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Kidney stone treatment without surgery

Posted in Diseases/Disabilities, Health, Kidney by Erineus on May 12, 2009

Updated May 12, 2009 12:00 AM

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Non-invasive treatment: Lithotripsy treats kidney stones by sending focused ultrasonic energy or shock waves directly to the stone first located with fluoroscopy or ultrasound. The shock waves break a large stone into smaller stones that pass through the urinary system.

MANILA, Philippines – Kidney stones are one of the most common disorders of the urinary tract. These develop from crystals that separate from the urine and build up on the inner surfaces of the kidney. If the crystals remain small, they can travel through the urinary tract and pass out unnoticed while urinating. However, if the crystals accumulate and form a large stone or stones, they can impair the function of the kidneys that can obstruct the flow of urine and cause excruciating pain. In cases like these, treatment should be done. If left untreated, kidneys may be permanently damaged by an obstructing stone in only a few days.

Diet, dehydration (not drinking enough water when doing manual labor or indulging in sport), and family history are just a few of the reasons why stones occur.

The common symptoms of stone disease are sharp pain in the abdomen or lower back, fever, blood in the urine, and pain when urinating.

Kidney stones can be treated through surgery, the most common form of treatment. Surgery is painful, leaves a scar, and requires a long recovery period — about four to six weeks. Lithotripsy or extracorporeal shock wave lithotripsy (ESWL) is the therapy of choice. This non-invasive technique uses shock waves instead of a knife to remove the stones from the kidney and urinary tract. The shockwaves pass harmlessly through body tissues. When the shock waves strike the kidney stone, cracks appear in the kidney stone’s surface. After about one hour, the stone is pulverized. The fragments pass out naturally during urination for a number of days or even weeks after lithotripsy.

Lithotripsy uses a simple device called a lithotripter. The physician localizes and then focuses shock waves directly on the stone. The lithotripter is very precise, delivering the right amount of energy to break the stone without damaging organs or surrounding tissues. The treatment usually consists of several thousand shocks which break the stone into very small fragments. These fragments are passed spontaneously during urination. The procedure usually lasts about one hour and is performed on an outpatient (OPD) basis. Re-treatment may be necessary in some cases to completely disintegrate larger stones.

The procedure is safe and performed worldwide with excellent results. It is non-invasive and conducted under the supervision of a highly-trained physician and technician. Occasional side effects are bruising around the treatment area, blood in urine, and pain for a few days following lithotripsy. While most people can undergo lithotripsy, inform your doctor if you have high blood pressure, a blood clotting disorder, or a urinary tract infection. Pregnant women must not undergo lithotripsy. To date, over 25,000 patients have been treated in the Philippines in the last 15 years with stone-free rates ranging from 70 to 100 percent, depending on the stone burden, location, and number of treatments.

For more information on non-surgical kidney stone treatment and related concerns, call De Los Santos Medical Center Stone Center at 723-0041-54 local 127 and 129 or direct line 726-3572 from Monday to Friday.


Hair today, more hair tomorrow?

Posted in Diseases/Disabilities, Medicine by Erineus on May 8, 2009

AN APPLE A DAY By Tyrone M. Reyes, M.D. Updated May 05, 2009 12:00 AM

For men and women experiencing the most common type of hair loss — androgenetic alopecia, or pattern hair loss — and pondering what, if anything, could be done about it, there’s a mix of encouraging and discouraging news. There’s still no great way to easily restore your hair to its former glory. No drug treatment has gained US FDA approval since 1997, and the most effective existing therapy — hair transplant — is expensive and unlikely to come down in price. But on a more positive note, for those who can afford them, hair transplants now offer increasingly satisfying results — thanks to improved surgical techniques. Also heartening is the news that recent biotechnology discoveries may lead to less invasive treatments.

Falling Follicles

As a teenager, the average person has about 100,000 scalp hairs. Nearly everyone experiences some hair loss with age, but for people with pattern hair loss — a genetic condition inherited from one’s parents that causes hair on top of the head to gradually fall out — the problem is more noticeable. About half of men have significant hair loss by about age 50, and 38 percent of women have it by age 70.

