Tag Archives: minerals

THE GROWING RISKS OF CHEMO-FOG; THE ETHICAL DILEMMA OF INFORMED CONSENT. WHAT SHOULD BE OBLIGATORY SCREENING?

neil.burman@gmail.com.      for debate.

ETHICAL CONSIDERATIONS: given the increasing evidence of cognitive and mood effects of cancer and fear on patients with extracranial cancer, let alone after chemo-and radio-therapy, it becomes a major ethical issue as to whether the patient alone should be the decision-maker in the fearmongering-driven decision about whether  to have xray-screening mammography  or prostate  or colon cancer screening in the absence of symptoms and familial high risk.

Similarly, given the epidemic nature of HIV-AIDs and  overweight-prediabetes-Hypertension in Africa, and the giant public cost of illness and deaths  from these diseases, should screening and treatment  for these be voluntary or compulsory?

Equally, are patients diagnosed with cancer, hypertension or HIV-AIDs  competent to make decisions alone for themselves about cancer or other  therapy? Can the patient alone decide about active interventions, versus withdrawal from all therapy – giving up and accepting death – when there are so many options that may help and even cure despite advanced cancer, AIDs and diabetes-hypertension. Surely the patient’s most responsible relative needs to be involved.

  We frequently see such patients plunge into therapy, or withdraw from therapy to die. Current cancer reviews from America, Italy and Portugal  explore this need for truly informed consent. and adequate support for cancer, AIDs and hypertension. 

The need is as great in  AIDs- HIV infection- in our local state AIDs  clinics,   patients have to bring along a buddy, someone – partner, family or friend – from their neighbourhood- who can be relied upon to support the patient through thick and thin, ensure compliance with both complicated drug therapy and all aspects of nutrition and function in consultation with the medical and social backup team.

BACKGROUND:

The analogy of Cancer  with AIDs and overweight-prediabetes-hypertension  is strong. With HIV-AIDs there is oftem  inital  anxiety and depression in anticipation of the screening test, especially in someone who has symptoms; and then if the test is positive. more guilt, anger, fear and despair needing support till the patient adjusts to living with HIV and the necessary prevention and precautions;  until the cycle repeats itself when deterioration necessitates active therapy for active AIDs ARVs (antiretroviral therapy) and if necessary antituberculous therapy. . Both AIDs and ARVs can seriously affect both mood, cognition and thus behaviour. The latest Pubmed  reviews are  from Spain and USA.

 In survivors of brain cancer as well as cancer outside the nervous system, the effects of radiotherapy on the brain’s longterm mental, sensory, cognitive  and motor  function and hormone output, are well known, even in the absence of nervous system malignancies or direct nervous system therapeutic irradiation. The same applies to the deadly longterm consequences of untreated overweeight-prediabetes-hypertension and HIV-AIDs.

Cramond 1968 is the earliest reference found on Pubmed search  (for cognitive impairment and cancer),  an omnibus pair of articles that reviewed all of organic psychosis – cognitive, mood and behaviour effects on the brain of organic disease;  but in the second article   he  quoted only a case of intracranial cancer.  He did not refer to brain effects of extracranial cancer or chemo-radiotherapy.

The first report of brain impairment after combined radio-chemotherapy appears on Pubmed in 1978.  

” Affective and cognitive effects of chemotherapy in cancer patients”   was  first linked in 1980  by  Silberfarb PM, Philibert D, and Levine PM         

 and Chemo brain in  a 2005 review  of  cognitive impairment in patients before any treatment. 

 By 2007 chemo fog was no longer regarded as an illusion in a major New York Times review

There are increasing numbers of long-lived survivors of cancer treatment -especially in middle-aged ie prime-time women after breast cancer. .

Now teams from Amsterdam and Oxford universities 2011,  and Harvard 2010,   show cognitive impairment is common long term in survivors treated even only with cancer chemotherapy for non- nervous system cancers. . This is associated with predictable white and grey matter damage from cytotoxic drugs- such poisons naturally damage healthy as well as killer cells.

 This was and is  the deadly fallacy of the profiteering screening xray mammography industry marketeering that “xray mammography saves lives” highlighted previously in this column, that lowdose irradiation and chemotherapy would not damage healthy tissues. .

Obviously this  cognitive impairment long term with cancer, and iatrogenic after chemo/radiotherapy,  must also be weighed up by the patient who faces multiple choices of therapies for cancer – especially as conventional allopathic cancer therapy does not cure even 10% of all cancers.

Most patients who die old – with or without a history of cancer- have some usually undiagnosed ie dormant cancer somewhere in their body.

This applies also to those considering having invasive screening tests for clinically asymptomatic cancers of eg the breast and prostate, for which the wished-for longterm benefits of preclinical diagnosis and treatment have been disproven, indeed discredited by the risks.. As a result, even the value of colon screening for all is being increasingly questioned in the asymptomatic without family history of colon disease.

