Bone erosions are seen in this patient with breast cancer metastatic to the bone on CT imaging. (IMA / GPLv3)
March 31, 2012
Metastatic Breast Cancer
Bone erosions are seen in this patient with breast cancer metastatic to the bone on CT imaging. (IMA / GPLv3)
March 28, 2012
USMLE: Biostatistics App
Here is another free android medical app from the Internet Medical Association.
Online Version | Android App
Online Version | Android App
March 27, 2012
Superscan on Tc-99m scintigraphy
This patient with breast cancer had widespread bony metastatic disease at the time of this Tc99m MDP bone scan. This is an unusual presentation of a superscan.
Medical Decision Making App
Get the new free medical decision making android app from the Internet Medical Association.
Mobile App | Online Version
Mobile App | Online Version
March 24, 2012
Can Low Grade Radiation Protect Against Cancer?
Surprising Research Finds Beneficial Effects of Low Level Radiation Exposure
Author: Tom Heston, MD
Cancer is a heterogeneous disease characterized by uncontrolled cellular growth and multiplication. There are several risk factors associated with cancer, including smoking, inactivity, and a poor diet. However, the role of radiation exposure as a risk factor is unclear. We do know that sudden high doses of radiation, such as that experienced by people exposed to the atomic bomb blasts in Hiroshima and Nagasaki, increases cancer risk. But does all radiation increase the risk of cancer? Surprising evidence suggests that the opposite occurs, that low levels of radiation may actually protect against cancer by a process called radiation hormesis .
The best evidence for a beneficial effect of low level radiation comes from Asia. In Taiwan, approximately 25 years ago, recycled steel was accidentally contaminated with radioactive cobalt-60. This steel was used to build more than 180 buildings, and approximately 10,000 people occupied this buildings for about 10 to 20 years. The mean dose to the residents was approximately 13 mSv per year and the maximum dose was 160 mSv per year. For comparison purposes, the occupational limit for radiation workers in the U.S. is 50 mSv per year. The International Atomic Energy Agency sets the occupational limit at 20 mSv per year.
This unique research, made possible due to the accidental contamination of steel used to make apartment buildings, found that estimates of radiation risk from the International Commission on Radiological Protection were completely wrong. Compared to residents of nearby apartment buildings, that did not contain the radioactive cobalt-50 contamination, the people exposed to low level radiation had greatly reduced cancer deaths and congenital malformations. The cancer death rate among those exposed to low level radiation was only 3% of the rate of the general public. Put another way, the general public was more than 30 times more likely to die of cancer than the people living in the apartment buildings that exposed them to low level radiation over many years. Furthermore, the congenital malformation rate of the radiation exposed residents was 6.5% of the rate of the general public. The general public was more than 15 times more likely to have a child with congenital malformations compared to the radiation exposed residents.
This is strong evidence that a low level of radiation exposure has a beneficial health effect in terms of cancer and congenital malformations. Furthermore, this research is from real world data, not conjecture or theoretical mathematical models.
Based upon this promising research, and similar findings from other epidemiologic studies, some scientists have proposed that further human experiments be carried out, perhaps in nursing homes. Of course, such research would require full consent, Institutional Review Board oversight, and full disclosure to all individuals involved. But if death from cancer can be reduced by a factor of 30, certainly more research into this possibility is needed.
Current radiation hysteria and the linear no-threshold hypothesis do not appear to be based upon valid, scientific evidence. It is time to move out of the dark ages when it comes to radiation, and insist that policy decisions be based upon real world evidence.
REFERENCE: Chen WL et al. Is chronic radiation an effective prophylaxis against cancer? J Amer Phys Surg 2004;9(1):6-10.
Author: Tom Heston, MD
Cancer is a heterogeneous disease characterized by uncontrolled cellular growth and multiplication. There are several risk factors associated with cancer, including smoking, inactivity, and a poor diet. However, the role of radiation exposure as a risk factor is unclear. We do know that sudden high doses of radiation, such as that experienced by people exposed to the atomic bomb blasts in Hiroshima and Nagasaki, increases cancer risk. But does all radiation increase the risk of cancer? Surprising evidence suggests that the opposite occurs, that low levels of radiation may actually protect against cancer by a process called radiation hormesis .
The best evidence for a beneficial effect of low level radiation comes from Asia. In Taiwan, approximately 25 years ago, recycled steel was accidentally contaminated with radioactive cobalt-60. This steel was used to build more than 180 buildings, and approximately 10,000 people occupied this buildings for about 10 to 20 years. The mean dose to the residents was approximately 13 mSv per year and the maximum dose was 160 mSv per year. For comparison purposes, the occupational limit for radiation workers in the U.S. is 50 mSv per year. The International Atomic Energy Agency sets the occupational limit at 20 mSv per year.
