Corona Virus – Update

I have been receiving multiple calls and inquiries from patients concerned about travelling within the continental United States and exposure to Coronavirus or its new name, Covid-19. To date, there have been NO cases identified in the general population outside the high-risk groups whose exposure came in China or from exposure to sick individuals who caught their illness from someone who had been to China. While the quarantine has slowed the spread of the virus here in the continental United States, there are still many unknowns such as:

1. What are the different ways it is transmitted?
2. Can asymptomatic persons transmit the disease before they become ill and how far in advance of symptoms can they be contagious?
3. How long can the untreated virus live and transmit the disease on a surface such as a tabletop or doorknob?
4. How aggressive is this virus? What percentage of the patients who contract the illness get minimally ill? What are the unexpected risk factors for severe complications? Why is the illness sparing children – for the most part?

If you have travel plans in the USA, I suggest you go. Given the season, it’s far more likely to contract illnesses such as cold or influenza.

When you travel, as always, wash your hands frequently and keep them away from your face.  Wipe down surfaces with antiviral commercial preparations frequently.

If you still haven’t received your flu shot, get one now!  Consider a second seasonal flu shot if it has been more than 3 months since the original one. However, expect to pay for the second shot since most insurers do not cover it.  Also, most pharmacy technicians will say you don’t need it.

Do not hesitate to call me if you are my patient and have any questions.

PLCO Data Support Protective Effect of Aspirin in Preventing Deaths

In recent months, the US Preventive Task Force has recommended adults without diabetes or documented coronary artery disease avoid taking baby aspirin to prevent heart attacks and strokes. They believe the risk of bleeding outweighs the benefit derived. They still recommend aspirin prevention in men with known cardiovascular, cerebrovascular disease and diabetes.

The Prostate, Lung, Colorectal and Ovarian Cancer Trial (PLCO) just made the decision-making much more complex. In their study, reported in this month’s JAMA Network Open, they found that taking aspirin as infrequently as 1 to 3 times per month reduced the risk of all-cause and cancer related mortality compared to no aspirin in their study with 146,152 patient participants.

Weekly use of aspirin significantly reduced the risk of mortality from both GI and colorectal cancer and all mortality endpoints irrespective of how heavy you were. When the study looked at 12.5 years of aspirin use 1 to 3 times a month, compared to none, the all-cause mortality was reduced by 16%. The results were even more encouraging when aspirin was taken three or more times per week.

The PLCO Cancer Screening Trial involved participants aged 55-74 who were randomized to a cancer screening group or a control group at 10 United States Medical Centers. This review looked at men and women 65 years or older at baseline. While this study showed a beneficial effect of aspirin in the elderly, other recent studies have been less favorable. The ASPREE study, Aspirin in Reducing Events in the Elderly, found that individuals taking 100 mg of aspirin daily were at increased risk for all-cause mortality compared to those taking a placebo.

The decision to take low dose aspirin, or not, is something you should discuss with your physician so that you can tailor the situation and risks to your personalized needs.

Talcum Powder Does Not Cause Ovarian Cancer

Katie O’ Brien, PhD, of the National Institute of Environmental Health Sciences in North Carolina reported a study in nearly 250,000 women over an 11 year span that showed that talcum powder does not contribute to the development of ovarian cancer, The study was published in JAMA, the Journal of the American Medical Association.

The study found that in women who used talcum powder in the genital area, a total of 61 cases per 100,000 persons years was detected. When they compared that to women who never used talcum powder in that area, they found 55 cases of ovarian cancer per 100,000. The difference between users of talcum powder developing ovarian cancer by age 70 compared to nonusers was just 0.09%.

The concern about talcum powder use and cancer occurred in 1976 when asbestos was found in talcum powder. Most talcum powder is felt to be asbestos free today.

Making Sense of the Corona Virus Outbreak in China

The news media has been extensively covering the outbreak of a new virus that causes upper respiratory symptoms. What is known is that it probably originated in bats in a cave and passed through animals and is now infectious to human beings.

The first cases were reported as originating in a fish market in Wuhan, China that illegally sold exotic animals as well. Sources have reported on this new illness for months with much of the information being suppressed by the Chinese government.

Wuhan, China is home to a first-class, state-of-the art virology research lab. That lab’s main researcher has been urging infectious disease experts to evaluate these corona viruses for years while receiving little reward for her efforts. She reports that the previous epidemic of SARS is caused by a corona virus as well.

At this point, researchers from the World Health Organization (WHO) and the US Center for Disease Control (CDC) are attempting to obtain enough information to evaluate how much of a threat this new illness represents. We do not yet publicly know the exact incubation period. We do not know the length of time an individual is a contagious carrier prior to symptoms developing. Some have claimed you are contagious for about two weeks before symptoms appear. This is not consistent with a Vietnamese visitor to Wuhan who returned home ill and his family in Vietnam were all ill with the new coronavirus within three days. We do not know how aggressive this disease is yet.

Are the fatalities from it primarily in the infirm, very young and very old or does the disease strike down the fittest and healthiest as well? Are the deaths in China due to the lack of availability of modern health care, respiratory treatments and medications?

More information should be forthcoming soon. An evacuation of 200 Americans from Wuhan this week, to a military base in Riverside, California, for a voluntary quarantine should provide valuable data. These frightened but responsible individuals will be monitored and treated and studied.

