Need a PET?

Although there are not many PET scan machines in Malaysia, it is a very useful imaging tool to visualise tumours in the body.

• The Star Malaysia
• 31 May 2020
• By Dr ALEX KHOO CHEEN HOE

Most PET scanners are combined with CT scanners, as in this PET-CT machine, in order to provide hybrid imaging that utilises the best of both types of imaging. — Filepic

IT isn’t creatures that we keep as pets that I am referring to, but PET scans that are used in the medical field.

What is a PET scan (or simply PET) and why is it necessary?

PET is the acronym for positron emission tomography, which doctors use to visualise the structures within the body.

This scan is most commonly performed in tandem with computed tomography (CT) for hybrid imaging.

It is a non-invasive, fast, sensitive and comprehensive way to assess patients, particularly those with cancer, to determine the stage of the disease, the site to treat, as well as to evaluate treatment response.

PET imaging uses a low dose of radioactive elements that are tagged to specific tracers (known as radiotracers) that enable doctors to clearly see what needs to be seen.

Unlike conventional CT scans and MRI (magnetic resonance imaging), there are various radiotracers that can be used in PET scans, such as 2-(18F)FDG, Na(18F) F, (68Ga)Ga-PSMA and (68Ga) Ga-DOTATATE.

Once injected into the body, these radiotracers will distribute to specific target sites, e.g. areas of high glucose metabolism when using 2-(18F)FDG.

Therefore, areas of illness or abnormal activity in the body can be easily identified, rather than looking for a needle in a haystack.

In addition to the visualisation of these areas, doctors are able to measure the lesion for future comparison.

This is to determine the metabolism of the tumour to see if it is still viable or active, or to check for any changes in metabolic activity.

Targeted imaging

As previously mentioned, most PET scanners worldwide are also equipped with CT scanners for hybrid imaging.

There are only a handful of PET scanners that also have in-built MRI scanners (none so far in Malaysia) for better visualisation of certain structures like the brain and pelvic organs.

PET scans are usually performed for cancer-related indications such as staging, restaging and assessment of treatment response.

For example, in newly-diagnosed lung cancer cases, it is very important for the oncologist to accurately stage the disease as it would determine whether the patient undergoes curative surgery and chemotherapy, or only palliative chemotherapy.

The use of the 2-(18F)FDG radiotracer in a PET-CT scan helps the oncologist to see if the lung cancer has spread to a particular lymph node(s) of interest.

During treatment, the oncologist may request for another PET-CT scan to be performed in order to evaluate the response of the tumour to the treatment.

If the treatment is effective, the abnormal uptake of the radiotracer will either reduce or disappear.

With all the other advanced imaging modalities like CT scans and MRI, many patients do wonder if it is necessary for them to undergo PET scans.

However, unlike CT scans and MRI, which are focused on structures (anatomy), the PET scan is a unique targeted imaging modality that utilises radiotracers, which can be equated to a target-specific missile.

The most widely-used radiotracer, 2-(18F)FDG, has properties similar to glucose and will seek out cancer cells that have high glucose metabolism.

Therefore, by performing a PET scan with this radiotracer, doctors are not only able to view the site of the cancer, but also to evaluate the metabolism or activity of the tumour.

Metabolic changes precede anatomical changes, thus, earlier detection of tumours is possible with PET scans.

PET scans also have other uses, such as in the assessment of dementia and seizures, checking the functions of the heart and in the evaluation of unresolved fever.

The use for such non-cancerrelated conditions in Malaysia is still relatively low, but with more PET scanners and awareness, the numbers will increase.

Benefits outweigh risks

There is, without doubt, always the fear of undergoing scans involving radioactive elements.

It is important to understand that the need of the PET scan is usually justified, and the doctors have already considered the risks versus the benefits of the scan for the patient.

Secondly, the amount of radiotracer injected is low and not harmful to the body.

The radiotracers (analogous to colouring) clear rather rapidly from the body with fluid consumption, and decays exponentially on its own.

These radiotracers do not harm the kidneys or remain in the body for long.

PET scans have been used extensively in Europe, the United States, Australia and many parts of Asia, particularly in Japan, South Korea and China.

Even Singapore has a higher ratio of PET scanners to the total population, compared to Malaysia.