This unique research, made possible due to the accidental contamination of steel used to make apartment buildings, found that estimates of radiation risk from the International Commission on Radiological Protection were completely wrong. Compared to residents of nearby apartment buildings, that did not contain the radioactive cobalt-50 contamination, the people exposed to low level radiation had greatly reduced cancer deaths and congenital malformations. The cancer death rate among those exposed to low level radiation was only 3% of the rate of the general public. Put another way, the general public was more than 30 times more likely to die of cancer than the people living in the apartment buildings that exposed them to low level radiation over many years. Furthermore, the congenital malformation rate of the radiation exposed residents was 6.5% of the rate of the general public. The general public was more than 15 times more likely to have a child with congenital malformations compared to the radiation exposed residents.
This is strong evidence that a low level of radiation exposure has a beneficial health effect in terms of cancer and congenital malformations. Furthermore, this research is from real world data, not conjecture or theoretical mathematical models.
Based upon this promising research, and similar findings from other epidemiologic studies, some scientists have proposed that further human experiments be carried out, perhaps in nursing homes. Of course, such research would require full consent, Institutional Review Board oversight, and full disclosure to all individuals involved. But if death from cancer can be reduced by a factor of 30, certainly more research into this possibility is needed.
Current radiation hysteria and the linear no-threshold hypothesis do not appear to be based upon valid, scientific evidence. It is time to move out of the dark ages when it comes to radiation, and insist that policy decisions be based upon real world evidence.
REFERENCE: Chen WL et al. Is chronic radiation an effective prophylaxis against cancer? J Amer Phys Surg 2004;9(1):6-10.
March 21, 2012
Be an Expert: Medical Decision Making
How to Become an Expert: read the news daily, research weekly, and a top book monthly.
March 15, 2012
March 13, 2012
Transient ischemic dilation in myocardial perfusion imaging
Measurement of ventricular size after
stress compared to at rest an important diagnostic tool
Author: Tom Heston MD
People with known or suspected coronary artery disease frequently undergo myocardial perfusion imaging as part of the workup for disease and risk management. The stress versus rest gated SPECT myocardial perfusion scan is particularly useful because it evaluates overall physiologic function (exercise capacity), electrocardiographic changes with stress, left ventricular size, myocardial perfusion, and left ventricular ventricular function.
One useful measurement from gated SPECT imaging that helps provide an overall picture of cardiac health is the response of the left ventricle to stress. This can be quantified in two ways. The first is the "transient ischemic dilation" (TID) ratio. The TID ratio is the average left ventricular size after stress divided by the average left ventricular size at rest. When elevated to approximately 1.2 or greater, it increases the risk of advanced cardiovascular disease.
Because the "average" ventricular size is a computer generated measurement which is uncommonly used in other imaging procedures, an alternative to the TID ratio is the end systolic or end diastolic volume ratio, or a combination of both. Again, with these measurements, an elevated ratio raises the risk of advanced cardiovascular disease.
A recent manuscript in the Journal of Nuclear Cardiology attempted to quantify the upper limit of normal for end diastolic and end systolic volume ratios. They found the upper limit of normal for the end systolic volume ratio to be 1.46, the upper limit of normal for the end diastolic volume ratio to be 1.23, and the upper limit for the TID ratio to be 1.19 when performing single day rest followed by stress gated SPECT myocardial perfusion imaging. They looked at 259 patients. Patients with ratios above these limits were significantly more likely to have advanced cardiac disease.
These values are to be utilized with caution because the authors did not throw out the patients where end systolic volumes ratios are highly fragile, namely, in patients with a high ejection fraction and a small heart. In my personal database of over 3700 patients, the upper limit of normal for the end systolic volume (ESV) ratio is 1.34 and the upper limit for the end diastolic volume (EDV) ratio is 1.20. When throwing out all patients with an ejection fraction of 70 or greater, the upper limit for the ESV ratio falls to 1.27 but the upper limit for the end diastolic volume ratio remains almost the same at 1.19.
All stress vs rest volume ratios were significant predictors of advanced cardiac disease. Furthermore, they found that when there was at least a small perfusion defect in addition to an elevated stress vs rest ventricular volume ratio, the sensitivity of an elevated ratio went up while the specificity remained unchanged. The sensitivity of TID for the detection of advanced disease was about 65% to 70%.
Take-Home Messages from this study:
- The study reaffirms that increased change in ventricular volume with stress is a marker of increased cardiovascular risk.
- The TID ratio, end systolic volume ratio, and end diastolic volume ratio all are significant predictors of increased risk.
- There may be some advantage to using the EDV and/or TID ratios, as they might be more resistant to variations in heart size compared to the ESV ratio.
