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Wednesday, November 25, 2009

Hyptis crenata (Brazilian Mint Tea) as pain reliever

Cup of mint tea is an effective painkiller

Graciela Rocha with one of her Brazilian mint plants
Graciela Rocha with one of her Brazilian mint plants

A cup of Brazilian mint tea has pain relieving qualities to match those of commercially available analgesics, a study suggests.

Hyptis crenata has been prescribed by Brazilian healers for millennia to treat ailments from headaches and stomach pain to fever and flu.

Working on mice, a Newcastle University team has proved scientifically that the ancient medicine men were right.

The study is published in the journal Acta Horticulturae.

In order to mimic the traditional treatment as closely as possible, the Newcastle team carried out a survey in Brazil to find out how the medicine is typically prepared and how much should be consumed.

The most common method was to produce a decoction. This involves boiling the dried leaves in water for 30 minutes and allowing the liquid to cool before drinking it as a tea.

The taste isn't what most people here in the UK would recognize as a mint
Graciela Rocha
Newcastle University

The team found that when the mint was given at a dose similar to that prescribed by traditional healers, the medicine was as effective at relieving pain as a synthetic aspirin-style drug called Indometacin.

They plan to launch clinical trials to find out how effective the mint is as a pain relief for people.

Lead researcher Graciela Rocha said: "Since humans first walked the Earth we have looked to plants to provide a cure for our ailments - in fact it is estimated more than 50,000 plants are used worldwide for medicinal purposes.

"Besides traditional use, more than half of all prescription drugs are based on a molecule that occurs naturally in a plant.

"What we have done is to take a plant that is widely used to safely treat pain and scientifically proven that it works as well as some synthetic drugs.

"Now the next step is to find out how and why the plant works."

Graciela is Brazilian and remembers being given the tea as a cure for every childhood illness.

'Interesting research'

She said: "The taste isn't what most people here in the UK would recognize as a mint.

"In fact it tastes more like sage which is another member of the mint family.

"Not that nice, really, but then medicine isn't supposed to be nice, is it?"

Dr Beverly Collett, chair of the Chronic Pain Policy Coalition, said: "Obviously further work needs to be done to identify the molecule involved, but this is interesting research into what may be a new analgesic for the future.

"The effects of aspirin-like substances have been known since the ancient Greeks recorded the use of the willow bark as a fever fighter.

"The leaves and bark of the willow tree contain a substance called salicin, a naturally occurring compound similar to acetylsalicylic acid, the chemical name for aspirin."

The research is being presented at the International Symposium on Medicinal and Nutraceutical Plants in New Delhi, India.


Source: BBC Health: http://news.bbc.co.uk/2/hi/health/8373791.stm

Sunday, November 22, 2009

Carbon Monoxide Poisoning

This PowerPoint Presentation was created by Sharon K. Saleeby, RRT as part of a MUSC class project. It will be presented at the December 2009 IST for MCRS.

Saturday, November 21, 2009

Ugly Numbers



Some Ugly Numbers


- JP Saleeby, MD

Examples of where a state implements a "Mandatory Health Insurance" policy are seeing some ominous signs. Massachusetts is a state that requires its citizens to carry health insurance and the outcome this year is that fewer (less than 44%) of Internists are accepting new patients, down from 58% in 2008. Only 60% of Family Practice physicians are accepting new patients, down from 65% in 2008 and 70% in 2007.

Another critical problem for Massachusetts is that there is a growing physician shortage and it is worsening. Poor reimbursements from government and private insurance companies will make "medicine" less attractive a career for those considering entering medical school thus compounding the problem. Doctors now are working harder than ever for less pay and the demands placed upon them by hospitals, insurance companies, CMS, and the public are becoming intolerable for many. This will be witnessed in other states should no action be taken to reform health care in a positive way, not only from a reimbursement end, but physician autonomy, freedom to practice with fewer restrictions and third party oversight.

