Candid Conversations with Dr. Lowe

Lyme Disease is on the rise. There are several reasons for this. Global warming is one of the most important factors responsible for the rising incidence of Lyme disease. The warming of the climate is changing the habitat of many of the vectors and hosts for the Borrelia species that are responsible for Lyme Disease. As the vectors and hosts extend their habitat, they transport the pathogen with them, bringing them closer into contact with humankind. People themselves create opportunities for infection through recreational activities and logging. Since the 1970s, we have become much more familiar with Lyme disease, and scientists have recognized the different stages and sequelae of Lyme disease. Among these is the Post Lyme syndrome, which includes the (PTLDS) the post treatment Lyme disease syndrome that is easily misdiagnosed as fibromyalgia. Differentiating post Lyme disease syndrome from fibromyalgia is a challenge for which there is no simple solution. In this video, viewers will learn about the challenges that arise in differentiating Lyme Syndrome from fibromyalgia, and what solutions exist to assist in making this all-important distinction.

Diarrhea is one of those conditions that everyone can say they had at one time or another. It is like the common cold. Yet, diarrhea can be the symptom of more ominous conditions that are sometimes easily overlooked. To put it another way, we can say that some systemic diseases can masquerade as diarrhea, driving practitioners to the brink of insanity as they struggle to uncover the underlying cause of a patient’s diarrhea. While the more familiar causes like infection and bowel inflammation are easily recognized, the less common causes of diarrhea can create a dilemma for practitioner and patient alike. Hyperthyroidism is one such systemic use that sometimes can mislead and cause headaches for practitioners if they do not think of hyperthyroidism while doing their work-up of a patient’s diarrhea. Scientists have been aware of the role of hyperthyroidism as a cause of diarrhea for decades, but the exact mechanism by which it causes diarrhea remains an enigma. Speculations have been made regarding the mechanism by which hyperthyroidism causes diarrhea, such as the decreased transit time and secretory diarrhea caused by a disturbance of the electrolyte flux in the bowel wall. Hyperthyroidism is a known cause of diarrhea, but without constant vigilance, we are apt to overlook it.

As the population of the world ages, the number of people suffering from dementia grows. This growth is especially pronounced in the LMIC countries, as their lifestyles change, as they adopt Western dietary practices. Dementia has many causes, some of which are controllable. This means that by controlling those factors that are within our power to change, we can eliminate some of the risk factors of dementia and people can decrease the likelihood of developing dementia in later life. But those changes have to start in our youth, because after dementia has set in, it is already too late to completely reverse the pathological changes that have already occurred in the brain. Preventing dementia is a matter of making sensible lifestyle changes that, fortunately, provide benefit from a cardiovascular perspective too. Dementia is not a normal part of aging. Dementia is a pathological condition that arises, in large part, from the lifestyle choices we make. We can significantly decrease the risk of developing dementia by making the appropriate changes in our lives.

SLE or systemic lupus erythematosus, (Lupus), has been recognized for hundreds of years, but even today, the etiology of Lupus remains obscure. Lupus presents in a variety of clinical presentations, which suggests that this syndrome may indeed have a variety of causes. One repeated occurrence, however, is EBV (Epstein-Barr Virus) infections in people suffering from Lupus. Multiple studies have demonstrated an association of EBV with Lupus. EBV (Epstein-Barr Virus) has also been implicated in the etiology of other autoimmune diseases, and is therefore not exclusive for Lupus. That having been said, at least six reports of Lupus occurring after EBV infection have been reported in the literature. Lupus can sometimes be severe and cause significant amounts of disability and loss of income, and the fact that lupus preferentially afflicts persons, especially women, in their prime, makes it even more urgent that the exact cause and pathophysiology of Lupus be uncovered. This video presents a case of new onset Lupus immediately after EBV infection and provides a clear and concise account of the possible mechanism by which infection with EBV may cause Lupus.

