The Medical News Report

#137

June, 2023

Samuel J. LaMonte, M.D., FACS

www.themedicalnewsreport.com

Subjects for June 2023:

1. Late breaking medical news—COVID; Doctors; Major medical organizations received money from Pfizer to promote mandates for their vaccine; Best migraine meds; CDC Director Walensky resigning and vaccine info

2.  OB/Gyn Series-part 10—menstrual disorders and new therapies

3. Cancer stats and cancer screeninigs--are behind!

4. Celebrties with unusual diseases—Part 2

Toby Keith-Stomach (Gastric) cancer,

Jimmy Kimmel-Narcolepsy,

Venus Williams-Sjogren’s Syndrome

5. Oral and throat cancer;  HPV viral vaccine, dry mouth syndrome

6. The Havana Syndrome continues—CIA and its declassified report

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. Late Breaking Medical News

A. Long COVID syndrome and different immunity

   People who get long COVID syndrome react to the vaccines differently. The reason is the immune response to the infection and with prolonged symptoms, it causes an increased immune response, but the syndrome cause is still unknown.

  According to the April 27, 2023, Medscape article, this syndrome reduces the effect of the vaccine. The long syndrome creates a secondary immune reaction that others don’t have, and makes vaccination unnecessary. The secondary immune response fights the virus not only against the spike protein in COVID, but also interferes with replication of the virus.

  The bottom line is that if a person gets the long syndrome, the COVID vaccine might not be necessary, which goes against what the CDC recommends. How long this added immunity stays high is not known, but a year or more is expected.

  For people who have serious underlying diseases still should consider getting all the vaccines recommended, but obviously with this new information, further discussion with the treating doctor will be necessary. Confusion continues! The risk/benefit discussion is always necessary.

  With the potential for side effects from vaccines, which continues to be reported, getting more vaccines may not be worth the risk, but patients and doctors need to decide together.

B. Now only one dose of COVID bivalent vaccine is enough!! CDC Director resigns!

  Medscape announced that the FDA and the CDC have now suddenly stated that one dose of the bivalent COVID vaccine makes a person “whole” and don’t need any more shots. OMG!! This goes for out of country flying requirements too.

  Can you believe what the administration is doing to us with the enormous financial influence of Big Pharma, especially Pfizer. The shot has not changed, but since so few people (16%) were willing to receive the booster, they just adjusted their thinking and figured more people would at least get one shot….not a scientific decision!! And the administration continues to hold back COVID funds approved by the Congress.

  This recommendation (of one bivalent booster only) is for unvaccinated and previously vaccinated individuals. Big Pharma and the administration have destroyed confidence  decision making.

  How stupid do they think we are? And now the Director of the CDC is resigning, giving no reason (Dr. Walensky).

  The CDC and FDA had a gag order put on them from talking to the media a year ago. She, just like Dr Redfield, I am sure, got tired of being told what to tell the public about COVID from the White House and Dr. Fauci given the microphone. He was also responsible for deciding all grants ($35 billlion) from the NIH to researchers. This administration has just made us a banana republic. We must have a change. They have made a mockery of public health, and public confidence is at an all time low.

  Also, there is “word on the street” that there is new funds from the NIH for more “gain of function” research on the bat coronovirus. They are still doing this very dangerous research after they were told to stop because it was so dangerous. My source comes from the Department of Defense. Why isn’t questions being asked about this, since Fauci testified there were no NIH funds being used in Congress. Our government just needs to be honest with us, if there are good reasons for this continued research for more potent vaccines, etc.

C. COVID vs Influenza hospitalizations, deaths 2022-2023

  The stats for VA patients have changed considerably since COVID began in 2019. For 2022-23, here are the comparisons. In the early pandemic, there was 5X the risk of a 30 day mortality. COVID remains a serious illness in selected groups, but with a significant drop in risk of death.

   5.98% of COVID patients died while 2.23% of Influenza died within 30 daysin the older population of veterans in this study. These were all hospitalized patients. Deaths decreased with vaccinations. Studies for general populations are hard to find, because the stats from John Hopkins were stopped, who the CDC relied on, and using numbers lost their fear factor with the U.S. residents. Also the number of vaccinated plus those having natural immunity have lessened the chance for these new virus variants to find someone to sicken.

  Clearly, unvaccinated sickly people continue to be the high risk group with diabetics, obese, those with lung and cardiovascular disease, but flu and COVID continue to be of concern, even with the pandemic declared over. Reinfections and long COVID syndrome continues. The latest variant XBB.1.16 account for 64% of cases, and boosters will include them. Flu shots have been very successful this year as well.

  Controversy continues about annual boosters, and are realy just indicated for high risk individuals. Only 16% got the last booster.

  All these infectious diseases deserve respect, and with the invasion of thousands of children without any childhood vaccines, we are facing outbreaks of all these childhood diseases, including tuberculosis. These viruses will have an impact on us for years to come. Just pitiful what our administration has allowed.

2-3X more patients were hospitalized with COVID than influenza, but the numbers have drastically decreased as the newer variants have become less severe. As usual, influenza can still be a wicked illness. RSV, even with a new vaccine, will have little impact, except on the very young and the sickly.

JAMA Network, April 6, 2023

 D. Doctor’s medical license now transferrable to Canada

  The world is getting short on doctors and nurses, which includes Canada. That is not good news for the U.S., with our shortage. Some of our burned out doctors are going to Canada to practice socialized medicine accepted a socialized system (Canada is socialized).

  Two Canadian provinces (Nova Scotia and Ontario) are now allowing board certified U.S. doctors to begin practicing immediately with full licensure in these provinces with no limitations including no supervision and no exams. The other provinces are considering the same relaxation of rules.

  Canada is experiencing an acute shortage of licensed physicians and expects a shortfall of 44,000 by 2028. Family doctors account for 72% of that shortage with 13% of the population without a family doctor.

  Canada has also expedited work visas for American doctors. I predict they will do the same for nurses.

  Family doctors in a socialized system average make an average $40,000 less ($195K vs $236K), but other incentives can make up the difference ( with fewer hours working,  no personal malpractice, and no hassle from insurance companie).  

  Patients pay high taxes to have a socialized system, and have no out of pocket expenses although medications are not often covered. This system continues to appeal to more healthcare professionals, and the younger generations are just fine with it, and they are our future doctors (and nurses).