There are only 16 PET-CT scanners in Malaysia, with the majority located in the Klang Valley.

However, there are only two PET-CT scanners in public hospitals (IJN and National Cancer Institute, Putrajaya) and another three in public university hospitals.

Data from the latest Malaysian National Cancer Registry Report shows an increase in the number of new cancer cases diagnosed, from 103,507 cases in the previous report to 115,238 cases in this one.

This is likely to be just the tip of the iceberg as the number of patients with cancers, whether diagnosed or undiagnosed, is definitely much higher.

The lack of PET-CT scanners in Malaysia means that many cancer patients are not be able to benefit from this imaging modality.

Many oncologists have to resort to treating their patients based on whatever imaging modality is available and affordable, even though it is suboptimal.

Nonetheless, the importance of a PET-CT scan should not be overlooked.

Earlier detection and accurate staging of cancer not only saves time and money, but also saves lives!

https://www.pressreader.com/malaysia/the-star-malaysia/20200531/282376926795358

SEE also:

New imaging machines for IJN

What’s the best imaging technique to detect cancer?

A patient recently approached me to know which medical imaging modality was the best to detect cancer, if any, within her.

March 13, 2019 Health, Wellness

By dr alex khoo cheen hoe

Imaging modalities are important to allow doctors to see what’s going on inside our bodies. — Photos.com

This question has always been asked and will continue to boggle the minds of many.

First and foremost, there is no universal imaging modality that can detect everything.

It is also important to know what are the underlying health issues (if any), which organ is involved, what needs to be assessed and why is the imaging needed.

There are many medical imaging modalities available, including ultrasound, echocardiography, conventional x-rays, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine imaging (gamma imaging and positron emission tomography, or PET).

Each of these imaging modalities has their own strengths and weaknesses.

For example, ultrasound, which basically uses attenuation and deflection of sound waves for tissue mapping, is very useful in assessing superficial soft tissue organs.

Women who undergo antenatal follow-up are quite familiar with the use of this imaging modality to evaluate their baby in the womb.

However, it is difficult to get good quality images of organs in certain areas and in obese patients with an ultrasound.

The widely available conventional radiography (or more commonly known as x-ray) has been used since its first discovery by Wilhelm Roentgen in 1895.

Most people will remember undergoing chest x-rays for their pre-employment screening test.

On the other hand, CT scans, which also use x-rays , are able to visualise the body in three dimensions (3D).

This imaging modality is available in most hospitals and has become an important tool in clinical practice.

It has been used to detect cerebrovascular accidents (strokes), lung diseases, cancers and fractures.

However, this scan is limited when it comes to visualising soft tissue lesions, particularly in the brain, spinal cord and pelvic organs.

The good news is that the days where radiation from the CT machines was an issue are gone, as newer CT machines are able to produce better quality images with much lower radiation.

MRI, which uses magnetic resonance of the protons within the body, is basically free of ionising radiation.

It is able to visualise soft tissues within the body with better resolution compared to a CT scan.

Unfortunately, the lungs and bone structures are not well visualised on MRI.

Patients with non-MRI compatible implants, like a non-compatible pacemaker or implantable cardioverter defibrillator (ICD), are also not allowed to undergo the scan.

Fortunately, the newer generation of such implants are now MRI-compatible.

Though uncommon, the side effects related to the use of gadolinium-based contrasts – used in x-rays, CT scans and MRIs to help visualise the targeted area – are real and the search for better alternative contrast agents is underway.

A PET scan of a head. This nuclear medicine imaging has a high sensitivity in detecting cancers. — Photos: AFP

Nuclear medicine imaging

Being in the field of nuclear medicine, I am frequently asked to comment if nuclear medicine imaging is still relevant when we already have other good imaging modalities.

The answer is simple: Nuclear medicine imaging has its strength in functional imaging.

In nuclear medicine imaging, small doses of radioactive substances are used either independently or paired with special pharmaceuticals to visualise the organ of interest.

If doctors need to evaluate the skeletal system, a radioactive bone scan using Technetium-99m methylenediphosphonate (Tc-99m MDP) can be done.

This radiopharmaceutical will be distributed within the bones in such a way that any abnormalities will cause either an increase or decrease in its levels, which can be detected.

