The Medical News Report

#124

May, 2022

Samuel J. LaMonte, M.D., FACS

 

samlamonte@gmail.com

www.themedicalnewsreport.com

 

Subjects:

1. COVID-19 updates

2. Autoimmune diseases part 4 Addison’s disease, Sjogren’s disease, Myasthenia Gravis

3. Stress incontinence of the bladder

4. Resurfacing of aging skin--Retinoids, Vitamin C, Hyaluronic acid, and lasers

5. Progress in cancer 1971-2022

6. E-15 gasoline in 2300 stations

 




 

IMPORTANT REMINDER!!!! PLEASE READ!!!

  I remind you that any medical information provided in these reports is just that…information only!! Not medical advice!! I am not your doctor, and decisions about your health require consultation with your trusted personal physicians and consultants. 

  The information I provide you is to empower you with knowledge, and I have repeatedly asked you to be the team leader for your OWN healthcare concerns.  You should never act on anything you read in these reports. I have encouraged you to seek the advice of your physicians regarding health issues. Feel free to share this information with family and friends, but remind them about this being informational only. You must be proactive in our current medical environment.

  Don’t settle for a visit to your doctor without them giving you complete information about your illness, the options for treatment, care instructions, possible side effects to look for, and plans for follow up. Be sure the prescriptions you take are accurate (pharmacies make mistakes) and always take your meds as prescribed. The more you know, the better your care will be, because your doctor will sense you are informed and expect more out of them. Always write down your questions before going for a visit. 

Thank you, Dr. Sam



 

1) COVID-19 updates
 

A. Opening 

  There are many good reports in this update, and be sure to read the strategies for the future and criticisms of the management of the pandemic towards the end.

  Another shocker about China!! 2 Australian researchers have proof positive that Chinese surgeons have been routinely procuring organs for transplant from patients still with brain activity and are still alive. This information was published in the Journal of Organ Transplantation identifying 71 articles in the Chinese databases between 1980-2020 procuring the organs before the person was declared dead. These databases were apparently never read by anyone with a soul before these 2 reseachers obtained 71, with 348 surgeons reporting on this practice involving problematic deaths.

  This activity made China the second largest transplant country in the world. The publication did not mention where these patients came from, but who wants to bet they are Uyugors from Northwestern China, who have been tortured, sterilized, and kept prisoners, working for little money, and unvaccinated!

  This inhumane practice should make those doubters about the medical practices, lying, deceiving, etc. and should not be trusted for their research in the Wuhan Virology Labs.

  If this is not enough evidence that the Chinese Communist Party is capable of any atrocity and can’t be trusted for any health related issue, such as leaking the virus from the Wuhan Virology Labs, I am sorry for those who don’t get it. 

  These 348 Chinese surgeons performed these inhumane practices since 1980 just as the Nazis performed unthinkable medical experiments during WWII on thousands of Jewish prisoners..

American Journal of Transplantation, April 4, 2022

The natural immunity afforded by a COVID infection in unvaccinated people 

  The JAMA Network released a study that proved those who got the infection and were unvaccinated, got the same amount of immunity as those with the vaccine, and the natural immunity lasts longer, according to the Providence Health and Services (one of the largest health networks) and the University of Chicago, performed in the fall of 2021. Why are we hearing about it now in May, 2022??? 

  The researchers found those unvaccinated that contracted an infection had an 85% protection against re-infection and 88% of hospitalization if they did get re-infected. These are the same statistics produced by the vaccine companies and researchers working for them. 

JAMA Network Open, April 19, 2022

  These stats were before Omicron, and are only now being made public. BA-2 Omicron has changed the stats for both groups.  Omicron has also reinfected people with the booster. It also now known that the first booster afforded only about 4 weeks of higher immunity than what the vaccine gave. The research on the 4th dose (2nd booster has shown even less time for accelerated immunity).

  Keep in mind there has never been a scientific study to prove just how much immunity individuals need to be protected from COVID. Only observational studies have been published, and the controlled nature of these studies has been often questioned. 

  This information has been plentiful from multiple sources, while the administration and the CDC has ignored what most of us intuitively knew. Their answer has been mandates, firings, exclusions, loss of employment and businesses, and financial dependence on the federal government. And now that the college kids came back from spring break, the case loads at colleges have put them back in masks, taking classes at home, and essentially shutting down the campuses. This is only true in certain North Eastern U.S., California, Illinois, and Texas campuses. 

  Vaccines have never been the only answer to the pandemic. Even with natural immunity and or vaccinations with boosters, we still do not have long term immunity, and still will need more shots. However, what that means has yet to determined.

  I have supported the vaccine but constantly criticized the government for not rcognizing natural immunity and not performing studies on these individuals, just to strengthen the vaccine need and force people to get it against their will.

  Our government has depended on Israel’s research for decisions primarily, when, in many opinions, the U.S. should have been performing these critically important studies in our country.   

  Big Pharma has way too much power over our government, and even though the vaccine is the safest way to obtain immunity, those who got the infection should be very upset they have been treated like second class citizens. 

  This mismanagement is a a good example of how much we do not want socialism and a Marxist country for their future. The writing is on the wall for those who propose globalism, socialism, cancel culture, CRT, and woke ideologies. Most of us will not tolerate it.  

  My concerns are real, but having been a big supporter of the vaccine (and still am), as long as this is a free country, we deserve to make personal decisions for ourselves, trust in science, and we don’t need a woke big tech, media, and big corporations telling us what to do without the best sound scientific research. As usual politics have interfered with good judgement. 

  

B. BA-2 (so called stealth variant) Omicron now global

  86% of sequenced cases are now BA-2 Omicron in the U.S., the subvariant of Omicron, more transmissible but not more deadly, so with the percent of the population that has been vaccinated, boosted, and has natural immunity, we still should have herd immunity, but with the BA-2 Omicron, these new variants are finding ways with new mutations to get around the immunity most of us have plus higher transmissibility, however, these infections are not severe, but those who get re-infected are usually those with higher risks. This calculates to a continued drop in hospitalizations, and deaths. 

  Boosters are more important to reduce cases, but a 4th is just not necessary for healthy people, even though Big Pharma wants everyone to get them to pad their pockets, and give more money to lobbyists to buy our government. It is still a free country with some who want freedom of speech on Twitter. Thank you Elon Musk!

  China and Europe, and especially Germany are seeing upticks in the virus, but must not create hysteria in our country. This virus will continue to mutate and cause trouble. We will have to live with it.

  Re-infection has occurred in those who got infected with the Delta variant, however, the BA-2 Omicron infection has had some re-infection cases recently reported.

Reuters Health News, March 30, 2022

  60% of the country already has been infected, and 95% of the country has some level of antibodies against COVID-19. 

   Healthy children who are vaccinated do not have many re-infections fortunately. Adults with vaccinations do much better than those who don’t get vaccinated. 

  People with a prior infection have at least 6-9 months of immunity (possibly longer), but they are better protected with just one vaccine dose, and the CDC needs to admit it and get these people back to work and off the mandate.

 

C. COVID Testing now using a breath test

  Finally, a FDA approved simple test, a breath test, to diagnose COVID-19, whether asymptomatic or not. This emergency use approval for a device called InspectIR COVID-19 Breathalyzer delivers results in 3 minutes. 

  It must administered by a trained operator. The device can run about 160 tests per day, and will be available in clinics, hospitals, and authorized  mobile sites. 

  This is a test of chemical mixtures that spots the presence of 5 compounds associated with the coronovirus.  It uses chromatography and spectrometry techniques, correctly diagnosing the virus in 91.2% of correctly identifies the virus (sensitivity) and 99.3% of the false negatives (specificity). It has been just as effective for the different variants and subvariants. Why have we not heard about this from the CDC and media?

  The FDA still recommends confirmation with a PCR test as well, which seems like overkill, but with a new test, confirmation of a positive test is critical. 

  The FDA stressed it should not be used as the sole test for now, as the PCR nasal test is still the standard. It did not state it will be covered by the feds, and for that matter, there are reports that in 3 months, the vaccines, testing, and treating of COVID-19 will no longer be provided free. This could change when the public finds out about that information.

MedicineNet.com 

 

D. Mask mandates overturned by Federal Court

  On April 19, a Federal Court Judge overturned the adminstration’s mask mandates for transportation including airlines, buses, trains, cabs, uber, etc. 

  This mandate without scientific data, enacted this in February, 2021, was declared unconstitutional, because the Congress never granted the CDC the power to create a requirement for transit mask mandates. Of course, the administration will appeal the decision. Where is the scientific proof for their decisions. Power and control!!

  Airlines will not require masks, however, certain airports are holding on to the mandates. 

Medscape Surgery, April 18, 2022

  The CDC does not mandate masks in schools, but many still require it anyway. 