Pattern hair loss is caused by a gradual shrinkage of hair follicles on top of the head, so they become less effective at sprouting hair. Normally, each hair grows for two to six years, rests for several months, and falls out. Then a new hair emerges. In a healthier scalp, more than 90 percent of hair follicles are in the growth phase. But as our hair follicles shrink, the growth phase gets shorter and the resting phase, longer. The result is double trouble: Not only are the new hairs shorter, there are also fewer of them. These older, smaller follicles also produce thinner hair. Men with pattern hair loss (and a very small percentage of women) have a third problem: the follicles shrink so much they stop producing hair altogether, so the bald patch starts to take over.

Follicles become less productive because hormone levels change. An enzyme called 5-alpha-reductase converts testosterone to dihydrotestosterone(DHT), which stimulates the growth of hair follicles, but typically on the face and other parts of the body and not the scalp, where it has the opposite effect. Young men and women with androgenetic alopecia have higher levels of 5-alpha-reductase, as well as lower levels of an enzyme that converts testosterone into estrogen. Still, the cause of women’s pattern hair loss is less well understood. Researchers believe that several enzymes and hormones may combine to produce effects that are similar to DHT. Estrogen seems to be protective against hair loss, so some research suggests that the estrogen-to-testosterone ratio may be a factor. Although hair thinning can occur at any time after puberty, many women first experience it in their 50s, possibly as a result of ebbing estrogen levels.

Be Gentle

In the early stages, you can minimize hair loss by treating your hair gently. Hair is more fragile when it’s wet, so it’s important to softly dry it with a towel — and don’t pull at it with a comb or brush. Twirling your hair can twist it off its follicle moorings. Head scratching may help you think, but it’s hard on your hair. If you’ve got an itchy scalp, the hair-friendly solution is to use some kind of an anti-itch shampoo. Hairstyles with braids — indeed, any style that pulls the hair back — can speed hair loss because they tug on the hair.


You can find plenty of treatments for hair loss on the Internet. Some are combinations of “specially formulated” shampoos and herbal supplements in capsule form that may have saw palmetto as an ingredient. But aside from paid “it really works” testimonials, there’s not much evidence that these remedies are effective. Save your money. Of course, a hairpiece of some sort is an option, but it tends to wear out or fade after a year or two of regular use because of combing, sun exposure, and routine cleaning. The less detectable ones are often expensive.

The US FDA has approved only two drugs for hair loss: over-the-counter minoxidil (Rogaine and generic) and prescription finasteride (Propecia). Minoxidil is available as a two-percent liquid solution for women and a two-percent or five-percent solution for men. In studies, between a quarter and a half of people who apply minoxidil twice a day notice a slowdown in their hair loss or even some hair regrowth. The most common side effects are itching and skin irritation, and the monthly cost is about P2,000.

Finasteride comes as a one-milligram tablet when used as a hair loss treatment. Men take it in larger doses as a treatment for an enlarged prostate gland. The drug, which blocks the conversion of testosterone to DHT, is only approved for use by men; some recent studies suggest that finasteride might be effective in women under certain circumstances, but early trials came out negative. Finasteride is more effective than minoxidil, with up to two-thirds of users reporting hair regrowth. It also costs about P 2,000 a month. Side effects are rare but may include impotence and decreased libido. A major drawback of minoxidil and finasteride is that you need to keep taking them to sustain the benefits. If you stop, your scalp will return to the balding state it was in before you started using the medicines. So year after year of treatment can start to get expensive. Doctors usually advise patients with significant pattern hair loss to try the conventional drug treatments for at least a year. If results aren’t satisfactory, a hair transplant is an option.

