Category: Diseases & Conditions

Are the Health Risks of Smoking Reversible?

By Mark A. Kelley, MD |09/07/16

As a lung specialist, I am often asked whether the body can recover from many years of smoking.  Based on decades of research, the answer is a resounding “Yes” … but only if you quit smoking – completely.

What Are The Risks of Smoking?

Cigarette smoking kills over 400,000 Americans each year – more than the combined deaths from alcohol, illegal drug use, homicide, suicide, car accidents, and AIDS combined.

Cancer – Before cigarette smoking became widespread in the twentieth century, lung cancer was a rare disease. However, as smoking become popular, lung cancer rose to became a leading cause of death.  Scientific research demonstrated that the toxic chemicals in cigarette smoke are carcinogenic. Smoking is also associated with cancers of the throat and digestive tract.

Heart and Vascular Disease – there is a strong association between smoking and the development of atherosclerosis, the “hardening of the arteries” that causes heart attacks, strokes and aneurysms. These conditions are among the major causes of death in smokers. A heart attack is 2-4 times more likely in a smoker than a non-smoker. Quitting smoking is the single most effective way to reduce the risk of a future heart attack.

Lung Injury and COPD – A person’s first puff from a cigarette invariably causes coughing.   This is the body’s warning sign–inhaled smoke damages the lung. Cigarette smoke irritates the lung’s bronchial tubes, causing mucus production.  The smoke also paralyzes the cells that clear mucus and debris out of the lung. . Over time, cigarette smoke causes mucus plugging, swelling and, sometimes, destruction of the bronchial tubes. This makes the lung more vulnerable to infections. When bronchial tubes are blocked or distorted, it is also much harder to move air in and out of the lung. This condition, called chronic obstructive pulmonary disease (COPD), is a leading cause of death and disability.

Nicotine Addiction – Nicotine is one of the most addictive substances known — often compared to heroin.  Nicotine withdrawal produces symptoms similar to opiates, which is why is it so difficult to quit smoking, Cigarette smoke delivers nicotine immediately to brain areas associated with pleasurable sensations. Nicotine also increases heart rate and blood pressure, and constricts blood vessels. This puts strain on the heart and promotes vascular disease..

If You Quit Smoking, Health Risks Fall Dramatically. 

Cancer – Smoking cessation for 10 years cuts the risk of lung cancer in half.  The reason is that the lung is no longer exposed to the carcinogens in cigarette smoke. With continued abstinence from smoking, the risk continues to decline. Similar results have been seen with laryngeal and other forms of cancer.

Heart and Vascular Disease – For someone with known coronary artery disease (CAD), smoking cession reduces the risk of a future cardiac event by 50%. For someone without CAD, quitting smoking for one year reduces the risk of CAD by 50%. If abstinence continues for 15 years, the risk of future heart events is almost the same as a lifetime non-smoker. The same is true for the risk of stroke.

COPD – Smokers expose their lungs to the constant irritation of cigarette smoke, and have a faster decline in lung function than non-smokers.   This decline occurs slowly and is not noticeable until the lung function is so low that it affects everyday activity. At that point, smoking cessation will reduce lung irritation but the chronically diseased lung cannot repair years of damage. The best strategy is to stop smoking before significant damage has occurred. The good news is smoking cessation can halt the rapid decline in lung function before more damage occurs.

Nicotine Addiction – Most smokers want to quit smoking but nicotine withdrawal is a major obstacle. As the old saying goes, “if it were easy, everyone would do it”. Most smokers who try to quit fail multiple times. However, the encouraging statistic is that millions of Americans have kicked the habit. The best results come from planned programs to break the nicotine addiction and eliminate lifestyle habits associated with smoking. (see references below)

In summary, smoking has life-threatening health care risks. Once a person stops smoking, these risks decline significantly over time. While kicking the habit is challenging, the health benefits are enormous. It is never too late to quit.

For more information about smoking and health risks, see the Centers for Disease Control (CDC) and the American Lung Association.

The Sun — America’s Leading Cause of Cancer

By Mark A. Kelley, MD |08/23/16

Skin cancer is the most common cancer in the United States. Here are some facts:

•Over 3 million Americans are treated for skin cancer every year.

One in five Americans will develop skin cancer during their lifetime.