  Unfortunately, rationing of care and huge delays in testing (imaging, elective procedures, etc.) has always been a big problem in Canada, which the U.S. system does not suffer from near as much….yet!

  The U.S. needs to negotiate a middle of the road system, if only our political parties could work together.

  Emergency doctors are commonly getting burned out and looking for primary care as an alternative. The U. S. is looking at a shortage of 124,000 physicians across all specialities by 2034, according to the Association of American Medical Colleges.

  After just spending 4 days in a local hospital, I was exposed to the shortage of hospital personnel at all levels. It is becoming epidemic.

 The feds need to address right now, as they continue keep the borders wide open. All of my concernsvoiced over the last few years are quickly becoming reality.If your loved one is admitted to the hospital, stay with them to be sure their care is satisfactory, because personnel shortages are everywhere.    

E. Groups were given money by Pfizer (Big Pharma) to promote COVID vaccine mandates

  Groups such as the American Academy of Pediatrics, American College of Preventive Medicine, American College of Emergency Medicine, American Academy of Family Physicians, and many more organizations that promoted vaccine mandates were all given large mega thousand dollar grants from Pfizer,, which was never discovered until some research by journalist Lee Fang, which was responsible for a publication in The Epoch Times, a conservative newspaper.

  Once again we see the power of lobbying and its influence on the administration and many very liberal medical organizations who all promote socialized medicine.

  Our government including congress are all on the take and the country is suffering from major influence by Big Pharma and other major organizations who buy influence in the governance of country. How bad does it have to get to change people’s minds about our leaders?

  Are my readers beginning to understand that Big Medicine is just as bad as Big Pharma and Big Government? It is all about the money for these big medical centers and hospitals.

The Epoch Times, May 3, 2023

E. The Best Migraine meds

  It is rare medications are tested against each other, but this study did what we wish could happen often. The top 25 migraine meds were compared with each other, using ibuprofens as the control. 3 drugs stood out!

  Tryptans, ergots, and anti-nausea meds stood out. Individual medications with the highest patient effectiveness were eletriptn (Relpax), zolmitriptan (Zomig), zumitriptan (Zecuity). Look in my subjects index for a complete report on migraines.

Medscape General Surgery, May 2, 2023

2. OB/Gyn Series—part 10—Menstrual difficulties and new therapies

  There are many menstrual issues every biological female must deal with monthly. Some for the most frequent problems center around periods that are painful (dysmenorrheal), missed periods (amenorrhea), have excessive or prolonged bleeding, light or infrequent periods (oligomenorrhea), PMS, or have non-cancerous tumors—fibroids, and premenstrual dysphonic disorder. Here is some information on these issues.

Workup for menstrual disorders

  Any disorder dealing with menstruation should always begin with a thorough history and physical examination.

 A. Blood and hormonal tests

  Blood tests--Pregnancy test, hormonal testing (FSH-follicle stimulating hormone, prolactin hormone test, male hormone levels), thyroid studies that may indicate a thyroid disorder, pituitary tumor, or polycystic ovarian syndrome. 

  Imaging--ultrasound, hysterography (ultrasound with injection inside the uterus to expand the uterine cavity for better imaging). MRI for detailed exam of the entire pelvic cavity including the uterus, ovaries, fallopian tubes, bladder and rectal part of the colon.

B.  Direct visualization procedures

  Hysteroscopy using a scope to visualize the vagina, cervix, and inside of the uterus for fibroids, polyps, etc.

Laparoscopy uses an endoscope through the abdominal wall to visualize the contents of the pelvis, inspecting the lining of the pelvis (peritoneum), ovaries, tubes, and outside of the uterus for signs of disease.

C. Endometrial biopsy to examine under a microscope the lining of the interior of the uterus for abnormal cells, cancer or otherwise.

  D&C—scrapings of the uterine lining to remove abnormally thick lining, biopsy, using a curette.

D. Dysmenorrhea—painful periods occur in most women, and create not only physical but psychological symptoms.  There are over 200,000 cases reported annually. This usually occurs from ages 18-50. There may be a family history.

  Primary Dysmenorrhea is the name for menstrual cramps and pain that are recurrent with each period, usually occurring 1-2 days before menstruation or whenever it begins.

  The pain may occur in the lower abdomen, back, and or thighs. The pain usually lasts 12-72 hours, and may be associated with nausea, vomiting, or diarrhea. They may disappear with pregnancy and lessen with age.

  Primary dysmenorrhea implies no menstrual period. It usually due to inadequate levels of female hormone, but could be due to some anatomical abnormalities.

  Secondary Dysmenorrhea means there is a disorder or infection in the reproductive organs. The pain may occur earlier in the menstrual cycle and lasts longer than primary. It is not associated with gastrointestinal symptoms.

  Secondary dysmenorrhea is defined as no periods for 3 or more months. Pregnancy, menopause, taking birth control (pills, injections, implants) and breast feeding are the most common reasons, but there can be hormonal causes.

  Menstrual pain (dysmenorrhea) occurs when there is secretion of a chemical called prostaglandin, which contracts the uterine muscle. With excessive contraction, the blood vessels nearby may be compressed, cutting of the oxygen supply to the uterine muscle eliciting pain. There are medications (NSAIDs) that block the secretion of this lipid with hormone-like properties to help with painful uterine contractions. It can also help if endometriosis or fibroids are present. NSAIDs are a class of pain meds everyone knows (Aleve, ibuprofen, etc.).    

    Symptoms may include a milky nipple discharge, hair loss, headache, vision changes, excess facial hair, pelvic pain, and acne. These symptoms point to disorders already mentioned, such as polycystic ovary disease, hyperthyroidism, pituitary tumors, or premature menopause in the 40s instead of the 50s.

    Life style changes such as low body weight (10% or greater loss--, excessive exercise, anorexia, bulimia, etc. can interrupt the hormonal cycle. Gymnastics, ballet, athletes, and stress can lead to amenorrhea. The hypothalamus (brain) controls the pituitary gland that has control of the hormones including estrogen and can stop periods.

    Structural abnormalities may include scarring inside the uterus after a D&C, congenital abnormalities of the uterus or ovaries, or an intact hymen.

