Treating concussions in professional sports

For years I have been fascinated by the pharmacological properties of Hydergine and have prescribed it for mild forms of Alzheimer’s when I was in medical practice. In several of my previous blog posts, I describe the many functions of this drug and suggest it may be useful in protecting against possible concussions following head injuries of athletes in contact sports like hockey, football and soccer. (Readers may wish to review these previous blog posts.) Additional coaches are sometimes recruited by professional sports teams in an effort to win games. Teams should also be recruiting medical professionals to possibly help them prevent and/or reduce the incidence of encephalopathy and concussions, and provide the best diagnosis, treatment and care immediately following any injuries. In the case of cardiac arrests or drowning, we immediately perform CPR but in the case of head injuries we waste valuable time asking the victim if they know where they are, or what day it is, or the name of the current leader of the country. We should apply a more consistent, effective approach to evaluating athletes with head injuries and be more swift to administer hydergine or similar drugs in an effort to minimize or avoid the immediate and long-term adverse effects of brain injuries and optimize recovery.

Importance of knowledge of tumor biology

In previous blog posts, I discuss the importance of formal courses in tumor biology and nutrition for medical students, as well as for practicing physicians, especially oncologists.

We all know that pathogenic bacteria can develop resistance to specific antibiotics. I wonder whether the poor response to specific anti-tumor drugs in some cancer patients, and/or the development of remissions, are related to the ability of cancer cells to undergo heteroploid transformation and the specific selection of a karyotype.

I recall from my research as a cell biologist with the Department of Cancer Research at the University of Saskatchewan in Saskatoon (from 1961 to 1965) where I demonstrated that if a single cancer cell from a cell line was isolated and then allowed to undergo numerous cell divisions in cell culture – I used the tumor cell line called HeLa – that chromosomal analysis of many cells from this population showed cells with varying number of chromosomes. This phenomenon is called heteroploid transformation. Chromosomal values in my experiment ranged from the low 50’s to the 70’s, with a stem cell line in the early 60’s. (Hrushovetz, S.B. Importance of heteroploid transformation in the etiology of neoplasia. Proceedings of the 17th Western Regional Group MRC/NCI. 1963).

For my Master’s degree in Biochemistry from the University of Alberta, I had earlier shown that the addition of specific amino acids to the culture medium on which the cereal plant pathogen – called Helminthosporium sativum – was sub-cultivated could alter the virulence of this pathogen in producing root rot disease. (see publication Phytopathology 47:261-264. 1957).

Alternatively, these experiments could be interpreted as demonstrating that for a pathogen to retain its virulence, it requires the presence of specific nutrients in its environment.

Cancer etiology: genetic or environmental

In order to prevent what is going to kill you, you need to know what those factors are. Let’s zero in on Canada’s number one killer: cancer.

Taking Canadian vital statistics on causes of death for the year 2011, there were 246,596 deaths. Statistics Canada divided the population into 4 age groups: 1-24, 25-44, 45-64, 65 years and over. The percentage of cancer deaths were 10%, 21%, 44% and 28% respectively.

Not surprisingly, cancer was the number one cause of death in all 4 age groups. But what surprised me was that cancer caused 10% of the 2,679 deaths in the youngest age group.

Most oncologists estimate that only 10-20% of cancers are genetically determined, with the rest due to environmental factors, with diet responsible for 35% and tobacco 25%(at least for males with the percentage in females rapidly approaching the same figure). It is also well-documented that the main reason for the higher cancer deaths in those 45 and over for lung cancer, and possibly also for the other environmental factors like diet and radiation, is due to the so-called lag period.

If this hypothesis for the mechanism of environmental carcinogenesis applies, then genetically-determined cancers in the 1-24 age group should be responsible for more cancer deaths with fewer from environmental such as by food, smoking, radiation, etc. Such information may give the oncologists, epidemiologists, and genetic counselling specialists new tools for their management of this major killer.

Choices for Alzheimer’s management: more nursing home beds or medical research?

Before discussing these 2 choices, here are some interesting facts regarding Alzheimer’s that I have come across in my research.