Splitting Hair Follicles

Hair transplants involve removing hair follicles from areas of growth on the sides of the head and implanting them in bald or thinning areas. One of the main obstacles is money: The labor-intensive surgery, which typically takes a surgical team of up to nine people five hours to perform, is expensive. One or two procedures may be needed for the best results. Hair transplant has steadily improved since its introduction in the 1950s, making for a more natural hairline and appearance. Surgeons have moved from large grafts (known as plugs) to a combination of minigrafts (three to six hair follicles) and micrografts (one or two hair follicles).

The most recent development, known as follicular unit transplantation, or FUT, continues the trend towards smaller and smaller grafts. A follicular unit is a small bundle that includes one to four follicles, oil glands, a tiny muscle, and other tissues. Once follicular units are extracted — either in a narrow strip or one unit at a time — the surgeon dissects away extra tissue before implanting the individual follicular units (see drawing on Page D-1).

This technique allows for a denser packing of transplanted hair and minimizes inadvertent damage to the follicles as they are being transplanted. FUT has improved results for women, so they’re now better candidates for hair transplantation. About 80 percent of transplanted hair falls out within three weeks, but about three months after that, the follicles start producing hair at a normal rate, and hair continues to grow from then on. Applying minoxidil can accelerate this process. Complications are rare but may include bleeding, infection, and scarring.

Getting Abrasive

Several drugs that preserve the health of functioning follicles are in the pipeline. Conceptually, this is the same approach that minoxidil and finasteride take. But some companies hope to develop entirely new approaches that would involve creating hair follicles from scratch. One example started with a University of Pennsylvania researcher’s discovery that mice healing from wounds can produce new hair follicles. In a report published in 2007 in the prestigious scientific journal Nature, the researcher, Dr. George Cotsarelis, showed that when skin is damaged, the skin cells behave like stem cells and generate new hair follicles. A company he founded is working to apply the discovery to humans which, in theory, would involve using an abrasive gel to gently damage the skin and then the application of a topical cream to switch on the follicle-generating genes.

Another biotech possibility is a technique in which hair-forming cells are extracted, multiplied under controlled conditions (such as a culture), and reimplanted into the scalp.

Your Choice

Aside from the psychological implications, pattern hair loss has no negative health consequences. What you choose to do about it — which may be absolutely nothing — is a personal decision, best made after talking over the options with a dermatologist, family, and maybe some fairly objective friends. You’ll need to take into account your age, the extent of your hair loss, your expectations, and your bank account. There’s no right or wrong decision — just what you consider worthwhile relative to your personal appearance, inconvenience, and the cost.

View previous articles of this column.


High blood pressure leads to kidney damage

Posted in Diseases/Disabilities, Health, Health Care by Erineus on April 20, 2009

By Joy Angelica Subido Updated April 14, 2009 12:00 AM

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Celebrating World Kidney Day: Novartis Philippines corporate affairs and market access director Christine Liwanag; hypertension specialist and resource speaker Dr. Rody Sy; National Kidney & Transplant Institute executive director Dr. Enrique Ona; Department of Health assistant secretary Dr. Elmer Punzalan; UP-PGH Department of Medicine chair Dr. Agnes Mejia; and Novartis Philippines president and CEO Eric van Oppens
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MANILA, Philippines – Control your blood pressure and save your kidneys. This was the message of health experts during the recent celebration of World Kidney Day. With more people succumbing to kidney failure and chronic kidney disease (CKD) worldwide, knowing that high blood pressure destroys the kidneys is important. Concomitantly, an increased vigilance to keep blood pressure within normal parameters will result in lessening the incidence of cardiovascular disease, stroke or debilitating kidney damage. In turn, this will lead to better health and longer, more productive lives.

“In the Philippines, renal disease is the number 10 cause of death today,” says Dr. Enrique Ona, executive director of the National Kidney and Transplant Institute. He estimates that 100 to 120 individuals per population of one million develop end-stage renal failure. “This is the most expensive disease that one can encounter,” he continues.

The kidney is a non-regenerating organ, therefore making damage permanent. Since the disease is chronic, dialysis is expensive and a compatible kidney donor may be difficult to find, the resources that an average patient can spend for maintenance will likely run out. Without proper treatment, the toxins will accumulate in the body and eventually poison the patient.