- The upper limit of normal for both the TID ratio and the EDV ratio is approximately 1.20.
Xu Y, Arsanjani R, Clond M et al. Transient ischemic dilation for coronary artery disease in quantitative analysis of same-day sestamibi myocardial perfusion SPECT. J Nucl Cardiol. 2012 Mar 8.
Tanaka H, Chikamori T, Hida S, Igarashi Y, Miyagi M, Ohtaki Y, Shiba C, Hirose K, Hatano T, Usui Y, Yamashina A. The diagnostic utility of the Heston Index in gated SPECT to detect multi-vessel coronary artery disease. J Cardiol. 2008 Feb;51(1):42-9.
NOTE: medicine is a rapidly changing field. Always consult with your physician regarding your personal health issues. Keep in mind the words from Mark Twain, updated for the Internet age: "Be careful of reading health information online, you might die of a misprint."
The Courage Walk
"All serious daring starts from within." - Harriet Beecher Stowe
To build your courage, start from within. An excellent way to begin doing this is the courage walk.
You can build up your courage from within by regularly going on Courage Walks. The courage walk helps build up your inner strength in three important ways. First of all, it involves going on a walk. This perfect exercise tones your body, cleans your lungs, and strengthens your heart. It is a perfect exercise for many of us because it can be done anywhere, for your entire life.
Secondly, the Courage Walk clears away the clutter in your brain. In effect, it serves to perform a brain reboot. Sometimes, a computer can build up an excessive number of programs in its RAM. This memory is for short-term, temporary use. It is not used for long- term memory, which is stored on the hard drive. This RAM can get overwhelmed by running too many programs all at once, and cause your computer to crash. When this happens, a simple reboot of the computer will clear the RAM, and the computer will function normally once again. In a similar fashion, your brain also benefits from clearing out the clutter of random, petty, miscellaneous thoughts. The Courage Walk helps you performs this vital function, allowing you to reset and recalibrate your brain.
Finally, the Courage Walk strengthens your spirit. It makes your thoughts, and your soul, more resilient. It helps your creativity. The Courage Walk makes you stronger in body, mind, and spirit. Here's how the Courage Walk is performed.
First, go on a walk. On your walk, clear your thoughts by focusing on your breathing. You can focus on your breathing in many different ways. One simple way is to breathe in for 4 steps, hold your breath for 4 steps, then breath out for 4 steps. Another method to help you focus on your breathing is to talk a deep, deep breath. Hold it. then let it out slowly. The main thing is just to focus on your breathing.
Now, imagine breathing in healthy energy and letting it fill up your entire body. Imagine taking the energy in when you inhale. As you inhale, imagine your body becoming full of positive, beautiful colors. Many people imagine themselves becoming more full of a bright, warm light. The molecules of your body resonate with harmonious, positive life. Your aura builds up a stronger glow. Now exhale, and imagine negative energy leaving you through the palms of your hands and the soles of your feet. The toxins are being released. Negativity flows out easily as you exhale.
Let your aura, your inner light become so strong that absolutely nothing can diminish it, harm it, or overcome it. Your aura is so powerful, it reaches out to others, affecting them in a positive, healthy way. This light is your (good) force, helping you, helping others, and strengthening the universe. Now, let all of the color leave your body. Every time you inhale, every time you exhale, the glow grows less and less until finally nothing is left. Imagine your body as completely invisible, completely gone.... yet your spirit remains. You are greater than your body. Your spirit is something greater than the physical world, and therefore nothing in the physical world can diminish, harm, or destroy your spirit.
Continue to meditate on filling your body with a brilliant light, then releasing all of the light. Imagine building up the spirit within your body, and then imagine your spirit as greater than just your body. Fill your body full of healthy energy, yet realize that while your body is temporary, your spirit is something greater.
Your Courage Walk is now over. Your brain has been rebooted. Your heart, your lungs, and your muscles all have been re- energized. Your inner glow, your aura has grown in strength and brilliance, just like a fire that has just been stoked. Finally, you have reaffirmed that your spirit is greater than your body, that life is much more than just the physical world.
SUMMARY: BUILD COURAGE WITH THE COURAGE WALK
* Go on a walk and focus on your breathing
* Breathe in positive energy and exhale negative energy
* Imaging your aura so bright and strong that nothing can diminish its glow
* Now, imagine your spirit and your entire being as invisible to the world, and unaffected by earthly concerns
To build your courage, start from within. An excellent way to begin doing this is the courage walk.
You can build up your courage from within by regularly going on Courage Walks. The courage walk helps build up your inner strength in three important ways. First of all, it involves going on a walk. This perfect exercise tones your body, cleans your lungs, and strengthens your heart. It is a perfect exercise for many of us because it can be done anywhere, for your entire life.