Some Ugly numbers:

  • According to recent reports from the US Census Bureau & the Am. Journal of Public Health we see that 46.3 million Americans are uninsured in 2008. This is a rise from the 45.6M in 2007.
  • There has been a drop in the number of Americans with job-based health insurance in the last year from 177.4M to 176.3M.
  • The most recent data (from 2005) of deaths attributed to lack of insurance was 44,840 and that number is expected to climb.

source: Medical Economics Journal 10/2009

- Dr. Saleeby is providing high quality, individualized health care to his patients via "house calls" in a step to reduce overhead and pass savings to his patients. He is currently taking steps that are impacting health care in American in a positive way with sliding-scale fees for those patients who are under-insured or without insurance. Dr. Saleeby advocates Health Insurance with low monthly premiums (higher annual deductible) that is affordable for catastrophic events, and a health savings account (HSA) / medical saving account (MSA) for routine medical and preventive care. For more information on the practice visit: http://www.CarolinaMobileMD.com

Monday, November 16, 2009

Ezetimibe (Zetia) shown INFERIOR to Niacin (B3)

Expensive Cholesterol Drug Loses Ground To Good Old Niacin (B3)

Zetia Tablets


The battle over expensive lipid lowering prescriptions versus inexpensive safe and effective vitamins took a major turn today. Cable news programs, Newspapers and Radio all broadcasted the latest clinical trial that gave the proverbial big two thumbs down to expensive medications and a grin to Vitamin B3.


One thing disturbs me however, and that is the fact that Vitamin B3 is reported as “Niacin” or “a prescription version of Niacin” or “Niaspan” and it appears that the press (possibly under the thumbscrews of Big Pharma) are trying to belittle the fact that a Vitamin beat out a million-dollar drug. Goliath here has been smitten by a young David. And I must admire the genitals of the researchers and the journal that reported these finding as I am sure the political pressure was enormous not to publish the findings.


Once again critics bash the finding stating that they don’t believe reduction in arterial plaques have an impact on cardiovascular death rates… hogwash! The researchers that don’t want to admit that this is just one of many studies that bash expensive, dangerous and ineffective drugs are just prostitutes for Big Pharma. My 8-year old child can deduce what this study has spelled out. Stay away from costly, often times harmful and in this case ineffective medication and stick with what nature has provided. Vitamin B3 or Niacin is a safe, rather inexpensive option that really makes an impact on cardiovascular health.


Vytorin ® which is a combination of ezetimibe (the drug found in this study to be ineffective) and simvastatin a statin drug will cost you $112 for a 30 day supply at a discount pharmacy. Zetia 10mg is ezetimibe alone and will set you back $111/month at the same pharmacy. Niacin 500mg for a 100 count bottle will only run you about $6. You do the math.


Ironically, as the news spreads today about this Merck drug, Merck stocks rise as Wall Street believes this study is too limited in scope. Are people crazy? Oh, yeah and ObamaCare is spot on for us to embrace as the cure-all and fix-all for our healthcare woes. Dream on. Come on folks, wake up and think for yourselves for a moment. This study was published on the online version of the New England Journal of Medicine and was presented at this year’s American Heart Association scientific meeting in Orlando, Florida, is called ARBITER-6. And even now alongside the studies posting is an editorial by some hired gun (on the Merck payroll) who despite the study’s facts is peddling the line that people should not abandon Zetia just yet… Oh, and what are we waiting for?

Please read my “Beyond Cholesterol” article (below) and power point presentation (link) on this blog.