Of interest to me was an article in the NY Times weekend edition by a “medical historian” who outlined the lack of success in containing infectious diseases we have had when no medications or treatments for these diseases existed. As I read it, I kept thinking that while the quarantines were certainly not 100% effective, what data exists to predict the infection severity and mortality that would have occurred if the quarantines had not been put in place?

As a doctor who regularly sees individuals with acute upper respiratory illness, I am comfortable with the CDC’s initial recommendations of avoiding travel to China, hand washing, wearing a mask and taking a travel history on your patients presenting with upper respiratory tract symptoms.

For those of you looking for more information on the new Corona Virus I suggest accessing the online infectious disease newsletter produced by the University of Minnesota School of Medicine called CIDRAP at http://www.CIDRAP.com. They cover this illness, Ebola, SARS, MERS (Middle Eastern Respiratory Syndrome) Bird Flu, food poisoning outbreaks due to infectious agents and other infectious diseases worldwide. If you read that newsletter you will be informed, and frightened, by the reality of what is out there.

Blood Test Detects Gastrointestinal Cancers

David Wolpin, M.D. MPH of the Dana-Farber Cancer Institute discussed with online periodical MedPage Today the results of his research on detecting gastrointestinal cancers with a simple blood test. The test is not yet commercially available and is still in its developmental stages. The blood test did not detect cancer in 2000 cancer free individuals but did find it in the 135 GI cancer patients being evaluated at the Dana-Farber Cancer Institute. In most cases they were able to pinpoint the location of the malignancy in the GI tract based on the testing used. The more advanced the cancer, the more accurate the blood test was.

The report was part of a larger study named the Circulating Cell-Free Genome Study. This is a multi-center trial looking at over 15,000 individual patients from over 142 different medical institutions. The hope is that as the sophistication and accuracy of the test are improved, the ability of physicians to detect cancers early would improve as well.

Dr. Wolpin reminds us that most cancers that occur in the gastrointestinal tract are difficult to find and screen for and are detected at an advanced stage. He hopes that lives can be saved by finding the cancers early with a simple blood test.

New Approaches to Early Prostate Cancer

Men today diagnosed with early prostate cancer, Gleason Stage 7 or less, have the option of a new arm of care called watchful waiting. With periodic PSA blood tests, prostate biopsies and imaging studies; urologists and oncologists can follow the patient with disease felt to be not aggressive rather than radiate the lesion or surgically remove it as was done in the past. In some cases, they can watch it even closer with an approach called Active Surveillance. This week a new research treatment was made public.

MedPage Today published work by Steve Raman, M.D., of the UCLA Medical Center on his TULSA-PRO ablation clinical trial. One hundred-fifteen men with localized and low, or intermediate, risk prostate cancer underwent ultrasound blasting of the cancer using the MRI imaging equipment to direct the therapy. In his study, prostate volume decreased from 39 cubic centimeters before treatment down to 3.8 cubic centimeters after a year. Clinically significant cancer was eliminated in 80% of the study participants and 65% had no evidence of cancer after biopsy at one year. PSA blood levels decreased by 95%. The side effects were minimal with low rates of incontinence and impotence and few bowel complications.

The study leader noted that if prostate cancer reoccurred then the modalities of repeat ultrasound treatment, surgery or radiation were still possible. In August 2019, the FDA approved the TULSA-PRO Device for use. The procedure involves placing a rod-shaped device into the urethra. The device has ten ultrasound probes which are controlled by a computer program while the patient is observed in an MRI machine. The probes shoot out sound waves that heat and destroy the tissue the sound is directed at. The procedure is an outpatient procedure which can also be used to shrink a non-cancerous enlarged prostate from benign prostatic hypertrophy.

Natural Substances That Work

In an article published in the pharmaceutical journal MPR, pharmacist Cassandra Pardini, compares the use of melatonin to provide sleep to hospitalized patients taking sleep medicine zolpidem (brand name is Ambien). The patients were hospital inpatients over 18 years of age who were unaware whether they were receiving melatonin or zolpidem to sleep. These patients completed a questionnaire using the Verran and Snyder-Halpem sleep scale to respond.

There were a total of 100 patients included in the study which showed that the favorable sleep effects of melatonin were as effective as the favorable sleep effects of the zolpidem. Both sleep aids were well tolerated and there were few, if any, adverse effects such as morning grogginess or headaches.

The authors concluded that melatonin may be a better choice for inpatient sleep aid because of the lower profile for serious adverse effects. Further studies looking at dosages and drug interactions are in the planning stages.

The same periodical presented a review of the scent Lavender used to reduce anxiety. The authors performed a literature review of all the published studies on the subject. There are over 65 randomized controlled studies and 25 non -randomized studies.

When lavender was used in an inhalation method, they found a general decline in reported anxiety. The inhalation method did not lower systolic blood pressure which is felt to be a physiological marker of anxiety. When the lavender was administered as an oil preparation (Silexan 80 mg per day), for at least six weeks, there was a reduction in anxiety as measured by an accepted Anxiety scale. In a smaller study, lavender administered by massage had a positive effect as well.

There were few if any adverse effects in these studies. Clearly lavender does reduce anxiety in subsets of patients and should be considered as part of our treatment options.