Philip S. Chua M.D

Philip S. Chua M.D (6)

Health@Heart

Sexually Transmitted Diseases

It is quite alarming that forty-five to fifty percent of men and women in the United States have HPV – genital Human Papillomavirus – infection. This information was recently reported by the Center for Disease Control’s National Center for Health. It is, indeed, the most common sexually transmitted disease in the country. Here are the details, which are conservative statistics since this does not include institutionalized higher risk individuals, like prisoners, addicts, and the homeless:

“Using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014, researchers found the following:
Oral HPV prevalence was 7% for adults under age 70. The prevalence of high-risk oral HPV was just 4%.
For adults under age 60, the prevalence of genital HPV was 43% in 2013 to 2014. It reached 64% among black adults. Non-Hispanic Asian adults had the lowest prevalence at 24%.
Roughly 23% of adults had high-risk genital HPV, with the highest prevalence among black males (40%).

HPV and cancer
There are more than 108 different types of genital HPV, more than 30 of these are sexually transmitted, causing infection involving the skin of the penis, vagina (vulva), cervix, and even the anus and rectum.
US government statistics show that 25 percent of men and 20 percent of women have the strain of human papilloma virus or human wart (virus) that causes cancer. To protect individuals who are 25 and younger from acquiring this HPV-related cancer, the vaccine listed below is available today.
Cervical cancer
Cervical cancer is malignant tumor of the cervix (mouth of the womb). It is the second most cancer in women and the third most common gynecologic cancer, the second being cancer of the ovary. The most common gynecologic malignancy is endometrial (inner wall of womb) cancer, which is the fourth most common cancer in women. The first being cancer of the breasts, followed by colorectal cancer and lung cancer. Cervical cancer develops in women at the mean age of 50 years old, although it can occur in women as young as 20. In the Philippines it is the number 2 most common form of cancer among women. In the United States it accounts for least 3000 deaths, and globally, about 300,000, annually.
How prevalent is cervical cancer?

More than 20 million of Americans have HPV infection. In the Philippines, there are about 5000 new cases of cervical cancer each year. By age 50, about 80 percent of American women will have acquired genital HPV. However, more alarming than that is the fact that there are between 10,000 to 25,000 women walking around (not seen by physician) who have undiagnosed pre-invasive lesions in their cervix. If diagnosed early, these women could be saved. For every four survivors of breasts cancer, there are less than 3 women who survive cervical cancer, which shows how virulent cervical cancer is.

What causes cervical cancer?

Human Papilloma Virus (HPV, also known as genital herpes virus) accounts for most, if not all, cervical cancers. At least 50% of sexually active men and women are infected with genital HPV, especially those with multiple partners. There are about 20 million American men and women infected with HPV, many linked with abnormal pap tests, genital warts and cervical cancer. It is estimated more than 10,000 new cases of cervical cancers are discovered annually. Between half a million to a million Americans have genital warts, transmitted thru sexual contacts. The so-called high risk HPV may cause positive Pap test, and it could cause cancer of the cervix, vulva, vagina, penis, anus or rectum. The low-risk , milder form, causes single or multiple bumps of genital warts (kulugo) and could be cauliflower shaped.

Is the cure for cervical cancer?

Better than the cure! A vaccine that prevents cervical cancer has been in use since it was introduced in June 2006 and found to be “effective 100%, in the short term, at blocking the cancer and lesions likely to turn to cancer” (like the pre-invasive lesions), according to drug manufacturer, Merck & Co.

The vaccines, which are genetically engineered, Gardasil and Cervarix, which block infection caused by two of the more than 108 types of human papilloma virus (HPV), strains 16 and 18. These two sexually transmitted viruses are responsible for about 70% of cervical cancers. HPV, in one form or the other. The other strains of the virus cause painful genital warts, and sometimes, cervical cancers too. The newer versions of these vaccines are effective for more strains of HPV.

How early should the vaccine be given?