Secondly, the Courage Walk clears away the clutter in your brain. In effect, it serves to perform a brain reboot. Sometimes, a computer can build up an excessive number of programs in its RAM. This memory is for short-term, temporary use. It is not used for long- term memory, which is stored on the hard drive. This RAM can get overwhelmed by running too many programs all at once, and cause your computer to crash. When this happens, a simple reboot of the computer will clear the RAM, and the computer will function normally once again. In a similar fashion, your brain also benefits from clearing out the clutter of random, petty, miscellaneous thoughts. The Courage Walk helps you performs this vital function, allowing you to reset and recalibrate your brain.
Finally, the Courage Walk strengthens your spirit. It makes your thoughts, and your soul, more resilient. It helps your creativity. The Courage Walk makes you stronger in body, mind, and spirit. Here's how the Courage Walk is performed.
First, go on a walk. On your walk, clear your thoughts by focusing on your breathing. You can focus on your breathing in many different ways. One simple way is to breathe in for 4 steps, hold your breath for 4 steps, then breath out for 4 steps. Another method to help you focus on your breathing is to talk a deep, deep breath. Hold it. then let it out slowly. The main thing is just to focus on your breathing.
Now, imagine breathing in healthy energy and letting it fill up your entire body. Imagine taking the energy in when you inhale. As you inhale, imagine your body becoming full of positive, beautiful colors. Many people imagine themselves becoming more full of a bright, warm light. The molecules of your body resonate with harmonious, positive life. Your aura builds up a stronger glow. Now exhale, and imagine negative energy leaving you through the palms of your hands and the soles of your feet. The toxins are being released. Negativity flows out easily as you exhale.
Let your aura, your inner light become so strong that absolutely nothing can diminish it, harm it, or overcome it. Your aura is so powerful, it reaches out to others, affecting them in a positive, healthy way. This light is your (good) force, helping you, helping others, and strengthening the universe. Now, let all of the color leave your body. Every time you inhale, every time you exhale, the glow grows less and less until finally nothing is left. Imagine your body as completely invisible, completely gone.... yet your spirit remains. You are greater than your body. Your spirit is something greater than the physical world, and therefore nothing in the physical world can diminish, harm, or destroy your spirit.
Continue to meditate on filling your body with a brilliant light, then releasing all of the light. Imagine building up the spirit within your body, and then imagine your spirit as greater than just your body. Fill your body full of healthy energy, yet realize that while your body is temporary, your spirit is something greater.
Your Courage Walk is now over. Your brain has been rebooted. Your heart, your lungs, and your muscles all have been re- energized. Your inner glow, your aura has grown in strength and brilliance, just like a fire that has just been stoked. Finally, you have reaffirmed that your spirit is greater than your body, that life is much more than just the physical world.
SUMMARY: BUILD COURAGE WITH THE COURAGE WALK
* Go on a walk and focus on your breathing
* Breathe in positive energy and exhale negative energy
* Imaging your aura so bright and strong that nothing can diminish its glow
* Now, imagine your spirit and your entire being as invisible to the world, and unaffected by earthly concerns
March 9, 2012
Overcome Fear and Strengthen Your Courage
Author: Tom Heston MD
Have you been in a life or death situation that required you to summon up great courage? Many of us have not. Although we have been in situations that test our resolve, usually it is not life or death. Frequently, our courage is called upon during everyday life, when performing seemingly routine activities.
Modern life has protected us from many dangers that were quite common in generations past. For example, no longer do we all need guns in our homes to protect us from grizzly bears, mountain lions, or other wild animals. We do not need to weather the elements with raw materials. In the current day and age people have electricity, running water, and adequate housing. Instead of hunting, we only need go to the supermarket. And instead of braving the elements, we can often get from home to work and back without even going outside. So why is it that when we think of courage, we only think of someone who overcame great odds or a life or death situation?
Sometimes when thinking of courage, we only think it applies to rare and uncommon situations. Yet can our ordinary life also be full of courage, even if we are not facing the end of a gun, a wild animal, or a vicious criminal? Can we fill our routine days with courage?
One definition of courage is the ability to overcome one's fears, and we can all overcome at least some of our fears. It is in this manner that every one, on a daily basis, can build up their courage.
The process is simple but challenging. First, select one of your fears. Figure out a plan to overcome it. Then follow your plan. In this way, courage grows and strengthens.
The first step is to write down your fears. Don't run away from your fears, don't avoid them. Face them head on.
Then, write down several specific actions that you can take in order to overcome those fears. Make up a master list of ACTION STEPS that will lead to overcoming your fear, or at least greatly decrease the fear.