    Risk Factors include family history, eating disorders, athletic training, and certain gynecologic procedures-D&C, etc.    

    Medications such as antipsychotics, cancer chemotherapy, antidepressants, blood pressure meds, and allergy pills may also interfere with menstrual cycles.

    Complications can arise if amenorrhea is present including infertility, psychological disorders, osteoporosis, cardiovascular disease, and pelvic pain.

   E. Treatment of Dysmenorrhea

    Stopping birth control may take the body a few months for the cycle to regulate.

    Hormonal challenge test

  Hormones prescribed for 7-10 days may stimulate a menstrual cycle.

  After ruling out the above disorders and diseases, if there is no obvious cause, these patients must be followed. Birth control pills are the best chance of restarting a normal cycle.

   Treatment of underlying causes like thyroid abnormalities, and removal of a pituitary tumor with hormonal replacement. Athletes that continue their excessive workouts will just have to accept amenorrhea.

  A progesterone, Medroxyprogesterone, may start periods,  and clomiphene may also trigger ovulation in patients with polycystic ovary disease.   

Mayo Clinic

F. PMS—Premenstrual syndrome

  More than 3 million women, usually 18-35 years of age have PMS. The cause is not really known, but experts feel it is a hormonal level variation that may be playing a role. Mood stabilizers, such as serotonin, also may be playing a role, which is  one of the most important brain neurotransmitters that are involved in depression. Anti- depressants can be very helpful.

  A wide variety of signs and symptoms in PMS may play a role, including mood swings, food cravings, fatigue, irritability, and overt depression. Of course, all of these symptoms can be a sign of a depression disorder, and thus it should be treated as such with hormonal stabilization. Other symptoms in the depression spectrum can include crying spells, insomnia, social withdrawal, poor concentration, and changes in libido.

  Joint and muscle pain, headache, fatigue, fluid retention, abdominal bloating, acne flare-ups, constipation, and alcohol intolerance can occur.

  Differentiating depression from PMS

 All of these psychosomatic symptoms are not diagnostic of PMS, unless it occurs just during the premenstrual time period, and disappear within 4 days after the period begins. If the syndrome is to the extreme, it is called PMMD-premenstrual dysphoric disorder.

  It is important to keep good records to determine the extent of the disorder and the symptoms that need addressing, if they are interfering with life, relationship, job, family and friends.

  Many of these symptoms overlap with chronic fatigue syndrome (now known as central hypersensitivity syndrome), thyroid dysfunction, depression and anxiety disorder.

Treatment Summary for PMS

  It should include antidepressants (full time, not just during the symptoms), using the SSRIs, which level the serotonin neurochemicals in the brain. NSAIDs for neuromuscular symptoms, diuretics for fluid retention (Aldactone), and birth control pills (estrogen and progestin) to stop ovulation may improve PMS. Periods may stop if taking the pills continuously.

  Diet modification may help, with less salt, smaller meals, high carbohydrates (fruits) and vegetables, and whole grains. Foods rich in calcium, and avoidance of caffeine and alcohol are recommended. Exercise 30 minutes a day, yoga, relaxation breathing exercises, meditation, and avoidance of stressful situations are all obvious to assist in the control of PMS. Some herbal remedies are recommended (gingko, St. John’s wort, chasteberry, evening primrose oil, and ginger). Acupuncture helps some.

Mayo Clinic, Cleveland Clinic

3. Cancer statistics and screenings lag behind; which cancers need to be screened for?

  I have reported several times on the terrible side effects of the mismanagement of the pandemic on the psychological and physical side effects of all Americans. We also know that hesitation, fear, and reluctance to go to medical facilities have put cancer screenings way behind, and now we have the stats to prove it. Cancers are being diagnosed in later stages of the disease. There have been other factors, which will be discussed in this report.

  Here is a look at the most common cancers:

Cancer screenings account for 14% of early diagnoses of cancers

  Screenings are currently recommended for 4 cancers—breast, cervical, colorectal, and lung are recommended by the USPSTF. Living in Florida, I would recommend an annual Derm consult for a full body exam for skin cancers.

  Although many organizations recommend men strongly consider prostate screening with a PSA blood test, while the advisory committee to the administration (USPSTF) has  discouraged PSAs on all populations, concentrating on the potential complications from biopsies and over diagnosis of “mild” cancers that might just watched, especially at more advanced ages. Because there is an increasing number of prostate cancers being diagnosed that are very serious, they have joined the ACS and other medical organizations that recommend discussion regarding obtaining a PSA with their doctor from age 55-69.

   Now the country is experiencing a jump in more advanced prostate dancers, as there was a significant number of men who quit getting tested and were not diagnosed until they had more serious symptoms.

  Unfortunately, the symptoms of prostate cancer are the same as those with a big prostate (frequency, urgency, getting up at night to urinate, etc.).

Routine screening guidance from ACS

  Prostate cancer screenings are a decision between a doctor and patient, and The American Cancer Society recommends:

  the general population  consider testing annually at 50 (not 55); 45 years of age if African American, or the man has a first degree relative who had prostate cancer; 40 years of age, if there are 2 first degree relatives. After 70, the decision needs to include health and life span.

  If the PSA is less 2.5mg/l, they may wish to be tested every 2 years. If higher—annually.

  Once a cancer becomes symptomatic, after diagnosis, these cancers account for 70% of cancer deaths.

  If it is recommended to have a prostate biopsy, there are newer techniques being used. Instead of transrectal approach, they are being approached through the perineum (between the rectum and scrotum). See the differences of approach in the drawing: 

These 4 cancers account for 29% of all organ cancers and about 25% of all cancer deaths in the U.S.

  Screening for common cancers is a tremendous opportunity to catch the cancer when it is curable. Prostate cancers found later in life, however, may be able to be followed with delay in treatment and only if the milder cancer becomes more aggressive on biopsies ( higher Gleason score). Some cancers are very low grade (20+%) and surveillance is a good consideration. This certainly needs to be considered in older men or those with low grade cancers.

Other cancer screenings

  Breast mammography, colorectal screening including fecal, blood, and endoscopy tests, Pap smear including HPV screening are highly recommended. Age differs, so check with you doctor. If there is family history and positive genetic tests in the family, screening may need to be started earlier.