Students in grammar school, middle school and high school should be vaccinated before they become sexually active, because once they catch HPV infection, there is no cure; herpes is for life. This was the recommendation of Dr. Gloria Bachmann, director of The Women’s Health Institute at Robert Wood Johnson Medical School in Brunswick, NJ., who said this vaccine is a “phenomenal breakthrough. This is, today, the standard of care.
Can oral sex cause cancer?
The most common cause (70 percent) of throat cancer is oral sex with a partner who has active HPV infection. About 4 percent of adults who practice oral sex will have oral infection with a high-risk form of cancer-causing HPV. Experts say head and neck cancer will surpass cervical cancer as the most common cause of HPV-related cancer by 2020. Without being flippant, the use of seran wrap or plastic film to cover the female pelvis (similar to the use of condom for males), if oral sex is to be practiced at all, could be of some protection against HPV contamination. However, the CDC review of 138 peer-reviewed scientific studies showed that the use of condom is not effective in reducing the risk of STDs. Out of 100 women who used condom religiously, 37 of them still developed HPV. At least 1 percent of condoms are defective.
Syphilis higher among homosexuals
While society regards syphilis as an STD of the past, it is actually still very much with us, domestically and globally. Rarer than it was a century ago, syphilis remains a much dreaded disease.
Men who have sex with men have much higher rates of syphilis infection, according to a study. The rate is 106 times more than the rate of syphilis among heterosexual men, and 167 times higher than the rate of infection among women.
Homosexuals had a rate of 309 cases per 100,000 population for a primary and secondary syphilis, compared to 2.9 and 1.8 cases per 100,000 for heterosexual men and women, respectively. The region with the highest rates are located in the Southern region, with a rate of 748 per 100,000 in North Carolina.
This may sound like over simplification and quite obvious, but the best way, the surest way, to prevent getting any sexually transmitted diseases is not to have sexual contact with someone infected, or possibly infected, with HPV/HIV/Syphilis/Gonorrhea.

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The new silent killer

The silent killer of the 1970s, high blood pressure, is now replaced by Metabolic Syndrome, a cluster of three or more risk factors like abdominal obesity, high blood pressure, high triglycerides, abnormal lipids, and insulin resistance (pre-diabetes T2).

The expanding waistlines of Americans (and Filipinos also) the past several decades has been alarming, not only from the cosmetic/physical point of view but, more importantly, from their adverse impact on health, morbidity. and mortality. It is now obvious that “love handle” can be deadly.

The researchers from Charles E. Schmidt College of Medicine at Florida Atlantic University, in an article posted this year in the Journal of Cardiovascular Pharmacology ad Therapeutics, stated that “being overweight and obesity contribute to metabolic syndrome, which affects 1 in 3 adults and about 40 percent of adults aged 40 and older…that the risk factors are more than just the sum of their parts.”

Obesity is indeed surpassing tobacco as the pre-eminent preventable cause of early morbidity and premature deaths in the United States and globally.

The rule of thumb is that optimizing health requires and includes a waistline of less than 40 in men and less than 35 in women, and a healthy lifestyle: diet, exercise, abstinence from tobacco, disciplined alcohol intake, and stress management.

The authors of the study explain “that the visceral fat component of abdominal obesity leads not only to insulin resistance but also to the release of non-esterified free fatty acids from adipose tissues or body fat…the lipids then accumulate in other sites such as the liver and muscles, further predisposing individuals to insulin resistance and dyslipidemia-abnormal amounts of lipids…and adipose tissue may produce various adipokines that may separately impact insulin resistance and cardiovascular disease risk factors.”

Persons with metabolic syndrome are generally without symptoms and severely underdiagnosed and untreated, but have a 10-year risk of a first heart attack, according to the Framingham Risk score of 16 to 18 percent, which puts them in a higher risk category similar to those who already had a previous heart attack.

Various clinical studies have shown than even with a normal Body Mass Index (BMI), individuals with expanding waistline from visceral fats could still have metabolic syndrome. Those who consume soft drinks of any kind, cola or uncola, diet or regular, caffeinated or not, have a higher risk for the development of metabolic syndrome, especially children. Indeed, soft drinks are toxic to our body, to our DNA

As I have highlighted in the book Let’s Stop “Killing” Our Children, healthy lifestyle and disease prevention, in order to be fully effective, must start in the womb, and dieting and discipline must begin in the crib to protect the children’s DNA. This pre-emptive and proactive strategy at the cellular/molecular level will exempt them from having the so-called “expected and normal diseases of aging,” like arthritis, high blood pressure, diabetes T2, heart diseases, stroke, Alzheimer’s, and even cancer. Indeed, these are preventable.