  Masks are correct for the high risk, but not as a political statement.

  As mentioned above, some colleges have had rising numbers of cases, and are shutting down classes,  requiring masks indoor and outdoor on campuses, cancelling gatherings.  



 

E. Vaccinations are still very effective against all variants; 2nd booster (4th dose) value shortlived; Children twice as likely to be hospitalized if unvaccinated

  Comparing vaccinated to unvaccinated people, those with at least one dose of vaccine had an incidence 2.4 cases/100,000 of reinfections, while the unvaccinated have 10.26 cases/100,000. That is 82% effectiveness.

  Those over 65 had slightly higher numbers (3.02 cases/100,000).

  They also found that multiple doses didn’t really change the numbers of cases much, so why the 4th dose?

  Israel, smartly, have recommended 1 dose of vaccine for those who had a COVID infection and natural immunity. The CDC follows everything Israel has put out, so why not just the one dose for those with natural immunity in the U.S.??? 

  BTW, Israel has no mandates!! 

NEJM, March 31, 2022

  A year after an infection (and probably the vaccine) the body still has responses from memory blood T and B cells, and have not been disrupted by recent variants. Finding ways to make these memory cells respond better would be another option for prevention of re-infection or even the long term syndrome in the future.

Reuters Health News, March 28, 2022

  The latest data from Israel (published in NEJM, April 5, 2022) reports that the 2nd booster (4th dose) works but not for long. The immunity starts waning by 4 weeks. 

Reuters Health News, April 6, 2022

Children still can get infected if not vaccinated

  Children 5-11 are twice as likely to be hospitalized if not vaccinated, according to a study from Atlanta analyzing children from 11 states.

   A third of the children had no underlying diseases to complicate their illness. Black children were twice as likely to have more severe disease than white kids (44% vs 22%). Many of the more severe cases had obesity and diabetes. The majority of cases were Omicron.

  It was noted that no children needed high flow oxygen. Regardless the number of cases hospitalized, it was still small, so take that into consideration when reading this article. 

From the CDC Morbidity and Mortality Weekly Report, April 19, 2022

  Big Pharma continues to push for vaccines given to those 6 months-4 years of age, although not FDA approved yet. 

  When we get the science, I hope they will separate cases, etc. in healthy vs higher risk kids. Everyone knows that high risk humans at any age should be overly protected, but healthy kids may not.

 

F. Long term COVID syndrome; updates on value of vaccination, medications and ivermectin

  The best way to prevent the long term COVID syndrome is to get vaccinated with a booster.

  It is being recommended to receive the vaccine soon after a COVID diagnosis, because they have less liklihood of getting the long COVID syndrome. Re-infections are fewer also if vaccinated.

  Another study found that those on immunosuppressive drugs for ulcerative colitis or Crohn’s disease, who stopped their meds when infected, were more likely to develop Long COVID. Older patients and those with underlying disease were more likely as well.

  Many researchers are working hard to come up with a drug(s) that will treat the multiple symptoms of the long syndrome from prolonged symptoms after recovery from infection. 

  4 drugs are being studied 2 antihistamines—loratidine (Claritin), and famotidine (Pepcid-AC), the gout anti-inflammatory drug colchicines, and the oral anticoagulant Xarelto.

  The goal of treating these symptoms is to return the normal function of the mitochondria in the cell, thought to cause fatigue in this syndrome.

  The risk of developing the long term syndrome is 20%.

Medscape, March 28, 2022

 

Ivermectin Research

  I have seen many research articles from various foreign countries (China and India) that refute the value of ivermectin, an FDA approved medication for human worms. Since it is FDA approved, it can legally be prescribed “off label” for any disease. There has been little research outside of the animal lab that ivermectin has any real value for treating early COVID-19. There are even studies that show value against cancer too, but not in any well known medical journal. 

  This month, the NEJM, just published 2 separate peer reviewed studies from Brazil and the U.S, and ivermectin was compared to placebo (without any other supplementsor medications being added),and was found to be of little value in decreasing hospitalizations or emergency room visits. 

  No study has been performed regarding symptom reduction as outpatients due to the difficulty of keeping the study from being contaminated with untrustworthy data. But there are plenty of testimonials, which means nothing scientifically.

  Many doctors have been fired, removed from their hospitals, etc. for writing a prescription for a drug with little to no side effects. I have no proof that there is good scientific data that unequivocally proves it’s value in reducing the severity of COVID-19 symptoms, although, I have been told by many people (testimonials) that it was very helpful in reducing their symptoms. I can’t recommend a drug without scientific proof. 

  This is very controversial, but talk to your doctor if you want his or her opinion.

NEJM-Journal Watch, April 8, 2022 

 

G. Vaccination updates and other information 

  As noted by certain medical studies, giving the first 2 vaccines so close together created really only one shot for raising the antibody levels. In fact, if given at least 10 weeks apart, they would have given a 10 fold increase in those 45-54 and 13 fold in those younger than 25. This was another pharmaceutical decision to make money.

  Since we received the second dose in 3-4 weeks, there was only a 2 fold increase in antibodies. These results were obtained from healthcare workers in the UK. However, there are other forms of immunity that were not affected by the closeness of the 2 shots, according to the author, Dr. Ashley Otter.

  Those with a prior infection and later one dose vaccine was found to have the highest antibody response 3 months after the infection.

  4th doses were only given to those over 75 years of age in the UK. No one else!!

Findings presented at the 32nd European Congress of Microbiology and Infectious Diseases, published in Medscape, April 24, 2022   

  Over 30% of those 65 and over have not had a booster, 20% of nursing home residents have not. There are those with a booster that have been infected, which has deterred many from getting the booster. But if 65 or over, it is clear, one booster is worthwhile, and it still does prevent more serious disease at all ages. 

 J&J vaccine has higher death rates

  5/100,000 of the J&J vaccine die of infection vs other vaccines at 2/100,000, while those unvaccinated die at a much higher rate-20/100,000. 

  The J&J vaccine is not an mRNA vaccine as Pfizer and Moderna are. It is produced using an adenovirus and only needs 1 dose. Those patients must receive Pfizer or Moderna boosters, but even with that booster, their death rates were higher too.

  In defense of J&J, these recipients have fewer breakthrough or re-infection cases, according to the CDC. The low number of hospitalizations is also very good. 

  I don’t personally like to compare good vaccines with each other as long as they are showing great results. 

  The mix and match vaccines have been very successful. 

MDLinx, March 28, 2022

 

CDC’s guidelines for masks

  The CDC does not recommend masks unless the community has at least 1000 deaths per day nationwide, which we don’t have. They have also frozen certain preventative measures with the large drop in hospitalizations and deaths. 

  Recommendation for dropping Title 42 on the borders is a disaster, and I will discuss later in this report.

  Testing is being underutilized according to many experts. Yet, certain cities and colleges are overriding their recommendations with continued mandates for indoor masks.

New subvariants of Omicron

  There is another subvariant, XE, a combination of BA-1 and BA-2, including BA-4 and BA-5, which has begun in South Africa, but little information is available. 

  The future of continued vaccine boosters is still being studied. Likely, it will be a yearly shot, because more than that will not be met with enthusiasm. In fact, with a failed flu vaccine this year, expect significant hesitation.

 

H. COVID-19 linked to autoimmune diseases

  It is well known that this pandemic is an immunity disease, as are over 100 autoimmune diseases. The virus stimulates the same T and B cell lymphocytes that occurs in autoimmune diseases. The coronavirus stimulated inflammatory markers that cause damage similar to all these autoimmune diseases.

  A recent article in Medscape reported that those who are infected by COVID-19, between the ages of 18-65 are at higher risk for developing skin and vascular diseases that are autoimmune in etiology, according to the American Academy of Dermatology and Internal Medicine at Harvard Medical Center. 

  As stated many times, viruses have been implicated in developing many autoimmune diseases. The pro-inflammatory pathobiology of COVID-19 makes it a good choice for increased risk of developing these autoimmune diseases. Could there be a connection with the long term COVID syndrome as well? 

  They found an increased incidence of dermatomyositis, scleroderma, and lupus, all of which affects the skin and vascular system as well as other organs in their infected patients. Sarcoidosis, Raynaud’s phenomenon, temporal arteritis, cutaneous vasculitis, and granulomatosis with vasculitis also were more common in these patients. This fits perfectly into my series on autoimmune diseases, with 5 parts already in this and the last 4 reports.

Medscape General Surgery, March 26, 2022

 

I. Millions more with new Type 2 Diabetes as late manifestation of COVID-19

  According to a VA study, those previously infected have a 40% higher risk for developing type 2 diabetes within a year after infection. Obesity and family history are factors that increase the risk further. 

  All patients who had a symptomatic COVID infection should be screened later for diabetes, as millions of people will go undiagnosed without screening.