  Lung cancer screening is only recommended for those with a 20 pack year history, are smoking, or those who have quit less than 10 years. The spiral low dose CT scan is recommended annually and can drop the death rate by as much as 20% since the cancers are found early and are still potentially curable. Below are examples of lung and breast cancer:    

Spiral CT scan lung cancer

Mammogram with breast cancer

Medscape Medical News, December 20, 2023

Mammograms are often recommended at age 40-44. Women 45-54 should have annual exams, while those 55 and older should have every other year mammograms.

  Pap smears are performed during a pelvic exam to scrape the cells off the cervix to look for precancerous or cancerous cells.

   Since the HPV virus causes cervical cancer, testing for this virus is often done, and in some clinics, they have switched to that test exclusively.

  Pelvic exam to perform Pap smear:

Colorectal screening should start as early as 40 if there is a positive history, but the average person should start at 45. Fecal tests for blood (FIT) annually, and (Guaiac) every other year. Stool DNA (Cologuard) may detect colonoscopy will be recommended.

  These stool tests do not detect polyps, which are the precursor for most cancers, and is one of the best advantages of a colonoscopy.

  Flexible Colonoscopy is the best way to visualize polyps, adenomas, diverticuli, and other abnormalities, including cancers. It also allows biopsies of any lesions seen. Not all polyps are precancerous, but if there are numerous polyps, the normal every 10 year screening may be moved to every 3-5 years, depending on the type. Also villous poplys will be removed. A much easier procedure (sigmoidoscopy will visualize the first 60 cm, where 24% of colon cancer occur, whereas all 150 cm are visualized by a colonoscope.

Percentage of discovery with screening

  The highest rates of discovery is in prostate cancer (77%), breast (61%), cervical cancer (52%), colorectal (45%), and lung the lowest (3%).

  Sadly fewer Asian and South Pacific Islanders are less likely to be screened. The national average for screening is 12-14%, which varies geographically.

Important age for discussion with personal doctor

  It is very important when patients reach the age of 40-45, that all these screenings should be discussed with their doctors, and understand the risks and benefits for screening, but with the proven fact that screening can lower the death rate as much as 20%, it should be clear the decision. Also, family history is critical, in deciding when to start screening. Also, if there are genetic cancr markers present such as the BRCA gene mutations present in breast and ovarian cancer, and the females in the immediate family should be tested and mammograms, MRIs, and other tests may be recommended.

  If a man has women in the family with the BRCA gene, there is a higher risk of prostate cancer, and these men need to be tested at an earlier age and followed closely.

  Remember, these general screenings are recommended for the general asymptomatic population. People with risk factors will be advised differently.

American Cancer Society screening guidelines

Mayo Clinic 

4. Celebrities and their unusual diseases—Stomach cancer, Narcolepsy, Sjogren’s Syndrome

Toby Keith, Jimmy Kimmel, Venus Williams

  A. Tobey Keith—Stomach (Gastric) cancer

The famous Oklahoma country and western singer was diagnosed with stomach cancer in 2021. He underwent surgery, chemotherapy and radiation therapy over that year. He looks pretty good at courtside at OU basketball games in Norman, Oklahoma (my alma mater). He now has the Tobey Keith Cancer Foundation that supports children with cancer.

Gastric cancer

  26,500 cases of gastric cancer will be diagnosed in 2023, according to the American Cancer Society. 11,130 will die. It accounts for 1.5% of all new cancers. 6 out of 10 will be 65 or older when first diagnosed.

  Smoking, family history, men, and those with stomach ulcers caused by H.pylori are the primary risk factors. Being overweight, eating salted fish and meat, and pickled vegetables, processed, and grilled, charcoaled meats, and not eating fruits increases the risk. Drinking excessive alcohol, having pernicious anemia, and several hereditary syndromes associated with gastrointestinal polyps and cancers also can increase the risk.

Many of the symptoms of gastric cancer are similar to most stomach problems such as reflux, indigestion, stomach viruses, etc. with bloating, nausea, etc., and may be dismissed. However, persistent symptoms over 2-3 weeks should prompt anyone to see a doctor.

  Seeing a gastroenterologist for a endoscopic view of the stomach will easily discover very early cancers. Cultures for H.pylori can be performed, and if present, antibiotics can cure the infection.

Staging of the cancer (see above drawing) will determine the extent of treatment.

  Treatment may require removal of the stomach with surrounding lymph nodes to determine spread. The esophagus can be reconnected to the small intestine (similar to bariatric surgical procedures).

  If early enough (stage 1 or 2), endoscopic removal of part of the stomach can be performed, more commonly done in countries with high percentages of stomach cancer (Japan). They eat a lot of smoked fish.

  Radical gastrectomy involves removing the surrounding tissues as well (lower esophagus, pancreas, omentum, part of the small intestine, etc).

  Radiation and chemotherapy would be considered in more advanced cases, and since Tobey Keith received these treatments as well, one would assume his cancer was more advanced. It is not known about the status of his cancer today.

  Because stomach cancer is not diagnosed early in many cases, the 5 year overall survival rate is 33%, however, with early diagnosis, that rate jumps much higher.

American Cancer Society

  BTW, actor Jeff Bridges has lymphoma in his stomach, so I will discuss lymphomas in the next couple of months.

B. Jimmy Kimmel-Narcolepsy

Jimmy Kimmel has had congenital heart disease issues, and has had urethral stricture surgery, but I will report on his long standing narcolepsy.

  Narcolepsy is a serious sleep disorder, because it creates immediate REM (rapid eye movement) sleep and a patient can fall asleep immediately, perhaps behind the wheel of a car, or in many dangerous situations.

  A sudden loss of muscle tone (cataplexy), can occur from a strong emotion, such as laughter.

   Type 1 narcolepsy causes cataplexy, and type 2 narcolepsy does not. There is no cure, however medication and life style changes with friends and family support can allow these people to lead fairly normal lives. It is sudden without warning, in the middle of a sentence, or in any situation.

  Daytime drowsiness requires a workup not only for narcolepsy but obstructive sleep apnea. Both can be diagnosed with a sleep study at a certified sleep laboratory.

  Sleep paralysis can occur as the person falls asleep and they may not be able to speak or move, only lasting a few seconds, but very scary. Not everyone with sleep paralysis has narcolepsy.