Hypothyroidism results when the thyroid gland does not produce enough thyroid hormone. Because thyroid hormone acts on a wide range of tissues, its effects are widespread. Hypothyroidism is known to affect the skin, hair, musculoskeletal system, the heart, and even the brain. The treatment or hypothyroidism has rested for decades on hormone replacement therapy, but many people continue to have symptoms even after their thyroid hormone levels have normalized. Physicians and scientists attribute this to the availability of T3, which is converted in large part from T4. Although the symptoms of hypothyroidism are generally overt and easily recognizable, problems with libido are frequently attributed to one of the myriad other causes of low libido. Patients with hypothyroidism are therefore at risk of not recognizing their low libido as a symptom of their hypothyroidism. Newer studies have found receptors for thyroid hormone in the reproductive organs of both sexes, and given the presence of subclinical hypothyroidism, the incidence of hypothyroidism and its resulting disturbances of libido may well be higher than reported. Awareness of hypothyroidism as a potential cause of low libido and other sexual dysfunctions needs to be raised, since this is an easily reversible cause of low libido. 00:00 Introduction 00:29 Symptoms of Hypothyroidism 01:12 What is Hpothyroidism? 01:35 What is Thyroid Hormone? 01:52 Thyroid Feedback Mechanism 02:37 Thyroid and Sexual Function 04:23 What can be done? 04:39 Subclinical Hypothyroidism 05:21 Conclusion

Crohn’s disease is on the rise worldwide. Scientists suspect the rising incidence of Crohn’s disease is a direct result of the spread of the Western Diet. Patients with Crohn’s disease seem to know this instinctively, and many patients avoid certain foods. Yet, Crohn’s disease in adult patients is rarely treated with dietary intervention. More traditionally, Crohn’s disease is treated with medications, especially since the introduction of the newer biologicals. Only Crohn’s disease in children is regularly treated with dietary intervention and with excellent results. Failure of adult patients to respond to dietary intervention in studies on Crohn’s disease may be a result of poor compliance, although a few studies have reported favorable results from dietary intervention in adult patients with Crohn’s disease. Due to the cost of biologicals used to treat Crohn’s disease and the occurrence of drug failures, even with these state-of the-art drugs, dietary manipulations as a treatment modality for Crohn’s Disease remain an avenue worth exploring.

Major depression has afflicted humankind since time immemorial and has caused, and continues to cause, immense morbidity and lost hours of work worldwide. Depression is a common condition and can have more serious consequences, leading to other mental conditions that can have fatal outcomes. Studies have shown that depression affects the likelihood of survival after heart attacks and strokes, as well as the degree of control of diseases such as diabetes and HTN. Fortunately, we have an extensive selection of medications to manage depression, but many of these cause side effects that are intolerable to patients or fail to relieve symptoms completely. Wellbutrin (bupropion) is one of the medications used as an alternative or adjunct for failed treatment trials, and many patients have derived relief from Wellbutrin (bupropion). However, there exists a dark side to Wellbutrin (Bupropion) that many people are unaware of: the potential for abuse. In this video, we examine this lesser-known feature of Wellbutrin (bupropion).

Sinusitis or sinus infection is one of the most frequent infections people suffer in their lifetimes. Sinusitis / sinus infections are so common that the majority of people do not pay them much mind. This, however, is not warranted. Although most cases of sinusitis/sinus infection are easily treated with antibiotics, some are not. It is these rare cases of sinusitis that we need to be cognizant of. Sinus infections/sinusitis can present with symptoms that appear to have nothing to do with the sinus, misleading providers and patients alike. These unusual, and at times bizarre, symptoms of sinusitis/sinus infections are almost invariably the harbingers of serious complications, including permanent disability, or even causing the demise of the person affected. The list of sinusitis/sinus infection symptoms that accompany complications of sinusitis is long, and it is in everyone’s interest to familiarize themselves with it. Sinusitis/sinus infection is not as benign and harmless as it first appears. Even a simple act such as swimming or diving can cause sinusitis/sinus infection, which can progress within the space of one day to dangerous, life-threatening complications. This video discusses this dark side of sinusitis/sinus infections.

