April 2004 Newsletter - Patient with dizziness and syncope; Breast cancer screening
Dear Friends and Patients:
Dr. W is a long time friend and retired physician who recently drove up with his wife to see me. He and I reminisced about how medicine has changed over the past 30 years. We discussed how conventional medicine tries to fix everything with a pill or surgery, and where often times expensive technology is substituted for taking a patient history or doing a thorough physical exam. As I was completing Dr. W’s physical exam he shared with me his internist skipped doing a rectal and prostate exam on his last physical exam. Dr. W had been a former Professor at Shands Teaching Hospital and had a very successful private practice for many years in Plastic and Reconstructive surgery. He gave me an article from the February 12, 2004 edition of the Wall Street Journal entitled “Preventive Medicine Gets More Aggressive” in the Informed Patient column by Laura Landro.
The article pointed out that in spite of all our modern technology and a myriad of pills for virtually every ailment, we are in the midst of an epidemic of diabetes, cardiovascular disease, cancer and other chronic diseases. (I would point out all of these diseases are impacted by diet. Most of us never think the bodies we have today are not the same bodies we had four years or even four months ago. We become what we eat and our foods often lack the essential nutrients to promote optimal health!) Our health care system is not a health care system but a disease management system. The problem is once a person develops a disease, it is virtually impossible to reverse a disease process. The author points out this brings a new urgency to the concept of preventive medicine – or even a change from “preventive” to “prospective”. I would use the word “proactive.” While the concept of shared decision making between patients and doctors has been around for years, most physicians and insurers have yet to widely accept this idea or the idea of preventive medicine as such. At the Center, we view our relationship with our patients as a partnership in health improvement. Before we accept a patient for treatment, we ask what it is they are looking for and what it is they want to accomplish. All of our patients undergo a nutritional assessment. Before we embark on a nutritional or other treatment program, we discuss with our patients what their options are. Our patients make the final decision as to what is right for them. This is a very different medical model than the physician-centric model of healthcare I was taught when I went to medical school, where the doctor tells the patient what to do.
Each patient’s health plan is customized at the Center. Some programs, such as at my old alma mater, Duke University, are beginning to offer prospective health programs to their employees, where personalized planning with a health coach is being touted. The idea is not just to avoid a disease, but for overall well-being. “What we are trying to do is be on the leading edge of a change in how health care will be delivered in the next five years . . . not with a cookie cutter approach to every patient but by tailoring it to the individual” according to Duke’s chancellor for health affairs, Ralph Snyderman. We at the Center are proud that our patients have been on the “leading edge” of preventive health care since the Center opened in 2000.
A Success Story
Simon is an 87 y.o. patient who is also my father-in-law (he gave us permission to use his name). He is a remarkable person in that at age 87 he is mentally alert, has outlived two wives (and is currently dating), takes care of himself and is still able to drive a car. He is more active than some people half his age. In February of this year he called us at home and told us he had passed-out completely four times in the night. This was different than his usual dizziness that he had been experiencing for some time. My wife brought him to his cardiologist’s office as in the remote past he had a heart attack and also had carotid artery surgery to remove a blockage. His EKG was normal and an arterial flow study of the arteries in the neck was also normal. Much to our surprise and upset, a physician never examined him! His cardiologist was relying solely on high tech tests and procedures instead. I have treated literally hundreds of patients at the Center who felt something was wrong in spite of being told by a physician that their lab tests or x-rays were normal, or that what they were experiencing was just part of the aging process. So I examined my father-in-law and found him to have an elevated blood pressure in the 190′s/90′s range. His cardiac and neurological exams were normal. His Contact Reflex Analysis exam showed that there was a problem in the circulatory system meridians. The next day we began a program of EDTA chelation twice weekly and targeted nutritional supplements to support his heart and circulatory system. By the second treatment he had no further episodes of loss of consciousness and by the fifth treatment his dizziness of many months duration went completely away. His blood pressure dropped to the 120/80 range without drugs or medications. His lab tests later were returned as showing an increased body burden of lead which the EDTA was removing. Lead is known to cause hypertension and other health problems. Most likely the lead came from past exposures to leaded gasoline, lead plumbing, or perhaps lead paint. Simon states this is the best he has felt in years, and he is only 25% through his chelation program.
Please log on to our web site www.prevent-doc.com under topics of interest if you would like to learn more about EDTA chelation. As an update, the Center was invited to participate in the NIH (National Institutes of Health) TACT chelation therapy trials that started at the end of last year. Although we declined to participate as a research center due to time considerations, we are excited that a large scale study over five years is finally in progress to further evaluate EDTA chelation as it pertains to patients who have had a heart attack.
BREAST HEALTH – PART 1
This is the first of a two part article on breast health. This article deals with data on breast cancer and current screening methods. In the next issue of our newsletter I will discuss the suspected relationship between the environment and breast cancer, and make suggestions for improving breast health.
Scientists and physicians do not know why most women get breast cancer, yet breast cancer is the most frequent malignancy in women worldwide, and the annual incidence of breast cancer increased 55% between 1950 and 1991. IARC (the International Agency for Research on Cancer) reports breast cancer is the most common female cancer in industrialized countries, and second to cervical cancer in developing countries. Only about 5% of breast cancer is inherited, and about 80% of women diagnosed with the disease will be the first in their families to get breast cancer. Cumulative exposure to synthetic estrogens and xenoestrogens, and ionizing radiation underlie most of the known risk factors.