Are your kidneys at risk? Apart from hypertension and cardiovascular disease, another factor that can significantly affect the kidneys is diabetes mellitus and poor blood sugar level control. Smoking, being overweight, and a family history of kidney disease can tip the scales against you. Although age (over 50 years) also predisposes one to the disease, even the young can succumb to CKD.

Nephrologist Dr. Agnes Mejia, chairman of the Department of Medicine at the University of the Philippines- Philippine General Hospital, cited the case of a 22-year-old engineering student. Complaining of poor appetite, headache, weakness, pruritus (itching), weight loss, shortness of breath, and easy fatigability, he was admitted to the hospital for evaluation and was found to have end-stage kidney disease. A medical history showed that he suffered from bouts of urinary tract infection (UTI) in previous years. He should have taken heed.

“As a rule, men should not have UTI,” says Dr. Mejia. The frequency of the urinary tract infections should have alerted health providers about the possibility of a more serious underlying condition. His blood pressure was also elevated and when admitted to the hospital, the young man had a distinctive ammonia-like or fishy breath odor, a symptom associated with chronic kidney or renal failure. As is the case with most patients with severe renal failure, the story ended unhappily. The patient passed away during what should have been the prime of his life.

What are the symptoms to watch out for?

Dr. Mejia says one should be wary when urine is cloudy or bubbly — “beer urine with bubbles on top.” Nocturia or frequent urination at night and swelling of the legs (edema) without pain should also serve as warning signs. To be even more certain, blood pressure should be monitored so that it does not exceed 130/80 mm Hg. In addition, blood creatinine levels should be checked. Since creatinine or the breakdown product of creatine phosphate in muscle is filtered out of the blood by the kidneys, increased levels will signal that the kidney is not working effectively. The link between high blood pressure and CKD is unmistakable so that nephrologists worldwide seek to heighten awareness to make blood pressure measurement and examination of urine routine.

“High blood pressure is a global problem and the situation is projected to get worse. The world population is getting older and aging is the common risk factor for the development of high blood pressure and diabetes as well as CKD,” reiterates a fact sheet from the International Society of Nephrology and the International Federation of Kidney Foundations.

Although more innovative and effective medications to control blood pressure and its attendant complications are being introduced to the market, it is best to avoid illness with healthy lifestyle choices.

Consider these facts and act accordingly: Weight loss of eight to 10 pounds can have a dramatic impact on blood pressure. Reducing alcohol consumption leads to decreased blood pressure. Lowering blood cholesterol prevents narrowing of blood vessels, which is another cause of blood pressure rise. Other key preventive measures are control of glucose (in diabetics) and anemia, smoking cessation, and increased activity.

Disease wreaks havoc on the individual’s body, possibly causing extreme pain and discomfort. The costs of treatment for CKD can financially burden a family. The consequences of increased prevalence burden healthcare systems and society. Undoubtedly, the best way to beat and prevent disease is to learn about it and act accordingly.

View previous articles from this author.

Kidney disease afflicts 10,000 Pinoys yearly

Posted in Diseases/Disabilities by Erineus on April 20, 2009

By Sheila Crisostomo Updated March 12, 2009 12:00 AM

MANILA, Philippines – Kidney experts warned against being complacent on hypertension and diabetes, saying these could progress into end-stage renal disease (ESRD), which affects some 10,800 Filipinos annually.

Dr. Enrique Ona, director of National Kidney and Transplant Institute (NKTI), said “infectious diseases” used to be the common causes of chronic kidney disease like ESRD decades ago.

But now, he said majority of patients got their kidney damaged because of diabetes and hypertension.

“ESRD is now the ninth or 10th leading cause of death… Some 100 to 120 per one million Filipinos annually develop ESRD and we are 90 million. This is something that we should not ignore,” he said in a press conference marking World Kidney Day today.

Ona added that ESRD is the “most expensive disease that one can have.”