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Beyond Cholesterol

By JP Saleeby, MD (posted April 2005)

Cardiovascular disease the number one killer in America is at the forefront of the battle that steals years away from many Americans. Men are hardest hit, but women are not immune. Postmenopausal women will suffer death from cardiovascular causes at a rate of one in two. Cardiovascular disease kills more Americans than all cancers combined. This goes for women also; heart attacks (acute myocardial infarction or AMI for short) will take the lives of more women than all the lung and breast cancer deaths combined. Researchers are still searching for the right answer and the right medicine. Cholesterol has been in the sights for years and considered the major culprit. But there is more to this story, it does not end with just this one etiology, it is multi-factorial. Other risk factors may have more of an impact on the coronary artery than just cholesterol. For example Homocysteine, Lipoprotein (a), C-Reactive Protein, Fibrinogen and even Apoprotein A-1 and B impact cardiovascular health significantly and may even play a bigger role than "cholesterol." Tackling these other risk factors would go beyond the scope of this article, but I will take apart the Cholesterol issue.

In the past the focus was on reducing total cholesterol and low-density lipoproteins (LDL-C) a subtype of cholesterol. The National Cholesterol Education Program (NCEP) set up guidelines where they recommend Total Cholesterol remain under 200 mg/dL and LDL-C under 100 mg/dL (recently changed from a value of less than 130 mg/dL). Drugs were developed to lower total and LDL-C and thus save lives. Come to find out the true hero is the high-density cholesterol (HDL-C) subunit of cholesterol. This type of cholesterol scavenges the "bad" cholesterol and thus does not allow plaque formation to occur which narrows the coronary arteries and results in AMI. One can even measure the 5 subclasses of HDL-C where H1 & H2 may be harmful while the larger HDL subclasses of H3, H4 & H5 are considered good and reduce risk. The true predictor for cardiac risk is not the total cholesterol or even the LDL-C, but the total cholesterol to HDL-C ration (TC:HDL-C). If this ratio is above 4.8 you are at increased risk to suffer from heart disease. Once a low HDL-C and/or high Total Cholesterol level is diagnosed it is important to implement treatment. Diet alone often fails, since the liver will make up what cholesterol you don’t eat. Several therapies exist, and it is more a matter of how aggressive you need to be and how well tolerated they are as to which you choose.

In a recent case study at the SLI a 36 year old male patient with a total cholesterol of 241 mg/dL, and LDL-C of 159 mg/dL and an HDL-C of 44 mg/dL prior to any therapy was given several regiments in an attempt to control his dyslipidemia. This patient was taking and continued to take a potent multivitamin and mineral supplement and the antioxidant coenzyme Q10 (25 mg daily). First was the very well tolerated and safe Inositol Hexanicotenate (which converts to niacin in the liver) 2000 mg and Garlic 500 mg daily and after 3 months the Total cholesterol was measured at 251, LDL at 150, HDL-C at 43. Not much of an improvement. This is seen in about 50% of subjects started on Inositol Hexanicotenate. The second trial was with Zocor 20 mg at bedtime (again coQ10 was continued at 50 mg per day to offset deficiencies that can occur with this drug) and after 60 days the results were as follows: Total Cholesterol 197, LDL-C 117, and HDL-C of 40. It is interesting to note that a recent study of 153 randomized patients with CAD and low HDL were given low dose Statin and niacin combination with and without antioxidants. The subjects taking antioxidants did not have a rise in HDL-C as did those who did not take an antioxidant cocktail which saw an increase in HDL of 42%. This is of importance when a patient is not responding to statin therapy and on concomitant antioxidant therapy. These were the best results so far.

Finally, because of complaints of muscle pain and the fear of "untoward effects" from the statin drug, the patient was tried on a "new" highly touted lipid-lowering agent called Policosonal (oxycosonal, a derivative of the waxy coating of sugar cane and considered a natural alternative). After 60 days the lipid profile was as follows: Total Cholesterol of 220, LDL-C of 139 and HDL-C of 39. A slight drop in the LDL-C and total, but not good enough. Finally Niacin (in the form of sustained release Niaspan) was attempted, but discontinued after 8 weeks due to constant flushing and pruritis (itching).