Nephrotic Syndrome can strike at any moment. Eighty to ninety percent of cases occur with no obvious cause. The reminder occurs in the setting of other well-known illnesses such as SLE (Lupus). While a sizeable proportion of people can recover, a large number go on to develop end-stage kidney disease, requiring dialysis or kidney transplants. Nephrotic syndrome presents with different kidney pathology, depending on race and age. Most cases of nephrotic syndrome in Caucasians present as membranous glomerulonephropathy, whereas in people of African descent focal segmental glomerulosclerosis is the more common pathology. The childhood variant of nephrotic syndrome most frequently presents as minimal change disease. In this video we look at nephrotic syndrome, its symptoms, causes and treatment. Images courtesy of: Tieum - https://commons.wikimedia.org/wiki/File:PhysiologieGlom%C3%A9rulaire.png, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=46789229 Content Providers(s): CDC/Dr. Myron Schultz Creation Date: 1975

Asthma is one of the commonest ailments people suffer around the world. But many people experience attacks of asthma shortly after the onset of thunderstorms when the pollen count is high. This connection between thunderstorms and asthma has been recognized since the late 20th century, and the number of thunderstorm related asthma pandemics is expected to rise as climate change causes increased numbers of thunderstorms and other weather phenomena that impact people suffering from asthma. One curious finding in thunderstorm asthma cases is that many people had never had an asthma attack before their onset of wheezing during thunderstorm asthma epidemics. Because the incidence of thunderstorm asthma attacks is expected to rise in the future, people diagnosed with allergic rhinitis and allergic asthma must be aware of this phenomenon in order to protect themselves.

Fungal infections of the private parts in women are a frequent and vexing complaint that affects women who are otherwise healthy and at the peak of their reproductive years. The condition is so common that it is estimated that 75% of all women will have a vaginal fungal infection at some time in their lives. The frequency of fungal infections in private parts in women causes a decrease in the quality of life in many women, but some women have recurrent infections that can profoundly affect their sex-lives because of the discomfort caused by the infection. Scientists are on the verge of a breakthrough that could eliminate fungal vaginal infections once and for all. Learn all about it here in this video.

The levels of uric acid are rising in people around the world, as the consumption of rich foods increases. Since ancient times, gout has been associated with rich foods and the excessive consumption of alcohol. But recent studies now show that high uric acid levels are not just a matter of painful joints and tophi. Now, we are facing far more serious complications of high uric acid levels, which strike at more vulnerable parts of our body. The proverbial tale is told of Napoleon Bonaparte not being able to mount his horse because of a vicious attack of the gout. But, at that time, he had no indication that beyond his painful joints, the disease was creating turmoil elsewhere in his body. Since those times when gout was considered a fashionable disease of the rich, we have come a long way. Now we know that hyperuricemia and gout cause heart disease. In fact, hyperuricemia and gout are now know considered major risk factors for heart disease and stroke.

Obesity is an ongoing modern-day pandemic. Weight loss is the solution. But, many people struggle to lose weight, only to regain the weight after they have achieved success. It may not because they are undisciplined or lack resolve. It may simply be that the science behind the regain of weight has been hidden in front of our very noses. That science is soon to become common knowledge, and knowing the scientific explanation may transform how we view weight loss forever.

Parkinson’s disease is the fastest growing neurologic disease worldwide, but its etiology still remains an enigma. There is a plethora of theories as to the cause of Parkinson’s disease, but no single cause has proven to be the one! Is it that Parkinson’s disease is a multifactorial disease that has a common presentation? From pesticides to herbicides and airborne metals, the etiology of Parkinson’s disease continues to evade discovery. The latest theory is the presence of nitrogen dioxide (NO2) in the air. If that turns to be the missing factor, there is an enormous problem, because NO2 nitrogen dioxide is all around us. The etiology of Parkinson’s disease is crucial for scientist to develop more specific treatments and for public health reasons.

Myositis is one of those diagnoses that we are still classifying. Two decades ago, there were only a few classes of myositis, but with the discovery of more and more myositis specific antibodies (MSA), the classification of myositis continues to evolve. Even today, there is disagreement between various authorities as to what belongs where and what differs from what. The relatively rare incidence of myositis only adds to the confusion, since the ability to run meaningful studies to shed light on our understanding of myositis is limited by the paucity of cases of myositis. At the same time, the discovery of myositis specific antibodies has transformed the disease, since we can now make specific diagnoses based on the presence of antibodies unique to a particular form of the myositis. Providers, because of the lack of exposure and hence the lack of experience with the disease, frequently mistake myositis for other more familiar conditions, leading to sometimes dire consequences for the recipients of the diagnoses made. Myositis can have a serious impact on the ability of people to perform their activities of daily living and, at times, can be a crippling disease. Not only does it occur spontaneously, but it can be the harbinger of cancers and other rheumatologic diseases. Myositis is one of the “great pretenders,” and undoubtedly, there are staggering revelations and surprises waiting in the future for providers treating myositis.

