Processed meats in particular linked with cancer. Probably the nitrites that are nearly always used.
Increases risk of colorectal cancer. As does alcohol. Dairy products, fruit/veg, fibre all prevent.
Category Archives: Medical
History of Medical Failures
Where to start!? Leaches, blood letting, pretty much everything doctors did in the pre-modern period…
Thalidomide and birth defects, of course. But unforeseen.
X-rays for pregnancy monitoring. Took years before people paid attention to the alarms. X-rays were also used for tinea capitis – not just brain tumours, strokes and ischaemic heart disease about 30% higher too.
Ribavirin (via SPAG machines) for RSV. Not harmful, just useless and expensive.
Iron supplements for preterm babies – increased sepsis.
Osteoporosis
Various causes of secondary osteoporosis: coeliac disease, hyperthyroidism, hypogonadism, IBD, chronic liver disease, JIA, chronic renal, immobility.
Consider calculating fracture risk if secondary osteoporosis or previous fragility fracture, frequent use of systemic steroids, FH hip fracture, low BMI, smoking/alcohol etc.
Use online tools FRAX or QFracture to estimate 10yr predicted fracture risk (FRAX includes previous bone mineral density value if DXA done, not necessary). If risk is in the region of “intervention threshold” for proposed treatment, consider doing DXA and recalculate FRAX. Tools may underestimate risk if history of multiple fractures, previous vertebral fracture, high dose steroids, other causes of secondary osteoporosis. These tools are meant for adults over 30-40yrs however.
“Intervention thresholds” are NOT covered in guideline, it says see local guidance!
For WOS, no Dexa for coeliac until in 20s.
Vitamins
A -orange or red foods. Apricots, carrots, peppers, sweet potato, squash. Also dairy, eggs, oily fish, (famously) liver.
B1 (thiamine) – deficiency causes several different syndromes including Wernicke’s encephalopathy (confusion, ataxia, ocular) and dry (peripheral neuropathy) or wet (cardiac failure) beri-beri. Depends on chronicity. Classically alcoholism or diet dependent on polished rice. Bread has it!
B6 – fish, potatoes, fruit, fortified breakfast cereal.
C – citrus, blackcurrant, kiwi, berries. Also peppers, broccoli, Brussel sprouts, potatoes.
B12 – see Vitamin B12. Found in fish, meat, eggs, milk, fortified breakfast cereal, yeast extract (Marmite). So a major issue for vegans. Deficiency classically causes macrocytic anaemia.
Curiously, teenagers often seem to have high levels in my experience. Apparently this can be a flag for some nasties, namely malignancies, liver and kidney diseases, and can then be accompanied by symptoms of deficiency, due to disrupted pathways… [QJM 2013]
E – nuts and seeds.
K – green leafy veg.
Folate (folic acid) – green leafy vegetables, broccoli, brussel sprouts. Oranges, wholegrain cereals, nuts and pulses (peas, chickpeas, kidney beans)
Treatment
If vision loss or other neurological complications of malnutrition, can use IV or IM Pabrinex – vitamins B1,B2, B6, C, nicotinamide and glucose for intravenous or intramuscular administration.
Additionally, vitamins A and B12 may be replaced using high-dose intramuscular injections but may need unlicensed imported product.
Cefalosporins
Cefalosporins have a broader activity than penicillins, esp 3rd generation eg cefotaxime, ceftriaxone which are effective against most gram positives and gram negatives.
Good for meningitis (penetrate inflamed meninges at high dose) but not effective against pseudomonas, enterococcus, listeria, MRSA, and not that great against normal staphs so beware if possible line infection or neonatal meningitis. Some pneumococci can be resistant (1st line meningitis treatment in US is cef with vanc).
Ceftriaxone is drug of choice for Lyme with complications; it is not recommended for immediate treatment of meningococcal disease as any subsequent calcium containing infusions will reduce its plasma levels.
Ceftriaxone also eradicates meningococcal colonization – since cefotaxime is essentially equivalent, no reason to switch just for this indication.
Contraindications to ceftriaxone:
- Concomitant treatment with intravenous calcium (including total parenteral nutrition) in premature and full-term neonates—risk of precipitation in urine and lungs (fatal reactions) ;
- full-term neonates with jaundice, hypoalbuminaemia, acidosis, unconjugated hyperbilirubinaemia, or impaired bilirubin binding—risk of developing bilirubin encephalopathy;
- premature neonates less than 41 weeks corrected gestational age
Health anxiety
DSM-5 has “illness anxiety disorder”, defined as preoccupation with the idea that you’re seriously ill, based on normal body sensations (such as a noisy stomach) or minor symptoms (such as a minor rash), to the degree that it gets in the way of normal life. Other features are persistence of such ideas over 6 months, finding little or no reassurance from negative test results or a doctor’s reassurance, repeatedly checking body, avoiding people, places or activities for fear of health risks.
In other words, hypochondriasis. Which gets its name from the idea that such feelings came from liver/spleen/gall bladder (“melancholy” – black bile). William Cullen, in Edinburgh in the 1790s, appeared to take a particular interest in this.
For the sake of diagnosis, this disorder requires the absence of symptoms, which excludes the large group of people who have similar preoccupation and fears about non-specific or unexplained signs and symptoms.
Health anxiety is therefore a broader concept, and can include anyone who is more desperate for relief from worry, than for relief from actual symptoms.
Cyberchondria = combination of increased pathologisation of society, and ability to browse the internet. Because provides the opportunity to find very serious, extremely unlikely explanation for problems.
Diagnosis of health anxiety is well accepted by patients if explained respectfully!
[BMJ 2016;353:i2250]