The pandemic of obesity, which begins in childhood, is increasing the past century, and the current generation of children and adolescents (who eat more calories and unhealthy foods and who exercise less) will reach middle age with higher morbidity and mortality from metabolic, cardiovascular diseases, stroke, and cancer, which may even be worse than their parents’ in spite of the great advances in medical science and technology.
While colon cancer rates have been going down among the elderly (55 and older) since the 1980s, they are increasing among those in their 20s and 30s. This was the recent alarming finding of a US cancer registry, which reviewed nearly half a million color-rectal cancers diagnosed between 1974 and 2013, published in the Journal of the National Cancer Institute and in the March 1, 2017 issue of the New England Journal of Medicine.
The research shows that for colon cancers, a rate increase of 2.4 percent annually was noted for those in their 20s and 1.0 percent among those in their 30s. For rectal cancers, the yearly increase was even higher, 3.2 percent. In general, the study also found that there was an increase in the rate among adults in their 40s and early 50s, but not as bad.
This report revealed an alarming retrogression in our battle against colorectal cancers: “that young adults' colorectal cancer risk is now similar to that of adults born around 1890.”
The investigators pointed out that high obesity rates the past several decades “may play a role in this generation. Obesity increases the risk for all types of cancers and cardiovascular diseases, like high blood pressure, heart attack, stroke, and diabetes.
Our lifestyle, which includes what and how much food we eat, where we exercise or not, and all our self-indulgences/abuses, contribute a lot to our state of health. Metabolic syndrome, especially obesity, and red meat and processed meat consumption, all increase the risk for cancer. Neglecting regular medical/ dental check-up and recommended tests also increase our health risk.

The national Institutes of Health reports “approximately 2/3 of adults between 20 and older are overweight or obese with BMI greater than 25, and nearly 1/3 have BMIs greater than 30…less than 1/3 of them are at a healthy weight with BMI of 18.5 to 24.9.”

The estimated cost of obesity in the United States is around $190.2 billion a year, almost 21 percent of medical spending, not including the personal expenses of the individuals and the toll on human misery and human life.

Shedding off at least 5 pounds of our excess weight thru disciplined caloric counting and walking exercise for about 20 minutes a day will reduce our risk for metabolic syndrome and cancer by more than 33 percent. This is a practical and wise strategy we can painlessly do, for free!

Glaringly obvious are the evidence-based roles and impact of diet, exercise, tobacco, and alcohol on our individual health and longevity. They can’t be any clearer.

To a great extent, our health and our life are in our hands and what to do with them is our choice.

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Breast Implant and cancer

The U.S. Food and Drug Administration reported last week that “nine deaths and hundreds of cases of a rare cancer have been linked with breast implants.”

The malignancy here is not breast cancer but an immune system cancer known as anaplastic large-cell lymphoma (ALCL). The cancer nurtures itself in the breast, notably in the scar tissue around the foreign body implant. Fortunately, in most cases this is treatable.

The implant-cancer link was noted in 2011. As of February 2017, the FDA has recorded 359 cases of ALCL linked to breast implant.

The Times reported stated “the disease is most likely to occur with textured implants that have a pebbly surface rather than a smooth surface…and of the 359 reported cases, there was information about the implant surface in 231. Of those, 203 patients had textured implants and 28 had smooth implants….Whether the implants contained silicone gel or saline appeared much less important than surface texture in disease risk.” The number of this ALCL cases worldwide is not known.

According to the American Society of Plastic Surgeons there were about 290,000 women in the United States in 2016 who had implants for breast enlargement and 109,000 received implants for reconstruction after breast cancer surgery.”
Any pain, lumps, fluid accumulation or swelling of the breast after an implant, no matter when surgery was done need to be evaluated by the surgeon.
To prevent blindness
A retrospective study published in the JAMA Ophthalmology found that many children and adolescents with diabetes are not being screened in a timely fashion for diabetic retinopathy, a common cause of blindness among diabetics.
Diabetic retinopathy is a dangerous complication of diabetes which causes blood vessels in the eyes to leak, causing distortion of vision and can eventually lead to blindness. In early stages, this disease of the retina may not have symptoms.
The American Academy of Ophthalmology strongly recommends retinopathy screening be performed five years after a diagnosis of type 1 (Juvenile) diabetes is confirmed to reduce the risk of blindness. For those with type 2 diabetes, common among adults, screening is done at the time diagnosis is made, not later.
Diabetics and parents/guardians of diabetic children are advised to confer with their attending physician about this retinal screening.
Dangers of body art

Body Art is a popular fad especially among adolescents and young adults, which includes tattooing or body part piercing. The tattoos are usually on the chest, arms, belly, butts, ankles, or on just about any area of the body. They come in different shapes, design, color and various objects, like a girl, snake, flag, heart, words of protest or love messages. It is estimated that 10% to 25% of young adults (25 and under) have at least one tattoo.