•Skin cancer is preventable and easy to detect.

•When caught early, this cancer is usually curable.

Skin cancer is caused by sunlight damage to the skin. The only way to prevent it is to stay out of the sun, or block the sun’s rays.

People with fair skin are more vulnerable to skin cancer. Those with dark complexions have some natural protection since their skin filters out some of the sun’s rays. Nonetheless, people of color can still get skin cancer.

The sun’s ultraviolet rays can damage the DNA of skin cells. These cells may grow abnormally and eventually become cancerous. This transformation may evolve slowly over many years or may occur earlier in life, particularly if sunlight exposure has been intense.

Sunlight can also lead to another problem–premature wrinkling of the skin.  Sun worshipers believe that a tan is healthy. In reality, a suntan is a sign of the skin injury. If it continues, the damage can destroy the foundations of the skin, and make it look like leather. Tanning also triples the likelihood of developing the most dangerous form of skin cancer, melanoma.

A melanoma starts as a pigmented skin lesion. Early detection and removal can cure this malignancy. However, if untreated, melanoma can spread to other parts of the body and cause death.

The other types of skin cancer are less aggressive and spread slowly to the surrounding tissue. The most common are basal cell and squamous cell carcinoma. These cancers are rarely fatal and in early stages, are easy to remove.  If ignored, they can invade deeply and widely, making surgical removal challenging.

To prevent skin cancer, protect your skin from sunlight:

1. Limit your exposure to the sun. The sun’s rays are most intense between 10 am and 4 pm.

2. If you must go out in the sun, block the sun’s rays with “cover-up” garments and/or with sunblock.

3. Use sunblock that has sun protection factor ratings (SPF) of 15 or more.   An SPF of 15 means that it would take you 15 times longer to get sunburn with the sunblock, compared to none at all.

4. Follow the directions for applying and reapplying the sunblock product. Sunblock can lose its effectiveness after a few hours. It can also be removed by perspiration or swimming.

5. Avoid indoor tanning salons. Research has shown that those using tanning beds have an alarming increase in skin cancer including the most deadly form, melanoma. Click here for more information.

Screening for Skin Cancer

The benefits of routine skin cancer screening are controversial. However, most experts agree that anyone with a suspicious skin lesion or with a history of skin cancer should seek medical advice. Click here for details.

More information on skin cancer can be found at the National Institutes of Health and the Skin Cancer Foundation.

How to Fight Zika — Lessons from the Panama Canal

By Mark A. Kelley, MD |08/08/16

The Zika virus continues to capture headlines. Zika virus has been found in Puerto Rico and now in a Miami Florida neighborhood.

Is this the beginning of a major epidemic? Not likely – if we follow the lessons of the Panama Canal.

I recently visited Panama and its famous canal that links the Atlantic and Pacific Oceans. The canal was built between 1880 and 1914 at the cost of many lives. Over 30,000 workers perished, most of them dying from tropical diseases. The most deadly were malaria and yellow fever. The latter could kill some victims within a week.

The tropical disease epidemic in Panama was stopped without the use of any vaccines or drugs. The key was understanding how mosquitoes spread these diseases to humans. Female mosquitoes need blood nourishment to lay their eggs. Infected mosquitoes can transmit the diseases to humans when they sample human blood. Eliminating mosquitoes prevents the disease.

Zika virus, known for almost seventy years, belongs to a group of tropical viruses transmitted by mosquitoes. Among them are yellow fever and dengue fever.
Until recently Zika was not considered a major public health problem because it rarely caused problems in humans.

Now Zika has changed and become dangerous. When the virus is transmitted from an infected woman to her fetus, the infant may be born with major birth defects, particularly of the brain. At the moment we have no drugs or vaccines to fight Zika.

This sounds like the Panama problem in the early 1900s. What stopped the epidemic back then?

The answer came from understanding the aegypti mosquito, the major carrier of these viruses. Each mosquito lives only 2-4 weeks. The female lays hundreds of eggs that hatch immediately upon contact with water. In dry conditions, these eggs can survive for 12 months. The resulting larvae emerge as adult mosquitoes in about ten days.

Aegypti mosquitoes have several important characteristics.