  More cardiovascular and kidney disease is expected as the study is still ongoing for these same patients. Type 2 diabetes is a hotbed for heart disease, hypertension, and kidney disease.

Lancet Endocrinology, March 21, 2022 

 

J. CPAP (continuous positive airway pressure) machines and COVID-19; prone positioning in COVID

  Early on in the pandemic, ventilator supply was overwhelmed, because so many cases were intubated and put on ventilators. Thanks to cooperation of the private sector with the government, hundreds of ventilators were made right here in the U.S.

  Unfortunately, doctors wrongly decided that high pressure from a ventilator was critical to save a patient who had dangerous drops in blood oxygen (less than 94% oxygen saturation). In many cases, the high pressure killed the patient.

  After losing hundreds of patients around the world from ventilator deaths, some brave treating doctors at major centers started using tightly placed face masks and CPAP (continuous positive pressure air pressure) machines instead of ventilators to raise the blood oxygen, perhaps not as high as previously desired and were successful in preventing the use of ventilators in many cases. They also found that placing patients in the face down position allowed better pulmonary ventilation. 

Ventilator

CPAP with mask

The death rate for using ventilators for respiratory failure has been reported as high as 50% as published in the American Journal of Respiratory Critical Care, Jan.1, 2021. These are the sickest patients requiring admission to the ICU and intensive medical and nursing care. Unfortunately, many patients had to be put on ventilators as no other methods worked. 

  A recent study in the UK found that CPAP masks with their machines currently being used by millions of people for obstructive sleep apnea had better results than with ventilators. 33% who were first treated with CPAP, and avoided a ventilator, while others without CPAP, required a ventilator in 41%. 

  Unfortunately, the death rate was the same, but it did prove that trying CPAP before using a ventilator is well worth it, especially where ventilators are scarce, and complications might be avoided.  

  A ventilator requires the patient to be totally sedated and paralyzed with medication. It also requires much more monitoring, costs a lot more, and causes many more airway complications. 

NEJM Journal Watch, January 24, 2022 

 

Prone Positioning in ICU improves ventilation; Value of anticoagulants and protection of organs in hospitalized patients

Patients were found to breathe better in the face down position (prone) for those intubated. Those not intubated also improved their breathing, gas exchange, and decreased lung stress, if they could tolerate the prone position.

  A recent study found that treating patients with high flow oxygen using nasal cannulas lowered their chances of needing intubation as well.

  When they started using the prone position in these patients as well, studies showed they were less likely to need intubation than those who were face up (supine, elevated). This saved a lot of lives.

Lancet Respiratory Medicine, March 17, 2022  

 

Anticoagulants (aspirin or heparin) and protection of emboli to organs during hospitalization for COVID

  Blood clots during a severe COVID infection are very common, and now a study was performed retrospectively to see if blood thinners improved survival and protected the body’s organs better than no blood thinner. Unfortunately, for those severely ill, it did not appreciably improve organ protection or survival. 

  Other studies have shown some improvement in moderately sick patients but these patients were not in the ICU. 

  The use of anticoagulants is common place in patients hospitalized because of the clotting abnormalities created by the inflammatory markers with emboli in some cases, and there has been a hypothesis that microemboli continue to occur in patients with the long COVID syndrome.

  It is always up to the treating physician to determine the need for any medication. JAMA Network, March, 22, 2022

 

K. Cardiovascular complications for at least a year after being infected with COVID-19

 

Those who get infected with COVID-19 have the long term syndrome to worry about, but also there is a new study that reports increased risks for cardiovascular issues for at least a year after recovery. This has even occurred in patients who did not have cardiovascular disease prior to infection, according to an article in the journal Nature on February 7, 2022. 

  This study found this occurred in young and old men and women and those with mild illnesses. Very few of these 154,000 veterans were vaccinated (from March, 2020-January, 2021.   This translates to 3 million patients with cardiovascular complications following even a mild infection if these stats would be the same in the millions of infected patients. 

  This is another good reason to get vaccinated regardless of the risk of getting infected even after a booster. These stats translate to a 72% higher risk of coronary artery disease, 63% of heart attack, 52% of stroke with a 55% overall risk of heart disease in people without vaccination during the first year after infection.

  This group is in contrast to those who were hospitalized with serious heart and lung complications from the acute COVID infection. 

  Those who developed cardiovascular disease were included in the long term COVID syndrome.

JAMA, March 2, 2022 

 

L. More on “gain of fuction research” and origin of the Wuhan virus

  Some more of the media, conservatives, and many moderate liberals have come to agree there is a distinct possibility that there was a leak from the Wuhan Virology Labs, and China continues to refuse comment or access to their data in the labs. We also now know that the U.S. Federal Government has provided grants for coronavirus “gain of function” not only in the U.S. and Wuhan, but now in Ukraine, before the pandemic was known to the world.

  There is information about the U.S. Department of Defense being responsible for grant money for coronavirus in Ukraine. There is a website providing COVID spending and as of February, 2022, the feds spent $3.63 trillion with a budget up to $4.7 trillion. www.usaspending.gov

  The newest information from that website found grants were given to Labyrinth Global Health Inc. for “biological reduction threat” research, collaborating with Peter Daszak, EcoHealth, the same non-profit company that received grants from the NIH for “gain of function” research for work in Wuhan. The grant was earmarked on November 12, 2019 to Kyiv Labs, a full month before there was evidence that a virus was killing people in China. 

  It appears the U.S. was trying to help Ukraine defend themselves against possible biological terriorism.

  This type of research to defend ourselves and other countries from potentially invading countries, makes total sense to me, but since a doctor denied to Congress that these grants ever happened (Dr. Fauci, Head of the infectious branch of the NIH), supporting  “gain of function research”, it comes into question, just what is the truth? 

  If the U.S. has been involved with research for the very virus that caused the pandemic, no wonder the federal government would not want to investigate the origin. But only the Chinese Communist Party’s lab likely leaked the virus, it would not be our fault for their carelessness, but allows fingers to be pointed at the U.S. and keeps us quiet.

 

  The printed matter below was copied from The Daily Expose’. If would be important for a U.S. Congressional investigation on the origin to be actively investigating, but none has been authorized House Speaker Pelosi. Maybe after November!!



 

 

M. Next steps for COVID-19—endemic or seasonal with surges; Who will decide the strategies? It is time to regroup??

  The next step for the pandemic is coming soon. Most experts have to admit with the number vaccinated, those infected and re-infected, and the reduced virulence of the latest variant (Omicron), we are nearing the end of the pandemic, according Dr. Soniya Gandhi, head of medical affairs at Cedars Sinai in New York. And why are the experts not saying we are at herd immunity and do not need any mandates? Primarily because these subvariants keep creating cases, but nothing like the last 2 years.

  Experts have stated that 95% of Americans have some level of immunity with 60% of Americans having had the infection.

  The CDC is not using the word herd immunity yet, for fear that will relax those uninformed and cause more infections with poor behavior. 

  With the other issues facing our country, especially the energy crisis, inflation, the southern border disaster, overdose deaths, and financial crises escalating, where are the solutions? 

  Previous Medical Directors of the CDC have been criticizing the administration for the CDC being under funded and not being able to meet the needs of the pandemic, relying on Johns Hopkins Medical School for the surveillance of cases, etc, with too much politicization of the organization from the White House. This was reported by Dr. Robert Redfield, most recent Past CDC Director, published in Medpage Today, April 22, 2022, who cited many problems, most of what I have been reporting. 

  Experts have been aware of how behind we have been in managing the pandemic from the beginning, with significant lack of preparations for decades. The MERS(2002) and SARS-V (2012) epidemics occurred during President Bush and Obama’s time, and yet nothing was done to prepare for future pandemics.  COVID-19 includes President Trump and Biden.

  With an administration’s overall approval rating at 33% (Quinnipiac Poll), who needs to be making decisions about the pandemic and our overall healthcare system? 

  Our children have been made pawns, our middle class devastated with lockdowns, our nursing homes and hospitals overwhelmed, and the delays in care have caused millions of patients to experience progression of their health condtions. Speaking of children, 1400 children were unaccompanied across our border last month by Cartels charging $5000 a child. OMG

  Our vaccine and boosters is not working as well as hoped against the current BA-2 Omicron variant, but still is much better than those unvaccinated. Every form of protection and prevention may need to be implemented in places who are experiencing surges, but mandates are not the answer.

  Private practicing physicians and academicians need to share in the decisions for managing pandemics with the public health officials when dealing with the public and fewer politicians. They were left out of this pandemic. There must be independent input not influenced by polls and politics to balance benefit with fewer horrible unintended consequences as we have experienced. 