A survey in one university involving 454 students (236 females and 218 males), which was 14% of the total enrollment, revealed that 23% (106) of them had one to three tattoos. This could well mirror the prevalence in other schools and universities in the country, perhaps higher in big cities, compared to the conservative communities. The most popular sites were the back among women and the arms and hands among men. One hundred twenty nine (51%) of those surveyed had a least one body piercing, 90% of men having had ears pierced, and 54% of the females had pierced navel, 49% ears and 27%, the tongue. Some of both the males and females had pierced nipples, eyebrows and genitalia.

Complications of body art include infection of the tattooed or pierced skin, transmission of hepatitis B and C, and HIV (AIDS). Allergic reaction, besides pain, swelling and bleeding, are potential complications of tattooing or body piercing. Keloid and scar formation is another. Infection is common because the needle and instruments used for tattooing or body piercing are mostly not medically sterile. A significant number of patients with hepatitis subsequently develop hepatoma, cancer of the liver, which is deadly.

Botox

Clostridium botulinum is a bacteria, whose toxin produces muscle paralysis among the victims of botulism food poisoning. Advances in medical technology has made it possible for physicians, usually plastic surgeons, to use the botulinum toxin (botox) as a shot in the face to induce transient and localized paralysis in the facial muscles to smoothen out wrinkles between the eyebrows, for frown lines and furrowed brows. The cosmetic effect has been impressive, but this is temporary. Besides this, botox shot has also been found to stave off migraine headaches among individuals who are resistant to conventional therapy. There are many more uses of this “good” toxin in clinical medicine today.
Colonoscopy saves lives
Colonoscopy is a procedure where a flexible endoscope (malleable tube like a telescope), equipped with fiberoptic lighting and (video CCD) camera, is passed through the anus, to view and examine the inner walls of the colon (large bowels) and distal part of the small bowels for any abnormality, like bleeding, ulcers, or the presence of benign poly(s), or cancer. Thru the colonoscope, excision of polyps, or biopsies may also be performed for a definitive microscopic tissue diagnosis. A sigmoidoscope is another scope that examines the final two feet of the colon, while the colonoscope examines the rest of the entire colon which is about four to five feet long. Many times it is done in conjunction with colonoscopy.

Colorectal cancer is the third-most common cancer in humans, topped only by cancer of the lungs and female breasts. More than 150,000 people in the United States each year discover they have cancer of the colon or rectum, and approximately 46,000 will die from it this year alone. The incidence starts to rise at the age 40 and the peak is between ages 60 to 75. Colon cancer is more common among women and cancer of the rectum among men. About 5% of the patients have both (synchronous cancer).

It appears that meat eaters have higher risk for the development of colorectal cancer. This malignancy is found more prevalent in populations whose diet is low in fiber and high in animal proteins, fats, and refined carbohydrates. The incidence of colorectal cancer is indeed high among those who eat red meat (pork, beef, etc) compared to those who eat high fiber diets (vegetables, fruits, wheat, bran, etc) and fish. The other predisposing factors include chronic ulcerative colitis, ganulomatous colitis, and familial polyposis. The older the person is, the higher the risk. Smoking and alcohol abuse increase the risk for cancer in general.

Everyone 50 years old and older should have an annual fecal occult blood test (FOBT), a rectal digital exam, and a prophylactic colonoscopy every 3 to 5 years. Those with a strong family history of cancer should have the examinations more frequently in accordance with the physician’s determination.

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The 3 Sex Pills

 

My column in this paper in 1998 was about Viagra, a headliner around the world then when it was first introduced that year. Two decades next year, Viagra and its competitors, Cialis and Levitra, still arouse interest globally.

Sildenafil (Viagra), the wonder pill for the treatment of erectile dysfunction (ED) in men, was approved by the US Food and Drug Administration in March 27, 1998, and sold like hot cakes that same year. More than $400 million worth was sold in the first quarter, 10,000 prescriptions a day. This blue pill was found to be very effective and safe. It boosts marriages and relationships. The surgical procedures for ED dropped dramatically since this pill was introduced.

Then came the competitors! Vardenafil (Levitra) was approved in September 2003, and on November 21, 2003, Tadalafil (Cialis) was launched. To this day, these 3 pills for ED are the most popular, dominant, and effective regimen in the management of erectile dysfunction and they have been found to also be very useful in enhancing erection even among those without ED. More than 20 percent of failed marriages and broken relationships are due to erectile dysfunction.