For example, perhaps you are afraid of dying prematurely from a heart attack. First, you would write down your fear, then you would write up a plan of action designed to overcome the fear. One plan might be to exercise more, or perhaps improve your diet. By doing these things, your fear will decrease because you know you are doing your very best.
So today ask yourself: What would a person of courage do? Courage is a primal force that can be summoned up by thinking and planning, but it only becomes a part of your life when you take action.
To strengthen your courage, follow these steps:
1. Recognize your fears.
2. Write down a plan of action that will cause you to overcome or at least lessen these fears.
3. Make up a task list, and prioritize it.
4. Take action immediately.
Have you been in a life or death situation that required you to summon up great courage? Many of us have not. Although we have been in situations that test our resolve, usually it is not life or death. Frequently, our courage is called upon during everyday life, when performing seemingly routine activities.
Modern life has protected us from many dangers that were quite common in generations past. For example, no longer do we all need guns in our homes to protect us from grizzly bears, mountain lions, or other wild animals. We do not need to weather the elements with raw materials. In the current day and age people have electricity, running water, and adequate housing. Instead of hunting, we only need go to the supermarket. And instead of braving the elements, we can often get from home to work and back without even going outside. So why is it that when we think of courage, we only think of someone who overcame great odds or a life or death situation?
Sometimes when thinking of courage, we only think it applies to rare and uncommon situations. Yet can our ordinary life also be full of courage, even if we are not facing the end of a gun, a wild animal, or a vicious criminal? Can we fill our routine days with courage?
One definition of courage is the ability to overcome one's fears, and we can all overcome at least some of our fears. It is in this manner that every one, on a daily basis, can build up their courage.
The process is simple but challenging. First, select one of your fears. Figure out a plan to overcome it. Then follow your plan. In this way, courage grows and strengthens.
The first step is to write down your fears. Don't run away from your fears, don't avoid them. Face them head on.
Then, write down several specific actions that you can take in order to overcome those fears. Make up a master list of ACTION STEPS that will lead to overcoming your fear, or at least greatly decrease the fear.
For example, perhaps you are afraid of dying prematurely from a heart attack. First, you would write down your fear, then you would write up a plan of action designed to overcome the fear. One plan might be to exercise more, or perhaps improve your diet. By doing these things, your fear will decrease because you know you are doing your very best.
So today ask yourself: What would a person of courage do? Courage is a primal force that can be summoned up by thinking and planning, but it only becomes a part of your life when you take action.
To strengthen your courage, follow these steps:
1. Recognize your fears.
2. Write down a plan of action that will cause you to overcome or at least lessen these fears.
3. Make up a task list, and prioritize it.
4. Take action immediately.
How to Prevent Cancer: Current Recommendations
Author: Tom Heston MD
For the majority of people who do not smoke, the prevention of cancer relies mainly upon weight control, dietary habits, and physical activity. Approximately a third of the cancer deaths that occur can be attributed to poor dietary and physical activity habits. Another third of cancer deaths in Americans is due to exposure to tobacco and tobacco products. The final third is due to genetics, spontaneous mutations, unknown factors, or various other reasons. This means that for most people, the risk of cancer is greatly affected by their personal habits.
The American Cancer Society in January, 2012 released guidelines on how to decrease the risk of cancer. Some of their major points include:
* Maintain a proper weight. People who are overweight or obese benefit from even a small decrease in their weight. Exact cutoffs for a healthy weight is somewhat arbitrary, but most experts consider a body mass index between 18.5 and 25.0 kg/m2 to be healthy.
* Consume a healthy diet that emphasizes plant foods.
* Men should consume no more than 2 alcoholic drinks per day, and women no more than 1 alcoholic drink per day.
* Adults should engage in about 20 minutes a day of moderately intense physical activity, or about 10 minutes a day of vigorously intense physical activity.
* Children and adolescents should engage in at least an hour of moderate or vigorous intensity physical activity daily. They should engage in vigorous activity at least 3 days a week.
* Eat whole grains instead of refined grain products.
* Limit consumption of processed meat and red meat.
* Read food labels to become more aware of calories consumed, and be aware that "low fat" or "nonfat" does equal "low calorie."
* Eat at least 2.5 cups of fruits and vegetables every day.
* To minimize risk of breast cancer, in addition to not smoking, engage in regular physical activity and minimize weight gain throughout life.
These American Cancer Society guidelines to reduce the risk of getting cancer are straightforward and relatively easy to adopt. 1. Achieve and maintain a healthy weight throughout life. 2. Adopt an active lifestyle. 3. Consume a healthy diet, emphasizing plant based foods. 4. Limit consumption of alcoholic drinks to no more than 1 a day for women and 2 a day for men. 5. Don't smoke or use tobacco products. 5. Finally, get regular cancer screening.