In fact, Tc-99m MDP is so sensitive that a 5% change in bone turnover can be detected, compared to 40%-50% on conventional radiograph or even a CT scan.

And early detection means early intervention.

Nuclear medicine is also unique as some radioactive substances not only treat diseases, but are also able to provide images at the same time – hence the word “theranostic”, a portmanteau of “therapy” and “diagnostic”.

For example, not only can radioactive iodine-131 be used for the treatment of well-differentiated thyroid cancer, but imaging of the cancer distribution can also be done – literally “killing two birds with a stone”.

PET pros and cons

PET imaging is currently the “in-thing” in cancer management.

Whether used with CT or MRI (PET/CT or PET/MRI), the high sensitivity in detection of cancers, and most uniquely, the determination of the level of metabolic activity within the cancer is very useful to clinicians.

Though some cancers are already dead after treatment, the physical aspect of the cancer may still be seen on conventional radiographs and CT for a period of time, analogous to a dead tree stump.

When dealing with cancers, time is essential and any residual metabolically-active disease should be dealt with swiftly.

Hence, information of the metabolic activity of the tumour is very useful – no metabolic activity means dead tissue.

Furthermore, the radioactive substance can be used safely in patients with renal (kidney) impairment without causing further deterioration.

Then again, PET/CT or PET/MRI is not the ultimate imaging modality.

There are limitations to using PET as not all tumours take up the radioactive substance and there might be masking by physiological uptake by normal cells.

The fear of having radioactive substances within the body is also a major deterrent in many patients.

However, with proper counselling, they will realise that the radioactive substance used will basically decay exponentially and wash out from the body, similar to any other medical imaging contrasts.

Imaging is necessary

The ultrasound is one of the more commonly experienced imaging modalities as pregnant women are required to undergo them as part of their regular check-ups.

Once again, I highlight that no imaging modality is perfect.

Not all clinical information can be gathered from non-ionising medical imaging such as ultrasounds and MRI, and neither are all patients suitable to undergo them.

Patients undergoing x-rays, CT and nuclear medicine imaging, including PET/CT and PET/MRI, are exposed to certain levels of radiation.

Technological advancement has significantly reduced the radiation exposure to the least possible, compared to many years ago.

Even though the radiation exposure is minimal, many people still harbour the unfounded fear of it possibly triggering or exacerbating cancer.

In actual fact, the radiation exposure from medical imaging is negligible in the course of medical treatment.

Cost is no doubt an issue in this day and age. It goes without saying, that the more expensive the imaging is, the more likely that patients will try to avoid it.

Better equipment and technology comes with a price.

One needs to consider the investment, equipment costs, research and clinical trials involved before an imaging modality is approved, similar to how smartphones are being improved and made.

The better the specifications of the phone, the pricier it is. But with time, prices will fall due to increasing demand and availability.

Nuclear medicine imaging is relatively expensive due to the scanner, as well as the radioactive substances needed for the imaging.

These substances need to be specially ordered and are not widely available.

Nonetheless, it is a small price to pay for crucial clinical information needed to manage our own health.

In short, it is important for patients to understand that doctors choose imaging modalities to help diagnose, stage, plan, evaluate and monitor their condition.

There are times when doctors will order multiple imaging modalities in the course of their management.

The risk and benefits for each imaging is always taken into account before subjecting patients to them. Each and every person is unique and every disease is different.

Whenever I hear patients sharing their medical conditions, I do sometimes wonder if they actually realise that they are unique individuals with different medical issues and their experience may not be applicable to their listeners.

In the era of precision medicine, there is no one imaging that fits all. To achieve the best treatment, it is important to tailor the treatment according to the patient and underlying condition.

If in doubt, discuss with your doctor. I end with a quote from Ralph Waldo Emerson: “Don’t waste life in doubts and fears.”

https://www.star2.com/health/2019/03/13/whats-the-best-imaging-technique-to-detect-cancer/

New imaging machines for IJN

Technological advances increasingly mean that doctors are able to see and assess the function and structure of our organs without having to cut our bodies open or insert instruments into us.

March 5, 2019 Health, Wellness

By TAN SHIOW CHIN

Dr Ahmad explaining the features of the new PET-CT scan machine, which includes reduced radiation exposure for the patient and the ability to measure coronary flow reserve.