 

 N. Title 42 must stay! We need better management and more concerns for our country!

  As far as health disasters, Mexican Cartels are being allowed to make $100 million a week just for human trafficking of illegals across the southern border. 1400 children came across our border UNACCOMPANIED in one week. OMG!

  That does not include the revenue made with illegal drugs being smuggled across the border, causing 105,000 deaths in the U.S. last year from overdoses for all ages (66% were from fentanyl), manufactured in China and added to 40% of other illegal drugs including cocaine, methamphetamines, and opioids bought on the streets of our country.

  The number of drug deaths has doubled in ages 14-18 and 77% were fentanyl related. Have you heard any concern from the White House about the disastrous overdoses, cartels, crime, sex trafficking, disease spread, and economic strain of our country using millions of COVID dollars to spend on the illegals?? Also COVID dollars by the billions have been spent on the southern borders, given to states for non-COVID purposes (especially NewYork, Illinois, and California).

  VA doctors are being sent to the border to care for the 120,000 illegals crossing our borders monthly? There is 150,000 cases backed up in the VA now, and the administration wants to send VA doctors to care for sick illegals instead of our veterans. OMG!

God bless our poor border agents who are burned out and have had to overcome every adversity with 7000 illegals a week and with the loss of Title 42, 18,000 are expected per week. The Homeland Security Secretary said they can handle no more than 5000 a week and has no answer for what could occur after May 23. This came from The New York Post article and an interview with Assistant Attorney General of Texas, Brent Webster.

  Webster said that by the time the first presidential term is over in 2024, we will have over 40 million illegals in the U.S., who have crossed our southern border since the new administration took over. Add the 30 million illegals already here before 2021, and America’s population will consist of 20% who will be illegal. Why???? VOTES at any cost.

  The latest answer to the our gas crisis….put E-15 ethanol (10% is allowed now) gas in the summer months in 2,300 gas stations to begin with. Ridiculous! It will harm our engines unless the car is equipped to use variable octane gas. Normally ethanol is restricted during hot months because of potential harm. 

  See the last article in this report for the name of stations, as of April 10, cities, and states, from the website: www.pure-gas.org

  These are health issues, and the reason I report on it and sad to have to.

 

Walgreen’s shares the opioid crisis responsibility

  BTW, Walgreen’s is being sued with the company that manufactured oxycodone for distributing the drug in enormous amounts to small town pharmacies around the country. An example includes distributing 2 million pills to 2 towns with populations of around 12,000. 

 

O. Medical Journal Quality questioned by experts

  At long last, there was an article in Medpage Today stating that the quality of medical journal articles have suffered greatly from the pandemic. During the last 18 months, there have been 200,000 articles in various medical journals published, and the peer review process has suffered greatly dropping the equality and validity of research. 

  This is the most important quality control measure when outside experts evaluate the study and require questions and answers from the authors if there is confusing results with questionable methods.

  There is a new Editor-in-Chief for the JAMA, and she will take that journal representing many of the doctors in this country to a more preventative frame of mind. However, Dr. Kirsten Bibbins-Domingo is quite interested in many of the woke ideologies, and will be the main person who chooses what research is allowed to be published in JAMA. 

  I will continue to watch this continued liberal movement in medicine as many of the academicians are quite interested in taking our healthcare to socialized medicine.  

  Observational studies make up the majority of these research papers rather than double blind research projects, and the journal acceptance rate increased greatly allowing significant numbers of articles that were greatly questioned. This is according to Dr. Patrick Borgen, Maimonades Medical Center of NYC.

  Many of these journals through the internet have published articles on a weekly basis, when most of the journals only publish once a month. 

  The emergency crisis of the pandemic lowered the standards of medical journals, and now some experts are finally pointing the finger. I am happy they share in my concern, as I review hundreds of articles to pick the ones I feel are worthy of my report.

  The preprint websites have been the worst offenders. The internet site MedRxiv was specifically called out, with 11,000 submissions and 90% accepted.

  I will continue to be selective, and provide the best articles for the reports. 

Medpage Today, March 9, 2022 

  I will be discussing the difference between equity and equality next month, the medical journals are using the term equity when they should be using the word equality. This has clouded many articles in the liberal medical journals. 

  Equity implies equal service to all without regard to desire, qualifications, initiative, etc. Equality means everyone is given the same chance or opportunity to have , a medicine, operation, or treatment. Equality for all is our constitutional right, not equity. This has been emphasized when describing race, and has created a lot controversy. I will expand on this when I discuss all of the coined words that are used by the socialists.

 

P. Healthcare professionals have suffered from over 2 years of the pandemic, affecting care!!! READ THIS! 

  The AMA has announced that 1 in 5 physicians will likely leave their current practices within 2 years. 1 in 3 doctors and other healthcare staff state that they intend to reduce their working hours in the next 12 months, according to recent survey research published in the Mayo Clinic Proceedings. There were 20,000 respondents at 124 institutions across our country. Burnout, workload, fear of infection, anxiety and/or depression due to COVID-19 and the number of hours in practice were the key factors in their decision. 

  Because of the pandemic, 4% of all physicians in 2 years quit private practice and became employees from rasing the number from 69 to 73% of all physicians. This is not good for healthcare, because a physician who does not make his own rules for practice is a physician who is told what to do by administrators. The nurse practitioners are happy to fell the shortage, but even with their numbers rising, we are still going to be short by 2030. 

  In Florida, by 2035, the state will need 75,000 physicians to keep with the demands of the state’s growing population, however, it is only on track to have 57,000 doctors (20,000 short), according to Florida Trend Magazine, April 22, 2022   

  It is amazing how many doctor’s practice are not accepting new patients. 

  I am requesting every reader to reach out to their doctors and other healthcare professionals and thank them for their dedication to caring for our country in a terrible time for our country. 

  Accept telehealth visits when possible and be aware of your personal medical conditions, prescribed and OTC meds taken, and write down questions before doctor visits and be prepared.

AMA Morning News, February 20, 2022

Medpage Today, April 22, 2022 

        

AMA Morning News, February 20, 2022

Medpage Today, April 22, 2022 

 

2) Autoimmune Diseases Part 4 Addison’s disease, Sjogren’s disease, and Myasthenia Gravis

 

A. Myasthenia Gravis (MG)

Myasthenia gravis usually presents with difficulty raising the upper eyelids with drooping (some have double vision), however, it can progress to facial weakness, and limb weakness. Swallowing, chewing, and speaking can occur. (I diagnosed a few cases in my ENT-Facial Plastic Surgery practice).

Cause

It is an autoimmune disease caused by antibodies affecting the neurotransmitter chemical acetylcholine but can be congenital appearing at birth. Myasthenia comes from the Greek, meaning “grave or serious muscle disease”. When that neurotransmission does not occur easily, the muscle weakens, but can recover with rest.

Symptoms

  Weakness can worsen with fatigue or exercise getting more obvious as the day goes on and improves with rest. It needs immediate attention before it progresses. It can be life threatening causing breathing problems. Other neurological disorders must be ruled out.

Incidence 

  MG is rare--1000 cases diagnosed each year, but this is not a curable disease, so there are thousands of cases in the U.S. most under treatment. It usually creates symptoms under the age of 40 in women, and over the age of 60 in men, but can occur at any age. It can occur in the newborn rarely, due to a genetic, and usually regresses after 2-3 months of age.

 

The Thymus gland

The thymus gland can create the disease by triggering the development of these antibodies. The thymus gland found below the thyroid gland in the upper middle chest is an immune gland, which grows until puberty, and then gradually shrinks and is replace by fat. The thymus is responsible for the development of T-cell lymphocytes, a very important source of antibodies. In adults with MG, the thymus may enlarge, sometimes forming tumors (thymomas) which are usually innocent and benign, but can become cancerous.

  There may be as associated thyroid condition that should be evaluated with thyroid blood tests.

  Rarely, a “myasthenic crisis” can occur causing acute breathing issues requiring a ventilator. I had a dear friend who was initially diagnosed with MG, but later was diagnosed with ALS and has passed. My prayers have been with him and his family from the beginning.

 

Diagnosis

  The diagnosis is confirmed by testing muscle strength with a chemical test that temporarily strengthens the muscles (edrophoium blocks the breakdown of the acetylcholine allowing the muscle to function normally). The upper eyelid would open normally, for instance. An EMG (electromyogram) can also test muscle function by a neurologist. An MRI will diagnose abnormalities of the thymus gland.

 

Treatment

 

1) Thymectomy-remove the thymus gland and allow about 50% to go into prolonged remission.

2) monoclonal antibodies similar to those used in many autoimmune diseases. Eculizumab (Solaris), Retuximab, belimumab, etc. 

  A new FDA approved medication (Vyvgart) combats the antibodies that the body secretes that cause muscle weakness in those affected by generalized MG. They must test positive for the anti-acetylcholine receptor antibody.

