John T. Rowe, MD

Blood Smear

Hematology-Oncology

What Is the Specialty of Hematology-Oncology?

          Well, actually, it’s a sub-specialty, because to become a Hematologist-Oncologist, a doctor must first complete residency training in the specialty of Internal Medicine and then complete fellowship training in the sub-specialty of Hematology-Oncology.  Hematology pertains to the study, diagnosis, treatment and prevention of diseases related to the blood and blood forming tissues.  The term is derived from the Greek word, haima, meaning blood.  Oncology pertains to the study, diagnosis, treatment and prevention of neoplasms (tumors, cancer).  Again, we get the term from Greek, this time from the word, onkos, meaning bulk or tumor.  So why are these two disciplines linked together into one sub-specialty?

How Are Hematology and Oncology Related?

          There are two reasons why it makes sense for the same sub-specialist to practice in these two disciplines.  First, many of the malignancies that an oncologist treats originate in the blood forming organs, for example leukemia, lymphoma and multiple myeloma.  Second, the treatment for many types of cancer have a deleterious effect on the various types of blood cells as an unwanted side effect.  Fine tuning the treatment of malignancies, while at the same time managing the complications of that treatment is an art in itself and requires extensive knowledge of the blood cell system.  So, in addition to being an expert in treating blood disorders which develop spontaneously, the Hematologist-Oncologist is ideally suited to treat malignancies and the blood disorders resulting as a complication of that treatment.

A Few More Interesting Points

          The CBC or Complete Blood Count is a laboratory test performed on blood that is withdrawn from a vein.  It is used to measure the levels of different types of blood cells, including red blood cells, white blood cells and platelets.  The red blood cells have a limited life span of about 120 days and contain a protein called hemoglobin which carries oxygen from the lungs to the rest of the body.  The white blood cells are part of the immune system and help fight infections.  The main function of platelets is to help stop bleeding.  Each of these blood elements is formed in the bone marrow, where they grow rapidly and have a fast turnover time.  Many chemotherapy drugs are effective against malignancies because they take advantage of the rapid turnover times of the cancer cells they are targeting.  Unfortunately, good cells, like the blood elements, are also susceptible to the toxic effects of chemotherapy drugs because of their rapid turnover times.

Blood Smear
Illustration of a Blood Smear Showing
Red Blood Cells, White Blood Cells and Platelets

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The Importance of Vaccinations

The Measles Outbreak

          The recent outbreak of measles in the United States should give us all pause to consider the importance of getting immunizations for our children and ourselves.  For most patients, measles, or rubeola, is a fairly benign illness, characterized by fever, runny nose, cough, sore throat, redness of the eyes and a rash consisting of small red dots that starts around the face and then spreads to the arms, trunk and legs.  These signs and symptoms begin 10 to 14 days after exposure to the highly contagious measles virus, which is spread through the air by coughing and sneezing.  Unfortunately, a small percent of those with measles may experience more serious complications, including, ear infection, pneumonia, encephalitis and low platelet count and that is why it is so important to have your children vaccinated.

One of the Greatest Public Health Achievements

          Since the English physician, Edward Jenner, pioneered the first vaccine (against small pox) in 1796, immunizations have proven to be one of the greatest public health achievements throughout history.  Anyone who lived through the polio epidemic of the early 1950s can appreciate the importance of vaccinations.  Fortunately, there are now time-tested vaccines against many infections which formerly caused significant morbidity and mortality throughout the world.  Unless there is a specific medical contraindication to getting immunized, it is wise to follow your physician’s advice regarding vaccinations and to have them administered in accordance with the recommended schedule.

Recommended Measles Immunization Schedule

          For children, the measles vaccine is administered as the MMR or measles, mumps, rubella vaccine in two doses.  The first is given between 12 to 15 months of age and the second before the start of kindergarten at 4 to 6 years of age.  For questions regarding vaccines, consult your health care provider and explore the links below for more information.

For More Information:

Children’s Hospital of Philadelphia, Vaccine Education Center

CDC, Vaccines and Immunizations

Measles

The Polio Vaccine Success Story

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A Promising New Antibiotic on the Horizon

Teixobactin Thwarts Resistance

          This month NovoBiotic Pharmaceuticals of Cambridge, Massachusetts reported that it was working on a new antibiotic called Teixobactin which in early studies has proven effective against Gram-positive bacteria that have become resistant to currently available antibiotics.  Susceptible bacteria include enterococci, Mycobacterium tuberculosis (TB), Clostridium difficile, Bacillus anthracis (anthrax), Streptococcus pneumonia (pneumonia) and methicillin-resistant Staphylococcus aureus (MSRA).  Each of the bacteria noted above are responsible for significant disease and account for many deaths throughout the world each year.

Developed Through Private Enterprise 

            Teixobactin works by inhibiting cell wall synthesis and is not effective against Gram negative bacteria which have an outer membrane.  Human clinical trials are still a few years away, but thus far, studies have shown that target bacteria have not been able to develop resistance to the new antibiotic through mutations.  This is very good news, indeed, since resistance to currently available antibiotics has increasingly become a problem in the treatment of infectious diseases.  It looks like physicians may soon have another great drug to add to their armamentarium, made possible through the efforts of a United States pharmaceutical company thriving in the environment of private enterprise and the profit motive.   

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New Year’s Resolutions

Many Resolutions Are Related to Health

          The tradition of making New Year’s Resolutions dates way back to ancient times.  Today, almost half of us make New Year’s Resolutions and far fewer actually keep them.  Nevertheless, it’s always worth a try, since those who do succeed can benefit both themselves and others.  It is an interesting fact that many, if not most, New Year’s Resolutions are related to health.  Here is a list of some of the most common resolutions:

     1)    Lose weight

     2)    Quit smoking

     3)    Drink less alcohol

     4)    Get fit

     5)    Eat healthy food

     6)    Manage stress

At least two of these are on my list this year.  How ‘bout you?  Happy New Year and best wishes for success with your New Year’s Resolutions!