REFERENCE
Kushi LH, Doyle C, McCullough M et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians 2012;62(1):30-67.
For the majority of people who do not smoke, the prevention of cancer relies mainly upon weight control, dietary habits, and physical activity. Approximately a third of the cancer deaths that occur can be attributed to poor dietary and physical activity habits. Another third of cancer deaths in Americans is due to exposure to tobacco and tobacco products. The final third is due to genetics, spontaneous mutations, unknown factors, or various other reasons. This means that for most people, the risk of cancer is greatly affected by their personal habits.
The American Cancer Society in January, 2012 released guidelines on how to decrease the risk of cancer. Some of their major points include:
* Maintain a proper weight. People who are overweight or obese benefit from even a small decrease in their weight. Exact cutoffs for a healthy weight is somewhat arbitrary, but most experts consider a body mass index between 18.5 and 25.0 kg/m2 to be healthy.
* Consume a healthy diet that emphasizes plant foods.
* Men should consume no more than 2 alcoholic drinks per day, and women no more than 1 alcoholic drink per day.
* Adults should engage in about 20 minutes a day of moderately intense physical activity, or about 10 minutes a day of vigorously intense physical activity.
* Children and adolescents should engage in at least an hour of moderate or vigorous intensity physical activity daily. They should engage in vigorous activity at least 3 days a week.
* Eat whole grains instead of refined grain products.
* Limit consumption of processed meat and red meat.
* Read food labels to become more aware of calories consumed, and be aware that "low fat" or "nonfat" does equal "low calorie."
* Eat at least 2.5 cups of fruits and vegetables every day.
* To minimize risk of breast cancer, in addition to not smoking, engage in regular physical activity and minimize weight gain throughout life.
These American Cancer Society guidelines to reduce the risk of getting cancer are straightforward and relatively easy to adopt. 1. Achieve and maintain a healthy weight throughout life. 2. Adopt an active lifestyle. 3. Consume a healthy diet, emphasizing plant based foods. 4. Limit consumption of alcoholic drinks to no more than 1 a day for women and 2 a day for men. 5. Don't smoke or use tobacco products. 5. Finally, get regular cancer screening.
REFERENCE
Kushi LH, Doyle C, McCullough M et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians 2012;62(1):30-67.
March 7, 2012
Artifactual Bladder Flare on PET/CT
This is an example of artifactual flaring or streaking posteriorly of F-18 FDG tracer activity on PET/CT imaging. This artifact appears to be due to bladder movement between PET and CT imaging.
March 6, 2012
Nuclear Medicine Physicians on Wikipedia
Author: Tom Heston, MD
Today I added "Nuclear Medicine Physicians" to the Wikipedia Category:Medical doctors by specialty. This marks the very first time that the specialty is recognized in this important section of Wikipedia. Prior to today, the specialty of radiology was recognized, but it was amazing to find that the specialty of nuclear medicine was not. Molecular imaging is an important specialty that has resulted from decades long work and research coming from the specialty of nuclear medicine. Now they people devoting their professional careers to the field will be fully recognized on Wikipedia.
Today I added "Nuclear Medicine Physicians" to the Wikipedia Category:Medical doctors by specialty. This marks the very first time that the specialty is recognized in this important section of Wikipedia. Prior to today, the specialty of radiology was recognized, but it was amazing to find that the specialty of nuclear medicine was not. Molecular imaging is an important specialty that has resulted from decades long work and research coming from the specialty of nuclear medicine. Now they people devoting their professional careers to the field will be fully recognized on Wikipedia.
Speaking Up for Courage
Author: Tom Heston, MD
Want to build up your courage, today? Then speak up for the things you know to be right. Stand tall. Speak up.
A fool speaks of trivial things without thinking, but it takes inner strength to talk about our most important thoughts in a respectful and courteous manner. Standing up for what is right by putting into words our most important thoughts takes courage.
"Moral cowardice that keeps us from speaking our minds is as dangerous to this country as irresponsible talk." - Margaret Chase Smith.
Margaret Chase Smith knows what she is talking about. She was the first woman to represent Maine in the U.S. House and first in the U.S. Senate. She was the first woman to serve in both houses of the United States Congress. In 1964, she became the first woman to ever be placed in nomination for the U.S. Presidency by one of the major political parties. What was her secret to achieving groundbreaking success? Most certainly, one reason she was so successful was her courage to speak up for what she believed to be true and right.
Do you know anyone who is afraid to say "I love you" but always has the latest neighborhood gossip? It's possible that this person is afraid to make a real connection with you, and instead prefer to keep the relationship at a distant, superficial level. Usually, their fear of rejection -- not lack of love -- prevents them from ever sharing their deepest thoughts.Without the courage to speak up, their relationships remain shallow, and likewise their contribution to society remains shallow.