  Vyvgart binds to the antibodies that attack the receptors at the neuromuscular junction where a nerve sends impulses to the muscle to move, which cause the weakness. The clinical trials showed a 68% result compared to the placebo group who showed a 30% effect.

3) Anticholinesterase inhibitors—Mestinon or pyridostigmine, commonly used.

4) Immunosuppressive drugs such as corticosteroids, Imuran, etc.

5) Immunoglobulins and plasmapherisis

 

Prognosis

  With treatment, patients can live a normal or near normal life. Like many of the autoimmune diseases, there can be remissions, allowing the patient to stop treatment.

National Institutes of Health/Neurological diseases and Stroke

 

  

B. Addison’s disease

  This is a difficult diagnosis to make, but if not picked up by the doctors, it can progress into a very difficult medical problem. 

  Addison’s disease is adrenal gland insufficiency. The adrenal glands sit on top of the kidneys, hence the name ad=above renal=kidney. 

 

 

Insufficiency causes a major reduction of corticosteroids, probably one of the most important hormones in our body in terms of metabolic function, and is a major life saver for a myriad of medical diseases in acute emergencies, swelling of the body, etc. 

  Cortisone, when released by the adrenal glands, can help stress, and dangerous situation, as does adrenaline, and it can increase the metabolism of glucose (which can create hypoglycemia); it can control the blood pressure, and reduce inflammation in the body from everything from COVID symptoms to allergic reactions, and can reduce swelling by reducing inflammation.

  Cortisol is a hormone since the adrenal gland is an endocrine gland just as the testes, ovaries, thyroid, etc.

  Addison’s disease is an autoimmune disease, which means there is no obvious cause found just as it is with any autoimmune disease. However, trauma, infections (tuberculosis and others), cancers of the adenal gland (rare), and disorders of the pituitary gland (the controlling gland at the base of the skull that controls all endocrine glands). 

  Long term use of cortisone in asthmatics, those with severe autoimmune diseases, etc. will cause the pituitiary (ACTH) to quit releasing stimulating hormones that tells the adrenal gland to quit making cortisol.

  This disease occurs very slowly over months, and does not cause many symptoms until it is fairly severe. The symptoms are vague, such as fatigue, decreased appetite, weight loss, darkening of the skin, low blood pressure, craving of salt, low blood sugar, mild nausea, or abdominal pain, vague muscle and joint pain, irritability, depression, and body hair loss or sexual dysfunction.

  It occurs at all ages and sexes.

  An acute adrenal (Addisonian) crisis can appear as confusion, weakness, lower leg pain, severe abdominal pain, nausea and diarrhea. It can progress to delirium or unconsciousness. With these symptoms there will be low blood sodium and high levels of blood potassium.

  Because it is an autoimmune disease, and can create other autoimmune diseases such as hypothyroidism, vitiligo (loss of pigment such as Michael Jackson), pernicious anemia, Sjogren’s disease, Graves disease, and gut diseases. 

 

Diagnosis 

  Testing includes blood tests for cortisol levels as well as ACTH levels from the pituitary, and sodium and potassium.

  An ACTH stimulation test, which is performed by injecting ACTH and then testing for levels of cortisol will confirm the diagnosis. If the ACTH levels are still low after the test, the pituitary may a problem (tumor or pituitary insufficiency) or the adrenal gland can’t respond, or if the levels are high, that means the adrenal gland can still produce cortisol but there is a problem with normal production of cortisol.

  A CT scan of the abdomen to look at the adrenal glands and kidneys for tumors, shrinkage, etc. An MRI of the pituitary may be necessary to rule out tumor or other abnormality.

Treatment 

  The treatment is cortisone replacement, based on the blood levels and will take time to level the blood cortisone to a normal level. If the adrenal is insufficient because of a treatable disease, the additional treatment of cortisone may be temporary. Otherewise, it will be permanent. 

  If treated properly, the patient should do well.

Mayo Clinic; NIH 

 

Results of treatment

  Usually, treating with cortisone meds will stabilize the symptoms and the patient should do well. If a tumor is present, removal and replacement therapy may do the trick. If there is an infection, control should allow the adrenal gland to return to some kind of normal unless the infection destroys both glands. 

 

C. Sjogren’s disease


 

I diagnosed many patients with Sjogren’s* disease, because they had dry mouths, dry eyes, and swelling of their salivary glands, especially the parotid glands, as seen in the drawing above. 

  That triad was classic, and required a biopsy of the minor salivary glands on the inside of the cheek, since the autoimmune inflammatory pathologic process** is diagnostic. The lack of saliva causes a terribly dry mouth, and causes multiple dental caries. I have that issue from radiation therapy that destroyed my salivary glands to treat my throat cancer in 1991. 

*Sjogren=Dr. Henry Sjogren, a Swedish Ophthalmologist, who diagnosed this disease

**pathology=infiltration of T cell lymphocytes, monocytes, and plasma cells in the salivary and lacrimal (tear) glands

  This is another one of the 100+autoimmune diseases characterized by the above triad of symptoms, called Primary Sjogren’s, however, there can be many more symptoms may occur, called Secondary Sjogren’s which may appear in other autoimmune diseases, such as scleroderma, rheumatoid arthritis, polymyositis, or lupus. 

  Many parts of the body can be affected—sinusitis, skin symptoms, vasculitis, lung (pneumonia, bronchitis), kidney/bladder dysfunction, GI(constipation, pain), neurological(prolonged fatigue, weakness, peripheral neuropathy), joint pain, and gynecological symptoms (vaginal dryness, yeast infections). All of these symptoms could be considered in most of the autoimmune diseases, as this is clearly a systemic disease as the immune system can affect every organ. 

  A small percentage may develop lymphoma in the lymph nodes with swelling wherever they may exist.

  This is diagnosed 3 million times a year in the U.S., and 1-2% of the population suffers from this disease. It usually appears like most autoimmune diseases do—in ages 35-50 and more common in females (95%). 

 

Diagnosis

  As mentioned, a biopsy of a minor salivary gland in the inner cheek, which are plentiful, will confirm the diagnosis. Other tests include blood tests, immunology tests, liver and kidney function studies, ultrasounds of the parotid glands, dye studies of the parotid ducts, tear tests, dental exam for caries, chest X-ray. 

 

Treatment

1-Eye-immunological medications such as Restasis and Xidra, the same meds for keratoconjunctivitis sicca. Tear duct plugs and even procedure to block the ducts. 

2-Dry mouth-there are many OTC and internet preparations that moisten the mouth, gels, sprays, lozenges, etc. Maximum hydration is obvious. Sips of water may be necessary to swallow solid food. Sugarless gum and non-alcohol mouth wash (ACT) I wrote an extensive article on dry mouth  and is quite valuable: www.themedicalnewsreport.com/72

Medications to increase salivation include Salagen and Evoxac, but have side effects.

3-Joints and muscle pain—NSAIDs (ibuprofen and napoxen-Aleve, etc.)

4-Swelling of the parotid glands-moist heat, massage, hydration

5-Immunologic medication—Plaquenil is hydroxychloroquine, the same drug for malaria and is often used in COVID (with little proof it helps). 

Mayo Clinic, NIH

Sjogren’s Foundation 

 

3. Stress incontinence of the bladder 

  I discussed incontinence in the 83rd report regarding so many lawsuits for a poor transvaginal mesh implant to “easily” treat stress incontinence. However, there are several surgical options if conservative measures do not improve the problem sufficiently. 

  Stress incontinence implies a weakness of the pelvic diaphragm (muscles) from having children, being overweight, etc. These muscles and ligaments support the contents of the pelvis including the urinary bladder, uterus/ovaries, and rectal portion of the colon. Prolapse occurs when one or more of these organs sag further into the pelvis causing urinary and colonic leakage, and pressure from the uterus bulging into the vagina causing painful intercourse. 

  There are 5 things to remember about helping to control mild urinary incontinence. With 32 million Americans with incontinence

1. Keep your weight ideal 

2. Don’t smoke 

3. Work out and tone your muscles, especially do Kegel exercises 

4. Minimize bladder irritants (caffeine, alcohol, carbonated beverages, artificial sweeteners-aspartamine is in most but Stevia, spicy foods, citrus fruits and juices) 

5. Don’t strain with bowel movements

 

Pathology causing prolapse

  Loss of muscular support in the pelvis occurs allowing the bladder neck and urethra cannot close adequately to prevent urine leakage. The sphincter usually does not fail until the issue is more severe. 46% of women have some stress incontinence increasing to 50% with women over 40 and higher in white women. Pregnancy, vaginal delivery, over weight, etc. 