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You'd Need to Walk 72 Minutes to Burn Off the 260 Calories in the Average Donut.

We’re Losing the War on Obesity

We’re Losing the War on Obesity

        There is mounting evidence that we’re losing the war on obesity in the United States despite the best efforts of the federal government to do the job that is actually the responsibility of parents and local schools.  Data released by Gallop and Healthways Lifestyle Solutions earlier this year indicate that the adult obesity rate is 27.7% this year, up from 27.1% in 2013 and 25.5% in 2008.  The Centers for Disease Control and Prevention (CDC) reported that in 2012, more than one third of children and adolescents in the United States were obese or overweight, a statistic that is essentially unchanged since 2003-2004.      

A Major Health Risk

        Because obesity is a major risk factor for developing conditions such as hypertension and diabetes, these alarming statistics portend a looming major public health crisis.  As just one example, the CDC reported earlier this year that the number of Americans with diabetes has reached 29 million and at this rate 20% of Americans could have diabetes by 2025.  Individuals who are overweight or obese are also at greater risk of developing heart disease, stroke, certain types of cancer, osteoarthritis and sleep apnea, among other serious conditions.

It’s a Family Matter

        I was recently at the Safeway grocery store in the middle of the afternoon when I observed an obese ten year old boy reach into the self-serve pastry shelf and pull out a huge chocolate covered donut about twice the size of a normal donut.  He was with both of his parents who were also obese.  Just moments later they were in front of me at the checkout stand where the lad held out an empty piece of waxed paper so the clerk could charge them accordingly.  Now why, I ask you, would parents allow their obese child to gobble down a huge donut in the middle of the afternoon!  It seems this unfortunate young man was dealt a double whammy by having an inherited tendency for obesity in addition to irresponsible parents.

You'd Need to Walk 72 Minutes to Burn Off the 260 Calories in the Average Donut.
You’d Need to Walk 72 Minutes
to Burn Off the 260 Calories in the Average Donut.

Parents Are in Charge

        It is the responsibility of parents to teach their children about good eating habits, including self-control.  This can be done by modeling good eating behavior, saying ‘no’ when appropriate and monitoring their children’s weight.  Children should not have free reign over the contents of the refrigerator at home until they have demonstrated self-control.  Without proper training, unsupervised children at home cannot be expected to show restraint.  Sitting down together at the family dinner table each evening is the perfect setting for children to learn these important lessons.  In addition, setting aside time for exercise as a family activity is a great way to get children started on a lifetime program of fitness.

Schools Play a Role

        The federal government simply cannot solve the obesity epidemic.  This can only be done by parents with proper support from schools.  Schools should spend less time on social issues that affect less than 2% of the population and spend more time on critical issues that affect 100% of the population.  This includes having daily physical education, teaching students how to prepare a nutritious meal on a shoestring budget and other important matters like how to manage finances.  There is no reason why low income families should be eating fattening burgers from the dollar menu at McDonald’s when for the same amount of money they could prepare a nutritious meal at home.  Let’s say a family of four orders two $1 burgers each (a low estimate) at McDonalds…I could prepare a tasty, nutritious family meal at home for them with that same $8.  Someone in almost every household has access to the internet where a quick Google search will bring up lots of recipes for nutritious, easy to prepare meals on a budget.  Fortunately, the low income communities that I have observed in my area have a number of excellent, large, well-stocked discount supermarkets within walking distance of housing, unlike the town of Ferguson, Missouri which just lost two local grocery stores which were burned down by rioters, fulfilling the food desert narrative. 

Dr. John’s Prescription for the Obesity Epidemic

        Getting a handle on the obesity epidemic is not rocket science.  It’s just common sense!  It is much easier to maintain your ideal weight if you never allow yourself to become obese in the first place.  Invest in a good scale (like the EatSmart Precision Premium Digital Bathroom Scale which can be ordered from Amazon for less than $35) and weigh yourself every day at the same time, keeping a log of your weight.  Titrate your diet based on the trends you see in your weight.  Use smaller portions, eat slowly and exercise self-control.  Substitute water for sodas.  Get plenty of exercise, even if it’s just walking.  If you follow these simple guidelines, you’ll have a good start on keeping your own weight under control, while at the same time helping your children avoid a life-long battle with obesity and all the health problems that go along with it.

EatSmart Precision Premium Digital Bathroom Scale
EatSmart Precision Premium Digital Bathroom Scale

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Influenza

Fall is Flu Season

          The end of summer and the beginning of fall bring cooler weather, falling leaves, kids going back to school, holiday festivities and the flu.  Flu season is typically from October to April in the Northern Hemisphere.  Flu is caused by the influenza virus which infects the respiratory tract, including the nose, throat, trachea and lungs.  This highly contagious infection is spread by coughing, sneezing and even talking.

Symptoms of Influenza

          Symptoms of influenza include fever, chills, muscle aches, congestion, runny nose, cough and breathing difficulty.  Other viral illnesses can cause these same symptoms, but are not as likely to cause severe pneumonia.  The population at highest risk for complications from influenza include those over 65 years of age and children younger than four years.

Prevention with the Influenza Vaccine

          Like other viral infections, influenza cannot be treated with antibiotics.  The best way to prevent influenza is by getting the influenza vaccine, which is recommended for everyone six months of age and older.  While the vaccine may not completely prevent influenza infection, it decreases the length and severity of the illness.  Because antibodies wane and the influenza virus can change from year to year, it is important to get the current influenza vaccine each year.

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