John T. Rowe, MD, Author at Health Matters

A Body in Motion

John T. Rowe, MD / September 28, 2015

A Body in Motion Stays in Motion

Apparently, Newton’s First Law of Motion applies to the human body, as well. There’s a lot of buzz these days, both in the popular press and in the medical journals, about the importance of keeping active. And we’re not just talking about vigorous exercise. There is more and more evidence that even minimal activity, like walking, standing and even fidgeting is good for your health. Yes, that’s right…fidgeting. A study of British women by Hagger-Johnson, Gow, Burley, Greenwood and Cade reported in the American Journal of Preventive Medicine this month concluded that, ‘Fidgeting may reduce the risk of all-cause mortality associated with excessive sitting time’.

Reduce Sedentary Time

Perhaps you’ve heard about standing desks or maybe you even know someone at work who has one. How about treadmill desks? The latest research suggests that almost anything which decreases the amount of ‘sedentary time’ you have each day is beneficial to your health. Simple activities like getting up from your desk at regular intervals, standing while talking on the phone and using the stairs rather than the elevator can help. Simply stated, don’t be a couch potato! To get the most benefit from these habits, they should begin early in life and continue at a level consistent with your age and health throughout your lifetime. That’s why it is so important for all of us to advocate for regular recess activities for school age children and daily physical education at all levels through high school.

The Bottom Line

So, let there be more standing and less sitting, more fidgeting and less medicating active children, more walking, hiking, dancing, gardening and whatever else interests you, and, hopefully, less cardiovascular disease as a result.

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Kidney Stones

John T. Rowe, MD / August 24, 2015

Signs and Symptoms of Kidney Stones

Kidney stones are small mineral deposits that form within the kidneys. The medical term for kidney stones is nephrolithiasis. Approximately one in every twenty individuals will develop kidney stones at some time during their lifetime. Low fluid intake is one of the main risk factors for the formation of kidney stones, also called renal calculi. When a kidney stone moves around in the kidney or moves into the ureter, which is the tube connecting the kidney to the bladder, the patient may experience pain in the lower back radiating around to the lower abdomen and groin area. The pain can fluctuate and has been described as one of the most excruciating types of pain one can experience. It may be accompanied by nausea, vomiting, red discoloration of the urine (blood) and pain on urination.

Risk Factors

There are several types of kidney stones based on the composition of the stones. They can be comprised of calcium oxalate, calcium phosphate, uric acid, struvite or cysteine. Calcium oxalate is by far the most common type of kidney stone, accounting for 75 to 80% of all stones. Additional factors affecting one’s risk of having kidney stones include a family history of kidney stones, medications, diet, obesity, hyperparathyroidism, hypertension, gout, a history of urinary tract infections, intestinal bypass surgery, inflammatory bowel disease and certain inherited conditions. In the United States the highest incidence of kidney stones is seen in the South where there may be a higher content of minerals in the local water.

Diagnosis

Blood testing may reveal higher than normal levels of kidney stone forming minerals like uric acid and calcium and can also point to other medical conditions that predispose to stone formation. Urine testing may show blood in the urine. Analysis of the urine sediment can help identify the type of kidney stone which, in turn, will guide treatment and prevention strategies. Radiographic studies, the most basic of which is a simple x-ray of the abdominal area, may reveal the presence of a kidney stone. Other helpful imaging studies include CT scans, intravenous pyelogram and ultrasound.

Treatment and Prevention

Most kidney stones pass naturally. In fact, 80% of symptomatic kidney stones will pass within three days with appropriate hydration. Treatment of pain with NSAIDS and narcotic medications when necessary is usually all that is required. Use of alpha blockers, which relax the muscles in the wall of the ureter, have been shown to increase the rate of stone passage. Depending on the size and location of the stone, the patient’s symptoms and whether the stone passes spontaneously, additional treatment modalities may be necessary. Extracorporeal shock-wave lithotripsy (sound waves) may be used to break up the stones. Percutaneous nephrolithotomy or surgical removal of the stone through a small incision in the back is sometimes used to remove the stone. Additionally, a small stone may be removed using a scope through the urethra. Kidney stones tend to recur, so prevention strategies are important. Identifiable dietary and metabolic factors should be addressed and modified as indicated. By far the best preventive measure is consumption of more than two liters of fluid a day.