  For those who have pelvic organ prolapse with incontinence there is surgical repair. Hysterectomy would help. It would be the first organ to go if past the child bearing era. Bladder suspension and pelvic prolapse surgery have been around a long time. What was once accepted lost its appeal because of apparent easier surgeries with mesh implants. Now because of complications of mesh implants, especially placed through the vagina, the previously popular surgeries were updated and improved with laparoscopic approaches. I will describe the normal anatomy and compare it to prolapse of each of the 3 organs--cystocele-bladder, rectocele-rectal colon, and uterine prolapse. 

  It is easy to diagnose urinary incontinence with the patient having leakage with coughing, sneezing, laughing, and straining. 40% of women do not seek care. 

  Referral to a urogynecologist or a urologist specializing in these issues is recommended. There are specific tests to measure the amount of problem called urodynamics or cystometric testing. 

  Normal pelvic anatomy includes the bladder, uterus, and rectum with the vagina as an extension of the uterus in its proper place. A cross-section of the normal anatomy follows in the next page. The musculature of the pelvis is demonstated in this drawing.

  

 

 

Below there is a drawing of normal pelvic anatomy and prolapse of the uterus, bladder, and rectum. There are several stages of prolapse that require more aggressive treatment. 

 

Below is an example of a bladder prolapsing into the vagina on pelvic examination. Cystocele shown bulging  and obliterating a view of the vagina is shown in the drawing below. 

 

Prolapse of bladder into the vagina

Stages of cystocele

 

For pelvic muscle relaxation, with multiple births, weight gain, inactivity, etc., gravity plays a major role along with other factors to create both urinary and fecal incontinence, pain, and a host of other symptoms. The bladder, uterus, and rectum all play a role in prolapse. 

 

Non-surgical treatment of stress incontinence

  Weight loss is the most common and obvious problem. Losing as much as 15lbs. can show as much as a 58% improvement according to an excellent article in NEJM. June 24, 2021. 

  Exercises is critical to strengthen the pelvic floor. The exercises such as Kegel exercises  must be performed in all patients using isometric technique (squeezing the muscles and holding them for a few seconds, relaxing and repeating 10 times, resting and doing it again). This should be a daily regimen including core exercises of the body from yoga and other forms of strengthening. 

  The above article cited a 74% improvement or cure in patients with mild to moderate stress incontinence within 3-6 months. There are physical therapy experts trained to help women with this and they get better results. 

  Vaginal devices are a variety of pessaries for mild to moderate symptoms. Note there is pressure against the area between the urethra and bladder neck and is stabilized there by the posterior part of the pessary snugly fit into the back of the upper vagina as demonstrated in the drawing below.

    

 

 

The combination of Kegel exercises and a pessary provides an even higher chance of control.

  Twice weekly vaginal estrogen cream is recommended for all pessary users, to make the lining more resistant to trauma (tears, bleeding, etc.), accorsing to a 2020 Journal of OBGYN article. 

  Patients were encouraged to try and insert and remove the pessary at night. If not able to self insert, they should visit their doctor for an exam, removal, replacement with a new one every few months assuming there has been no problems.

 Pessaries should always be offered before any surgical considerations. 

  Duloxetine, an antidepressant is approved for stress incontinence in Europe has been shown to improve symptoms. It can be prescribed off-label in the U.S.

   Acupuncture compared to sham techniques has proven of value short term. 

 

Surgical correction

  Surgery is the most effective treatment if the incontinence persists.

  Transvaginal mesh placements had such a high extrusion rate and other complications, the FDA took them off the market and stopped its use in the U.S. This office procedure is distinctly different from the surgical placement of mesh or facial slings. I discussed this at length in a previous report. This procedure continues to be performed in other countries despite high rates of complications.

  Also vaginal energy devices (radiofrequency or laser) to increase tone in the musculature has not been FDA approved, it is also being widely used.

  Obviously, talking to a very qualified urogynecologist or urologist with good experience in these procedures. 

  NEJM, June 24, 2012

  

A. Mid-urethral suspension mesh sling

  This is the most common procedure because it is quick, simple, and takes 30 minutes, has a low complication rate, and highly effective. Exposure of the mesh in the vagina can occur with possible perforation of the bladder or urethra.

  There are 3 options for this procedure as depicted in these drawings showing different positions of the sling. The arrow points to the sling.

               

  The trans-obturator technique has the best long term results with the lowest complications although all 3 are quite effective. However, a new report found the mini single-sling procedure was just as good. NEJM, March 31, 2022

  In one 5 year study evaluating 95,000 women with the transobturator or retropubic technique, after 9 years, the rate of reoperation was 4.5% for stress incontinence, 3.3% for sling removal, and 6.9% for any reoperation including mesh removal.

  Minislings are easier to perform with one incision but not as effective.

 

  B. Burch colposuspension (urethropexy)

  This procedure requires surgical elevation of the vaginal wall to provide support of the urethra. It can be performed trans-abdominally or laparoscopically. This is less effective 74% vs 81% but still a good procedure with longer hospitalization and a few more postoperative issues. 

 

  C. Pubovaginal sling

  This procedure uses actual human tissue (abdominal rectus muscle fascia). The results are similar but with more postoperative complications including prolonged urgency and frequent urination and more perforations.

 

  D. Urethral bulking 

   This simple office procedure involves injecting bulk materials into the urethral lining to prevent incontinence. such as collagen injections similar to those injected in the face for wrinkles. Repeat injections are not uncommon, and not near as effective as surgical repair. Only about 26% have good results at one year, but may a choice for high risk patients.

  

 Rectocele 

  If the rectum prolapses, constipation or diarrhea, pain on sexual intercourse, urinary incontinence, and rectal pressure are common. Pessaries are also used in these cases.

  Mesh and fascial slings are not used. A posterior transvaginal incision is performed to expose the prolapsing rectum and suturing the surrounding tissue to tighten the tissue holding the rectum in place. 

  Colonic surgeons prefer a transanal approach to accomplish tightening of the same pelvic support tissues as in stress incontinence cases.

Cleveland Clinic and Johns Hopkins Medical Center

 

4. Resurfacing aging skin—Retinoids, Vitamin C, and Laser Therapy

 

Resurfacing the skin surface occurs every day normally, however, as age catches up, sun and wind damage begins to cause more damage than the skin can handle. The top layer of skin sheds dead cells to revitalize the skin, but as the skin ages, has sun and wind damage (and smoking), the skin develops a rougher surface with more dead cell layers, hyperpigmentation, discoloration, precancerous spots, and as wrinkles occur the age of the skin starts to show the years. 

  Obviously, most in their 20s don’t have much damage but by the 30s, it starts to appear, and can even earlier in those with light skin, blond and red hair. 

  There are three types of resurfacing agents:

Physical

  This technique involves some type of abrasive product, scrubs to microdermabrasion performed by skin care salons. Before lasers were available, I used a regular dermabrasion machine used for acne scars. But it could not be used around the eyes for fear of tearing the skin, but was successful in selected cases. Lasers were a big improvement, could be used around the eyes, and was much safer 

Chemical

  Retinoids (Retin-A), ascorbic acid (Vitamin C), other fruits acids, botanicals, alpha hydroxy acids are all effective over time and don’t usally cause visible problems except for a few days at most. Glycolic acid is used in very mild chemical peels, and I performed stronger glcolic acid peels once a week for 3-4 weeks on my patients.

  Trichloracetic acids in different concentration were used for resurfacing as well as phenol peels, but these were for more severe aging skin issues. Here are examples.

Mild chemical Peel

Moderate chemical peel with 20% trichloacetic acid

 

Strong Phenol Chemical Peels

    

 

Laser resurfacing

 Over the years I switched from phenol and trichloracetic acid peels to carbon dioxide laser treatments with great results. These lasers removed not only aging damaged skin but most smaller wrinkles especially around the eyes and mouth. To date, it is the best type of laser for more advanced skin  damage and fine wrinkles. Deep wrinkles require fillers and or lifting procedures.

  There are several types of lasers that may be offered to you, and be sure the results and options are explained to you before deciding. Offices with only one type will push that because of their office limitations. 

 

Types of lasers

Genesis laser is a 1064nm wavelength gently heats the dermis and is a great option for rosacea.

Pulsed dye laser can remove broken small blood vessels. It does not help damaged skin. No downtime.

Fraxel laser is best for mild to moderate skin damage, finer wrinkles, with a few days of downtime.

IPL laser  Laser Photo Rejuvenation target dark spots (melanin).  This hyperpigmentation will return after the peel unless bleaching agents (hydroquinolone) are not used long term and major facial sunscreen protection.

Carbon dioxide (CO2) laser is the best for acne scars and more significant skin damage, with more wrinkling. It was my choice at the time I was in practice, and in the right hands it still provides the best results in more severe cases. Here are comparisons of milder chemical peels to laser.