  Hallucinations (dreams) during sleep paralysis can be very vivid, especially if still awake, before falling sleep and when awakening. These hallucinations can occur with people suffering from Parkinson’s disease. Anyone stating they are “seeing things” at night with this condition must be thoroughly worked up for psychologic and neurophysiologic diseases.

  Normal people do not go from awake to REM (dream) sleep quickly, a deep sleep, rather it usually takes 60-90 minutes in normal sleep cycles. These sleep abnormalities can be diagnosed during a sleep study with an EEG. When it happens in the day, going from awake to REM creates the loss of muscle tone and the person can suddenly fall asleep and fall.

  People with narcolepsy may also have obstructive sleep apnea and need CPAP as well as treatment for narcolepsy. They also can suffer from insomnia, and a REM behavior disorder, when they act out their dreams during sleep.

  Causes of narcolepsy occur from a low level of hypocretin (also called orexin), a chemical in the brain that normally helps keep us awake and when we enter REM sleep, the levels drop.

   The disorder is thought to be autoimmune, lowering the levels of hypocretin. Genetics may play role as well, and runs in families 20-40X more likely.

  Mayo Clinic states the cause might have come from a swine flu virus and vaccine, but little is known.

Treatment

  Stimulants are the main treatment. Provigil or Nuvigil, less habit forming. Newer stimulants are Sunosi and Wakix. Pitolisant may help cataplexy. Older stimulants are still being Ritalin and Adderall, but are habit forming, and being abused all over the country, now being sold on the street laced with fentanyl, killing people.

  Antidepressants (SSRIs) keep the serotonin levels high to reduce hallucinations, cataplexy, and sleep paralysis. Effexor, Prozac, Zoloft are others that may help. Older tricyclics antidepepressants can help cataplexy, including Xyrem, Xywav.

  Side effects can be a problem with any medication. Avoid alcohol and caffeine.

  Support groups may be helpful in difficult cases.

Mayo Clinic

  C. Venus Williams—Sjogren’s Syndrome

Venus Williams, sister of Serena Williams, both world famous tennis players, has Sjogren’s Syndrome, an autoimmune disease, one of the rheumatoid diseases, lupus, etc.. This is thought to be familial, with no known cause, as in an autoimmune diseases, although, infections with viruses always is mentioned, and certain traumatic events that interfere with the immune system. Most people develop it by 40 years of age, as in most autoimmune diseases is more common in women, causing dry eyes, dry mouth, and salivary gland swelling. The lacrimal and saliva glands are attacked as well by the body’s immune cells and damage the function of those glands. The vaginal secretions can also be affected. Joint swelling and stiffness, skin rash, and a dry cough may occur. The liver, lungs, thyroid, kidneys, and nerves can be affected as in lupus.

  The same autoimmune tests can be positive—ANA, sedimentation  rate, rheumatoid factor and others. Tests of all those organs may need to be investigated depending abnormal testes of those organs.

  As in all these autoimmune diseases, there is no cure, but symptoms can be controlled, and life can be fairly normal, although, with the fatigue, Venus Williams had to stop playing competitive tennis.

  A biopsy of a minor salivary gland (I have done it dozens of times), will provide the pathologic diagnosis of Sjogren’s.

Treatment

   Treating dry eyes with lubricants and saline eye drops, sipping water to allow swallowing food, mouth lubricants from a multiple source of products (Allday, StellaLife, Biotene, etc.), NSAIDs for joint pain and swelling, and Plaquenil (hydroxychloroquine) can suppress the immune system (yes, it has been used considerably for COVID and totally blasted by the feds, CDC, and Big Medicine who have out many articles stating it does not work). Even Methotrexate, a chemotherapeutic agent,  may need to be used in serious cases.

  Oral  health to prevent dental caries with fluoride prescription strength tooth paste or dental trays at night are required.  

  I have written an extensive report on dry mouth (in the next article in this report), and if the reader needs the latest information click on www.themedicalnewsreport.com/72

www.mayoclinic.org

5. Oral and Throat cancers are rising—an update on diagnosis and treatments; dry mouth syndrome; HPV vaccine 

Oropharyngeal cancers are 80% positive for the HPV virus, and there are about 5% of all cancers (~20,000 cases) diagnosed in this area of the body, and the incidence is increasing annually.  Approximately 42 million Americans are infected in the U.S. with 13 million being infected each year. This virus goes dormant and can cause these cancers including 70% of cervical (uterus), genital, and anal cancers as well. People never know when they get infected and can transmit it usually sexually without any symptoms. 

  As a retired head and neck cancer surgeon as part of my ENT/Facial Plastic Surgical practice, I also operated on these cancers that required sophisticated reconstructions using chest and free flaps to rebuild the tongue, jaw, neck, etc.

  I also had the misfortune of developing one of these cancers (base of tongue), when I was just 51 years of age (not an uncommon age today for these cancers which are HPV positive).

  Fortunately, with radiation therapy my cancer was cured (1991).

  It is important to review the anatomy of the upper airway, as the different areas all have names. There are diagrams that demonstrate the key anatomy below.

Anatomy of the oral cavity, and oropharynx (throat)

The oral cavity includes the lips, tongue, floor of the mouth under the tongue, the cheek lining, the soft palate, and teeth. The tonsils, base of the tongue, and lower throat are called the oropharynx. 

  Cancers of the lips and oral cavity occur from dipping snuff, smoking cigars, chewing tobacco, and smoking cigarettes. Sharp teeth can irritate areas and cause precancerous area in the mouth as does tobacco. Chronically inflamed gums (gingivitis) can predispose to precancerous areaa as well, plus is a major source of inflammation in the cardiovascular system.

  The most common cancers of these areas are the oral lateral tongue, tonsils, and especially the back of the tongue.

  Dentists, dental hygienists, and doctors can be very helpful in screening for these visible pre-cancers in the mouth and throat.

  Any whitish area or rough area in the mouth should be examined carefully and biopsied, as it may be precancerous (leukoplakia). These areas can be removed with surgical excision or with a laser.