Imaging methods like X-rays and ultrasound are familiar to us all, with many of us having undergone at least a chest X-ray (as part of a health check-up before being hired) or an abdominal ultrasound (for pregnant women).

Some of us with medical concerns or conditions might have undergone more advanced imaging like CT (computed tomography) scans, PET (positron emission tomography) scans and MRI (magnetic resonance imaging).

According to National Heart Institute (commonly known by its Malay acronym, IJN) consultant cardiologist Datuk Dr Ahmad Khairuddin Mohamed Yusof, CT scans are actually multiple X-ray images taken from various different angles.

“From there, we reconstruct images so we can see the anatomical structures in the patient’s body,” explains the specialist in cardiovascular imaging and interventional cardiology.

The multiple X-ray images are combined into a number of cross-sectional images – also known as “slices”– of the targeted body part via a computer programme.

“On the other hand, the PET scan is the mechanism of seeing the function of the organ by introducing a radioisotope into the patient’s body. Once the radioisotope gets into the patient’s body, it will decay, and the decaying process will produce gamma-radiation,” he says.

“This radiation will be detected by special detectors, which will produce and reconstruct images via multiple complex algorithms, and from there, we can see how the organ functions as a whole.”

For example, the radioisotope fluorine-18 is commonly combined with glucose to form fluorodeoxyglucose, a common tracer for PET scans.

As a form of glucose, fluorodeoxyglucose is taken up by cells as part of their energy-producing process, thus enabling its concentration in various tissues and organs to be measured.

Cancer cells, for example, tend to use far more glucose than ordinary cells, making PET scans useful for identifying malignant tumours.

There are also PET-CT scan machines that combine both these methods into one piece of equipment. This allows for more accurate imaging as the anatomical images from the CT scan and the functional images from the PET scan, which are done consecutively in the same session, can be combined into a precise picture of the targeted organ.

IJN Imaging Centre manager Norizam Mois explains: “This advanced hybrid imaging modality or scanner has been shown to be superior to conventional imaging in terms of diagnostic accuracy, efficiency and lower dose.

“The primary purpose of using this scanner is to improve the evaluation of the functions of the heart and associated thoracic oncology.”

She adds: “IJN not only receives referrals for cardiovascular disease, but also for cases of thoracic surgery involving tumours, as well as other cancerous areas. We also offer PET-CT services to other hospitals for diagnostic evaluation.”

One of the main differences between PET scans and CT scans, she says, is that the PET scan reveals metabolic changes in an organ or tissue earlier at cellular level. “So, the use of the PET-CT scanner with the 128 slices, will help us manage these patients more effectively.”

Norizam adds: “IJN is also committed to establish an imaging centre that offers a comprehensive range of non-invasive diagnostic imaging for a wide scope of medical needs.”

Norizam notes that IJN not only receives cardiovascular cases, but also patients with lung cancer. The hospital also provides imaging services to other hospitals.

Advantages of PET-CT

“We handle a lot of patients with heart disease, so PET-CT is one way of assessing the function of the heart,” says Dr Ahmad.

“Although we do have SPECT, or single-photon emission computed tomography, which is another method of assessing the function of the heart, we consider PET-CT another newer method with advantages over the older one.”

One advantage is reduced radiation exposure for the patient, as the radioisotope dose profile for PET-CT scans are lower than those for SPECT.

Another is the ability to measure coronary flow reserve, which is the maximum increase in blood flow through the coronary arteries that supply the heart, above the normal resting volume.

This is usually done for patients suspected of having at least 50% stenosis, or narrowing, of one or more of their coronary arteries to see if they require treatment.

“By introducing a nitrogen-13–ammonia or rubidium-82 tracer, which are the special radioisotopes for this PET-CT scan, into the patient, we will be able to assess the coronary blood flow during rest and during stress.

“With these two pieces of information, we will be able to calculate the ratio and come up with the coronary flow reserve of this patient.”

Previously, the patient would have to undergo coronary angiogram, which requires inserting a catheter into a blood vessel in the groin or arm all the way up to the heart. If the cardiologist decides that there is a narrowing of 70% or more based on the angiogram, treatment will proceed.