While their mode of action are basically the same: they are a class of drugs called PDE-5 inhibitors. They block an enzyme called phosphodiesterase type 5, boosting a chemical in our body called nitric oxide, which relaxes muscles in the penis and open up veins, allowing more blood to enter and fill-up the veins of the penis, causing engorgement and maintaining erection.

Original Research: Serendipity

The original laboratory studies on these PE-5 inhibitors centered on their vasodilator effects as potential drug in the management of coronary heart disease and high blood pressure. However, the researchers noted that the experimental male mice given the PDE-5 inhibitor developed erection and were chasing the female mice. This serendipity discovery that the side-effect of the PDE-5 inhibitor was even a greater and more welcome discovery than the original intention of developing a new vasodilator for cardiovascular diseases. The side-effect (erection) in this case far outweighed the “original intent” for the use of the drug. This is one incident where the side-effect is more useful and beneficial.
Other uses

These pills for ED (PDE-5 inhibitors) are also prescribed for other medical conditions, like heart attack, pulmonary hypertension (even among children), pre-eclampsia, Crohn’s disease, and infertility.

Aphrodisiac?

Some think Viagra, Cialis, and Levitra are aphrodisiacs. No, they are not, because none of them increases libido (sexual desire). These 3 only enhance erection and sustain it for a successful sex. When taken, the man develops a sense of certainty, security, and confidence, which could incidentally increase the desire in both partners.

Indications for use

Those who could benefit from any of these 3 PDE-5 inhibitors are those who are unable to initiate and maintain erection for a successful intercourse, regardless of age, including those in their 20s, where stress and psychological condition negatively impact their sex life. One does not have to have a full-blown erectile dysfunction to benefit from these pills, since they have been found effective and save since they were introduced almost 20 years ago.

ED Stats

Cleveland Clinic reports that 52 percent of men have erectile dysfunction, “affecting 40 percent of men age 40, and 70 percent of men age 70.” Men who are on high blood pressure pills, beta-blockers, etc., have an increased risk of developing ED. Urology Care Foundation says 30 million of American males have occasional (mild to moderate) problem getting or keeping an erection.

Similarities

These three drugs for ED belong to one class of medication and have similar pharmacologic action: PDE-5 inhibitors. All three react with nitrates (heart medications that opens up arteries), which could cause drop in blood pressure and shock, even death. Those on nitrates MUST not take any of these drug for ED. These three are in oral form and there is no generic version of this ED drug yet, and is taken about 30 before anticipated sex. Any of these 3 needs medical consultation prior to use to rule out any contraindication and danger, since each individual reacts differently to medications. A prescription is needed to purchase pills for ED. They all cost about the same. Their safety records are also similar.

Differences

While their action, use, and efficacy are basically the same, there are difference among these three pills for ED. Viagra and Levitra stay in the blood stream for about 4-6 hours; Cialis, 17-18 hours, longer lasting. Other differences are in their side-effects.

Side-effects

The following side-effects are common among all three: stuffy nose, headache, upset stomach, priapism (erection, painful, that persists), sudden cardiac arrest, death (which are very rare). The differences: temporary change in vision and flushing are more in Viagra and Levitra. Backpain and muscle aches are more with Cialis. Alcoholic beverage reacts more with Cialis, leading to dizziness, less with Viagra and Levitra. But, as Shakespeare wrote: “Alcohol increases the desire but diminishes the performance.”

Warning

Any of these three drugs for ED dangerously reacts with nitrates, medications that dilate (open up) coronary arteries used in the management of coronary heart disease. A person on a nitrate medication (like nitroglycerin, isordil, imdur, peritrate, nitrostat, nitroderm, nitrolingual, nitrobid, etc.) must NEVER take any of these three pills for ED, because the combination will lead to severe drop in blood pressure, shock, and possibly death. Consult your physician if erection does not subside in 4 hours, a condition called priapism, where the penis is so engorged causing pain, one that needs urgent medical care.

Deaths

The reported deaths associated with the use of any of these three pills for ED were suspected to be due to the inadvertent concomitant use of nitrates. New studies have shown that these PDE-5 inhibitors could also increase platelet clumping in diseased coronary arteries causing blood clots, and heart attack in some individuals.

"It's reassuring that ... in general, for most patients, even those with existing coronary [heart] disease ... resuming sexual activity is very unlikely to trigger a [coronary] event," according to Murray A. Mittleman, MD, researcher and cardiologist at Beth Israel Deaconess Medical Center in Boston.

