Belly fat

Why does belly fat occur?

Why people develop belly fat remains a mystery. There are a lot of theories and speculations but no one really knows. Some health professionals claim that belly fat is due to age, others claim hormones, and yet others claim genes. One fact is known- as you get older, belly fat increases. This is especially true in females after menopause. There has been a lot of research which shows that gaining belly fat is not good for health. Experts claim that excess belly fat increases chances of heart attacks, high blood pressure, diabetes, and ever some cancers. One should not be disheartened by such news. Unlike fat anywhere else on the body, belly fat can be decreased by changes in diet and lifestyle.

One of the reasons why fat occurs around the belly is due to age and slowing down of metabolism. With age, the body slows down in its ability to breakdown fat, and this eventually results in fat accumulation in the body. Women generally tend to gain more weight after menopause due to slowing of metabolism. During this time period, the fat distribution also changes, and fat starts to gather around the belly and there is less fat in the arms, legs, and hips.

When belly fat accumulates, it is not only on surface of the abdomen but deep down there is a heavy-rim laddened down with fat. This deeper layer of fat around the belly has been associated with heart problems, diabetes, and breathing problems.

Even though everyone agrees that there is a decrease in metabolism of fat with age, why does fat disproportionally deposit in the belly? No one has the answer, but most experts claim it is genes- you just have a tendency to collect fat in that part of the body. While hormones have been blamed, it is not understood why hormones would cause fat to be deposited solely around the belly. The odd observation is that some women notice a rapid gain in fat around the belly without gain in weight anywhere else on the body. Even though one may not have fat elsewhere on the body, except the belly button, this is also linked to medical problems.

A fascinating finding has been that once fat gathers around the belly, these fat cells in turn become active and produce chemicals or hormones that affect your health. Studies on fat cells from the belly have been found to produce hormones that counter insulin and cause diabetes. When these fat cells produce estrogen, the risk of breast cancer is increased. Currently there is effort being made to determine which hormones are produced and how they influence health. Individuals who have belly fat should start making changes in their diet and start to walk, if they want to avoid health problems later in life.

Vitamin K for spider veins

Can I use Vitamin K creams to get rid of my spider veins? 

Millions of women have spider veins and the majority dislike them. Spider veins commonly occur on the face, outer thigh, and lower leg. While these skin lesions do not cause symptoms, they are not aesthetically pleasing. Some women only have a few spider veins, but a few unlucky women develop multiple spider veins.

Spider veins do not cause any symptoms and if one has pain, swelling, aches or itching, then the cause is not spider veins. Spider veins are only treated for a cosmetic reason. If you have any type of symptom, then the problem will not be cured by treating spider veins.

In the last decade, hundreds of treatments for spider veins have come and gone. Almost each week there is a new cream, lotion, potion, or liquid to help one get rid of spider veins. The latest in a long line of creams is vitamin K. 

There are vitamin K based products in every type of formulation on the market. These creams are sold in beauty parlors, pharmacies, cosmetic shops and at many spas. In each case, exaggerated claims are made such as applying the cream twice a day can erase the spider vein, make the skin soft, reduce wrinkles, improve skin texture and so on. Most vendors of these products claim that vitamin K can remove spider veins in a few weeks.

Vitamin K is known as a fat-soluble vitamin and is generally taken by mouth. In the hospital setting, it is sometimes administered as an injection in individuals who have bleeding disorders. All humans have large stores of vitamin k and do not require supplementation. Vitamin k is readily available from the diet when one eats vegetables and legumes. It is very rare for a health care worker to prescribe vitamin K for healthy individuals.

So do these vitamin K creams really work?

There is zero evidence that vitamin K can erase spider veins. There is not one scientific study which shows that vitamin K has the ability to reduce, prevent or remove spider veins. There is not one individual who can honestly come forward and claim that vitamin K creams removed his or her spider veins. One can eat, drink, slurp, or even use vitamin K as a suppository- the end result is just a waste of money.