While the Inositol Hexinecotinate/Garlic and Policosonal therapies are considered "natural" they certainly were not better at achieving results. Zocor a potent (HMG-CoA reductase inhibitor [Statin] drug (when taken correctly and monitored for liver toxicity and in combination with coQ10 supplementation) is a very aggressive way to lower LDL and raise HDL-C (minimally). There are now low dose statin drugs in combination with niacin (truly the one drug/supplement shown to raise HDL-C the best) that show promise. Factors that may interfere with this may be very high dose antioxidant therapy and one must follow on a case-by-case basis.

Another approach not yet explored with this patient is a combination of herbals and nutrients known to lower cholesterol. This "shot gun" approach may yield better results than any one agent used alone. As this patient is placed on a regiment of lower dose niacin, policosanol, plant sterols, tocotrienols, guggulipid, phosphatidylcholine, oat bran, garlic and antioxidants, time will tell and I will keep you posted. As an integrative physician I use the safest or least harmful therapeutics first, but should they fail, I apply more traditional synthetic drugs to reach an endpoint that is known to save or extend life. Not all that is synthetic is evil as this case study demonstrates; one has to always consider the risk benefit ratio.


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For the Beyond Cholesterol Slide Show: http://docsaleeby4.blogspot.com/2009/09/beyond-cholesterol-powerpoint.htmlfor PowerPoint Presentation

Thursday, November 12, 2009

Hypothyroidism article

This is a very good article that echoes my same sentiments and beliefs
on this disease. Is an interesting read for those interested:


Hypothyroidism: The Silent Epidemic

Hypothyroidism can be loosely defined as a medical condition that results from
the under-secretion of Thyroid Hormone. The difficulty with this traditional
approach to diagnosis of hypothyroidism is that it relies on ‘normal values,’ or
reference ranges that are defined by the population itself. It has been
estimated that as many as 50 million American suffer from undiagnosed
hypothyroidism.

Fact #1: Thyroid hormone is necessary to maintain basal metabolic rate, or the
amount of fuel that is consumed to sustain health. The manifestation is that of
temperature.
a. When a person is generating too little thyroid hormone, or if the individual
has an imbalance that involves thyroid metabolism, body temperatures will fall.

b. These persons may be told that they ‘normally have low temperatures.’
c. This bit of nonsense is causing tremendous problems for society.
d. The result is weight gain, depression and elevations in cholesterol levels.

Fact #2: The traditional approach to the diagnosis of hypothyroidism involves
measurement of a hormone released by the pituitary gland, TSH. If the central
nervous system senses that there is inadequate thyroid hormone in the blood
stream, TSH levels will increase. Increase in TSH should lead to increases in
the release of Thyroid Hormone from the Thyroid Gland. As levels of Thyroid
Hormone reach adequate levels, TSH release decreases.

Problem #1: Unfortunately, a lot can go wrong between the brain, pituitary
gland and the thyroid gland, itself. Inadequate levels of thyroid hormone can
persist, and the brain will ‘reset’ to new and lower levels of this hormone.
Factors that can cause this include:
1. chronic stress
2. pregnancy
3. trauma
4. chronic disease states.
5. autoimmune conditions
6. fasting or famine conditions.

As TSH levels drop back to normal, the diagnosis of hypothyroidism becomes more
difficult, if all the practitioner relies upon is the TSH level. Unfortunately,
this is the case more times than not.

Problem #2: Thyroid Hormone does not work alone. It requires adequate levels
of estradiol, estrone, progesterone, testosterone, cortisol, insulin, DHEA and a
host of other hormones, peptides, fatty acids and humoral elements. If any one
of these necessary pieces are missing, out of balance, or in excess, thyroid
hormone may not work properly, leading to a state of ‘functional
hypothyroidism.’

TSH levels, thyroid hormone levels are ‘normal,’ but the body does not function
properly and resembles the hypothyroid condition.