Any area that ulcerates, bleeds, or is extra sensitive should be examined carefully, as these areas could be early cancers, and should be biopsied by an ENT surgeon or oral surgeon (dentist with special training).                                                             

  Mouth cancers are commonly caused by people who dip snuff, chew tobacco, or smoke cigars and cigarettes. Oropharyngeal and laryngeal cancers are caused by smoking cigarettes and drinking excessive amounts of alcohol, but it is now known that the HPV virus plays a central roll in the cause of more than 80% of oral and oropharyngeal cancers. The photo in the above page shows an advanced precancerous lesion  leukoplakia (left), and need to be removed. Below are actual cancers of the tongue.

The average age for oropharyngeal cancers is 65, but 25% occur before age 55, and are more likely HPV positive.

  20,000 people in the U.S. develop these cancers each year, and are twice as common in men.

  When tissue is biopsied, it must be tested for the HPV virus. There is also a second test recommended, P-16, which a test for the HPV strain 16. They should both be positive, as knowing this information is critical in treatment and prognosis, as the cure rate of HPV positive cancers are better.

  85-90% 5 year survival rates are quoted if the tumor is HPV positive and in an early stage, compared to 70% for those that do not have HPV in the cancer tissue. Oropharyngeal (including tonsil) cancers have the highest rates of HPV positive tumors 60% vs oral cavity of 12%.

  These head and neck cancers are squamous cell carcinoma, the cellular type of most of these cancers.

  To visualize the back of the tongue, a mirror or endoscopic examination by an ENT surgeon is necessary, but with the finger, these tumors can be felt as a fullness in the depths of the tongue. Just looking at a mouth with a tongue blade is nor enough.

  However, some of these tumors are very small but can metastasize to the neck lymph nodes very early, which happened in my case, and a lump in the neck can be the first evidence of cancer coming from the mouth or throat.

  If your dentist does not perform an oral exam to screen for cancers, ask them to.

Saliva tests

  There have been some oral saliva tests that have come and gone to diagnose early cancer or even pre-cancer (leukoplakia), and the latest test to have some promise comes from the University of Surrey, UK, with a 92% accuracy reported. This comes at a time that the UK has seen an increase of 34% of oral cancers, released by the Oral Health Foundation in 2022. A machine (called DepTech 3 DEP analyzer) was developed to analyze brush biopsies of oral linings. Medscape UK, April 5, 2023. It is still experimental, and more clinical trials will be necessary to become approved for clinical use.

Locations of cancers

  The outer aspect of the oral tongue, tonsil, and base of tongue make up most of these cancers. Laryngeal and esophageal cancers have been added to the HPV related cancers.

  Symptoms of cancer in these areas include sore throat, a sore or ulcer, a swelling in the neck or tongue, difficulty swallowing, ear pain (referred pain to the ear from the throat). Any white patch on the lip, gums, or cheeks should be biopsied.

  Risk factors include an unknown HPV infection (strain 16 most common) most likely asymptomatic infection in the throat, usually by age 20, and accelerated when a person becomes sexually active, increasing the risk with multiple partners. As many as 20% of young people will be exposed to this virus and never know it. Once the virus is in the system, it stays.

HPV virus (human papilloma)

Not only are these head and neck cancers often positive for this virus, but it is also well known to be the cause of cervical, and anogenital cancers.

  The LBGTQ community has a much higher rate of these infections, and should be screened. Men having sex with men are the highest risk group, especially if they have multiple partners.

HPV Vaccination a must—Gardasil

 80% of oropharyngeal cancers are HPV positive!!

  There is no treatment for an acute infection of HPV, especially in the throat, since most are asymptomatic, however, the vaccine against HPV (human papilloma virus) (Gardasil or Cervarix) has been amazingly successful if received before sexual activity begins.

  The CDC recommends the 2 dose vaccine begin at 9-11 years of age, up to 26. From 27-45 years of age is recommended for higher risk individuals (LBGTQ, multiple sex partners, smokers, etc.), although the effectivenss is less. Recently, one dose is being recommended by the WHO since 2022, but check with your  doctor.

   Preventing genital, anal, and oropharyngeal cancers is worth a shot, because they are all tough cancers to have and to treat.

  Only 54% of children are being vaccinated. Parents….it is your responsibility. Don’t let your feelings about other vaccines cloud your decision making. You are preventing cancer in your kids..for God’s sake.

  Do not think because a parent agrees to the vaccine, that they are approving of their children to be sexually active.

  The latest statistics for those who have been vaccinated have dropped the incidence of cervical cancer (uterine cervix) by as much as 90%.

  It is still too early to know if the vaccine will prevent oral and oropharyngeal cancers, but experts are very optimistic.

  Prolonged smoking and alcohol are also additional risk factors, but since many of those who develop these cancers never smoked and never drank much alcohol, that is when HPV got more attention.

  The latest information about those patients who have a HPV positive cancer and keep smoking and drinking…their cure rates drop close to those who are HPV negative.

   It is very important to test the biopsied tissue for HPV virus, because it has significant bearing on staging, some treatments, and prognosis, as the HPV positive tumors are easier to cure (85-90% vs 70% for HPV negative).

  It is still not known why HPV positive cancers respond to treatment better, but they definitely do, with an 85% 5 year survival vs 67% for HPV negative cancers.  

  There are other differences reported recently that distant metastases occur later in HPV positive cases and can spread to atypical areas such as the kidney, skin, brain, skeletal muscles, and axillary lymph nodes. The lung is still the most common distant spread.

 NEJM, May 12, 2023

Diagnosis

  A biopsy is necessary, and in these cases, there is a small chance that there is a second cancer present somewhere in mouth, oropharnyx, larynx, lungs, or esophagus. Therefore a triple endoscopy (laryngoscopy, bronchoscopy, and esophagoscopy with blind biopsies are performed, since these cancers can be very small, as mine was. In fact, scans and examinations were negative in my case, and only those routine blind biopsies in the base of the tongue found my cancer.

A needle biopsy of a neck mass is also common if there is a lump in the neck. My needle biopsy of a 3 cm node was negative for cancer, and my partners had to remove the lymph node for the pathologist to diagnose the cancer. Persistence in diagnosis is critical.

  CT scans and often PET scans are performed to evaluate these areas, and provide the needed information to stage the disease, as the stage determines the treatment regimen. They can be negative, as mine were, but usually they are not.

  Biopsies, imaging, and all exams must be correlated to make the best diagnosis. I am in favor of all cancers being presented to a tumor board for a consensus decision on treatment techniques.