Perhaps you know people who will never say "I'm sorry." Why won't they ever say they are sorry? This usually is because they are afraid to admit they were wrong. They are afraid to show that they are human and capable of making mistakes. They are afraid to show weakness. Yet by not sharing our vulnerabilities, we create an emotional wall around ourselves. We become unable to build strong friendships. Everyone suffers.
So, do you want to become more courageous, today? Start right now by speaking up and sharing with others your most important feelings, and your most important thoughts.
Talk in a kind, and respectful manner, so others will respond positively. When we are rude or abrupt, others frequently stop listening, and our words then become meaningless. A good way to learn how to effectively speak up is by following the principles set forth by Toastmaster's International. Many communities have a local club that helps members improve their speaking. The goal is to speak effectively. Thoughtless speech cannot help others. People are going to be much more receptive to listening when we speak firmly, but in a kind, gentle, and respectful manner.
Finally, is there really such a thing as "quiet courage"? Although this concept has been romanticized in books, the concept is very misleading. Certainly, the courageous are quiet when it comes to complaining or criticizing. They don't seek out publicity for publicity's sake. But this doesn't mean courage is "quiet." Not at all. Courage comes from deep inside of us, and it grows only through sharing. We need to speak up in order to share our innermost feelings.
Follow these three principles to become more courageous, today.
1. Speak up with confidence. You can become a more courageous person, today, by sharing with others your most important feelings and thoughts.
2. Speak up about your beliefs. Moral courage requires us to stand up for what we believe in.
3. Speak up with respect. People are more receptive to your message when you speak up in a firm but kind and respectful manner.
Want to build up your courage, today? Then speak up for the things you know to be right. Stand tall. Speak up.
A fool speaks of trivial things without thinking, but it takes inner strength to talk about our most important thoughts in a respectful and courteous manner. Standing up for what is right by putting into words our most important thoughts takes courage.
"Moral cowardice that keeps us from speaking our minds is as dangerous to this country as irresponsible talk." - Margaret Chase Smith.
Margaret Chase Smith knows what she is talking about. She was the first woman to represent Maine in the U.S. House and first in the U.S. Senate. She was the first woman to serve in both houses of the United States Congress. In 1964, she became the first woman to ever be placed in nomination for the U.S. Presidency by one of the major political parties. What was her secret to achieving groundbreaking success? Most certainly, one reason she was so successful was her courage to speak up for what she believed to be true and right.
Do you know anyone who is afraid to say "I love you" but always has the latest neighborhood gossip? It's possible that this person is afraid to make a real connection with you, and instead prefer to keep the relationship at a distant, superficial level. Usually, their fear of rejection -- not lack of love -- prevents them from ever sharing their deepest thoughts.Without the courage to speak up, their relationships remain shallow, and likewise their contribution to society remains shallow.
Perhaps you know people who will never say "I'm sorry." Why won't they ever say they are sorry? This usually is because they are afraid to admit they were wrong. They are afraid to show that they are human and capable of making mistakes. They are afraid to show weakness. Yet by not sharing our vulnerabilities, we create an emotional wall around ourselves. We become unable to build strong friendships. Everyone suffers.
So, do you want to become more courageous, today? Start right now by speaking up and sharing with others your most important feelings, and your most important thoughts.
Talk in a kind, and respectful manner, so others will respond positively. When we are rude or abrupt, others frequently stop listening, and our words then become meaningless. A good way to learn how to effectively speak up is by following the principles set forth by Toastmaster's International. Many communities have a local club that helps members improve their speaking. The goal is to speak effectively. Thoughtless speech cannot help others. People are going to be much more receptive to listening when we speak firmly, but in a kind, gentle, and respectful manner.
Finally, is there really such a thing as "quiet courage"? Although this concept has been romanticized in books, the concept is very misleading. Certainly, the courageous are quiet when it comes to complaining or criticizing. They don't seek out publicity for publicity's sake. But this doesn't mean courage is "quiet." Not at all. Courage comes from deep inside of us, and it grows only through sharing. We need to speak up in order to share our innermost feelings.
Follow these three principles to become more courageous, today.
1. Speak up with confidence. You can become a more courageous person, today, by sharing with others your most important feelings and thoughts.
2. Speak up about your beliefs. Moral courage requires us to stand up for what we believe in.
3. Speak up with respect. People are more receptive to your message when you speak up in a firm but kind and respectful manner.
March 5, 2012
March 3, 2012
Omega-3 Fatty Acids, Red Yeast Rice, and Sudden Cardiac Death
For people with high cholesterol, or at an increased risk of cardiovascular disease, there are a couple of concentrated nutritional supplements that may be helpful to aid in lowering the risk of a fatal heart attack or disabling heart disease.