1. They stay close to human dwellings and need very little water for their eggs. These bugs prefer to be close to their victims and hide in and near dwellings –not in the jungle. They love stagnant water to lay their eggs. Human dwellings, with flowerpots and gardens, sinks and toilets, are perfect. During the Panama Canal construction, mosquitoes were happily breeding in the inkwell of the chief physician!

2. The typical female travels no more than a quarter mile during its lifetime. The only way for Zika virus to leave the neighborhood is by “hitching a ride” with a human. In the Miami outbreak, the “neighborhood” where Zika was found is about 10 blocks wide and 20 blocks long. An infected human who leaves this “Zika zone” may bitten by a mosquito in a new location that is “Zika-free”. If that local mosquito becomes infected, it can pass Zika to victims in the new neighborhood.

3. They like to bite humans during the day. This makes prevention more challenging for those who leave their home during daytime.

What stopped the Panama Canal epidemic a century ago? Public officials declared war on these mosquitoes with an aggressive action plan:

• Every house and neighborhood was inspected regularly to eliminate standing water and stop mosquitoes from breeding. All water containers were cleaned weekly to kill any eggs or larvae.

• Irrigation ditches and swampy areas near homes were drained.

• To prevent spread, yellow fever patients were kept in isolation from mosquitoes.

• Workers and the general public covered up with long sleeves and pants to reduce the chance of mosquito bites.

The plan worked. In less than one year, the yellow fever epidemic ended. .

Today, we have many more tools to fight this virus – window screens, air conditioning, municipal sanitation, and effective insect repellant. Also many regions in the U.S. either are too dry or too cool for the aegypti mosquito to thrive.

We still have much to learn about Zika. One surprise is that Zika can be transmitted by sexual contact. This makes things more complicated and prevention recommendations are still evolving. Hopefully, a Zika vaccine may eventually emerge, as happened with yellow fever.

Meanwhile, the lessons of the Panama Canal still hold true:

• Eliminate standing water near humans.

• Prevent mosquito bites by staying inside screened dwellings. When outside, wear clothing that covers the skin and use insect repellent.

These measures are effective. During a five-day visit to Panama City, none of my family and friends was bitten by a mosquito. In fact we never saw one.

For the most accurate and up-to-date information about Zika, check the Centers for Disease Control website. There you will find details about prevention, transmission, and Zika in Florida and other locations.

What is Precision Medicine?

By Mark A. Kelley, MD |08/01/16

In his State of Union address this year, President Obama announced a federally funded program called ”Precision Medicine”. This $215M project is designed to improve disease treatment and prevention by studying the variability in genes, the environment, and lifestyle for each person. A “cohort” of one million volunteers from different parts of the nation will followed over a number of years.

This project resembles the famous Framingham Heart Study, which began almost 70 years ago. That study has provided major insights into the causes of heart disease by following patients over many decades.

In this era, we have many more tools to improve our understanding of how diseases evolve over time. We can track massive amounts of information about patients and analyze their genes. We also have new electronic communication and monitoring tools. The hope is that we can find better ways of prevention, detection and cure of diseases. Already, medical research is facing some important challenges. Here are several examples.

Inherited disease is more complicated that we thought. Medical science has achieved major breakthroughs in understanding how the human genome behaves. Genes control most of the processes in our bodies and slight changes in those genes can cause problems. Some inherited genes have been known for decades – such as sickle cell disease and cystic fibrosis. However, the system is much more complex than ever imaged. Only recently have we begun to understand how inherited genes cause disease.

Genes can control our response to prescribed drugs. Some drugs, such as those for conditions like hypertension and blood clots do not work the same for everyone. Many patients may need higher (or lower doses) and for some, the drug does not work at all. Research suggests that these variances may be due to different genes that control the way the drug interacts with our bodies. How do we know which drugs are best for each person? Should we test everyone for genes that control response to prescribed drugs?

Genes can become abnormal and trigger disease. Curing cancer is at the core of the Precision Medicine project. All cancer is from the uncontrolled growth of cells. In many cancers, genes that control cell growth no longer work normally and the result is a tumor. We do not understand how or why this happens. In some cases, genetic analysis of the patient’s tumor reveals which genes are defective and therapy can be developed to block the effects of these abnormal genes. The influence of genes on human disease is the hottest area of medical research. Precision Medicine will help us understand much more about these processes.