Breast Cancer Screening
Current recommendations for routine screening for breast cancer vary according to the source. The American Cancer Society, American College of Radiology, American Medical Association, American College of Obstetricians and Gynecologists recommend clinical breast exams by a physician and mammography every 1-2 years, beginning at age 40. Once a woman is 50 or older, then recommend this be done annually.
The American College of Physicians recommends screening mammography every 2 years for women aged 50 -74 and recommends against mammograms for women under 50 or over 75 years of age. They see no difference in screening interval for high-risk women, unless the women expresses great anxiety about breast cancer.
Multiple clinical studies have been undertaken to determine the relative effectiveness of screening, but there is variation in length of the studies as well as other parameters that accounts for variation in results. Clinical examination (physician manual examination of the breasts) has limitations with a sensitivity rate often below 65%. In a large Canadian study, sensitivity of clinical breast examination for women age 40-49 was about 10% lower at initial screen than for women aged 50 – 59. Mammography sensitivity varied as well, from 75% up to 88%, depending upon the study and also the radiologist interpreting the study. Monthly self-breast examinations have also been suggested but the efficacy of these varies tremendously as well.
Danish researchers published a study in 2002 suggesting that mammograms do not lead to a reduction in the breast cancer death rate or the number of major surgeries for the disease. This created an uproar in the United States where The National Cancer Institute and others disagreed with the Danish findings. This is an emotionally charged topic. Proponents of annual mammograms point out that early detection reduces breast cancer mortality by 20-30%. Other studies, however, show the annual age-adjusted mortality rate from breast cancer has not changed since 1930.
Adverse Effects of Screening
Adverse effects of screening tests are also an important consideration. False-positive tests, resulting from the effort to maximize disease detection, may have negative consequences including unnecessary diagnostic tests. In the Canadian trials there were 7-10% false positives combined with clinical breast exams in women aged 40-49 and 4.5% – 8% among those aged 50 -59. In a study of the yield of a first mammogram, 3 cancers per 1000 were found in women age 40 – 49 compared to 6 cancers per 1000 in women aged 50 – 59. Yet the younger women underwent twice as many diagnostic tests per cancer. Some studies have reported an increased anxiety about breast cancer after a false-positive mammogram. Women who underwent biopsy as a result of a false-positive screening mammogram were more likely to report their evaluation as stressful than those who did not have a biopsy. There are also concerns about the radiation exposure risk to breast tissue from screening mammograms. A mean breast dose of 0.1 rad from a mammogram is considered a low dose of radiation by traditional medicine, but there are no clinical studies showing what the consequences of cumulative annual low dose radiation would be after 10 or 20 years. We do know ionizing radiation causes free radical formation, tissue and DNA damage, which are cancer risks.
Digital Infrared Thermal Imaging (Breast Thermography)
Digital Infrared Thermal Imaging is a 15 – 30 minute non invasive test of physiology. It is a valuable procedure for alerting your doctor to changes that can indicate early stage breast disease and in the evaluation of unexplained pain. Benefits include:
• Non invasive
• No radiation
• Painless
• No contact with the body
• F.D.A. approved
A very sensitive digital camera takes thermal images of the body and sends this data to a computer. The images are then interpreted by a qualified physician. In this way, skin temperatures, thermal and vascular patterns, and sympathetic responses can distinguish between normal and abnormal physiological function of the body. This is different than an X-ray, where radiation is passed through the body and an image is developed on an X-ray film to produce an anatomical image.
The underlying principle by which infrared imaging detects pre-cancerous and cancerous growths is because tumors have an increased vascularity in order to maintain the increased metabolism of cellular growth and multiplication. With this increased blood-flow comes an increased temperature, even in very small tumors. Like mammography and other breast imaging techniques, infrared imaging does not diagnose cancer (only biopsy can) – but merely indicates the presence of an abnormality. However, a woman’s thermal image is like a thumbprint and should not change over time. Serial studies are compared with previous studies for changes. If a woman has never had a breast thermogram before, an initial thermogram is performed and then a repeat study is done three months later to establish an accurate baseline. After this, annual thermography can be performed and compared with previous studies.
Thermography is very accurate compared to other methods of detection and screening. Spitalier and associates followed 61,000 women using thermography over a 10 year period of time. They found the false negative and false positive rate was in the 11% rang
e (89% sensitivity and specificity). Of the breast cancers that could not be felt on breast exam (nonpalpable), 9 in 10 were detected by thermography. Of all the patients with cancer, thermography alone was the first alarm in 60% of the cases. The physicians involved noted “in patients having no clinical or radiographic suspicion of malignancy, a persistently abnormal breast thermogram represents the highest known risk factor for the future development of breast cancer.” Thermography is especially useful where mammography has a more difficult time – in younger women with dense breast tissue, women on hormonal replacement, and women with fibrocystic breasts.
Because of thermography’s unique ability to image the thermovascular aspects of the breast, extremely early warning signals (from 8-10 years before any other detection method) have been observed in long-term studies. Consequently, thermography is the earliest known indicator of the future development of breast cancer and has a significant place as one of the front-line methods of breast health screening. We are pleased to offer this service to our patients beginning late May or early June 2004. More extensive information on breast screening, thermography, and a list of references left out of this newsletter due to space considerations are available on our website www.prevent-doc.com under Topics of Interest.