If it is less than 70%, the patient would need to go for another test, a dopamine-stress test, to see if there is a significant disruption in coronary blood flow during stress.

“However, once we have this PET-CT scanner, this issue can be addressed by asking the patient to undergo this scan. From there, we can immediately decide whether the patient needs ballooning or angioplasty,” he says.

The third advantage is being able to assess the viability and functionality of heart muscle. Says Dr Ahmad: “Let’s say the heart muscle is weak, and we want to know if the weakness is due to poor blood supply, or damaged or dead heart muscle.”

He explains that when the heart muscle has poor blood supply, it adapts by changing its metabolic activity. “Instead of using fat as the source of energy, it will use glucose as the source of energy. But this glucose is limited in supply, so the ability of the heart to pump is reduced,” he says.

Therefore, when the tracer fluorodeoxyglucose is introduced, it would be avidly taken up by the poorly-supplied heart muscle, which can be seen on the PET-CT images. If the muscle is damaged or dead, there would be no difference in the fluorodeoxyglucose levels.

This helps the cardiologist to decide on whether or not to treat any narrowed coronary arteries – yes, if the problem is poor blood supply, and no, if the heart muscle is already dead or damaged.

Dr Ahmad explaining the features of the new PET-CT scan machine, which includes reduced radiation exposure for the patient and the ability to measure coronary flow reserve.

Upgraded CT scan

IJN recently acquired a brand new PET-CT scanner. In addition, the institute upgraded one of its CT scanners, which now provides 512 slices, compared to the 64 slices of the older machines.

“This CT scan has less radiation exposure to the patient,” says Dr Ahmad. “The detector is bigger, so we will be able to image the heart at high quality without exposing the patient to high radiation, as compared to the old CT scanner.”

Due to the faster image capture, patients need only hold their breath for one to two seconds, compared to around 12 seconds for the older one. Most anxious patients can also skip a beta-blocker drug to slow down their heart rate, as this scanner can capture high-quality images in a heartbeat.

“This CT scan also has the capability of doing fractional flow reserve, which is a special technology not available in our previous CT scanner,” says Dr Ahmad.

Fractional flow reserve is the blood flow through a specific segment of the coronary artery. It is used to determine whether or not the narrowing of the artery results in a disruption of blood flow through it, and thus, whether or not it needs to be treated.

He added that the upgraded CT scanner can also function similarly to a cardiac MRI where it can detect stress-induced ischaemia, i.e. inadequate blood supply to the heart during physical stress. It does this by taking images while the patient is at rest and under drug-induced stress.

“So, in the future, we can offer this CT scan to those patients who are not able to get into a cardiac MRI scanner because of claustrophobia – fear of a closed environment,” says Dr Ahmad.

He explains that for an MRI, the patient’s body is fully enclosed by the machine, while only half of their body is enclosed for a CT scan.

IJN aims to provide high quality, but affordable care to Malaysian, says Dr Azhari. The hospital will be charging a maximum of RM3,000 for oncology screening by PET-CT, compared to over RM4,000 in private centres.

Latest tech

“We, being the National Heart Institute, are at the forefront of technology, and cardiac imaging is the area where the advancements are,” says IJN CEO Datuk Seri Dr Mohd Azhari Yakub.

“We are investing in this technology to provide patients non-invasive cardiac imaging, which can give us a lot of information without the patient having to go for an invasive technique.”

He added that they have also invested in their people by sending two doctors and four medical technicians overseas to be trained and certified in reading the PET-CT images and handling the machine respectively. While PET-CT scans are available in Malaysia, they are focused in the area of oncology, or cancer.

“Here we are providing not only screening or investigation for oncology patients, but also sub-specialising in cardiac PET-CT,” says the senior consultant cardiothoracic surgeon.

The two new and upgraded machines were sponsored by Permodalan Nasional Bhd (PNB) as part of their corporate social responsibility (CSR) efforts. “With their contribution, we are able to provide a very competitive fee for the imaging, which will benefit the patients,” says Dr Azhari.

He adds that IJN will be charging a maximum of RM3,000 for oncology screening by PET-CT. PET-CT cardiac imaging will cost slightly more than RM3,000 due to the more expensive radioisotope they have to use, he says.