Alzheimer’s ranks as the 6th leading cause of death in the US, surpassing  breast and  prostate cancer deaths combined; currently, someone develops Alzheimer’s every minute (thats 60 new cases every hour, 1440 for each day (24×60) and  525,600  for each year (1440×365). Predictions are that by 2050, this rate will double to a new case of Alzheimer’s developing every 30 seconds doubling the number to over 1 million new cases annually.

The medicare costs today to treat Alzheimer’s in the USA is $236 billion annually, excluding the $5000 that caregivers also spend annually. Based on the increase in the number of people over age 85, it is predicted that these costs will rise to over one trillion dollars annually by 2050.

Canadian picture -just as gloomy: according to Canadian vital statistics for  2013 , Alzheimer’s ranked as the 5th major cause of death behind, cancer, heart disease, stroke, and chronic respiratory disease; because the elderly are currently the fastest growing segment of our population  there are now more people over age 65 than those under age 17 with the prediction that by 2050 half of the elderly will be over age 85.

Since incidence of Alzheimer’s increases with age, only 8% of the Canadian population have some degree of Alzheimer’s at age 65, but by age 85 this incidence increases to 35%.  By the year 2050, with half of the the Canadian population over the age of 85, 35% of them could have Alzheimer’s, an alarming prognosis. It could also become the number one cause of death. The current annual health care costs for Alzheimer’s is around $30 billion,  which could increase to over $300 billion by 2050. It alone could bankrupt our healthcare system in Canada.

We desparetly need a solution now. In the title of this post I suggested there were 2 routes available: more nursing home beds or basic research to find the cause and cure  of Alzheimer’s. As with other pandemics in the past we also had similar 2 choices. For example, in the 1940’s and 50s with the polio epidemic, governments were facing a similar policy decision – should they   invest their resources to build more and better iron lungs and hospitals for the patients who need them? Or should they invest in basic medical research to find a cure for polio? The National Foundation for Infantile Paralysis as it was called in those days chose the latter – a wise decision.

Regarding Alzheimers we have the same 2 choices-more nursing home beds or medical research.  I especially like the comments by Dr. Roy Walford in his book  Maximum Life Span. (pages 17-18):

“… My point is that old age homes and all the vast social support structures continuously accumulating to care for the helpless aged are the iron lungs of gerontology. Improvements in the social, economic and medical support system for the elderly will merely provide symptomatic relief for an expanding problem. …” .

By giving top priority to constructing 1200 more nursing home beds, the province of Manitoba would seem to have made their decision. Of note in  Saskatchewan, the government claims that everyday there are 10 new cases of Alzheimer’s. That’s over 3600 cases each year. If eventually, 25% of these cases require nursing home beds, then the province would need to build over 900 beds annually. In the 19th century, tuberculosis – known also as the white plague – was the leading cause of death, claiming over 35% of the population. Sanatoria like the one in Ninette, Manitoba were quickly constructed and filled. With the discovery of antibiotics which specifically killed the tuberculosis bacterium, patients no longer needed to go to sanatoria to be cured and these buildings soon became museums.

I have become quite fascinated with the advances made in Alzheimer’s research, and will discuss the topics of the role of Vitamin D and the 7 common ways we have to slow the aging process in my future posts.

transgender vs cis(gender)

Cis(gender)- is defined as the sex you are assigned at birth, while transgender is an umbrella term for people whose gender identity differs from the sex they are assigned at birth.

Recently I have been working on various keynote presentations on the paradigm shift for gerontology, specifically on anti-aging.  To ‘add life to your years and years to your life’,  it seems gerontologists have shifted from pursing life extension strategies to anti-aging.

In that regard I have searched for more information on the biological markers for aging. One of the tests I have found relates to the significant loss of hormone levels, specifically DHEA. According to Roy Walford in his textbook (The 120 year diet ) table 2.2 in males DHEA  declines from 3400 ng./ml of plasma in the 20-30 age group to less than 900 ng/ml by age 60. Corresponding figures for females are 2200 to 800 .

The Fifth edition (2013) of Disease Prevention and Treatment  published by Life Extension Foundation on p. 608 details how DHEA is converted to Androstenediol an intermediate hormone which can then produce either and/or  both– the male and female sex hormones, viz. testosterone and the 3 major estrogens (estrone,, estradiol and estriol).  The hormonal cascade also shows that the enzyme aromatase can convert testosterone to the female sex hormones.