Sleep apnea is a condition in which people stop breathing during their sleep. Although science has established the profound impact of sleep apnea on health, sleep apnea remains largely undiagnosed. Sleep apnea is now a recognized factor for cardiovascular disease, and screening for sleep apnea is recommended for stroke victims. Because of years of obscurity, the link between sleep apnea and diseases of the heart, lungs and blood vessels is not generally recognized. Yet, sleep apnea appears as a precipitating comorbidity in a multitude of heart conditions. The complex cascade of events triggered by sleep apnea induces wide-reaching effects that lead to a long list of cardiovascular diseases. Cardiovascular disease is the leading cause of death in the more developed countries, so that a minor decrease in the complications caused by sleep apnea would have an enormous impact on morbidity and mortality from cardiovascular diseases. Generating greater awareness of the serious consequences of undiagnosed sleep apnea is a pressing public health intervention that could improve outcomes in diseases as diverse as insulin resistance and atherosclerosis. The simple CPAP machine, or other oral devices used to treat obstructive sleep apnea, are well worth the cost and provide benefits several times over. This video provides insight into sleep apnea and the enormous opportunity it presents to modify cardiovascular outcomes as a modifiable cardiovascular risk factor.

Restless leg syndrome or Willis-Ekbom disease is a common disease in the West, less common in Asian and African countries. Restless leg syndrome is the fourth leading cause of insomnia and is the cause of a significant amount of morbidity and impairment of daytime functioning among its sufferers. The disease was first described by Willis in 1685 and published by Ekbom in 1960. Restless Leg Syndrome is relatively common in the populations described and ranges from 3.9 to 15% in prevalence. RLS is frequently underdiagnosed or confused with other conditions. There is a need for greater awareness of restless leg syndrome and further research in its etiology, which would aid in the development of novel treatments.

Respiratory syncytial virus (RSV) is a common airway virus affecting both adults and children. The virus has been around for centuries, but recently there has been a spike in cases. Preventing RSV is easy if we follow a few simple rules. RSV can cause serious disease in vulnerable individuals, and because there is still no specific treatment, the best form of management is avoidance of infection. In this video we look at respiratory syncytial virus, how it is spread, its symptoms, its treatment, its prevention and who is vulnerable.

Hyaluronic Acid is found in thousands of cosmetic products, and millions of people use hyaluronic acid product for skin care. Since its discovery in the 1930s, hyaluronic acid has grown in popularity in leaps and bounds, but no more so than as a skincare product. Many of these products claim antiaging effects, including reversal of wrinkling and elasticity of the skin. In this video, we examine the claim that hyaluronic serum is effective as an antiaging cosmetic.

Results from new studies strongly support the long-held belief that Vitamin D can decrease the risk of premature death. Studies done at the University of South Australia showed that low values of vitamin D were associated with increased all-cause mortality, and supplementation progressively decreased all cause mortality up to a level of 50nmol/L. This information should encourage people to check their Vitamin D levels and seek supplementation when necessary.

Psoriasis is one of the most common skin diseases in the world. A few years ago, it was treated as a disease of the skin, but recent discoveries have transformed that perspective. The prevalence of psoriasis in the world today is about 3%. With a strong genetic predisposition. It is no wonder that the prevalence of psoriasis varies from population to population. And as the store of knowledge regarding psoriasis grows, so too have the therapeutic options to treat psoriasis. Savvy doctors today know that they can no longer write a prescription for a steroid cream and send their psoriasis patients on their merry way. The disease is much too involved for that, and the new “biologicals,” have made the treatment of psoriasis ever more effective. Because of the major psychological and physiological impact the disease has on sufferers, it is ever more important that people who suffer with psoriasis be kept up to date on the multifaceted nature of psoriasis. It may save their lives.