Staging of cancers

  The American Cancer Society has a staging process that is not easy to follow, but has changed somewhat depending on whether the cancer is positive or negative  for HPV virus, since the curability of a HPV 16 viral strain is better than if it is negative (as stated earlier). It is too complicated for most readers. I refer you to www.cancer.org for this staging of positive and negative cancers, since they differ.

Unknown primary cancers

  If the cancer primary can’t be seen but there is a lump in the neck found, may imply a cancer has come from outside the head and neck or from an unknown primary cancer in the mouth or throat. If there is a small lymph node (less than 6cm) positive for cancer in the neck, it is stage 1.

  All of the doctors would have to discuss such a case regarding the appropriate treatment regimen, most likely radiation to entire mouth, throat, and both sides of the neck.

Treatment

The reason for staging the cancers is to determine the extent of treatment needed to provide the best chance of cure, and especially if the tumor is positive or negative for HPV.

  Obviously, once the tumor has spread, it changes having localized surgery alone. But metastatic disease outside the neck would not mean those areas would be treated with surgical excision. These cases should be presented to a tumor board for discussion. His gives a patient in unbiased opinion from a panel of expers that come to a consensus on the best treatment(s).

  In summary, as many as 80% of oropharyngeal cancers are HPV positive and have a much better cure rate. All biopsies are checked for the HPV virus. Esrly diagnosis equals the best chance for cure and the least amount of treatment. Clinical trials for complicated late stage cancers are a good considerarion.

www.cancer.org

Surgery

If a tumor is caught early, the discussion would center on localized surgical removal with robotic surgery or open surgery versus radiation plus chemotherapy.

  If the neck has cancer spread to it, a radical neck dissection would be considered to remove the enlarged nodes but also the rest of the nodes on that side of the neck, which are in chains along the carotid and jugular vessels and certain nerves. These are the chains of nodes.

Lymph nodes are the first place cancers tend to spread, as they are policemen of the body trying to prevent disease of any kind trying to spread to distant parts of the body.

  Below is a photo of a robotic procedure to remove a small cancer in the throat.

This drawing below  is hard to follow but portrays removal of the lymph nodes of the neck with vessels and muscles of the neck in a radical neck dissection.

The drawing on the right above shows a pedicle flap of chest skin to reconstruct a defect of the face (in this case), but with a chest muscle attached to the skin, it can be used to reconstrust a tongue or removed side of the throat.

Myocutaneous flap reconstruction for facial and oropharngeal cancers

Myocutaneous chest flap reconstruction likely will be required in many cases with local or regional neck flaps to reconstruct the tongue or mouth structure. This was the most common flap I used in my surgical practice. The chest muscle with the skin is elevated on a pedicle and introduced into the mouth for reconstruction. The flap comes with the blood supply from the flap so it will heal nicely.

  Free flaps from the lower extremity may also be performed, sewing the blood vessels from the flap to the vessels surrounding the defect. These are called microvascular flaps since the blood vessels are severed and then hooke up to the vessels in the head and neck, transferring a large piece of tissue for reconstruction. 

Radiation Therapy

  Radiation alone may be the treatment of choice, especially for earlier cancers that are stage 1. There are choices of radiation:

 --External beam radiation-3D-CRT—a form of treatment mapping out the tumor and providing the beam from different directions.

--IMRT- image modulated radiation therapy--a form of the 3D-CRT method with the computerized body of the machine being moved around the patient. This limits the dose of radiation to sensitive areas around the tumor in non-cancerous tissue, that might be injured. It allows a higher dose to the tumor itself.

--Proton therapy is different and not Xray treatment which is a photon.  Where available (large cancer institutes and some universities is often recommended, but be sure insurance will cover it, since it is much more expensive. The cure rates are no better than the other types, but may cause less damage to normal tissues.

 HPV positive cancers respond better to radiation than those which are HPV negative. These treatments are daily (5 days a week) for 7 weeks providing a calculated dose.

  Radiation with or without chemotherapy may be added to the surgical excision after healing if the cancer is more advanced, and there is concern for persistence of microscopic cancer or recurrence in the future. There are studies that may be able to exclude chemotherapy in HPV positive tumors, and even use less radiation.

  In larger cancers, radiation with or without chemotherapy may be recommended to shrink the size of the tumor and allow for more conservative surgery.

Chemotherapy or targeted biologic therapy

  Chemo may be given before (neoadjuvant) or after (adjuvant) surgery with radiation, Cisplatin is often used when radiation is being performed as well. There are other choices as well.

  Chemo can be used for recurrences.

Targeted therapy (biologic)

  Cetuximab, a targeted biologic agent can be used when chemo is not used.

Side effects of treatment

  When I had my radiation treatments (TWICE A DAY FOR 7 WEEKS) back in 1991, chemotherapy was not used in addition to radiation, so twice a day radiation was the standard of care, and was brutal. Today once a day radiation is the standard of care with chemotherapy during that time.

Dental and gum pre-treatment evaluation absolutely necessary

  All people who require chemotherapy for any cancer, or radiation of the head and neck, must have a thorough evaluation before treatment, because the mouth will ulcerate and cause severe pain.

  Radiation caries (cavities in the teeth) are a huge issue. If the patient has bad gum disease and can’t have quick treatment done on the teeth before therapy, a full mouth extraction of all teeth might be recommended, however, with better education and preventative techniques, many patients are keeping their teeth, but it requires aggressive lifelong dental prophylaxis, fluoride trays, dental cleanings,and water pic cleaning of the teeth after each meal.

   I was not so lucky, and over 30 years, all of my teeth deteriorated requiring a mouth full of crowns, that cost me over $30,000, and insurance did not cover it. Add 3 extractions!!

  Once radiation or chemo starts making the mouth sore, brushing may become difficult, and a water pic cleaning will be necessary using special solutions of medication, including fluoride rinses and salt water gargles. Magic mouth washes that may be recommended, and your dentist can discuss this with you.

  Swallowing will be extremely difficult, and eating solid food difficult. Te airway can become  swollen, and may require sleeping propped up to prevent apneic episodes.

  A humidifier by my bedside is helpful to hydrate the mouth and airway, as the radiation may destroy or injure the saliva glands, which may be temporary or permanent.