I wonder if an imbalance of this hormonal cascade can produce the increase in transgenders we are witnessing. Maybe by altering these conversions we could preventive the transgender phenomenon.

 

 

Clinical types of early dementia

We are all aware of what we call “senior moments”- where we can’t recall the names of people we have known in the past -only to recall the name at a later date – usually before the end of the discussion. Sometimes remembering may take longer, either several hours or after a night’s sleep.

There is another more frustrating type of amnesia where the clinical feature  is a failure to recall or include a constructive idea or thesis, which would offer an excellent solution to the problem under discussion. To the scientist, this is called the “eureka moment”. That is why they say that scientists make their greatest contributions to research in the earlier years of their research career.

Anti-aging therapies and doctor assisted dying

These anti-aging therapies include bio-identical hormonal replacement, management of oxidative stress with anti- oxidants, reduction of chronic inflammation a forerunner of atherosclerosis and heart disease, genetic-restoring telomere length, stem cell therapy to replace senescent cells, etc.

In one of my keynote presentations, I discuss 7 ways to slow the aging process. Hopefully by slowing and/or reversing the aging process, these individuals can also change their biological clock to a period when they did not have these chronic diseases!

Should these breakthroughs materialize, we may even witness the time when people in nursing homes may actually be discharged and return to their homes, much like we now do with patients who are sent home from hospital after recovering from a medical illness or surgical treatment.

Maybe the health status of those individuals requesting “assisted dying” could be enhanced or their delayed if their biological life clock was reversed to an earlier period when they did not have those debilitating symptoms.

The late Dr.Roy Walford. in his book Maximum Life Span relates the history of the government’s approach to the polio epidemic of the 1940’s and 50’s His comment: “… if the government had invested in perfecting better iron lungs we would now have the best designed most comfortable iron lungs imaginable inhabited by thousands of polio victims…” Instead, by investing in basic research and developing a vaccine, epidemics like polio and smallpox have now theoretically been eradicated from our planet.

Regarding nursing homes, Walford comments “…the vast social support structures continuously accumulating to care for the helpless elderly are the iron lungs of Gerontology…”

It should be noted that in the 19th century when Dr. Edward Jenner developed his crude smallpox vaccine, he and the world did not know that smallpox was also caused by a virus. In my view the current knowledge of the causes of the aging process is probably at the same stage when Jenner was experimenting with a smallpox vaccine which he tested on his own son.

We do not really know what causes the aging process that leads to the development of the chronic symptoms and diseases of the elderly, what I like to call the 5 “D’s-disability, depression, discomfort, dementia, chronic diseases, and death. Why do the levels of hormones like DHEA begin to drop after age 30?

Concussion film to air Dec 25/2015

On Dec 23/2015 while enjoying my supper with the family, I happened to look up at the TV screen to discover that the channel was commenting on the film Concussion to be aired on Christmas Day. I searched for their comments on this “biographical sports thriller” about the condition of CTE: chronic traumatic encephalopathy.

Wikipedia’s evaluation of this film under its 9 sections was exceptionally well documented with special praises for the very talented actors-especially the role of the forensic pathologist.

As a medical doctor, a scientist and a gerontologist I was somewhat disappointed to find very little discussion on the preventative aspect of this disease. I guess their emphasis on the denial by the NFL of the problem of CTE was what made it a thriller.

Somehow it reminded me of the status of the polio epidemic of the 1940-50’s. The doctors and scientists of the day had a very important decision to make. They could have invested their resources in perfecting better iron lung machines. If that had been their decision we would now have the best designed iron lung machines inhabited by thousands of patients. Indeed an archival photo from one of the wards of a Winnipeg Hospital showed that this was already happening. Instead of iron lungs the decision was made to find a cure.

We all know the story: vaccines spearheaded by Sabin and Jonas Salk were soon developed. Now except for the occasional outbreak due mainly to the failure of vaccination of children, polio has all but been eliminated from the globe. A similar fate has happened to smallpox infections. The only difference was that in the case of smallpox , the vaccine was first developed in the 19th century by Dr. Edward Jenner long before it was known that smallpox like polio was caused by a virus.

In my view our knowledge of concussions and CTE is currently at the same level that smallpox was in the 1880’s when Dr. Jenner was practicing medicine. Even though we must confess that we really don’t seem to know the cause of concussions, maybe we can still find a cure without that knowledge.