How are diseases related to the environment, including social factors? We know much about toxins and other environmental risks but we need to learn more. The influence of social factors on health is not well understood. Poverty, education, and life style can affect health but the details are lacking. For example, is poverty a risk factor for hypertension when you exclude all other factors except poverty itself?

Fortunately, we have the tools to improve our understanding of these issues. Studying the human gene has become very sophisticated and less expensive. With this technology, we may learn how and when genetic testing is useful in a large population. Supercomputers can analyze enormous volumes of information about patients over many years. This may reveal important clues on disease patterns and risks for individual patients.

We in the United States are a very diverse population and each of us is uniquely different. With Precision Medicine, we may better understand how to provide the best care for every individual.

For more information about Precision Medicine, go to the National Institutes of Health website or the White House webpage.

If you are interested in enrolling in the project, contact the NIH Precision Medicine participation website.

Is Genetically Modified Food Safe?

By Mark A. Kelley, MD |07/25/16

Genetically Modified (GM) Food is a major breakthrough, but, like many discoveries, it has created controversy.

All living things, whether plants or animals, face many challenges to their survival: climate, predators, competition for food etc. Genes that give an organism a survival advantage are passed on to future generations.

There are many examples. Some plants develop their own natural insect repellent. Birds and fish have different colors to attract mates or to hide from predators. Bacteria develop resistance to antibiotics.

Science has now developed laboratory techniques to insert new genes into the DNA of some plants and animals. The goal is to make the food supply more productive. Plants can be changed to be more resistant to drought, heat, and insects. Farm animals can be bred to grow with less feed, water etc.

These biologically engineered animals are termed “Genetically Modified Organisms” or GMOs. You may see foods labeled as “GM” (or GMO) -free”. That means that the plant or animal has not been genetically modified by laboratory techniques.

What are the advantages of GM foods?
With climate change and expansion of the world population, many experts feel that we will need more efficient ways to grow food. Extremes of weather, and shortages of fertile land and water could all contribute to a food shortage. If we can genetically modify plants and animals to adapt to these challenges, the food supply may still thrive.

What are the risks of GM foods? So far, GM foods have proven very safe. One reason is that they must undergo safety tests before they can be introduced into the food chain. The food must be proven safe for human consumption and the plants and animals must not disrupt the environment. One common concern, especially for plants, is whether the new version can cause allergic reactions.

Can the new genes in the plant or animals be transmitted to humans? Eating a food product does not transmit genes. Every food has billions of genes that have no biologic way to mingle with our own genes. However, to artificially change a plant of animal gene, viruses are used to transmit the new DNA. . Some have argued that such viruses might linger in the food and infect humans. This theory has not been proven after decades of research. However, even if that were true, viruses have produced natural genetic changes in plants and animals for millions of years.. So far, humans have suffered so ill effects.

What are the dangers to the environment?
The GM organism could be so successful that it alters the natural balances in the environment. The organism may crowd out competitors or breed with them. We have seen this happen naturally when animals or plants from other continents have reached the US. With no competitors in their new land , these foreign organisms can spread rapidly. Examples include the zebra mussel in the Great Lakes and the Japanese beetle – found in almost every state. So far, no significant “outbreak” has happened with GM organisms.

Based on current information, these are the “take-home” messages about GM food:

• GM technology has improved food production, making food more affordable and available. With increasing pressure on the food supply, it is likely that more GM food will be developed.

• Most countries, including the US, regulate these products carefully, as they do other sources of food.

• The safety record of these GM foods has remained excellent , but the experience has only been over a few decades. Careful surveillance should continue.

• Before GMOs, we made serious mistakes in our food supply. Examples include applying harmful pesticides, and feeding animals growth-enhancing antibiotics that cause the life-threatening infections in food.

• The lesson is that we should always pay close attention to the safety of our food supply. GMOs are no exception. They have many benefits and minimal, if any risks to our health. Whether GMOs will threaten other organisms and the environment remains unknown.

You can learn more about GMOs from the Scientific American and the World Health Organization.

Preventing vs. Detecting Disease — What is the Difference?

By Mark A. Kelley, MD |07/11/16

For decades, the public has been educated that prevention is the best way to reduce the risk of disease.

From time to time, news articles describe how some tests or procedures may not be effective in preventing medical conditions. This can be confusing because the reports may not explain the difference between preventing a disease versus detecting it.