Rabies is one of the deadliest viral diseases the humanity faces. Once the clinical disease presents, the mortality rate is almost 100%. Yet, there are measures we can take to increase our chances of survival in the event of exposure. Rabies exposure can be subtle of it can take the form of a severe bite wound after an attack by a rabid animal. The subtle cases involve the bite from bats, such as vampire bats, in which the puncture wound is so small (about the size of a hypodermic needle) that it goes completely unnoticed. In such cases, rabies can be a diagnostic nightmare and frequently ends up being misdiagnosed as Guillain-Barre Syndrome, a stroke or other forms of encephalitis. Rabies is not as uncommon as we think, and rabies can be contracted from wild animals or from pets that come into contact with wild animals quite unexpectedly. Rabies awareness is necessary to prevent more deaths from this deadly disease.

About 3 out of every 4 people suffer from lactose intolerance. Many will know that they are lactose intolerant by the connection between their symptoms and the eating of dairy products. Lactose intolerance is not a disease but a normal variant of the human genetic make-up. As adults, fewer of us are able to tolerate dairy containing lactose. The symptoms we experience differ in severity from person to person and with the amount and type of dairy products we consume. Most people with lactose intolerance can tolerate the amount of lactose contained in a standard glass of milk. When we exceed this amount, we develop bloating and abdominal symptoms that are typical of lactose intolerance. What fewer people are aware of is that there are various forms of lactase deficiency that cause the symptoms of lactose intolerance. Hereditary forms exist, some of which can be fatal in newborns if not recognized for what they are. Management of the common type of lactose intolerance is simple, and most people can avoid developing the symptoms of lactose intolerance. The most important fact is that we must replace those nutrients found in dairy products with alternatives if we are to remain healthy.

Cushing syndrome is an elusive disease until its late stages. The disease is caused by an excess of cortisol or other corticosteroids in the body. Although the syndrome can be caused by a small tumor in the pituitary gland or hyperactivity of the pituitary gland without a tumor, a disease known as Cushing Disease, this is not the most frequent cause of Cushing Syndrome. The most common cause is medication overuse or drug-drug interaction that produces the syndrome. Early Cushing Syndrome is frequently not manifest and can be confused with other diseases that cause weight gain. Because of the large number of corticosteroids prescribed by clinicians, its incidence may be higher than reported. Ectopic ACTH-producing tumors, most often lung tumors, can also cause Cushing Syndrome, but these are often accompanied by other symptoms not seen in pure Cushing Syndrome. What are the symptoms of Cushing Syndrome? Weight gain and obesity, for the most part. But patients with Cushing Syndrome have a “cushingoid appearance,” with central obesity, muscle wasting in the extremities, and facial plethora. Many patients have early Cushing Syndrome because of medications they are taking, but they are unaware because the early presentation of Cushing Syndrome is so non-specific. Both clinicians and patients need to be aware of the threat pose posed by Iatrogenic Cushing Syndrome, since many of the medications that can cause debilitating Cushing Syndrome are sold over the counter as well. 00:00 Introduction 00:30 Theme 00:42 Patient History 01:44 Symptoms 02:49 What is Cushing Syndrome? 04:02 Cushing Disease 04:16 Most Common Cause 05:19 Conclusion To subscribe to this channel, please click this link: https://www.youtube.com/channel/UC8Aym3CP43EU9S5kOCsEBEQ/?sub_confirmation=1 Images Courtesy of: https://commons.wikimedia.org/wiki/File:Asthma_Inhaler_(28962959030).jpg https://cnx.org/contents/5CvTdmJL@4.4

The cause of prostate cancer still eludes the scientific world. Theories abound for causes of prostate cancer. Yet there is strong evidence for an infective etiology. Why is this important? Because prostate cancer is the 2nd most commonly diagnosed cancer in men and minor changes in its incidence can have a profound impact on the epidemiology of this disease. We have seen success in cervical cancer in women after the discovery of HPV as an infectious cause and similar success in gastric cancer after the discovery of the H. Pylori bacterium. Any confirmation of an infectious etiology would be a tremendous breakthrough in Prostate Cancer.