Doctor’s blog

Treatment of primary breast cancer is generally breast conserving treatment. Breast-conserving treatments generally consist of the removal of the primary tumor by some form of lumpectomy (removal of lump or tumor) with or without giving radiation therapy in the breast. The survival result of breast conserving treatment is as good as (or may be slightly superior to) that after extensive radical mastectomy (removal of breast) or modified radical mastectomy, in combination or without radiation therapy. But radiation therapy after lumpectomy greatly reduces the risk of recurrence of breast cancer in the breast and is recommended (ideally).

Breast conservation surgery is associated with a possibility of recurrence in the breast, but the 10-year survival (as seen by many clinical studies and follow up trials) is as good if not better, as that after more radical surgery (mastectomy). Postoperative radiation, especially to the regional lymph nodes following mastectomy (or lumpectomy) is also associated with an improvement in survival. Because radiation therapy can also reduce the rate of local or regional recurrence of breast cancer, it is strongly recommended following mastectomy and lumpectomy for women with high-risk primary tumors. Lumpectomy is becoming more popular and at present, nearly one-third of women of breast cancer in the United States are managed by lumpectomy.

Breast-conserving surgery may not be suitable for all patients with breast cancer. The following candidates of breast cancer are generally not suitable for breast conserving surgery are, tumors which are more than 5 cm (for smaller tumors if the breast is small) size, for tumors involving the nipple and areola, for tumors with extensive involvement of multiple quadrants of the breast, for women with a history of collagen-vascular disease, and for women who either do not have the motivation for breast conservation or do not have convenient access to radiation therapy. But the above groups most likely do not account for more than one-third of patients who are treated with mastectomy.

To be slim is a desire of many individual for looking good and attractive. To be slim and in ideal body weight has other health advantages also, other than looking attractive. Persons with ideal body weight or in recommended body weight are healthier and live longer than obese persons. Individuals maintaining body weight within normal recommended range are at lower risk of cardiovascular diseases like stroke, hypertension (high blood pressure), other heart troubles etc. to name a few.

Diet pills play an important role in reducing body weight of obese and overweight individuals. But the diet pills which you used for losing weight should have proven efficacy and ideally approved by competent authorities. Only proven and licensed diet pills should be used for reducing body weight, otherwise they may do more harm than benefit. Everybody should be careful in buying medication, especially for diet pills (as the internet and other markets are full of these products) to avoid unwanted side effects, which may be potentially dangerous.  

Among many diet pills orlistat or Alli is one of the proven and approved (FDA has approved Alli to be for use in weight loss) weight loss diet pill. Many clinical trials have shown that Alli is effective in reducing weight, although there are some side effects of it.

Side effects of Alli:

The side effects of Alli are common, but all the side effects are not serious. The side effects that a person may encounter while taking Alli and should keep in mind are nausea, flatulence, abdominal pain, steatorrhea (passing of fat in stool or fatty diarrhea), vitamin deficiency (mainly fat soluble vitamins), fluid motions etc. Deficiency of fat soluble vitamins is due to reduced absorption of fats (triglycerides, cholesterol etc.) while taking Alli, as fat soluble vitamins are absorbed along with fats after getting dissolved in fats.

Chlorine solution, chlorine tablets, iodine etc. are also used for purification of drinking water for household use and for special situations like camping and hiking expeditions. The use of the above mentioned chemical purifications are limited in special situations only and not used widely due to certain limitations.

Chlorine tablets:

These are available in various trade names like halogen tablets. Chlorine tablets are very good for small scale water purification, but high cost limits their widespread use as water purifier. Generally a single tablet of 0.5 gram is sufficient for purifying 20 liters of water. A contact period of one hour is required for the purification. Chlorine tablets are commonly used by hikers and in wild camps due to high effectiveness in purifying drinking water. Chlorine tablets are preferred over many other chemical purifiers, because they are easy to use, easily available and they provide residual effect. Unlike chlorine solution the strength of chlorine tablets do not reduce so much on storage.

Chlorine solutions:

Chlorine solution can be prepared from bleaching powder. 1 kilogram of bleaching powder if mixed with 5 liters of water and the strength of available chlorine is 25%, than we get 5 per cent chlorine solution. Pre made chlorine solutions are available in the market, but the disadvantage of chlorine solution is the loss of available chlorine on prolonged storage, especially if exposed to light. The solution should be stored in a dark color container in a dry place. The use of chlorine solution is same as bleaching powder.

Iodine as water purifier:

Iodine solutions are available for use in emergency situations. To purify 1 liter of drinking water 2 drops of iodine solution is required and contact period of 20 to 30 minutes. Iodine solution is prepared by dissolving iodine in 2 percent alcohol (ethyl alcohol). Advantage of iodine as water purifier is its effectiveness in wider rage of pH as it does not react with ammonia or certain other compounds. Another advantage of iodine is the longer duration of effectiveness in compare to other chemical purifiers like chlorine. The disadvantage of iodine is its high cost and the presence of physiologically active iodine which may affect thyroid gland.

