur in patients receiving statins.

7. Sexual function problems, fatigue, dizziness.

Dosage and Administration of Policosanol:

1. Generally, starting dosages are 10 to 20 mg, by mouth daily. Cholesterol
levels can be expected to drop 10 to 20% at the 20 mg dosage, and increasing it
to 20 mg twice daily may give additional although non-linear results.

2. I [
David Stephen Klein, MD] start my patients on 20 mg twice daily. Policosanol is so inexpensive and
so devoid of side-effects that the higher dosage is the better place to start.

3. To this, I add Folic Acid 5,000 mcg (5 mg) once daily.

[**editors note: I will often time recommend Niacin (no-flush niacin) and extract of red rice yeast in addition to
policosanol. Also coQ10 is added in smaller amounts then what is recommended to be taken with statins when using
red rice yeast extract because in fact it is a natural "statin" agent]


** additions by JP Saleeby, MD

Thursday, October 22, 2009

Dr. Saleeby's Medical Antique Collection up for grabs

Dr. Saleeby's Antique Medical Instruments& Books

Sample of Dr. Saleeby's Antique Medical Instrument Collection. Photo by Paul Nurenberg, featured in Savannah Magazine in 2005

Over 100 medical antiques and books from 100 AD Roman instruments to Civil War Era (amputation kit, field surgical kit, etc.) to 1940's -50's equipment.

Currently for Sale (e-mail for price and viewing)
Craigslist Posting ID:

Monday, October 12, 2009

Quote of the day

"Words - so innocent and powerless as they are, as standing in a dictionary, how potent for good and evil they become, in the hands of one who knows how to combine them!" - Nathaniel Hawthorne (1804 - 1864)

Thursday, October 8, 2009

Ovarian Cancer

Ovarian Cancer (Ab ovo)

By JP Saleeby, MD

Ovarian cancer is the 5th most common cancer in women after lung, breast, colorectal and pancreatic cancers. It accounts for only three percent of cancer in women, and fortunately there has been a decline in incidence of this type of cancer by about 1% over the last twenty years. Unfortunately, diagnosis is usually late as there are very subtle and often protean symptoms and signs. Ovarian cancer is not just a cancer of old age, it can occur at any age, even infancy, however, the incidence of this cancer does rise significantly after the age of 50.

There are certain risk factors for ovarian cancer, chief amongst them is family history and some associated genetic syndromes. A blood relative with ovarian cancer raises the risk for their female relative by 5% for this cancer. There is a syndrome of hereditary breast and ovarian cancer which occurs in one out of every 500 women and being an autosomal dominant genetic disorder results in BRCA1 and/or BRCA2 gene mutation. The other is Lynch II syndrome a hereditary non-polyposis colorectal cancer syndrome, again autosomal dominant, which increases risk for ovarian cancer by 12%. However, the majority of women diagnosed with ovarian cancer have no family history and the etiology remains unknown. When ovarian cancer occurs and is not detected early when localized to one ovary, the cancer will usually spread to the unaffected ovary and uterus first, but can spread to the liver, lungs, adrenal glands, spleen and other intraperitoneal organs.

Some things that reduce risk are the protective effects of oral contraceptives, late menarche, early menopause, multipariety (having more than one child) and breastfeeding. Progesterone appears to be protective, but there is controversy as a 2009 Danish study suggests that all HRT results in increased risk (the study was performed with estrogen alone (unopposed) or estrogen & progestin (progestin is a synthetic progesterone compound). Further study in the use of natural bio-identical hormones for prevention will need to be performed to clear up this controversy as earlier studies showed HRT to be protective. There are modifiable factors such as reducing weight (avoiding obesity), smoke cessation, reducing a high starch and fat diet that can reduce risk of this cancer. It has been shown that a well balanced diet high in carotene, vitamin C and E and unsaturated fats with moderate physical activity all help reduce ovarian cancer risk.