    

 

 

I performed hundreds of facial cosmetic surgeries, forehead lifts, brow lifts, and facelifts with and without liposuction. CO2 Laser peels were often performed around the eyes and mouth at the same time as the surgery. Results were quite satisfying. I will discuss lifting surgery another time.

  Be sure you consult a well known and respected surgeon when contemplating rejuvenation surgery.. The results can be fantastic. I will cover lifting procedures in near future.

  Those who protect their skin can prevent much of the superficial skin aging. Those who don’t will begin to need some type of treatment.

  Skin care specialists, who are specially trained cosmetologists, are the best progessionals to seek help. The use of exfoliants, bleaching agents, and regular facials with mild peels every few weeks of months will keep the skin looking great.

  If age proceeds and sports, swimming, etc. wins out, further treatments may be necessary. This is good time to seek dermatologists or estheticians with special interest in skin care. PAs usually will be the professional you will see in Dermatology offices. 

  Microdermabasions, glycolic acid peels, Vitamin C containing peel products will provide a lighter but significant result for milder cases, but will need repeating. Redness and peeling may occur, and then complete healing. 

  Daily skin care is necessary to maintain the skin no matter what type of resurfacing is chosen. When deciding, the extent of aging damaged skin, and the length of results must be considered, as well as cost and potential complications. Skin care salons are a great complement to cosmetic surgeons and dermatologist’s procedures. Be sure you are given the options. 

  Retinoids are derived from Vitamin A and have been the mainstay of aging skin products for quite sometime. The skin care industry developed a milder form of Retin A, called Retinol. It can be purchased in different strengths in cosmetic products., although Retin-A full requires a prescription.

  Retinoids are not just exfollients (like scrubbing away lthe superficial layers of the skin away), they actually encourage new collagen formation in the skin, the backbone of proteins that provide structure and firmness of the skin, preventing laxity and sagging of the skin. 

  The constant nightly use of Retin-A over the years will keep the skin looking fresh, but with Retin-A, the sun will burn the skin more easily and keep the skin red and redamage the skin even faster. Even Retin-A  daily use can cause redness, therefore, the lowest % of the medication should be used first. Retin-A still requires a prescription 0.025%, 0.05%, and 0.1%.

  Aging is a tough customer and superficial improvements in the texture and elasticity of the skin may occur temporarily, but the tissues will give way to gravity with deepening of wrinkles and sagging, and these retinoids can only do so much, preferably to be used as the first line of defense at an early age.

  Good skin care with cleansing, use of toners to balance the pH of the skin, good moisturizers to hold hydration in the skin and soften the skin. They can be oil based (emollients), water based (humectants), and occlusive moisturizers. The latter must be avoided, as it will plug the pores. 

  Estheticians are the best technicians to get advise and have facials regularly. I worked with a great one in my practice and had all my cosmetic patients see them to provide the healthiest skin before any surgical procedure.

   Mark Lees PhD, and I worked in Pensacola for 20+ years. His skin care salon was the best, and the doctor that took over my practice still works with his salon as well. Mark and I cohosted a monthly call-in TV show together “Doctor Make Me Beautiful” for over 10 years. My partner and he still cohost the show on BLAB Cable TV, in the Panhandle of Florida.   

  Of course, good hydration, clean skin, at the proper pH, and a well balanced diet loaded with vitamins and minerals are critical for healthy skin.

  Avoiding smoking and moderation in alcohol, with good sun protection with sunscreens (at least 30SPF and proper protective clothing are all just as important). 

  Genetics also plays a big role in the thickness and pigment in the skin, which is much slower to age than those with Scandinavian and European descent. People that struggle to tan are the most at risk. 

  Sunburns age the face the worst. Those who are active in outdoor sports, boating, gardening, etc, must protect their skin from the time of childhood. Repeated sunburns are one of the highest risk factors for developing skin cancers especially melanoma.

  Wrinkles occur as the skin thins with loss of collagen and raising the forehead and squinting or smiling wrinkle the surrounding eye and lip tissues (smoking really accelerates the lip lines). Botox can temporarily paralyze the facial muscles, but must be repeated every 3-5 months. Fillers enhance the results. I reported on fillers at www.themedicalnewsreport.com/103.  

  Retin-A is the most well known (tretinoin), but a milder treatment is Adapalene (Differin) is OTC 0.1% gel is used for acne, and aging skin. 

  Retinols are milder and not as effective but are in many cosmetics and unlikely help much. Retinols are different than retinoids and also come in creams, liquids, and gels.

  Be patient, because daily use will take up to 6 months to see visible results. If a person wants to maintain smoother skin, they should commit to these regimens for years. 

  Talk to your plastic surgeon, dermatologist, or skin care professional (esthetician).  Medicine.net 

  Complications can occur, so be sure you prepare your skin well for these procedures, avoid the sun, consider taking an anti-fever blister medicine prior to treatment, and have enough time after the procedure to tend to your skin and heal. Scarring can occur if you scratch itchy places, so keep the skin well moisturized and follow your doctor’s orders. The CO2 laser may cause some loss of pigment requiring makeup to blend the skin, but it is a small price to pay for such improved skin. 

  One of my favorite skin care lines for peels is Dr. Zein Obagi products. He taught me chemical peels in courses in California. Mark Lees and I held many seminars on this subject for years to the public. 

  

 

5. Progress in cancer 1971-2022

  The AARP Bulletin for November, 2021 had a very nice lead story, “war on cancer turns 50”. 

  Dr. Vincent Devita, Jr. M.D. was the chief of the National Cancer Institute in 1971, when President Richard Nixon launched “the war on cancer”. 50 years and $100 billion later, he believes that , “we are not only winning the war against cancer, the death of cancer is inevitable”. That turned out to be untrue.

  Yet, as the article states, cancer is the number one cause of death for Hispanics, Blacks, women over 50, and everyone 60-80. The lifetime risk for men is 1 in 2, for women 1 in 3. While cancer can strike at any time, the average age in 66, some experts feel cancer is a disease of aging, more complex than ever imagined.

  In 1971, people with cancer had 50% chance of survival, and people could not even utter the word, with many older people not even seeking treatment. It was thought you could catch cancer from others, which was scoffed by the medical profession and the public, and now we know that the HPV virus transmitted sexually is the cause of cervical and all genital cancers, as well as a high percentage of oral and throat cancer. 

  The advances in early cancer diagnosis, prevention, and treatment (as well as survivorship issues) have taken off since the 90s. There are 71 major cancer centers in 36 states and Washington D.C. and excel in all aspects of cancer. 

  A recent release of statistics regarding the benefit of early diagnosis found that early detection before a tumor has spread will reduce the death rate by 26-32% for women and 18-24% in men. The best results came from colorectal and prostate cancer in men and breast cancer in women, and melanoma. Int J Cancer, January 17, 2022

 

 New medications and radiation techniques; vaccines

 The development of new chemotherapies, immunotherapies, and better ways to use radiation therapy continue to progress. 

  The discovery that a virus causes genital cancers and 75% of oral and throat cancers led to a viral vaccine that has had tremendous success in preventing these genital cancers. The virus is HPV (human papilloma virus) and the vaccine is Gardasil is recommended for all children (9-12), before sexual activity occurs and can be taken up to age 45 years of age with fewer cancers depending on the sexual history of the individual. 

  In the January 2022 report, I discussed the latest innovations about head and neck cancer, more commonly known as oral, tonsil, throat, and laryngeal cancer, one of my subspecialties for 30 years. A recent study continue to show that we have seen a 225% increase in these cancers between 1988-2004 and surpassed cervical cancer in women in 2020 as the most common HPV (human papilloma virus) cancer.  

  Anal cancer is rising rapidly and 90% are HPV positive. It was rising in 20-44 year olds, but thanks to the HPV vaccine, especially in the LBGTQ+ community, the rate is decreasing. Anal cancer is 9X higher in this gay lesbian, transsexual community. It unfortunately is still rising in older individuals especially women. JAMA Network, Feb. 10, 2022

  Most infections with HPV occur in the very young and most do not even know they had the infection, but often keep the virus in their system and cause cancers years later. 

  Since doctors have been administering the vaccine, the rate of cervical cancers has dropped considerably with rates almost 100% after receiving the HPV vaccine. It requires 2 doses 6 months apart (3 doses is required if the first dose occurred at 15 yrs. of age or later). However, recent research has shown that one shot can prevent most of the cancers that 3 can.

  The rate of youngsters being vaccinated was 54% in 2020, but I suspect COVID dropped that rate like most other vaccine schedules. Please get your children and grandchildren vaccinated.

  Cancer genetics has expanded greatly, since in 1979, the most commonly mutated gene was discovered, and now we have sequenced the first cancer genome, expanding the field of the newest cancer treatments—immunotherapy and targeted therapies are zeroing in on the molecules of cancer allowing the body’s own immune system to fight the cancer, especially if there are genetic markers found in the specific patients. These treatments are not chemotherapy, and many are not cures, but have prolonged the lives of millions of cancer patients. These immunotherapies are similar to some of the treatments for COVID.  