This doubt about screening obviously falls away in patients who have strong risk (from previous cancer or family history) of the Big Five sexhormone-linked cancers – breast, prostate, colon, endometrium and ovary.

 Obviously accumulating life stresses, familial anxiety-depression and dementia,  aging-related vascular disease, smoking, alcohol, virus infection, multiple hormone and other imbalances (dietary and minerals; vitamin- and other biologicals) will compound the problem of cancer-therapy-associated mood, cognitive and behavioural  impairment. These need anticipation ie simple holistic prevention with safe natural supplements from as young as possible, to prevent both cancer and the other common comorbid degenerative diseases of aging.

The authoritative Life Extension Foundation lists many useful and often evidence-based brain-protective supplements.

www.cancer-prevention.net  is a comprehensive review of different strategies, although it strangely discredits itself because it is incomprehensibly undated, anonymous and unreferenced. .

 But each putative individual supplement can be simply referenced for it’s evdence base  on Google and Pubmed.

CONCLUSION: Like untreated asymptomatic hypertension, diabetes,  menopause and AIDs, cancer screening let alone cancer itself is often associated with  organic brain problems-  depression, cognitive and perhaps behavioural.  These require  evaluation and consideration at all time, especially in regards to invasive screening and management- or avoidance of these. Is eager consent to invasive screening or invasive therapy- or refusal thereof – truly informed ethical consent, understanding of benefits and risks?

 The similarity  between hypertension, HIV-AIDs and cancer is that both avoidance of risk factors, lifestyle and supplements can make a major difference.

The difference is that many cancers can be left well alone, the immune system optimized by optimal diet-lifestyle and supplements, with permanent remission or progression often unaffected by conventional allopathic cancer therapy. In asymptomatic eg lung, prostate and breast cancer, and eg asymptomatic chronic leukemia,  screening of those not  symptomatic, not at high risk is thus fultile. Treatment can wait till cancer if ever presents clinically, while all practice sensible prevention.

 In HIV carriers and asymptomatic overweight-prediabetes-hypertension in  Africa at least,  only a tiny proporttion will not progress to terminal AIDs or malignant diabetes-hypertension, so regular monitoring is necessary to decide when to start ARVs and metformin plus antihypertensives to prolong life and health for decades. It can be strongly arguesd that compulsory periodic HIV and waistgirth and bloodpressure screening are both lifesaving and in the public interest since early diagnosis and mandatory intervention can be life-and health-saving.

Helen Zille, the Leader of the Opposition here, has the last word this morning, on the paradigm shift in thinking needed  in ‘Tackling the new AIDs denialism’.

Is recklessly spreading AIDs by unprotected sex- as African male culture apparently still promotes despite the outrage the promiscuous  then deputy-president Jacob Zuma himself provoked a decade ago in his rape trial- any different from reckless promotion of harmful screening xray mammography, or the legislative ignoral of the need for regular mandatory screening for hypertension and HIV?

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How to Survive a Heart Attack When Alone: coughing and deep breathing? too little too late.

How to Survive a Heart Attack When Alone: coughing and deep breathing?
This email doing the rounds may be inappropriate advice that could cost people their lives. – see http://www.hoax-slayer.com/survive-heart-attack.html and http://www.viahealth.org/body_rochester.cfm?id=329

BUT an apparently reputable cardiologist (apparently ex Vietnam Medic) also recommends it: http://www.karinya.com/cpr.htm

BUT see the notes of caution at http://en.wikipedia.org/wiki/Cough_CPR.

In short, it may save those who have sudden arrhythmia- but it is less likely to save those who are having a huge heart attack.- for whom most interventions are too late. The compromise may be to switch on the vehicle’s emergency flicker, stop the car, start coughing while collapsing visible over the steering wheel with a hand on the hooter to attract attention..

Very very few people recover or survive well long term after spontaneous (ie non-violent, non-toxic) cardiac arrest outside hospital – the studies below from France, Germany , USA & UK indicate that successful survival without impairment is – in the best hands – below perhaps 5%. .

So only primary prevention pays. Fish oil halves sudden death; metformin halves the deathrate in type 2 diabetics – and halves new diabetes in the overweight; appropriate estrogen replacement lowers allcause premature mortality by a third; deficiency of testosterone, estradiol, minerals, vitamins, CoQ10 , arginine, carnitine and ribose play a crucial role in the development and reversibility of arrhythmia, cardio/vascular and all-cause degenerative disease; and testosterone is antiarrhythmic but estrogen arrhythmogenic.

By contrast, unlike the above proven life-extenders, no modern designer drugs for chronic use have been shown to significantly reduce all major chronic degenerative diseases and premature all-cause mortality.