The use of anabolic steroids in sports is a common problem faced by the authorities of sports. Clenbuterol is one of the commonly abused anabolic steroids. It is abused by many sports persons in many sports events including highest sports event Olympics. Despite ban on performance enhancing substances like Clenbuterol, many athletes are still abusing these drugs. Abuse of these drugs is banned in sports, because it is an unfair means of performing better in sports and also these performance enhancing substances are full of adverse effects, some of the adverse effects are potentially life threatening (heart attacks).

Clenbuterol is a selective beta-2 agonist/antagonist medicine. It is also a good bronchodilator and sometimes prescribed for chronic obstructive pulmonary disease (COPD). Clenbuterol, like any other anabolic steroids can increase lean muscle mass (for this it is abused by professional body builders), but it also has potentially serious side effects. WADA (world anti doping agency) maintains an extensive list of all banned performance-enhancing substances and Clenbuterol is one of them.

The side effects of Clenbuterol are liver damage, skin problems like severe acne, increase in LDL cholesterol (known as bad cholesterol) and decrease in HDL (known as good cholesterol) cholesterol, gynecomastia or development of ‘male breast’ which is a common feminization side effect, infertility etc. to name a few. The combined effects of increased bad cholesterol and decrease in good cholesterol may have serious consequences by increasing the risks of cardiovascular problems by several folds.

The abuse of performance enhancing substances may be easier due to availability of these substances online and anyone can buy Clenbuterol and other banned substances online very easily.

Purification of water for household purpose by chemicals is a common practice, especially in developing nations. The most commonly used chemical disinfectant for purification of drinking water is bleaching powder (contain 33% available chlorine), chlorine tablets, chlorine solution etc. Bleaching powder is chlorinated lime (CaOCl₂). Other chemical disinfectants that are sometimes used are iodine, potassium permanganate etc. For household use chlorine tablets and chlorine solutions are the best suited. These are also very popular among mountain climbers, hikers, and those who are fond of outdoor activities.

Water purification by bleaching powder:

Bleaching powder is also called chlorinated lime and its chemical formula is CaOCl₂. Bleaching powder is a white amorphous powder with a pungent smell of chlorine. It contains approximately 33% available chlorine if freshly prepared. But on storage it loses its chlorine content as it is unstable compound. It loses its chlorine content on exposure to air, moisture and light very rapidly. Bleaching powder is made stable (known as stabilized bleach) by mixing with excess lime, which can retain its strength.

The requirement of bleaching powder is measured and made a solution by adding adequate water in it. The upper clear part of the solution is taken and added to the water to be purified and a contact period of one hour is allowed for the chlorine to act and kill the germs (mainly bacteria and virus).

How to store bleaching powder?

Storage of bleaching powder should be in a dark, cool and dry place away from light, heat and moisture. The container should be corrosion resistant and tightly closed. For quality maintenance the chlorine content should be checked regularly.

Principle of chlorination:

The principle of chlorination is to ensure “free” residual chlorine of approximately 0.5 mg/liter at the end of one hour contact period. For bleaching powder (chlorine) to act, the water should be physically and chemically clean. Turbid and highly polluted water can not be purified with bleaching powder.

Drug addiction and abuse (including abuse of steroid, anabolic steroids and corticosteroids, former being much more common) is a common social problem which is prevalent in all the societies of the world. The abuse of anabolic steroids is more common in the field of sports, which is used by athletes to perform better.

Anabolic steroids are synthetic versions of the male hormone testosterone. Anabolic steroids are legally available only by prescription (from a qualified doctor) and they are prescribed to treat a variety of conditions that cause a loss of lean muscle mass for any reason other than malnutrition.

Anabolic steroids are available in injection form and as oral tablets. Oral anabolic steroids are oxymetholone, oxandrolone, stanozolol and methandrostenolone. Injectable anabolic steroids are nandrolone decanoate, nandrolone phenpropionate, boldenone undecylenate, testosterone cypionate etc. All of these anabolic steroids are available online and any athlete can buy steroids anytime from home.

Steroids abuse can result in many harmful health conditions in men and women. The effects of steroid abuse are different in men and women. In women steroids abuse can lead to excessive growth of body hair, male like deep voice, male-pattern baldness, severe acne and cyst, enlargement of the clitoris etc. and in males steroids abuse can lead to baldness, infertility, severe acne and cyst, gynecomastia (male breast development), testes become smaller etc. Steroids abuse can also have other serious medical problems for both men and women like high blood pressure, increased LDL cholesterol, decreased HDL cholesterol, heart attacks, mania, tendon rupture (especially among athletes), delayed growth among adolescents etc.     

Olympics are the most important sports events in the world. Every sports person wants to perform well in Olympics and gives their best. The preparation for Olympics starts long before the schedule time for Olympics. Because of highest competition level every sports person try their best (sometimes by using illegal means like by abusing performance enhancing substances) to win and some of them want to win at any cost. The chances of abuse of performance enhancing substances are also very high and International Olympic Committee or IOC tries to curb the abuse of steroids and other banned substances in Olympics. But the modern sportsperson can buy steroids easily while sitting in the comfort of home just by clicking a mouse.