“To go on living, you have to go through dialysis at least twice a week for the rest of your life or undergo kidney transplant. Some 30,000 to 40,000 ESRD patients need to undergo dialy­sis at any given time but only 3,000 are able to get it,” he said.

Dr. Agnes Mejia, who chairs the Department of Medicine at the Philippine General Hospital’s Department of Medicine, said everyone must look out for the warning signs of chronic kidney diseases.

“Abnormality in kidney function often serves as an early warning sign of potentially more serious health problems, providing both doctor and patient with an excellent window of opportunity to address such problems before they worsen. If detected early, kidney disease can be treated, thereby reducing other complications,” she added.

Such warning signs include family history — to know if one is probe to developing kidney ailments; hypertension, diabetes and presence of bubbles in urine that is colored like beer.

“Men should not have UTI because men have longer urethra than the women,” Mejia said, referring to urinary tract infection.

She recommends that everyone must regularly undergo urinalysis and creatinine test to check on his or her kidney.

To reverse the trend, Health Assistant Secretary Elmer Punzalan urged the public to observe healthy lifestyle.

In 2007, he said the NKTI recorded 8,155 ESRD cases.

“It can become a major public health problem… so the Department of Health (DOH) has devised several measures, including the ‘Healthy Lifestyle to the Max’ program,” Punzalan said.

Under this program, the DOH promotes healthy diet, exercise and management of hypertension and sugar level, among other measures.
View previous articles from this author.


Useful site:  www.lifealysis.com

Cure for skin cancer, not too far in the future

Posted in Cancer, Diseases/Disabilities by Erineus on March 12, 2009
By Heizel L. Mainar
March 9, 2009, 5:35pm

After garnering awards and citations both in the local and international medical scene, who would have not heard of the name Rolando dela Cruz.

Dela Cruz’ invention, a cream that treats and cures Basal Cell Carcinoma (BCC), is another milestone in his already fruitful career.

According to Dela Cruz, his discovery of DeBCC was after the insistence of one of his client who was suffering from skin cancer. The client pleaded that he use the cream to treat his condition. Although not sure at first, he told the client to come back and using a stronger formulation, the treatment proved to be successful.

However, Dela Cruz knows that further tests needs to be done to prove the efficacy of his new found treatment.  It must have been devine providence that he met up with Dr. Eric S.M. Talens in one of Dela Cruz’ medial missions.

Tie-up with medical experts

A graduate of medicine in the University of the Philippines and Chief of the Division of Trauma, Department of Surgery at Philippine General Hospital (PGH), Dr. Talens shares that it was during a coffee break after the mission that Dela Cruz told him about the cream and that he tried it to treat skin cancer.  Dela Cruz even showed him some pictures of the treatment process but being a man of science and being a natural skeptic, he told Dela Cruz to put science behind the indigenous treatment. “They (indigenous treatment) don’t come out in the practice of medicine because there is no science to it,” he says and further explains that for Dela Cruz to convince doctors, a study must be done.

“We started looking at patients and treating them, documenting it, measuring them with all the biopsies…we collated the data and it was very encouraging.” From then on, the 14 cases they documented was the start of the continuous awards and recognitions both local and international including the Best Scientific Exhibit, the world’s largest convention for surgeons held at New Orleans in Louisiana U.S.A. last 2007.

“Now we have 39 well-documented cases 16 of which are declared cured.” Dr. Talens explains that for a BCC condition to be declared cured, a period of 5 years after treatment showed no signs or evidence of disease.

Proper documentation

He explains that most people who suffer from BCC are the elderly and the treatment before DeBCC came into being was to perform a surgery. And the process of surgery was to remove a portion of the skin surrounding the skin cancer and in some cases will totally deform those affected areas like the face, neck or shoulders (areas usually exposed to the sun). Although surgery proved to be efficient, Dr. Talens cited three major problems. First is when the BCC affected a large skin portion especially in the face, second the process of reconstruction, and lastly, the risk involved.  He further relates that some of their patients are those who cannot and do not want to be handled by other institutions because of the above-mentioned considerations. With this, the use of the cream is the only non-surgical option left.