Thus all should take natural supplements early and permanently – appropriate vigorous supplements of minerals, vitamins and biologicals (including fish oil, insulin sensitizers and sex hormone replacement), to minimize early vascular disease and arrhythmia potential.

ndb

Heart. 2007 ;93:601-5. Sudden arrhythmic death syndrome SADS : a national survey of sudden unexplained cardiac death.Behr ER, Casey A, Sheppard M, University of London, UK. The estimated mortality from SADS was 0.16/100 000 per annum (95% CI 0.12 to 0.21), compared with an official mortality of 0.10/100 000 per annum for International Classification of Diseases 798.1 (sudden death, cause unknown-instantaneous death) or 1.34/100 000 per annum for unascertained causes of death. CONCLUSIONS: Deaths from SADS occur predominantly in young males. When compared with official mortality, the incidence of SADS may be up to eight times higher than estimated: more than 500 potential SADS cases per annum in England. Families with SADS carry genetic cardiac disease, placing them at risk of further sudden deaths. SADS should therefore be a certifiable cause of death prompting specialised cardiological evaluation of families.

European Heart Journal 2006 27:406-412 Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management Jill P. Pell ea University of Glasgow,
The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991–01 following pre-hospital arrest due to cardiac aetiology. Over the period studied, the proportion of people suffering pre-hospital arrest who survived to discharge from hospital changed from 11.6% (552/4766) in 1991–93, to 7.0% (558/8006) in 1997–01.

Resuscitation. 2005 65:49-55. Outcome after cardiac arrest: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale. Pfeifer R, ea University of Jena, Germany.
BACKGROUND AND PURPOSE: Patients resuscitated from cardiac arrest are at risk of subsequent death or poor neurological outcome up to a persistent vegetative state. We investigated the prognostic value of several epidemiological and clinical markers in 97 patients undergoing cardiopulmonary resuscitation (CPR) after non-traumatic cardiac arrest between 1998 and 2002. RESULTS: 72.% of the patients died or remained in a persistent vegetative state; and 28.8% survived with severe, moderate or without neurological disorders. .

N Engl J Med. 1999 341(8):569-75. A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. French Active Compression-Decompression Cardiopulmonary Resuscitation Study Group.Plaisance P, ea .Lariboisière University Hospital, Paris, France. BACKGROUND: We previously observed that short-term survival after out-of-hospital cardiac arrest was greater with active compression-decompression cardiopulmonary resuscitation (CPR) than with standard CPR. In the current study, we assessed the effects of the active compression-decompression method on one-year survival. METHODS: Patients who had cardiac arrest in France, more than 80 percent of whom had asystole, were assigned to receive either standard CPR (377 patients) or active compression-decompression CPR (373 patients) according to whether their arrest occurred on an even or odd day of the month, respectively. The primary end point was survival at one year. The rate of survival to hospital discharge without neurologic impairment and the neurologic outcome were secondary end points. RESULTS: Both the rate of hospital discharge without neurologic impairment (6 percent vs. 2 percent, P=0.01) and the one-year survival rate (5 percent vs. 2 percent, P=0.03) were significantly higher among patients who received active compression-decompression CPR than among those who received standard CPR.

Chest. 1994 ;106:872-9. Survival after in-hospital cardiopulmonary arrest of noncritically ill patients. A prospective study. Berger R, Kelley M. Veterans Affairs Medical Center, Lexington, KY 40511.
BACKGROUND: The rising healthcare costs and the ethical and economic implications of cardiopulmonary resuscitation (CPR) have generated interest in defining criteria to predict the appropriateness of CPR in specific patients. Age has been proposed as one such a criterion. METHODS: As part of a quality assurance program, all instances of CPR (code-500) at our VA Medical Center were prospectively studied over a period of 45 months. Only events in noncritical care hospital areas were included in this analysis. The CPR data were prospectively collected, and follow-up of initial survivors was continued until the end of the study period or until a patient died. RESULTS: Of a total of 422 code-500 events, 387 (92 percent) met our study definition of cardiorespiratory arrest, and 255 of these occurred in a noncritical care area and were included in the study. Our immediate survival was 52 percent (n = 132), survival after intensive care unit (ICU) stay was 22 percent (n = 55), survival to hospital discharge was 11 percent (n = 28), and 4 percent of the patients (n = 10) were alive at the end of follow-up (mean, 22 months). None of the patients discharged alive had a significant new neurologic deficit, and all but one returned to their preadmission environment. The post-CPR hospital charges for each of the surviving patients was estimated at $63,000. Whether in-hospital CPR in noncritical care areas is cost-effective is an issue that society at large must eventually decide.