 Spider veins have no relation to vitamin K and there is no cream, herb or lotion which can be applied on the skin that will remove spider veins. Every single vitamin K cream sold on the market is simply false advertising with lots of false promises- such is the world of cosmesis

Individuals who have spider veins have three options, do nothing, try sclerotherapy or laser. Vitamin K based creams or any other creams are a waste of money, time and are best considered junk therapy. These expensive creams do little more than moisturize your skin.

If you have spider veins and are not bothered by them, leave them alone. For those who seek vanity, perhaps laser is the best option. Remember though, laser is expensive, painful and spider veins do recur.

Propecia for hair growth

Can finasteride (propecia) grow hair?

Finasteride is the generic name for the brand names proscar and propecia. Finasteride was initially marketed for treatment of enlarged prostate. However, during the clinical trials it was observed that some men complained of hair growth. The amount of hair growth during these trials was never quantified and in most cases was mild. This did not stop the drug company from turning the product around and marketing it for males going bald. There is both a 1 mg pill and a topical solution available for hair growth. The company claims that the 1 mg pill can lower levels of DHT and help minimize hair loss. A lot of numbers are given by the company on the success of this drug in restoring hair.

So what is the real evidence?

If there ever was a scam, than this is it. Finasteride at best only grows a strand of hair here and there. There is not an individual on this universe that can step forward and claim to have decent hair growth following use of finasteride. Individuals have used finasteride for more than 5-10 years, and in the majority, the drug has done nothing. The drug is expensive and in 99.9999999% of individuals, it does nothing. In the other 0.000001% of individuals, they may get some pubic hair growth.

Therefore, the best advice for those who have loss of hair or baldness, get used to the condition, or get a wig. There is no drug out there that will grow more than 1-2 hairs a year. Unfortunately, there is nothing in the drug market that works for hair growth. If you have no money and are going baldness, get used to that bald look, wear a hat or get rid of your mirror. If you have money and are going baldness get a wig. Hair transplant is an option, but it is exorbitantly expensive and often does not work great. Baldness sucks especially when it occurs in the prime of your life, but I would rather be bald and have money, then be bald and having wasted all my money on a worthless drug.

-->

Silicone implant leak

Can a small leak in silicone breast implant change shape of my breast?

After a silicone breast implant, if you have pain or change in the shape or size of your breast, a leak must be ruled out. When the breast implant is first inserted, a fibrous capsule or scar tissue forms around the implant. When the silicone leaks, it incites an inflammatory reaction of this scar tissue. This will present as pain and hardening of your breast. You will notice that the skin texture around the leaked site is different or firm. Many women complain of an odd ache or discomfort when a leak occurs. You need an MRI-which will cost you close to $1,500.

Breast implant rupture

I had silicone breast implants recently and think I may have a rupture. Is this dangerous?

Breast implants are sturdy and durable but they sure can rupture. When a breast implant ruptures, the silicone leaks around the breast and can cause development of a thick firm scar. This may lead to pain and asymmetry of the breast. You will definitely notice a chance in the contour of the breast. Over the years, there has been a lot of controversy if the ruptured implant can cause cancer or other collagen vascular disorders. Some people say it does and some say it does not. The best advice is to see your surgeon and let him decide the next course of action. You can rest assured- managing a ruptured implant is an expensive undertaking.

 

Treatment of phobias

How are phobias generally treated?

Once the phobia is diagnosed, there are treatments for this mental disorder. In most cases, a combination of medication and behavior therapy can help reduce the phobia. In the majority of cases, a phobia will never get better if it is left alone.  There is no cure for phobia but the therapies can help reduce the fear and anxiety. The behavior therapies can help you manage your reactions to the phobic-causing situation. The types of medications used to treat phobia range from beta-blockers to reduce the symptoms of fast heart rate and sweating, anti-depressants and sedatives. Behavior therapy can help one adjust to the phobia. The therapies emphasize learning and developing a sense of behavior control of thoughts and actions.

Feeling afraid for no reason

I sometimes feel afraid for no apparent reason. What do you think is wrong?