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Attention to Water Safety is Essential During the Summer.

Healthy Swimming

John T. Rowe, MD / July 27, 2015

Healthy Swimming

July and August are prime time for recreational swimming. With many parts of the country and world experiencing warm temperatures right now, folks of all ages will be jumping in rivers, lakes, swimming pools and spas. While water safety is paramount, awareness of water borne illnesses is also important. Dr. Bonnie M. Word, a pediatric infectious disease specialist, wrote an excellent article titled, “Water Woes: Recognizing and Treating Recreational Water Illness”, which I encourage all of my patients to read. It summarizes some of the more common infectious agents that can be present in water and which can cause illness in swimmers. For more information, the Centers for Disease Control and Prevention (CDC) also has some helpful information about Healthy Swimming. Happy Summer!

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Pancreatic Cancer

John T. Rowe, MD / June 27, 2015

Pancreatic Cancer: A Dreaded Disease

Very few afflictions of the human body are feared more than pancreatic cancer and while it is relatively uncommon, approximately 30,000 new cases are diagnosed in the United States each year. We have all known someone who died from pancreatic cancer and we also remember celebrities who succumbed to this dreaded form of cancer. A large part of this fear is based on the fact that so little can be done to treat it by the time it is discovered and victims usually have a rapid demise. The average life expectancy after a diagnosis with metastatic pancreatic cancer is just three to six months.

Why Pancreatic Cancer is Difficult to Detect

The pancreas sits behind the stomach, extending about six inches along the back of the abdomen. It connects to the upper part of the small intestine by way of a tube called the pancreatic duct. Because of its location deep within the abdomen, developing tumors are rarely felt on physical examination and only come to light when they interfere with the functions of the pancreas or are discovered as an incidental finding on an imaging scan done for some other reason.

Functions of the Pancreas

Most individuals know very little about the pancreas and the important role it plays in the digestive system. In simple terms, the pancreas performs two vital functions. First it secretes enzymes directly into the small intestine through the pancreatic duct to help digest food. Second it secretes hormones, namely insulin and glucagon, directly into the blood stream to help control blood sugar levels. Identifying when the pancreas is failing to perform these functions may provide early clues to the presence of pancreatic cancer.

Assessing Your Risk of Pancreatic Cancer

Since most patients with pancreatic adenocarcinoma are not diagnosed until they are already in the later stages of the disease, when it is 95% fatal, wouldn’t it be great if there was some way to identify this insidious cancer before it gets to this point. A team of physicians at the Mayo Clinic (Moris M, Raimondo M, Woodward TA, et al) developed a profile that may help identify individuals at risk for pancreatic cancer, based on clues provided by abnormalities in the functioning of the pancreas as described above. These patients could then be monitored through means such as transabdominal ultrasound in an attempt to identify the development of pancreatic cancer while it is still treatable.

Early Signs of Pancreatic Malfunction May Provide Warning

The Mayo Clinic researchers noted that while age, obesity and a history of smoking and chronic pancreatitis were risk factors for pancreatic cancer, abdominal pain was not usually present until late in the disease. Jaundice or yellow discoloration of the skin, eyes and mucous membranes were an obvious symptom of pancreatic cancer, but they also found that steatorrhea or fat droplets in the stool may be noticeable in earlier stages of the disease. This is a result of the pancreas not producing sufficient enzymes for digestion of food (first function of the pancreas described above). They also noted that many patients who will develop pancreatic cancer have elevated blood sugars up to three years before the development of pancreatic cancer (second function of the pancreas described above). They pointed out that a patient over 50 years of age with no family history of diabetes who develops blood sugar abnormalities deserves monitoring for pancreatic cancer.

Hope for the Future

In summary, the profile that may help identify someone at risk for developing pancreatic cancer includes the risk factors of age, obesity and a history of smoking and chronic pancreatitis. In addition, jaundice, fat droplets in the stool and unexpected elevations in blood sugar levels, all of which indicate abnormalities in the functioning of the pancreas, complete the profile. Raising awareness of this profile and implementing strategies for monitoring patients who meet these criteria provide hope that someday we may be able to catch more cases of pancreatic cancer while it is still treatable.