  However, it was pointed out there was a lot “hit and miss” treatments with only 19 of 93 drugs fast tracked by the FDA that accelerated the approval process (just like the current emergency approval authorization for COVID-19 vaccines). 

  Many of these drugs caused serious side effects and gave chemo a bad name. Fortunately, the advances on prevention and treatment of side effects has greatly improved. 

  When it became clear that when a cancer could be diagnosed early, it equated to better survival (as much as 20% better), therefore, routine screening for the most common cancers was greatly encouraged by organizations such as the American Cancer Society who was an early supporter for insurance coverage in cancer screening techniques. With insurance coverage, it became easier to encourage perfectly normal individuals to schedule mammograms, Pap smears, colonoscopies, PSAs, and low dose CT scans for smokers who had 30 pack year history even if they quick for years. 

  When the Surgeon General announced there was a direct relationship with lung cancer and smoking in the 1970s, smoking cessation was pushed including medications to help cessation, and we have seen a gradual decrease in smoking cigarettes since the 1940s. In 2020, the rate was 21%. Gallup poll

Age is a factor as well. Getting kids to start smoking is the main goal of the tobacco companies. 8% ages 18-24 smoke, while 17% ages 25-64 smoke, and 8% 65 and older still smoke. 13.5% of women smoke, while 17.7% of men smoke.

  It is well known that those who smoke a pack of cigarettes a day for 30 years will increase their risk of many cancers (especially the lung). 

  Low dose spiral CT scans of the lung every year for these individuals, including those who have quit in the past 10 years, as well as current smokers are eligible for these CT scans, covered by most insurances. It has picked up many treatable lung cancers improving the 5 year survival by 20% in this group.

  When the American Cancer Society and other non-profits convinced the government to make indoor smoking illegal, that helped a significant number to quit. 

  80% of lung cancers are caused by the byproducts inhaled in tobacco. However, there is increased risk for smokers for oral, throat, larynx, esophageal, stomach, pancreas, bladder, kidney, cervix, liver, colon, and rectum. Alcohol combined with smoking increases the risk much greater.

  After quitting smoking for 10 years, the risk starts to decrease, so it is never too late to quit. Medication, nicotine patches, vaping, and other techniques may help, but nicotine addiction affects the same brain centers as opioids, and is as hard to stop.

    It was discovered through research that we can decrease the risk of cancer by not smoking, regular exercise, avoiding excess alcohol, and maintaining a healthy weight with a diet high in grains, vegetable, and fruit with less meat, avoiding sugary drinks and junk food. These preventative moves can prevent 20-40% of all cancers. Thankfully smoking is down 63%. And with the obesity epidemic, it will soon surpass smoking tobacco as the #1 cause of cancer. Currently obesity is responsible for 40% of U.S. cancers.

  Currently the concept of a liquid biopsy (a blood test) can diagnose many cancers. This blood test could identify genes that cause certain hereditary cancers, according to Dr. Nicholas Papadopoulos, professor at Johns Hopkins Dept. of Pathology, who discovered these genes.

  Another problem ignored by researchers for decades was that subjects in research studies did not include older individuals.

  When the average age of someone being diagnosed with cancer is 66 and 40% are 70 or older, it seems obvious that older people should be included in these studies. 

  The medications and other forms of treatment did not have direct age specific data relating to older individuals. 

  It is now known that lower doses of treatment may be just as effective with fewer side effects. Assessing older individuals and making recommendations with less treatment has shown similar survival rates, according to Dr. Wm. Dale, Director of the Center for Cancer and Aging at City of Hope.

  Just in the last 20 years, with millions of Americans living with cancer, the concept of cancer survivorship was created.

   I am proud to have been involved with many recommendations and guidelines (as a member of the Survivorship Task Force for the American Cancer Society) for doctors to use in following and caring for cancer patients who are living with their cancer. I volunteered for 40 years.

  These patients now called cancer survivors (from the time of diagnosis to the end of life) and are being given more refined and skillful surveillance in their followup. 

  Prostate cancer is a common cancer that is often low grade and slow growing, and the concept of surveillance rather than treatment of many of these cancers is now endorsed by most oncologists.

  The organization (USPSTF) that advises the federal government was forced in 2017 to change its guidance on PSA testing for men 55-69 to a PSA on a case by case basis, rather than no testing, but still recommended no testing from 40-54. 

  Since the American Cancer Society came out with recommending a PSA be discussed with both age groups because of increasing numbers of more aggressive cases in younger men, the Urological Association joined ACS in their recommendations for screening. 

  There has been a 12.5% increase of PSA testing in men 40-89. It is still a discussion how to treat or observe between the urologist and patient with all health issues being considered. 

  There are many new studies that can help decide surveillance versus radiation, chemo, or surgery. Biomarkers and polygenic risk scores are now commonly ordered as well as MRI guided biopsies. JAMA Oncology, November, 2021  

  The concept of surveillance as an option instead of radiation, chemotherapy, or surgery for low grade and very isolated cases of prostate cancer has become very popular especially those with a life expectancy of less than 10 years. 

  Some studies cited close to 50% choosing surveillance over the past few years, with about 30% choosing early treatment. Of course, if the cancer progresses, the decision for more aggressive treatment is necessary. Those who delay treatment even if the cancer progesses, have about the same 5 year survivals as those who choose treatment initially (only for early, lower grade, small, isolated tumors). 

  The NCCN*, National Comprehensive Cancer Network this month changed their recommendation of surveillance as an option to the primary choice, but only for early, isolated, low grade prostate cancers. Most urologists were comfortable with surveillance as the primary choice for these early, low grade cases already.

*NCCN has a great website at www.nccn.org

Medscape, November 30, 2021

  Many of these older patients die of natural causes and other medical conditions before the cancer takes them, and delaying treatment in specifically chosen patients have prevented them from undergoing difficult surgery, chemo, and radiation with serious side effects and lower quality of life issues.  

  More tests are now available to determine the risk including PSA density, a high number of positive cores (3 or more), a high genomic risk from molecular tumor analysis, and a known BRCA-2 germline mutation (found in women with breast cancer….if a man had women in their family with breast cancer, this test is a must). 

 

  Second opinions are always important if there is concern about making a decision.

  We have not won the fight against cancer, but we are making great gains giving millions of Americans hope for living longer, and enjoy their later years of life.

  Diversity is a critical issue with higher rates of cancer and lower 5 year survival rates in Hispanics, Blacks, American Indians, Native Alaskans, and U.S. South Pacific natives. Access, screening, and early treatment are all challenges. These are complex problems centered in their traditions, beliefs, trusting American healthcare, and other socioeconomic factors.

  With 600,000 deaths a year from cancer, we obviously have a lot work to do!

  Finally, here is a glance at the progress we have made in the 5 year survival rates of these individuals with percent in 1975 vs 2013—source National Cancer Institute-SEER database: (obviously not all good news)

Prostate—1975—66.3%, 2013—98%

Non-Hodgkins Lymphoma—1975—46%, 2013—75.8%

Lung cancer—1975—11.5%, 2013—22.1%

Brain cancer—1975—23%, 2013—35.8%

Leukemia—1975—33.4%, 2013—67.2%

Bladder cancer—71.8%, 2013—78.8%

Colorectal cancer—1975—48.9%, 66.3%

Uterine cancer—1975-88%, 82.5%

Melanoma—1975—81.9%, 2013—95.8%

Breast cancer—1975—75.3%, 2013—91.8%

Pancreatic cancer—1975—3.1%, 2013—12.1%* increasing in numbers 

# of cancer survivors—1971-3.1 million, 2019—16.9 million

    

AARP November Bulletin

The American Cancer Society www.acs.org

The National Cancer Institute www.cancer.org

Johns Hopkins School of Medicine

 

6. E-15 gasoline

This was published 4/13, 2022 and will change. Be sure you avoid this much ethanol unless your car can use various octanes.

 

Bradenton, Georgia

 

Clayton, Georgia

 

Franklin, North Carolina

 

Thank you for reading the May report. The June, 2022 report will include:

1. COVID updates, new subvariants

2. Autoimmune Diseases—Part 6—Scleroderma, Alopecia areata, Dermatomyositis, and Wegener’s Granulomatosis

3. Alzheimer’s disease updates; sleep and how it affects neurological disease

4. Ob/Gyn Series—Part 3—Post-menopausal issues; Early removal of the uterus and ovaries-effects

5. New drug for insomnia; Is Mike Huckabee right about Relaxium?

Enjoy your summer, and spend your hard earned money on the most important necessities as we suffer from inflation and U.S. regulatory disasters, Dr. Sam