I refer the reader to the small textbook entitled “The Physicians guide to Life extension Drugs” published by the Life Extension Foundation. I currently have the 1998 edition-It is a small volume of only 268 pages. Pages 141-150 discuss the pharmacologic properties of hydergine. Reading this chapter especially the “cat experiment ” suggested to me that this drug might have protective properties in the early phases of a head injury assuming hypoxia and free radical pathology are at play and that this damage occurs before features of a concussion are diagnosed clinically.

Elsewhere I have suggested that players engaged in contact sport might first- take a tablet of this drug before they begin playing. Much like we take our Vitamin C pills to prevent those winter flus. Or like the surgeons who give hydergine intravenously to their patients in some European countries before they begin their cardiac or other major surgeries on their patients as a preventative measure should the patients experience cardiac arrest on the operating table.

Now wouldn’t that make a fascinating medical thriller? I am sure that if Berton Roueche, author of “Eleven Blue Men”,  knew about this epidemic of concussions he might have changed the title of his book to “Twelve Blue Men”.

Can slowing the aging process reduce the incidence of Alzheimer’s

See my previous blog posts for statistics about the incidence of Alzheimer’s in Canada and Nursing homes as possible research labs for dementia.

Briefly here are the relevant statistics:
– by age 65, 8% of the population have some degree of dementia’ Others say at age 65 5% of population have Alzheimers and it doubles every 5 years so by age 85 it would be 25. – Canadian figures say by age 85 it has reached 35% of the population. Regardless of which figures you taketh data all suggest that aging is a risk factor for Alzheimers.

So my  question is If we can slow the aging process so that those at the chronological age of 85 could have the biological markers of a person age 65, would the incidence of Alzheimer’s also be slowed from 35 % to 8% . Or with the other prediction data ( doubling every 5 years ) dropping from 25% at age 85 t0  8% at age 65

It seems to me that it would not be difficult to design such an experiment, especially since at present we do not have a specific medical treatment for dementia.

Gerontologists could see some positive results within a decade.

Just think if one could slow the aging process significantly, the elderly would die of other chronic diseases  such as heart attacks, strokes, cancer or diabetes. It could certainly reduce the number of Alzheimer’s residents in our nursing homes if positive results are obtained.As I am making  alterations of this post we are witnessing high death rates from the Covid-19 pandemic -80% of which are the elderly in nursing home.It would be interesting to check the data to see what fraction  of these deaths are  residents with dementia,

Carotid massage: a possible new cardiac resuscitation procedure

In our current resuscitation procedure for unconscious patients, we rationalize that by compressing the chest wall, we also compress the heart and the major arteries in the chest cavity, resulting in some arterial blood flow to vital organs like the brain. In the past, this procedure was called “cardio-pulmonary resuscitation”, but I believe we now feel the pulmonary component is unnecessary and omit it from the acronym.

On one of the TV channels this morning, which just happens to be Christmas Day 2014, it showed how apes were able to successfully resuscitate one of their own after the ape had been electrocuted on railway tracks rendering him unconscious on a railway platform below. As the startled passengers at the station looked on, with no one willing to come forward to offer first aid, one of the apes on the railway platform decided to take over.

The video showed how this non-human first aid worker first tried dipping their relative in puddle of water found between the tracks. When that was unsuccessful, he began what seemed to be a biting-like manoeuvre on the side of the neck. He continued this for 20 minutes.

As I looked more closely at this Youtube video which was shown on repeated broadcasts, it appeared to me that the ape may actually be applying pressure to the carotid artery or massaging it to move blood forward.

Could this is a more effective way of getting arterial perfusion passively to the brain than with the method we now use, namely compression of the chest wall?

Could our distant cousins the apes be giving us, their more advanced cousins, a special Christmas gift? A better CPR technique than the one we currently are using?

This approach may be worth further study. I vaguely seem to recall a lecture from my undergraduate medical study days (over 55 years ago) that there may be a collection of nerves in the carotid artery (a node) which if massaged can restart the heart beat. I must look this up on the internet. If I do find it I will post another blog with an update.

Incidentally, if carotid artery massage and/or whatever you want to call this procedure is found to be more effective, there would be no need to change the acronym – just substitute carotid for cardiac.