Phobia is defined as an intense and irrational fear of a situation or an object that in reality poses little risk. A phobia is different from anxiety and can be long lasting, cause severe physical and emotional reactions that can affect one’s ability to function normally. There are many types of phobias- some people hate closed spaces, others fear certain animals, some are afraid to get in the elevator and so on. In general, phobia does not need treatment if it does not affect you daily life.

Can Electricity improve memory!

 We know that no drugs can improve memory, and researchers have been looking at more exotic methods to stimulate the brain. Recently scientists from the famed British University, Oxford, revealed that tiny electrical current to the brain could make one better at learning maths. They observed that when the parietal lobe of the brain was shocked, the ability of volunteers to solve mathematical problems improved. They suggest that perhaps this technique may help people who struggle with numbers (dyscalculia).

There are many people who have trouble with basic numbers, and this affects their ability to perform even the most basic maths and managing money. Some neuroscientists speculate that perhaps certain chemicals within the parietal lobe play a crucial role in memory.

Previous studies have shown that when magnetic field is applied to certain parts of the brain, it can disrupt electrical activity and lead to temporary difficulties in solving math problems. Therefore, these investigators applied electrical current to stimulate the parietal lobe in a small number of students. The electrical current was minor and had no untoward effects on other brain function. As the current was employed, the students performed much better at mathematical problems than those who were given no electrical current. In addition, the direct of the current was also very important. When the current was given in the wrong direction, their ability to solve problems declined drastically.

The study also revealed that the positive benefits were long lasting and persisted beyond 6 months.

Dr Cohen Kadosh, lead investigator said, "We are not advising people to go around giving themselves electric shocks, but we are extremely excited by the potential of our findings and are now looking into the underlying brain changes. We have shown before that we can induce dyscalculia, and now it seems we might be able to make someone better at maths, so we really want to see if we can help people with dyscalculia. Electrical stimulation is unlikely to turn you into the next Einstein, but if we're lucky it might be able to help some people to cope better with maths."

Final point: While the study is exciting, one should note that electrical therapy (ECT) has been used to treat depression for several decades. So before you start lining up for electrical therapy, remember that even though the current in ECT therapy is slightly high, the majority of people have one major side effect- memory loss, which is sometimes permanent. Until further studies are done on this novel therapy, people who cannot count their money are better off asking others to shop for them.

Vagus nerve stimulation for depression

Recently my doctor recommended a vagus nerve stimulation procedure to reverse depression. Does this work? Part 1

Many people with depression struggle and are always searching for a treatment that lasts long. While drugs have been the primary therapy for depression, many people do not always respond to them. Even when they respond, the benefits are short lived and plus the drugs also have potent side effects.

 Recently vagus nerve stimulation has been introduced as a treatment for depression. Vagus nerve stimulation has been used for the treatment of certain epileptic disorders. Over time, it became obvious that these individuals started to develop an improvement in their mood. So now vagal nerve stimulation is being tried as a therapy for chronic depression.

 Vagal nerve stimulation is a small surgical procedure. A thin electrode is placed near the vagus nerve in the neck and the wire is then connected to a pulse generator, which is implanted in the upper chest. The pulse generator emits electrical signals which stimulates the vagus nerve. Vagus nerve stimulation in turn results in mood improvement- at least that is the theory.

Vagus nerve stimulation is not standard therapy and only used in people in whom the standard anti-depressant therapies have failed. In addition, vagus nerve stimulation may be an option for people who are taking multiple drugs and have failed electroconvulsive therapy. Unfortunately, vagus nerve stimulation does not work in all depressed people. The few studies have not always shown convincing results and the result are also variable. Even among psychiatrists, the therapy is not accepted and many health insurance companies do not cover the procedure. In addition, the costs of vagal nerve stimulation are not trivial- considering that it may not even work.

Vagus nerve stimulation for depression

Recently my doctor recommended a vagus nerve stimulation procedure to reverse depression. Does this work? Part 2

While the procedure is easy to perform, it does have side effects that range from neck pain, infection, damage to the vague nerve, difficulty breathing, nausea and slowing of heart rate. In rare cases, one may develop vocal cord paralysis, voice changes, persistent cough and throat pain. While most side effects are tolerable, many people find the side effects annoying in the long run. However, of more concern is that in a few cases, vagal nerve stimulation may also lead to worsening of depression, suicidal thoughts and anxiety.