Drugs Exp Clin Res. 1992;18:355-65. Controlled study on L-carnitine therapeutic efficacy in post-infarction. Davini P, ea Santa Chiara Hospital,Pisa, Italy. A controlled study was carried out on 160 patients of both sexes (age between 39 and 86 years) discharged from the Cardiology Department of the Santa Chiara Hospital, Pisa, with a diagnosis of recent myocardial infarction. L-carnitine was randomly administered to 81 patients at an oral dose of g 4/die for 12 months, in addition to the pharmacological treatment generally used. For the whole period of 12 months, these patients showed, in comparison with the controls, an improvement in heart rate (p < 0.005), systolic arterial pressure (p < 0.005) and diastolic arterial pressure (NS); a decrease of anginal attacks (p < 0.005), of rhythm disorders (NS) and of clinical signs of impaired myocardial contractility (NS), and a clear improvement in the lipid pattern (p < 0.005). The above changes were accompanied by 90% lower mortality in the treated group (1.2%, p < 0.005), – in the control group mortality was 12.5%. Furthermore, in the control group there was a definite prevalence of deaths caused by reinfarction and sudden death. On the basis of these results, it is concluded that L-carnitine represents an effective treatment in post-infarction ischaemic cardiopathy, since it can improve the clinical evolution of this pathological condition as well as the patient’s quality of life and life expectancy.

Mol Aspects Med. 1994;15 Suppl:s165-75.
Usefulness of coenzyme Q10 in clinical cardiology: a long-term study.Langsjoen H, University of Texas Galveston .
Over an eight year period (1985-1993), we treated 424 patients with various forms of cardiovascular disease by adding coenzyme Q10 (CoQ10) to their medical regimens. Doses of CoQ10 ranged from 75 to 600 mg/day by mouth (average 242 mg). Patients were followed for an average of 17.8 months, with a total accumulation of 632 patient years. Eleven patients were omitted from this study: 10 due to non-compliance and one who experienced nausea. Eighteen deaths occurred during the study period with 10 attributable to cardiac causes.. Of 424 patients, 58 per cent improved by one NYHA class, 28% by two classes and 1.2% by three classes. A statistically significant improvement in myocardial function was documented . Before treatment with CoQ10, most patients were taking from one to five cardiac medications. During this study, overall medication requirements dropped considerably: 43% stopped between one and three drugs. Only 6% of the patients required the addition of one drug. No apparent side effects from CoQ10 treatment were noted other than a single case of transient nausea. In conclusion, CoQ10 is a safe and effective adjunctive treatment for a broad range of cardiovascular diseases, producing gratifying clinical responses while easing the medical and financial burden of multidrug therapy.

Mol Aspects Med. 1994;15 Suppl:s143-7. Coenzyme Q10 and antioxidants in acute myocardial infarction.
Kuklinski B, ea Klinikum Südstadt, Rostock, Germany.
Sixty-one patients admitted with acute myocardial infarction, and a symptom’s duration of less than 6 hr were randomized into two groups. Immediately after hospitalisation, members of the verum group (n = 32) received 500 mcg of selenium (as sodium selenite). Thereafter they received a daily dosage of 100 mg coenzyme Q10 (Bio-Quinone) and 100 mcg selenium (seleno-methionine) for a period of one year. The control group (n = 29) were given matching placebo preparations.. Biochemical parameters showed a reduced concentration of CPK- and ASAT-level in the verum group during the acute phase (although not statistically significant). None of the patients in the verum group (i.e. on antioxidative treatment) showed prolongation of the frequency corrected QT-interval. In the control group, 40% revealed a prolongation of the QT-interval by more than 440 msec (p < 0.001). There were no significant differences, with respect to early complications. During the one-year follow-up period after myocardial infarction, six patients (20%) from the control group died from re-infarction whereas one patient from the verum group suffered a non-cardiac death.

Int J Tissue React. 1990;12(3):163-8. Pronounced increase of survival of patients with cardiomyopathy when treated with coenzyme Q10 and conventional therapy. Langsjoen PH, ea Scott and White Clinic, Temple, TX USA.
During 1982-86, 43/137 patients with cardiomyopathy, Classes II, III and IV, had ejection fractions (EF) below 40%, and a mean EF of 25.1 +/- 10.3%. During treatment of these 43 patients with coenzyme Q10 (CoQ10), EF increased to 41.6 +/- 14.3% (p less than 0.001) over a mean period of 3 months (range, 2-4 months). The mean CoQ10 control blood level was 0.85 +/- 0.26 micrograms/ml which increased on treatment to 1.7 to 2.3 micrograms/ml for five periods up to 36 months (each period, p less than 0.001). The survival rates for all 137 patients treated with CoQ10 and for the 43 patients with EF below 40% were both about 75%/46 months. These two survival rates were comparable between 24 and 46 months, which is of extraordinary significance and importance when compared to survival of about 25%/36 months for 182 patients with EF below 46% on conventional therapy without CoQ10. The improved cardiac function and trippled survival show that therapy with CoQ10 is remarkably beneficial due to correction of CoQ10 deficiency in mechanisms of bioenergetics