Problem #3: Thyroid Hormone replacement may be inadequate or improper for the
patient. That is, not all thyroid replacement works for all patients. There
are chemicals in some of the commercially available thyroid preparations that
cause all manners of problems. One such substance is ‘Acacia,’ which is a
family of shrubs and trees, and portions of this plant are used in some
medications to provide form and shape to tablets. Lactose is also used in the
most popular of the Thyroid Replacement Hormones. Not only is Lactose an
allergic trigger for people with lactose intolerance, but it may actually block
the absorption of the thyroid replacement, itself. Signs of lactose intolerance
include nausea, cramps, bloating, gas, and diarrhea.

It is very common to hear patients tell the doctor that the thyroid medicine
that they are receiving is ‘making me sicker.’ Unfortunately, the practitioner
does not often make the effort to figure out why this might be the case.

Problem #4: Certain foods make thyroid conditions worse. Patients with
auto-immune disorders may be more sensitive to soy-protein than other persons.
Soy contains two chemicals that inhibit an important enzyme that is necessary
for thyroid hormone replacement. If a person is already ‘on the edge,’ taking
soy protein can make the condition worse. To a lesser extent, peanuts, pinto
beans do this, as well.

Recommendations:
1. In order to sort through the diagnosis of thyroid related problems, it is
important to determine not only the levels of thyroid hormones and TSH, but it
is important to determine the presence of antibodies to the binding protein and
converting enzymes.
2. If you suspect that you have hypothyroidism, it is necessary to cease eating
anything that contains soy, soy lecithin, peanuts and pinto beans.
3. Replacement of thyroid hormone should be accomplished with products that do
not contain lactose, Acacia, and artificial colorations.
4. Thyroid hormone must be taken on an empty stomach.
5. Determination of hormone imbalances that affect thyroid metabolism must be
accomplished.

Source: e-newsletter from David S. Klein, MD

Tuesday, November 10, 2009

MSM and Performance Athletes


Came across this article by Dr. Klein.  Spells out some basic principles on
neural reflexes and pain and performance. Added a few things to the piece in
"[ ]"

The Spinal Withdrawal Reflex and Athletic Performance

While the principal focus of athletic training has been placed, traditionally,
on improvement in strength and enhanced flexibility, measurable degradation in
actual performance results from involuntary, protective mechanisms ‘hard-wired’
into our nervous system.

The Spinal Withdrawal Reflex (SWR) is one such protective mechanism that robs
the athlete of what could be the winning difference or competitive edge.

Sometimes known as the nociceptive spinal reflex, the SWR protects the body from
self inflicted damage. Stretch, pressure, or pain receptors are triggered, and a
signal follows the sensory nervous system to the spinal cord. Processed in the
Dorsal Horn, a reflex signal is then sent back to the same limb or region of the
body accomplishing a ‘shut down’ of the offending muscle or muscle groups.

One example might be a tear in the rotator cuff of the shoulder. As the athlete
reaches with the arm, a pain signal from the damaged shoulder ligament travels
to the spinal cord causing a reflex ‘withdrawal’ of the shoulder muscles.
Because of the SWR, and due to the protective nature of the reflex, the shoulder
muscles are never allowed by this body to operate at full capacity,. The net
effect is decreased range of motion and a measurable decrease in strength. This
decrease is estimated to be between 1-4% of optimum performance.

Important to the athlete is that the decrease in range of motion, strength and
flexibility can be reduced or eliminated by decreasing the pain modulator in the
damaged tissue. That is, modulating the pain receptor can measurably and
significantly improve performance and recovery. This must be accomplished
without increasing the likelihood of re-injury. Medicines that ‘numb’ the pain
receptor increase the likelihood of re-injury by reducing the pain signals that
result from tissue damage. Local anesthetics and counter-stimulants fall into
this category.