The surgery for implantation of the device is done as an outpatient and done under local anesthesia. After implantation, the device is programmed to deliver electrical impulses at various frequencies. Most people are started at low electrical current, which is gradually increased to get the desired result. Each stimulation lasts 30 seconds and occurs every 5 minutes. During this period, the side effects are most common. All individuals are given a small hand-held magnet to control the device. The machine has to be turned off while eating or speaking.

The results of vagus nerve stimulation are not immediate and often take months before the desired electrical impulse is obtained. As soon as the stimulation stopped, the depressive symptoms return. The decision to undergo vagal nerve stimulation is difficult. The procedure is very costly and there is no guarantee it will work. So before you decide to get the procedure, speak to people who have had it done. Remember even after vagal stimulation, you may still need to take anti depressant medications and continue with psychotherapy.

Itchy nipples

I am 25 year old and have developed very itchy nipples. Can I apply something on them?

In young people, itchy nipples are nothing to worry about. The itching may be due to tight clothes or your nipple rubbing against your bra or under shirt. This can happen if you exercise without a bra. However, chronic itching can also be a sign of eczema. If the itching is bothersome, obtain hydrocortisone cream over the counter and apply it 3-4 times day. If this problem persists after application of hydrocortisone, it is wise to see your doctor. Another common cause of itching around the nipples is a fungal infection, which can also be easily treated with an anti fungal cream. If the itch is limited only to your nipples, perhaps a change of fabric or bra may be warranted

Erect nipples

Can you tell me why my nipples are erect all the time?

In most cases, nipple erection is associated with sexual arousal but in some women, nipples may remain erect without any sexual stimulation. Why this happens is not well known. Sometimes, nipples can be erect when they are excessively irritated like when you start to pluck hairs or wear tight clothing. Some women love to show of their erect nipples but for those who are shy, then there are a variety of padded bras which can be worn. If you constantly plucking your hair around the nipples, stop the habit and see what happens. If it is the clothes that cause erection of your nipples, start to wear a bra, change the fabric or wear loose clothing. In any case, erect nipples are treated conservatively and there is ZERO need for surgery- unless you love pain and have money to waste.

Stage 4 colon cancer and surgery

 My mother is 77 and very ill. She is barely able to walk and has been a heavy smoker all her life. Recently she was diagnosed with colon cancer that has spread to the liver. Her surgeon recommends surgery. I am not sure what to do.

The first thing is you need to get is a second opinion. Any surgeon who wants to operate on stage 4-colon cancer sick frail patient has very little clinical judgment. Colon cancer surgery in older age groups has its benefits but surgery is also of high risk. The general rule of surgery is that patients who are deemed to be at high risk for surgery need surgical clearance from other specialists. Finally, surgery for stage 4-colon cancer is never done as life expectancy is very poor and there is no chance of cure. Removing a mass from the liver is no piece of cake. With the quality of some surgeons we have, death is a high probability.

The best advice is to seek another medical opinion and still not undergo surgery – as surgery will not benefit your mother. Please dump this stupid doctor-there is something known as palliative care and this is what your mother needs.

PIP Breast Implants

Women who live in Europe, South and Central America continue to get confusing messages from their respective governments about their breast implants. The implants made by Poly Implant Prosthesis (PIP) were manufactured by a French medical company, which is now non-operational. The company made poor quality, cheap grade implants of silicone, but luckily, these implants never made it in the US.

In France alone, data indicate that at least 30,000 French patients (mostly women) will need to have the implants taken out and the government will pay for the cost of removal.

However, response from other governments is not consistent. In other European and South American countries, some women have been advised to have the implants removed but only at their own expense. In other cases, the government has offered to pay for the cost of removal if only the implant shows signs of leakage or is obviously defective. In most Central American countries, patients have simply been told to have their implant checked at their own expense.