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Sleep Requirements

2 Comments / John T. Rowe, MD / May 13, 2015

Sleep Is Important for Health and Safety

Getting a sufficient amount of sleep each night is important not only for one’s health, but for safety as well. It’s important to note that sleep deprivation is responsible for a significant number of auto accidents each year in the United States. In the case of children and teens, getting enough sleep is also important for proper growth and development, particularly development of the brain.

Sleep Requirements Vary by Age

The amount of sleep we require decreases as we age. The National Sleep Foundation recommends the following number of hours of sleep:

Newborn 0-3 months 14-17 hours

Infant 4-11 months 12-15 hours

Toddler 1-2 years 11-14 hours

Pre-School 3-5 years 10-13 hours

School Age 6-13 years 9-11 hours

Teenager 14-17 years 8-10 hours

Young Adult 18-25 years 7-9 hours

Adult 26-64 years 7-9 hours

Older Adult 65 years + 7-8 hours

Bedtime Routines

Bedtimes should be set in accordance with the sleep requirements noted above and school start times in the morning. Ideally, school start times should be around 8 AM, to coincide with parents’ schedules, rather than setting school start times later. It is the responsibility of parents to insure that their children go to bed early enough to get the required amount of sleep. It is helpful to avoid significant variation from these set bedtimes during weekends and vacation periods. Consistent bedtimes and rituals like reading a story before going to sleep can also help children adhere to appropriate bedtimes.

The Sleep Environment

Sleep is best induced in a dark, quiet and cool room. There is no place for electronic devices, including televisions, computers, cell phones, iPods and games in children’s bedrooms, particularly after bedtime and this is just as important, if not more so, for teenagers throughout the high school years. Studies have shown that the duration of adolescent sleep time has declined over the past few decades to the point where it is now estimated that one-fourth to one-third of adolescents do not get an adequate amount of sleep at night. Now that I have completely alienated my young readers, the words that my parents often said to me come to mind, “You may not like it, but it’s for your own good.” Thanks, Dad and Mom. You were so right!

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Tetanus

1 Comment / John T. Rowe, MD / April 12, 2015

Minor Cuts and Scrapes

With the approach of summer many of us are already looking forward to all the outdoor activities available during this warm weather period. Whether you enjoy hiking, camping, swimming, fishing, gardening, sports or what-have-you, minor cuts and scrapes are an inevitable part of summer fun. Cuts, scrapes, burns and even insect bites are exactly how the spores of the bacterium Clostridium tetani enter the body. The spores are present in soil and in the intestines and feces of some animals and can contaminate objects such as the proverbial ‘rusty nail’. Spores can remain infectious in the soil for more than forty years.

Symptoms of Tetanus

The spores enter the body when a contaminated object punctures the skin and if they are deposited deep enough in the tissue where oxygen is not available, they can germinate, producing a powerful exotoxin (tetanospasm). This toxin can spread throughout the body in the blood stream. Its effect on the central nervous system produces a spasm or rigidity which begins in the head and neck and may progress to the abdominal muscles and eventually inhibit the ability to breathe. Symptoms begin from three days to three weeks (average ten days) after the spores enter the body. Because the jaw muscles are often the first to manifest the spasm, the condition is frequently referred to as ‘lockjaw’. While tetanus is often fatal, it cannot be spread from one person to another.

Still a Major Health Problem

Fortunately, disease and deaths throughout the world due to tetanus have declined dramatically since the advent of tetanus toxoid vaccines. Nevertheless, neonatal and maternal tetanus are still a major concern in some parts of the world, particularly Asia and Africa. Maternal tetanus can occur during an abortion, miscarriage or delivery under unsterile conditions in an unimmunized mother. Neonatal tetanus can occur in an infant when the umbilical cord is cut under unsterile conditions and the mother is not immunized. It is estimated that more than 55,000 infants die each year from neonatal tetanus. Tetanus has become rare in the United States, where fewer than 50 cases are reported each year. Older adults are more likely to die from tetanus and a majority of adults over 70 years old are not adequately immunized.

Preventable with Vaccine

Tetanus toxoid was first produced in 1924 and was successfully used to prevent tetanus during World War II. Current vaccines are composed of deactivated tetanus toxins and are usually combined with diphtheria and pertussis vaccines. The recommended schedule for children is to receive the vaccine at 2, 4 and 6 months of age with a fourth dose given at 15 to 18 months of age and a fifth dose between four and six years of age. To maintain adequate immunity a booster dose must be given every ten years throughout life.

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