The first is the unique and natural native product from China - red yeast rice. It has been used in customary medical systems from about 800 A.D. This rice is produced when white rice is fermented with (monascus purpureus) red yeast. It is said to be used first in China (more than 2800 years in the past) as food coloring agent and food preservative. The first assumed use of the recipe for making red yeast rice was in 1368-1644 - the Ming Dynasty. It was reported even at that time to boost blood circulation. There is careful production of the red yeast rice extract to prevent any citrinin presence, a by-product of the process of fermentation which is sometimes toxic. When CoQ10 is added, there appears to be further enhancement of the product to support the immune system as well as healthy cardiovascular functions.
Chinese cuisine has used red yeast rice as cardiac supplements for centuries - that is, to encourage blood circulation and reduce clotting. Asian countries use red yeast rice as a staple for diets, used in making rice wine, flavour agent, as well as to maintain the colour and flavour of meat and fish. The red yeast rice develops inhibitors referred to as monacolins. These inhibitors (hydroxymethylglutaryl-CoA reductase (HMG-CoA reductase)) occur naturally. The healing properties of the red yeast rice positively affect the lipid reports of patients who are hypercholesterolemic.
The second concentrated nutritient that may be of benefit to your heart is omega-3 fatty acid. This appears to be helpful for people that are at risk of heart disease, or are currently experiencing the negative effects of heart disease. Omega-3 fatty acids appear to have an anti-arrhythmic effect, and have been shown in some research to reduce the risk of sudden death by about a half, and reduce the risk of cardiac death by a third. Modest doses are recommended because of the possible interaction with other supplements or medications a person may be taking, such as aspirin and other blood-thinning medications.
The primary side effects of red yeast rice appear to be primarily due to contaminants during production. Selecting a product from a reputable manufacturer is especially important for this supplement. The primary side effects of omega-3 fatty acids likely come from interactions with pharmaceuticals. It is important to let your physician and pharmacist know about what you are taking, so they can help you minimize any side-effects. Also, keep in mind that supplementation does not replace a healthy diet full of plant foods. Balance supplementation with a moderate and balanced diet.
REFERENCE
Ong HT, Cheah JS. Statin alternatives or just placebo: an objective review of omega-3, red yeast rice and garlic in cardiovascular therapeutics. Chin Med J (Engl). 2008 Aug 20;121(16):1588-94.
The first is the unique and natural native product from China - red yeast rice. It has been used in customary medical systems from about 800 A.D. This rice is produced when white rice is fermented with (monascus purpureus) red yeast. It is said to be used first in China (more than 2800 years in the past) as food coloring agent and food preservative. The first assumed use of the recipe for making red yeast rice was in 1368-1644 - the Ming Dynasty. It was reported even at that time to boost blood circulation. There is careful production of the red yeast rice extract to prevent any citrinin presence, a by-product of the process of fermentation which is sometimes toxic. When CoQ10 is added, there appears to be further enhancement of the product to support the immune system as well as healthy cardiovascular functions.
Chinese cuisine has used red yeast rice as cardiac supplements for centuries - that is, to encourage blood circulation and reduce clotting. Asian countries use red yeast rice as a staple for diets, used in making rice wine, flavour agent, as well as to maintain the colour and flavour of meat and fish. The red yeast rice develops inhibitors referred to as monacolins. These inhibitors (hydroxymethylglutaryl-CoA reductase (HMG-CoA reductase)) occur naturally. The healing properties of the red yeast rice positively affect the lipid reports of patients who are hypercholesterolemic.
The second concentrated nutritient that may be of benefit to your heart is omega-3 fatty acid. This appears to be helpful for people that are at risk of heart disease, or are currently experiencing the negative effects of heart disease. Omega-3 fatty acids appear to have an anti-arrhythmic effect, and have been shown in some research to reduce the risk of sudden death by about a half, and reduce the risk of cardiac death by a third. Modest doses are recommended because of the possible interaction with other supplements or medications a person may be taking, such as aspirin and other blood-thinning medications.
The primary side effects of red yeast rice appear to be primarily due to contaminants during production. Selecting a product from a reputable manufacturer is especially important for this supplement. The primary side effects of omega-3 fatty acids likely come from interactions with pharmaceuticals. It is important to let your physician and pharmacist know about what you are taking, so they can help you minimize any side-effects. Also, keep in mind that supplementation does not replace a healthy diet full of plant foods. Balance supplementation with a moderate and balanced diet.
REFERENCE
Ong HT, Cheah JS. Statin alternatives or just placebo: an objective review of omega-3, red yeast rice and garlic in cardiovascular therapeutics. Chin Med J (Engl). 2008 Aug 20;121(16):1588-94.
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