All evidence-based clinical information around the world today show that these three PDE-5 inhibitors are efficacious and safe, when used according to standard medical recommendation and under the supervision of an attending physician.

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Social life impacts health

You and I are social animals. Our two-legged and four-legged friends are also “social” creatures. They are usually in pairs or in herds. Like us, humans, these animals apparently also value, long for, and enjoy companionship. The loners among them usually do not survive long. Most obviously, social life, a sense of belonging, a comfortable feeling of security in number, a natural mental sense of community, is essential to health, mental and otherwise.

That social nature starts the day we are born, in the arms of our mother, nurtured in the crib, and developed into a complete positive mental state through interactions with both our parents, siblings, grandparents, and friends. All this enables us to develop lasting relationships and a rewarding mental health, which affect and influence all other lives we touch.

Human beings’ capacity to live a stable and happy life and our survival as a species heavily depend on our social skills, attitude, and social behavior.

The history of man on earth shows that cavemen started forming small groups, literally for security and for survival against the harsh and unforgiving environment, and vicious attacks from animals preying on them. That dependency on each other is still very evident even today, in this modern, technologically advanced society of ours. Indeed, no man is an island, and a loner is, comparatively, at a much graver risk of ill-health and attrition.

Like our need for proper nutrition and shelter, humans also need that sense of belonging, within the family, among friends, in a community, in society, and in the world at large. This support-group structures and interactions, emotional, recreational, even informational, are vital to people’s health and life. The last one has led to the popularity and proliferation of social media. This modern-day phenomenon is a tangible testimony to the value of social behavior as a natural need of homo sapiens.

A lonely person, alone, without friends, is doomed to be more depressed and more likely to die of ill-health, or even kill himself/herself, compared to another lonely individual who has a ton of family and friends providing him/her love, friendship, inspiration, and moral support.

A sense of belonging keeps us, humans, connected with our fellowmen, within our own circle, our community, conferring upon our being the reward of acceptance, a gratifying inner satisfaction that we are “in,” and “one of them,” akin to being a member of a club or a fraternity/sorority or a party. This sense of belonging is fundamental for our emotional and physical well-being, a powerful prescription that effectively enables each of us to cope with the sometimes unfriendly and harsh environment and social order.

Attitude and social skills

Our social skills, which are vital to our acceptance as a member of a group or community, are developed or impeded by our attitude, which, like social prowess, also significantly impacts our life and our health. Both are pre-requisites to health, happiness and inner peace in each of us human beings.

Show me a man with an attitude and I will show you one abandoned by his friends and scorned by strangers he irritated and riled. A good attitude compliments and boosts our social skills and acceptability to “belong.”

Here are some quotes of wisdom I have come across which are inspiring philosophical parachutes in life for those who, like many of us, sometimes find themselves falling towards the pit of discouragement and despair. With the proper attitude, these sage proverbs lift our spirit by allowing us to view and accept the trials and tribulations in this world in their most positive and best light. Indeed, all of us need a psychological boost, an inspiration, every now and then. Here are some that inspire and guide me:

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Barrett’s and GERD

What is Barrett’s esophagus?Barrett’s esophagus is a condition where the normal cell lining (stratifiedsquamous epithelium) of the food pipe (the tube that connects the mouth to the stomach),or a segment of it, is replaced with a different tissue similar to the lining of the intestine.The transformation is called intestinal metaplasia. This occurrence is rare and affectsabout 1.6 to 3 percent of people. In rare instances and in some individuals, this becomesa pre-cancerous risk.Why is Barrett’s a concern?This condition, while mostly without symptoms and could only be an incidentalfinding and diagnosed during gastroscopy, is of extreme interest to patients who havethem and their physicians because Barrett’s poses a slightly increased risk for causing atype of cancer of the esophagus called adenocarcinoma, which could kill if not detected,treated, and followed up regularly. This rare cancer affects one-half percent of peoplewith Barrett’s.Are Barrett’s and GERD associated?Yes, GastroEsophageal Reflux Disease (GERD), where the one-way sphincter(valve) between the food pipe and the stomach has become incompetent (loose and wideopen), allowing acid and other gastric chemicals to back-up into the lower end of theesophagus, is linked to GERD. It increases the risk for the development of Barrett’s,because those chemicals normally produced by the stomach to aid in food digestion areirritants to the esophagus. This situation also raises the risk for chemical burns, scarring,narrowing, and cancer of the lower end of the esophagus which is connected to the

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