There is much difficulty in making an early diagnosis due to the fact that signs and symptoms are very often subtle and non specific, and unless you go looking for this disease with specific diagnostic lab and radiology tests you are not likely to find it early on. Some symptoms include abdominal pain and fullness, back pain, nausea, constipation, diarrhea, fatigue, pelvic pain and urinary symptoms. Laboratory testing should be considered in women over 40-years of age if these symptoms persist as they are a higher risk population for ovarian cancer. Testing usually involves a CBC, metabolic panel and serum CA 125 levels. CA 125 is a cancer marker that is rather sensitive and specific for ovarian cancer, however there are some other conditions that can elevate this marker such as pelvic inflammatory disease (PID), endometriosis, ovarian cysts and pregnancy. CA 125 is a good test but not perfect since it is elevated in 90% of patients with advanced disease, but only upwards of 50% with stage I tumors. Additionally, there are other markers that make themselves useful, and they include the beta subunit of human chorionic gonadotropin (Beta-HCG), serum alpha-fetoprotein (AFP), neuron-specific enolase (NSE), and lactate dehydrogenase (LDH). Diagnosis is also made by diagnostic imaging, such as the Doppler transvaginal ultrasound (ultrasonography or US), often used as an initial evaluation for a pelvic mass. US is helpful in determining benign ovarian lesions such as simple cysts from those that appear more malignant such as complex solid tumors. Other modes of radiological imaging useful to the diagnostician are CT scan and gadolinium-enhanced MRI.

Treatment usually includes (after thorough diagnostic testing and staging) excision of the mass/tumor by surgery. Depending on the stage of the disease other organs may also be removed, for example the appendix is generally removed due to its potential target for metastasis. Following removal of the tumor, chemotherapy is typically initiated with a combination of platinum and taxane-based agents. Carboplatin and Taxol are two chemotherapeutic agents that are often used. For those women beyond their reproductive years, a total hysterectomy is often considered, while radiation therapy is reserved for palliative and persistent disease that reappears after a regiment of chemotherapy.

Prognosis is a bit complicated as it is based on the staging of the disease as well as the histological grade (type of tumor etiology) that typically plays a role in recurrence rates. For example, an epithelial ovarian cancer (histologically) has a low malignant potential if diagnosed at stage I and has a 95 – 99% survival rate at 10-years.

Screening for ovarian cancer should include annual physical examination and directed exams by markers and imaging only when warranted. Routine screening with CA 125 yield too many false positives and misses too many tumors early on to be a good general screening test. BRCA analysis should be reserved for descendents of those with mutated BRCA1 & BRCA2 genes, it is not recommended as a general screening tool. The current recommendations for women meeting criteria for high risk or very high risk for ovarian cancer is to be screened with a transvaginal ultrasound and have a CA 125 measured every six months during days 1 through 10 of their menstrual cycle beginning at age 35.

The take home message here is that women need to be diligent with regard to their annual physical examinations and to not ignore persistent symptoms that may point a finger to an underlying more serious condition.


JP Saleeby, MD is director of Carolina Mobile MD, a “house call service” offering integrative general medical services to clients in the Carolinas. For more visit:


Roett, M. Evans, P., “Ovarian Cancer: An Overview”, American Family Physician, Vol. 80, Num 6, September 15, 2009, p.609-616. (Accessed 10/8/2009) (Accessed 10/8/2009)

© 2009

Thursday, October 1, 2009

Dr. Casey Mann's last day at MPH

Dr. Casey Mann one of our fine and well loved FP docs at MPH is departing the fold to hang his shingle just outside Myrtle Beach, SC. Casey, was great working with you and you will be missed by patients and doctors alike in Marlboro Co. Pictured here is Dr. Moore, Casey, myself and one of our CNAs.

Quote of the day:

"Our moral progress may be measured by the degree in which we sympathize with individual suffering and individual joy." - George Eliot (1819-1880)


September 30th (night shift) marked my last day in the Rutherford Hospital ED. My 6 months helping out the group (REM) ended with the usual busy shift work. My stint in the Mts of NC is over for the summer. Back to BVille and my new "house call" practice. No great fan fair aside from the wonderful going away "party" the nursing and clerical staff threw me that evening. Will miss everyone staffing the ER up there as they were a great group of nurses, clerks, CNAs and EMTs.

About Me

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Charleston; Myrtle Beach, SC; Raleigh-Durham, NC; Orlando, FL, GA, NC, SC, VA, FL, United States