Currently, the clinical studies done by Dr. Talens and other medical experts like Drs. Daniel dela Paz, Orlando Ocampo, Porfirio Tica, and the late pharmacologist Horacio Estrada resulted to 36 case studies and 16 of it completed the 5-year follow-up period and were declared cured. “They (patients) came here na wala na silang option. Sila pa ang nagpupumilit na isama sila sa study.”

Dr. Talens further shares that a Randomized Controlled Trial is being done at University of the Philippines-PGH were a patient blindly selects the treatment (either DeBCC or surgery). “You’ll measure all the results, x-ray, kung may deformity, yung comfort ng patient, titignan namin lahat ng parameters na yun,” he says and so far, the trial accumulated 9 cases already.

(Write the author at wellbeing@mb.com.ph)

Why liver cancer is common in the Philippines

Posted in Cancer, Diseases/Disabilities by Erineus on March 6, 2009
March 02, 2009
(Illustration by Greco Milambiling)
(Illustration by Greco Milambiling)

Q. Our 68-year-old neighbor died of liver cancer last week, less than six months after he was diagnosed with the disease. I understand that the outlook for liver cancer patients is very poor. Why is this so? Also, why is this form of cancer common in the Philippines when it is rare in the US? Is there a way to prevent this form of cancer?

Celso N., Cebu City

A. Liver cancer has a poor prognosis or outlook because it is often diagnosed very late in its course. It usually presents no symptoms until the tumor is already at least 10 cm in size, at which time the disease has typically already spread and is in the advanced stage.

Most liver cancer patients die within a year of diagnosis, and the five-year survival rate for the disease (if no treatment is undertaken) is less than five percent. Even with treatment, the five-year survival rate for liver cancer is still a low 35 percent.

Liver cancer is only the eighth most common cancer worldwide, and as you mentioned, it is relatively rare in the US (and for that matter, other developed countries). In the Philippines and other underdeveloped countries, however, the incidence of liver cancer is rather high. The latest DOH advisory shows that liver cancer is the third most common form of cancer among Filipinos—in men, it is the second most common, while in women, it is the ninth most common.

Liver cancer is relatively common in our country primarily because many Filipinos suffer from cirrhosis of the liver, a major risk factor for liver cancer. Cirrhosis of the liver precedes 80 percent of all liver cancers; thus, any condition that predisposes to cirrhosis indirectly causes liver cancer. The usual cause of liver cirrhosis among Filipinos is chronic hepatitis B, a major public health problem in the country. Chronic hepatitis B afflicts between 10 and 12 percent of all Filipinos (i.e., more than 8 million Filipinos). Other less significant causes of cirrhosis are hepatitis C infection and alcoholism.

Another risk factor for liver cancer that adds to the high incidence of the malignancy among Filipinos is aflatoxin. Aflatoxin is a poisonous substance that damages the liver and may cause liver cancer. It is produced by certain species of molds that grow in foodstuff such as peanuts, corn, rice, dried fruits, spices, crude vegetable oils, cocoa beans, and copra, as well as milk and milk products from cattle that have consumed contaminated feed. The high temperature and relative humidity that prevail in the Philippines and the often improper storing, processing, and handling of foodstuff are the reasons why the aflatoxin content of the above-mentioned food products is frequently above the acceptable level.

Other less common causes of liver cancer in the Philippines are certain chemicals such as vinyl chloride (used in certain industries), and estrogens and androgens—hormones that are present in oral contraceptives and anabolic steroids, respectively.

The outlook for liver cancer is poor, but the disease is preventable because the major risk factors for the disease have already been identified. Measures that can significantly reduce one’s risk for cancer of the liver include vaccination for hepatitis B, avoidance of alcohol, and proper storage of foodstuff.

(Email inquiries on health matters to medical_notes@yahoo.com)

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