Non-medical use of anabolic steroids is illegal and banned by most major sports organizations including International Olympic Committee, which started a full-scale drug testing program in the Olympics was started in 1972 and since then onwards the techniques to detect the banned substances are improving. Many Olympics events are overshadowed by the controversy of abuse of banned substances. Any sports person can buy steroids (generally anabolic steroids are use for enhancing performance in sports) online, because they are easily available online.

Anabolic steroid like Oxandrolone (Anavar), Clenbuterol, Nandrolone, Stanozolol etc. are some of the anabolic steroids used commonly in sports for doing better in sports and win prizes. All of these anabolic steroids mentioned above are available online and anyone can buy steroids any time anywhere.

Some of the ill effects of abuse of anabolic steroids are infertility, development of breast in men, severe acne, male pattern baldness, shrinking of the testicles and many more.

Among the small scale water purification filtration is a very handy and useful water purification method. But only small quantity of water can be filtered for household use by filtration through ceramic filter. Generally 3 types of filters are used, namely Chamberland filter, Berkefeld filter and Katadyn filter. The main part of a filter is the “candle” of the filter, which is made of porcelain in Chamberland filter and in Berkefeld filter it is made of kieselgurh or infusorial earth. In Katadyn filter the candle is coated with silver catalyst and the bacteria coming in contact with silver surface are killed by the action (known as oligodynamic action) of silver ions.

Advantages of filtration as water purification technique:

1. Filter candles can remove bacteria, ameba, ova and cyst of worms etc. from drinking water.
2. Filtration is a useful, easily available and cheap water purification alternative. 
3. When combined with boiling it is very effective water purification method in small scale for household purpose.

Disadvantages of filtration as water purification method:

1. Filtration can not remove filter-passing viruses like hepatitis virus, polio virus, rota virus (commonest cause of diarrhea in infants) to name a few.
2. Candles of the filters may be logged by bacteria and impurities. Candles should be cleaned and boiled at least once a week to overcome these problems. Candles should be cleaned under running water by scrubbing with a hard brush.

Important points to remember about filters and filtration:

1.      Only clean water should be used for filtration.

2.      Clean the filter regularly, preferably once a week (also boil the candle once a week).

3.      Filtered water should be ideally boiled or chemically sterilized for most effective purification.  

Steroids use in sports is a vast subject. It is a matter of concern for the sporting authorities and they are trying to reduce the abuse of steroids in spots events, facing many hurdles in this effort because a sportspersons can buy steroids and other drugs easily. The steroids abuse has damaged carriers of many promising players, but the abuse is still in place despite the efforts of sports authorities to curb the abuse of performance enhancing substances including anabolic steroids.

Almost all medicines (drugs) are available online these days of internet. Anyone can buy steroids including banned (in sports) anabolic steroids like Nandrolone (deca durabolin), Stanozolol, oxandrolone etc. with a click of the mouse from the comfort of home. It will be delivered at the doorstep. Steroids and maximum of other medication (except over the counter medicines) can not be purchased without a valid prescription from a certified medical professional, but the availability of the drugs online has changed the situation entirely opposite.

The highest sports authorities including IOC (international Olympic committee) should add new approaches for curbing the menace of drug abuse in sports. The addition of new approach is required because the present approaches are unable to curb the abuse of drugs by sportspersons. The new approach should be educating the athletes and other sports persons about the ill effects of misuse or abuse of performance enhancing drugs in sports. A sports person generally starts using performance enhancing drugs for betterment of their performance and soon they become the victim of addiction of these drugs. This point should be emphasized for educating the sportspersons. The information about the ill effects of the drug abuse by sportspersons also should be easily accessible to all the sportspersons.

Pure drinking water is the basic requirement of humans and plays a major role in maintaining the health of families, especially in the developing countries where pure drinking water is not supplied. In many developing countries water purification in small scale at home is the only option of getting pure drinking water. There are mainly three ways of water purification in small scale ate home, namely, boiling, chemical disinfection and filtration. They can be used alone or in combination. Boiling alone is a satisfactory method of water purification at home in small scale.  

Advantages of boiling as water purification technique:

1. Boiling of water for 5 to 10 minutes can kill all the germs (bacteria, viruses, spores, cysts, ova etc.) and provide sterilized water for consumption.
2. Boiling of water can remove temporary “hardness of water” by removing carbon dioxide and by precipitating calcium carbonate.
3. Boiling of water is a cheap and easy way of getting sterilized water at home for consumption. 
   

Disadvantages of Boiling as water purification method:

1. Boiling of water does not offer any “residual protection” against subsequent contamination by microbes.
2. Boiling of water changes the taste of the water and may not be liked by some people, although it is harmless.
3. Water has to be (should ideally) boiled in the same container where it will be stored; otherwise there may be some microbial contamination.
4. Boiling of water may not be able remove chemical contamination, which may be a major contaminant.  
5. Water has to be boiled for at least 5 to 10 minutes to be fit for consumption (to kill all the bacteria, viruses, spores, ova and cysts of worms etc.).