  My mouth is dry after 30 years, requiring sips of water with every bite of food. Carrying water will become necessary. Hydration is critical.

  I have written extensively before about dry mouth syndrome, as there are many diseases including cancer treatments that cause it, and it must not be ignored. Click on my website www.themedicalnewsreport#72

  This report is extensive and fully worth your time.

  Loss of saliva takes away the necessary salivary enzymes  to protect the teeth from decay, and that sets the teeth up for serious decay the rest of the patient’s life. Loss of good blood supply to the mandible can set up a serious issue usually when a tooth mus be pulled (the jaw will melt away over time requiring reconstruction). An oral surgeon should be the dentist to pull any teeth with careful postop monitoring and Xrays of the bone to make sure it heals. Implants are not recommended for these patients.

  I have had 3 teeth pulled the last couple of years, and through the grace of God, my sockets healed and my jaw has not been a problem. It take a few months of monitoring.

  For most people having a temporary stomach tube placed through the stomach wall is a good idea during radiation, and will keep a patient better hydrated and lose less weight. Nutrition is critical to enhance healing.

  I lost 57 lbs., since I did not have that tube placed, when I received radiation and it took a year and half to regain most of my weight  back, and delayed my healing greatly.

Taste will disappear for a few months, so plan on food having little taste or altered taste. My mouth took a year to recover and for my taste to return.

  Newer radiation techniques described above are capable of sparing some of the salivary glands and have been extremely helpful in returning some of the saliva back into the mouth, although most patients will still have some trouble. Proton radiation therapy is better sparing the salivary glands.

  Fluoride prescription strength tooth paste is a must to brush with and gels to use in dental trays to fight the bacteria in the mouth for life to prevent decay.

  Sugar is a culprit, as it is the food that bacteria live off, so eliminate candy, gum (except sugarfree) from the diet.

  Be sure the dentist you are using has experience with radiation induced dry mouth syndrome. If they are not trained to care for radiated patients, seek out one by asking the radiation therapist for their recommendation.

  Formal cleaning and every 4-6 months are critical to catch early decay and tooth root issues. I have had to have many root canal procedures. 

  Pain and swelling around teeth, bleeding gums, etc. deserves immediate attention!

  Although not as big a problem with newer techniques, when I was irradiated, the carotid artery and even the cervical vertebrae were damaged with calcification from radiation and fusion of vertebrae with nerve damage. Over the years, I have had both my carotid arteries block off requiring surgery (endarterectomy and 2 stents. Calcification (a result of damage) occurs in those vessels and eventually blockage. Ultrasound testing is important to follow, as the blockage will be silent. Strokes can occur if left untreated.

  The lymph nodes in the chest are radiated as well, and will cause trouble with the esophagus, heart valves and coronary arteries potentially causing rigidity and calcification. Calcification is the result of inflammation caused by the burning effects of the radiation.

Survivorship

  In 2022, it was estimated that there were nearly 16.9 million cancer survivors in the U.S., 5.4% of the population, and is expected to increase by 24.4% by 2032, according to the American Cancer Society.

  This is a critical concept and one that I am proud to say I was one of the voices that encouraged the American Cancer Society to start a serious promotion of survivorship, when it became known that there were more than  a million cancer survivors living and deserved direct attention from the oncologists for more intensive followup with but primary care doctors getting involved.

  Today, large cancer centers have survivorship clinics to follow patients to monitor them closely for recurrence, new cancers (15% will get another cancer eventually), and treatment and preventative measures for the post-treatment side effects, which need continuous monitoring such as the dental and carotid issues.

 Head and neck cancer only accounts for 3-4% of all cancers, but deserve early diagnosis and rapid treatment.

  With early detection and treatment patients can expect high cure rates (85-90%). Do not restart smoking or drinking alcohol after treatment, as it increases the risk of recurrence and a second cancer.

  Never disregard a sore throat and pain and swelling in the mouth or throat that lasts for over 2 weeks. If a lump in the neck occurs, have it evaluated very soon, especially if non-painful. Voice changes, trouble swallowing, and any changes in the mouth and throat need attention.

References:

American Cancer Society, Cleveland Clinic, NCI

NEJM, May 2, 2023

6. The Havana Syndrome—CIA declassified report

  In October, 2018, I described the unusual symptoms that occurred in Cuba to some U.S. diplomats, hearing loud shrill noises in their  hotel rooms, which caused disorientation, memory lapses, ringing in the ears, dizziness, migraines, nausea, and a variety of other constitutional symptoms, which in some have continued. The initial events occurred in 2016, according to a report from Reuters. You need to read my report at www.themedicalnewsreport.com/81

  Another report by a globe spanning U.S. intelligence investigation (CIA) finally came out to the media and announced, they have not been able to come up with the cause or who created it. The leading proposed culprits are foreign adversaries that afflicted diplomats, spies, and U.S. personnel worldwide, according to a declassified report on March 1, 2023.

  About 1500 cases now have been reported by the feds, which continues to occur across the globe, even this year. They also concluded that there was no American foe that possessed a weapon or collection device, including an emitter of electromagnetic energy pulses.

  There was a mixed difference of opinion regarding a possible U.S. plot. A variety of tracking and moniotoring devices have come up with little proof of origin. Yet, since this is continuing, it appears our abilities to come up with answers certainly are concerning, so what is next, as we face WWIII?

  Why are the U.S. governmental personnel being targeted? This stinks of foreign involvement, and it is our fault the real answers have yet to come. If this is not a plot against our feds, color me stupid…..or they know and are not talking!

  These people continue to receive medical care, and we need to hear from the doctors taking care of them…and are not. The CIA needs James Bond.

Reuters, March 2, 2023

This concludes the June, 2023 report

Next month, the July report will include:

1. Celebrities with unusual diseases-Part 3—George Clooney, Justin Bieber Senator Feinstein (D-Calif), facial palsy, Ramsey-Hunt Syndrome; Lady Gaga--fibromyalgia

2. Breast Cancer Series—part 1—update 2023

3. A possible alternative to statins to reduce cholesterol—bempedoic acid

4. Hepatitis A, B, C; complications from cirrhosis

5. A drug that might improve libido and sexual performance-Kisspeptin 10

Thank you for reading my reports. Have a great summer, stay healthy and well, my friends, Dr. Sam