In Brazil and Mexico the governments have advised women to have the implants evaluated but have not recommended removal. In Colombia, the government has promised to pay for the removal if there is an indication. In Britain, the National Health Service has advised against routine removal and only those which are found to be defective will be eligible for free removal. In Holland, the government has advised women to have their PIP implant removed. The cost of removal is enormous but for women, it is the disfigurement and emotional torment that also has caries a heavy burden.

Latest estimates indicate that PIP sold close to 400,000 implants worldwide before going out of business several years ago. For those American patients who had PIP breast implants done abroad because the price was cheap, they should be aware that they are at great risk and should see a plastic surgeon.

In the last few years, complaints about these implants had been rising and include breast pain, inflammation, irritation and asymmetry of the breast. Many other implants had leaked or burst because of the inferior grade silicone. Several patients have also died of cancer in France.

Recently the FDA indicated that a type of lymphoma was a cause of death in some of these women with silicone breast implants. Fortunately, the number of cancers has been very few and no definite link has yet been established to the silicone.

For women, breast implants can improve their body image, personality and enhance their sex life.  However, consumers have to know that every prosthesis, like an implant, only lasts for 10-15 years. There is no implant that lasts a lifetime. At some point in time, the implant has to be removed because like any mechanical item, the wear and tear will cause deterioration.

Therefore, while plastic surgery is a great way to enhance self-esteem and confidence, it also carries some unknown risk, especially when cheap quality materials are used. This alone should be one reason not to seek any type of healthcare abroad. Outside of North America, cutting corners in healthcare to make money is the name of the game. Trust me-i have worked in over 27 countries.

Vitamins for glaucoma

I have had glaucoma for years. I just saw an ad for eye vitamins. Can these vitamins improve my vision or protect me from further vision loss?

No, that is all BS. These vitamin ads are bogus. There is no vitamin that can reverse or cure glaucoma. We have a health supplement industry that is unregulated and continues to make unsubstantiated claims. The sad part is that it is supported by unscrupulous healthcare workers who are simply interested in scamming desperate patients. 

Unfortunately, we also have a lot of gullible, stupid and/or desperate people who believe this type of crap. If you have glaucoma, go and see a bona fide eye doctor.  If you muck around with glaucoma at home with this vitamin BS, you will end up blind.

New onset Asthma in middle age

Can I develop asthma at the age of 67? I have never smoked and worked in an office all my life. I only have high blood pressure, which is well controlled. On a recent visit to my doctor, he told me I had developed asthma because of the chronic cough that I have had.

The majority of asthma cases are diagnosed in childhood or in the early teenager years. When one develops new onset asthma and a cough, this is a cause for concern. It is unlikely that one can have asthma out of the blue in the later years of life if the past medical history has been uneventful. Moreover, if you do not smoke or have no chemical related work history, then you definitely need more work up. The first thing to do is ask your doctor to get a chest x-ray and a referral to a lung specialist. Asthma may be related to the heart but this can easily be ruled out by obtaining an x-ray. If your doctor does not intend to work you up more thoroughly, you need a new doctor. At your age, something more ominous should always be ruled out first.

Generic statin

Can I take generic statin?

All statins currently available work in the same way. These medications inhibit a certain enzyme in the body, which prevents cholesterol build up in the body. However, the major difference between the statins is not their effectiveness but cost. Stains are expensive medications. The most expensive are rosuvastatin and atorvastatin. Individuals who have been prescribed these expensive medications should speak to their doctor about the generic statins. At the moment, mevacor, pravachol and zocor are available in generic form and for 1/3^rd the price. 

Many insurance companies may require that you try a generic statin before they will pay for a brand name statin. Some insurance cover all types of statins, after you pay a certain deductible. Statins bring a lot of money to the pharmaceutical industry, and usually doctors have little idea what generic brands are available.   

Remember statins have to be taken for life and can cost a fortune. If you really want to lower your cholesterol cheaply, then eat right and walk regularly. There is absolute no reason why generic statin will not work as effectively as the expensive brands. So, do not believe the hype that the more expensive statins are better than the cheaper brands. I personally believe that these medications are a rip off and instead recommend life style changes for my patients.