Prevention reduces the chance of ever getting a disease. Examples include public measures like clean water; vaccines against smallpox and polio; and lifestyle habits like not smoking. All these significantly reduce the risk of disease.

Detection of disease is a different strategy. If the patient already has the disease or condition, early detection may improve outcome, For example, early detection is particularly important in treating infections. The correct antibiotic, given early, has a much better chance of eliminating the infection before it can spread. In another example, early detection of high blood pressure or high cholesterol can lead to treatment that reduces the risk of heart attacks and stroke.

Some of the recent controversies have been about the early detection of cancer. This is an evolving strategy. Most cancers start as small tumors and cause no symptoms until they grow large or spread. In theory, finding and eliminating these early tumors could result in higher cure rates.

For the most common cancers, this strategy has been effective … but with some uncertainties.

“Early Detection” Success

Cervical Cancer: The Pap smear of the cervix has detected early, curable cancer in thousands of women. Early detection has transformed cervical cancer from an incurable disease to one with a very high cure rate.

Colon cancer: This slow-growing tumor, if detected early, is also highly curable. The detection tools are testing for blood in the stool or looking for tumors inside the colon periodically with a flexible scope.

Skin Cancer: There are multiple forms of skin cancer but in nearly every circumstance, early detection improves cure. The “test” is easy: examination of the skin by a trained expert and when necessary, skin biopsies to determine diagnosis.

“Early Detection” Success – Some Controversy

Breast Cancer: Mammography and related breast imaging technologies are excellent for detecting early breast cancer and this early detection saves lives. However, experts can disagree on the age a woman should begin this testing, or how often it should be performed. These decisions may depend on the woman’s risk for breast cancer based on family history and other factors.

Lung Cancer: Until recently, there was no early detection test for this common tumor. Recent research has suggested that periodic CT scans of the lung can detect early, curable cancer in current or former smokers. However, some experts think this recommendation is preliminary until more results are known.

“Early Detection” – More Controversy

Prostate Cancer: This malignancy grows slowly and is common in elderly men. A blood test called the PSA, when abnormal, suggests prostate cancer but the diagnosis must be confirmed with biopsies. Even if the biopsies confirm the diagnosis, it is often unclear when or how to treat prostate cancer since it is usually not very aggressive. This has made policy-makers wary of recommending the PSA since, so far, the test has not improved the cure rate. However many men and their physicians still monitor PSA levels.

Prevention and detection of disease are important to discuss with your doctor. As medical science gains new insights, some new recommendations may evolve.

However, one recommendation will never change: pay attention to your health and take the steps that can keep you healthy.

For more information about cancer screening tests, visit the website Choosing Wisely.

Does Your Physician Know What You Pay for Healthcare?

By Mark A. Kelley, MD |07/05/16

All of us should understand our own health care costs. However, as we have discussed here before, the issues can be complicated: e.g. insurance premiums, deductibles, co-pays, etc.

Physicians have a different perspective. Like any professional, they focus on how they are paid. Insurance companies require doctors to submit many details with their bills. Physicians rely on sophisticated billing systems to furnish that information, because without it, they are not paid. In a nutshell, patients worry about paying the bills and doctors worry about sending out the bills.

This raises a key question. How much do doctors know about your insurance and what you must pay?

Of course, the doctor can explain his/her own bills to you. Your doctor’s office has checked your insurance and knows how they should bill your insurance company.   Surprisingly, the doctor may not know much your hospital insurance coverage, or your deductible. Most physicians and their staffs have not been trained to gather this information because it does not affect physician payment.

But things have changed. With high deductible insurance plans, patients have more risk for out-of-pocket costs. A blood test, x-ray, or medication can come with a large bill if it drops into your deductible.

The prices may astound you. A friend recently enrolled in a high deductible insurance plan. She refilled prescription, which previously cost her $40 co-pay. With her new insurance, she had to pay $250 for the same refill because it was part of her deductible. The price was so high because the insurance company passed all the drug cost on to her.

Why is this important?   It is wise to know what you are paying for — and health care is no exception. Health care bills can mount quickly and squeeze the family budget. Sometimes, families face the tough choice of either paying the rent or seeing the doctor.