While it is critical for full recovery, to insure that the injury has proper
time to heal, it is also vitally important that the rehabilitation process
allows for full extension and performance of the injured area. Too many times
the physical therapy recovery is inhibited by the discomfort of the person going
through their exercises. We must make certain that the individuals in recovery
are “pushed” to their safe limits in order to guarantee they return at optimum
effectiveness. Ironically, the more strenuous the safe management of the
recovery process, the quicker we can usually expect a return to activity. This
time factor can be critical regardless of whether you run a dojo or are
competing.

The pain receptor can, however, be safely modulated with resulting improvement
in strength and flexibility using anti-inflammatory and anti-oxidant topical
medications such as a high-concentration methylsulfonylmethane (MSM) containing
salve.


In summary, the performance-robbing qualities of the spinal withdrawal reflex
can be reduced, with high concentration transdermal MSM, thereby improving
flexibility, range of motion and muscular strength. Improvement by as little as
2-5% in strength, reach and range of motion could make the difference between
winning and losing. It has been said that at the professional level in most
sports the difference between winning and losing is usually around a 1%
difference in performance. Low concentration MSM containing salves, such as
Tiger Balm® are somewhat beneficial where newer products that contain high
concentrations of MSM, such as Kink Ease® provide much more rapid and dramatic
results.

[Taking MSM orally or topically is beneficial. NSAIDs as well as SAMe, Vitamin C
and Zn for tissue repair, Boswellia serrata as an anti-inflammatory, Turmeric,
and L-Proline are all beneficial. These are found in Joint Support
(http://www.vitasanus.com/vsn_products/jointsupport.htm). Also MSM can be
compounded in a high potency topical cream by a compounding pharmacy under the
direction of an MD/DO. Oral MSM (http://www.vitasanus.com/vsn_products/msm.htm)
can be ordered from sites such as this.]

Source: David Stephen Klein, MD, FACA, FACPM
Pain Center of Orlando, Inc.

Monday, November 9, 2009

Vitamin D-3 & Viral Infections


Vitamin D-3 in the Prevention & Treatment of Viral Infections and Influenza

Supplemental cholecalciferol (vitamin D) significantly reduces all-cause
mortality emphasizes the medical, ethical, and legal implications of promptly
diagnosing and adequately treating vitamin D deficiency. Vitamin D deficiency is
common, and is implicated in most of the diseases of civilization.

Vitamin D-3 is a steroidal hormone that targets more than 200 human genes in
a wide variety of tissues. With genes as its target, vitamin D has been shown to
up-regulate the gene that is involved in the production of cathelicidin, a
naturally occurring broad-spectrum antibiotic.

Treatment of vitamin D deficiency, in otherwise healthy persons involves
dosages between 2,000-7,000 IU vitamin D-3, daily. With serious systemic
illnesses, associated with vitamin D deficiency, such as cancer, heart disease,
multiple sclerosis, diabetes, autism, the doses should be somewhat higher to
maintain 25(OH)D levels between 55 -70 ng per mL.

Vitamin D-deficient patients with serious illness should not only be
supplemented more aggressively than the well, they should have more frequent
monitoring of serum 25(OH)D and serum calcium.

NOTE: Doses of vitamin D-3 (2,000 IU per kg per day for three days) may produce
enough of the naturally occurring antibiotic cathelicidin to cure common viral

respiratory infections, such as influenza and the common cold, but such a theory

awaits further science. This is a very high dosage regimen. For general use,

Vitamin D-3 dosages of 2,000 to 5,000 IU are sufficient to enhance immune
function
and minimize flu symptoms, if exposed to the virus.




Vitamin D-3 is very inexpensive, about $4 per month.  Because Vitamin D-3 is
oil-soluble, it must be taken with an oil capsule, of almost any type.

Source: David S. Klein, MD, FACA, FACPM is the Medical Director of the Pain Center of
Orlando, Inc. A graduate of the University of Maryland School of Medicine, Dr.
Klein
received training in General Surgery at the University of North Carolina,

and Anesthesiology at Duke University.


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