I recently saw an episode of  PBS’s NATURE on television, titled “The Venom Cure”  It was amazing to see these highly deadly creatures, including snakes, spiders, and other creatures of horror movies as efficient killers.  Then, the scientists would reveal that research into these animals has resulted in the the development of life-saving medications that have changed millions of lives.  To be honest, when I watch these shows I’m usually underwhelmed. I expected them to announce that the cure was for an obscure illness or disease that affects a small number of people.  However, I was totally amazed to learn that the class of blood pressure medications called ACE-Inhibitors were developed by studying chemicals found in snake venom!   These are medications that I write prescriptions for everyday, and they originated in a slithering reptile in the trees of the rain forest.  This surprise gave me an epiphany about how most medical schools don’t emphasize how drugs are developed.

All cardiologists are familiar with the medication to treat irregular heartbeats called digoxin.  I recall my college organic chemistry professor telling me how as a child, her mother forbid her to place her pet bunny rabbit near the foxglove flowers (digitalis) in the garden.  She was told they were poisonous for rabbits.  Later as an adult, she learned the class of chemicals called Digitalin was developed from those same flowers!  Cardiology also its owes the most important medication, aspirin, to the bark of the willow tree.  In 400 B.C., Hippocrates knew that the willow tree’s leaves and bark could relieve pain and reduce fevers.

Thinking about how many creatures are yet to be discovered in the isolated forests and depths of the oceans, one can only imagine how many lives could be changed by discovering what new medicines are lurking in them.  Sadly, we are losing more and more species each year as the world’s population is encroaching on the jungles and forests.  By contributing to wildlife conservation, we are investing in our medical future.

As high protein, low carbohydrate diets are becoming more popular, I am noticing a surge of people presenting with constipation and hemorrhoids.  I believe some of these are caused by a lack of fiber in the diet.  If you think about food with high amounts of fiber, these include brown rice, whole wheat bread, and prunes, which are often prohibited in weight loss diets.

It is extremely important to have adequate fiber intake without adding extra calories.  Fiber is also important if you have high cholesterol.  You should aim to eat at least 5 servings of fruits and vegetables in your day or consider adding a fiber supplement to your routine.  Psyllium is an excellent source of fiber. It is sold under many different brands like Metamucil or Konsyl.  I prefer the powder that you mix with water, as the water will also help with constipation.  However, the taste can take some adjustment.  If this is an issue, the same psyllium is available in capsule form.

Mayor Bloomberg is advocating a ban on the sale of sugary drinks more than 16 ounces as reported in the New York Times today.  While this may sound radical, he is quite correct that this is a major source of excess calories for Gotham residents.  The amount of calories in sodas and sweetened ice teas is a signficant contributer to the obesity epidemic.  I have mentioned in previous blog posts that these beverages provide practically no nutritious benefit and can be called “empty calories”.  However, some of the responsibility should be placed on the individual.  

I believe more education needs to be provided to the public.  Unfortunately,  the media dollars spent by soda manufacturers have far surpassed government efforts at health and wellness education, and diluted the message with glitzy advertisements aimed at children.  An alternative to the Mayor’s extreme move at making New York City healthier would be to put labels on high calorie drinks much like the labels on tobacco products.  Perhaps a label that says, “To burn this 16 oz. soda off, you will have to walk 4 miles.”  Or maybe, “This beverage may increase your risk of diabetes, heart disease, and obesity.”  

Part of the solution is to have people kick the sugar habit, much like smoking cessation.  We need to retrain our tastebuds to enjoy beverages with less sugar.  Homemade unsweetened ice tea with a wedge of fresh lemon can be a refreshing and healthy alternative.  You can make this cheaply by using tea bags and a pot of boiling water on the stove.    Don’t forget that most fruit juice contains as many calories as soda, so it is not an equivalent replacement!  If you want fruits in your diet, eat the actual fruit as you will also be getting a great helping of fiber.

If you suffer from seasonal allergies, it is important to do daily irrigation of the nasal passages.  This process removes particles of pollen that are stuck in the small hairs of the nose that can make you sneeze even after you are back indoors.  I often recommend this to patients as an adjunct to oral antihistamines such as loratadine (Claritin) or diphenhydramine (Benadryl), and also for upper respiratory infections (URI) that cause sinus congestion.

Nasal saline rinses are available at most pharmacies in many different forms.  There are bottles that look like water bottles, “Neti pots” which look like small teapots, and metal cans that look like hairspray cans.  I prefer these aerosol saline nasal sprays as they are easy to use and require no mixing of salt and water.  You can do the rinses leaning over a sink at the office or while you are in the shower, as you will already be wet and the steam from the shower can help to loosen the mucus in the nasal passages.  Be sure to use gentle pressure as the lining of the nasal passages are delicate. If you happen to be by the ocean, a dip in the water is a great way to clean out the nasal passages.

The USPTF (United States Preventative Task Force) recommended against the use of PSA as a screening tool for prostate cancer today.  PSA (Prostate Specific Antigen) is a protein that is found in the blood which can be elevated with prostate cancer, prostate infections, and enlargements of the prostate.  The guideline, which can be accessed on the Annals of Internal Medicine site, carries the “D” designation which means the PSA screening causes more harm than good.  This is already causing a flurry of controversy in the medical community and among prostate cancer survivors. 

On one hand you have a disease that some experts consider an “inevitable” course of nature which all men will develop in older age.  This type of cancer is usually slow growing but can cause some problems if it grows large enough to cause blockage of the urinary tract or severe pain if it spreads to the pelvis and spine.  Opponents to PSA testing contend that too many people have been undergoing unnecessary biopsies and prostatectomy (surgery to remove the prostate) which can result in impotence and incontinence.  Each surgery performed also carries signficant cardiac risk, especially for men in their 50’s for whom PSA screening was previously recommended.

PSA is still recommended for men who have had prostate cancer in the past to monitor for recurrence, and for men with symptoms of prostate problems (difficulty urinating, incomplete voiding of the bladder, etc.).  When someone has symptoms, the test is no longer considered a “screening”.  The USPTF should have also considered that we have a growing population of men who are taking testosterone replacement and a population that is more obese than ever, both factors that raise the risk prostate cancer.

While I can see the argument on both sides, I think the patient should have the right to make an informed decision.  Most internal medicine associations have recommended that all doctors have a conversation with their patients laying out the risks and benefits of PSA screening with a digital rectal exam (DRE) and having the patient decide.  I still believe this to be the most prudent practice.  Unfortunately, with the statement made by the USPTF, insurance companies may start to deny payment for PSA testing.  My recommendation is that if you are over 50, and have not had an annual physical, go see your physician and have a talk about cancer screening.