Physicians are seeing more of their patients struggling with health care bills. This pressure may discourage them from seeking medical care. Tight finances are becoming a health care risk, even for families with decent incomes.

How can patients and doctors work together to control the “costs of care”?

Here are a few suggestions:

1. Know the details of your own insurance policy, especially “out-of-pocket costs”such as co-pays, coinsurance and deductibles. If you have any questions or concerns, contact your insurance company.

2. When your doctor recommends a test, procedure, or treatment, make sure you know what it involves, why you need it, how effective it will be and how soon it must happen. These are questions that any good doctor would be glad to answer.  The timing of the test or procedure may be important if you have already paid out your deductible before the end of the year. In that case, you may not have to pay anything for the service.

3. Cost may (or may not) influence your decision to get a test or procedure. For example, for an urgent life-saving procedure, cost may not even enter your mind. However, some tests or procedures may not be so convincing. In those cases, cost might influence your decision. If so, discuss the cost issue with your doctor who may suggest less expensive alternatives. The timing, location and type of service may all influence the cost: most often for planned (elective) procedures, x-rays, or some medications.

4. If health costs worry you, talk to your doctor. Don’t be afraid to bring up the issue. You are not alone. Many more patients are asking about costs these days. Physicians welcome solving these challenges with you. They can be very helpful if they understand your concerns.

Learn how physicians are addressing this problem on the website Costs of Care.

Our Immune System Fights Infection — Is Cancer Next?

By Mark A. Kelley, MD |06/20/16

Humans have been fighting disease for thousands of years. Until the 20th century, most people died young because they were exposed to deadly infections like small pox. However, smallpox survivors never experienced the disease again. The same is true for mumps, polio and measles. During these infections, our bodies create antibodies that recognize the virus as an alien invader and kill it before it can infect again. We have used this immune system to prevent infections and now we are using it against cancer.

The war against infections has been so effective that some infections are now rare. In fact, smallpox has been eradicated across the world. The reason is that we have developed vaccines that expose the body to proteins from viruses (like small pox) or bacteria (like tetanus) These proteins cause no infection but stimulate the body’s immune system to create antibodies that kill these organisms. Vaccines are among the most important discoveries in history and have saved millions of lives.

There are a few twists to this story. First, our immune system may need a “wake-up” call with a booster shot of vaccine. This revs up the immune system to create a fresh reserve of antibodies. A good example is the tetanus booster shot.

Second, viruses can change their appearance over time so that the immune system may not recognize them. For example, the influenza virus can change every year. Therefore, we need an annual flu shot to keep our immune system up-to-date.

In the past year, two different viruses, Zika and Ebola, have caused major epidemics. The Ebola virus is easily passed from human to human and has a high mortality rate. The Zika virus is transmitted by mosquito bites and rarely causes death or serious illness. The exception is unborn infants. For them, Zika can cause severe brain destruction leaving them disabled for life.

Both these viruses began in remote tropical areas of Africa and would have gone unnoticed before modern times. However, with larger cities and modern travel, diseases can rapidly infect people around the globe. Ebola, for now, has been confined to Africa, but Zika is steadily spreading across the Western Hemisphere.

These epidemics have awakened the world to the value of vaccines. There are now major efforts to create vaccines for these two dangerous viruses. However, it will take time to be certain that any new vaccine is safe and effective

The immune system is also becoming important in treating another major disease—cancer. Some cancers are linked to a viral infection. The best example is cervical cancer, which is associated with infection by the human papilloma virus. Vaccines against that virus, when given before puberty, reduces the risk of cervical cancer.

Cancer is a collection of abnormal cells that grow uncontrollably. Our immune system does not kill these cells because, on the surface, they look normal. If we could make these cells look abnormal, the immune system would destroy them quickly, just like any other invader. The effect would be dramatic. The immune system patrols the entire body and would hunt down every “strange” cancer cell.

Cancer research is now probing how to use our immune system to cure cancer. One approach is to make the cancer look like a foreign invader to our immune system. Another is to teach our immune system to use antibodies engineered to sabotage the growth of the cancer.

It may be a long time before we see results from this research … but we should be patient. It took decades to develop vaccines but the results have been spectacular. Our immune system is smart and ruthless in protecting us from infection. If we can train it to fight cancer, we will be moving closer to a cure.