He adds that IJN will be reducing the cost of CT scans in their centre with the addition of the two new machines, as they now have three CT-capable machines in total. “This is all part of the vision of IJN: to provide high-quality care, which is affordable to the ordinary Malaysian,” he says.

https://www.star2.com/health/2019/03/05/new-imaging-machines-ijn/

Is it Alzheimer’s or another dementia form?

Why doctors need to distinguish and how they might do so

Alzheimer’s disease now affects an estimated 5.5 million Americans, and after decades of feverish work, researchers have so far failed to find a treatment that halts or reverses the inexorable loss of memory, function and thinking ability that characterize this feared illness.

Melissa Healy27 July 2017

But researchers have been quite successful at devising ways to diagnose Alzheimer’s earlier and earlier. And that capability has emerged alongside evidence of a tantalizing possibility: that if you can catch the disease early enough — ideally when symptoms of confusion or memory loss are just emerging, or before — some therapies already in hand might essentially halt its progress.

For anyone who detects some mental slippage and wonders, “Is it Alzheimer’s?” the current state of dementia research raises a very real, and very wrenching, dilemma: If I can know, do I want to know?

That is, if it’s Alzheimer’s disease, would I do anything differently? Would there be some benefit in knowing for my loved ones, for myself?

Doctors and insurers, including the federal government, which administers Medicare, are asking some variants of the same questions: If an effective test, which costs between $3,000 and $5,000 a shot, can diagnose dementia early, and distinguish Alzheimer’s from other forms of dementia, should it be recommended to patients with cognitive concerns and routinely covered by their insurance? Would it make patients’ lives better, or lower the cost of their care?

Newly unveiled research results are bringing some clarity to such deliberations. And other new research, published Wednesday in the journal Neurology, proposes a new diagnostic tool that may be able to detect Alzheimer’s, and distinguish it from another form of dementia, more simply and cheaply than does the best test now available.

At the Alzheimer’s Assn. International Conference in London last week, researchers reported their preliminary findings from a trial that is testing the impact of diagnostic testing for Alzheimer’s disease on nearly 19,000 Medicare beneficiaries.

All of these study participants — largely people in their 70s, all with a diagnosis of either “mild cognitive impairment” or atypical dementia — are living with the unconfirmed suspicion that they have Alzheimer’s. The study is underwritten by the Centers for Medicare & Medicaid Services and the Alzheimer’s Assn. It set out to find out whether knowing — getting the costly test that would offer either confirmation or reprieve — would change the way that patients with cognitive troubles are treated, or the way that they plan their lives.

The preliminary results suggested it did. After getting the results of a PET brain scan to detect and measure amyloid deposits, which are the key hallmark of Alzheimer’s disease, roughly two-thirds of the subjects saw their medication regimens changed or were counseled differently by their doctors about what to expect.

That new information may have guided family caregivers in planning their own futures, or prodded patients to make financial decisions and power-of-attorney assignments sooner. Some who learned that they did not have Alzheimer’s discontinued medications that can have unpleasant side effects. Others learned they do have Alzheimer’s and decided to enroll in clinical trials that will test new drugs.

A second study presented in London analyzed data from several studies, and found that in a large population of research participants with cognitive concerns, brain amyloid PET scans led to a change in diagnosis in approximately 20% of cases.

“People should know what’s coming,” said Dr. Maria Carrillo, chief science officer for the Alzheimer’s Assn. The Centers for Medicare & Medicaid Services has given amyloid scans a provisional approval, meaning they do not routinely pay for them. The results may guide the agency to rethink its position, she added.

The PET scan bore bad news for Ken Lehmann, who enrolled last year in the IDEAS trial, short for Imaging Dementia — Evidence for Amyloid Scanning. After his long, slow decline that has flummoxed doctors, Lehmann’s brain scan clearly showed he has Alzheimer’s disease.

The certainty that has brought has been a long time coming. When Lehmann began withdrawing from friends, forgetting to pay bills and having trouble following conversations, he was just 58. Now, he’s 80.

Ken had always been considered a “Renaissance man” — a furniture company executive who rebuilt Porsches, played basketball and loved to entertain friends, said his wife, Mary Margaret Lehmann. But as years passed, his judgment seemed off. He would lose track of points he was making, and sometimes of where he was at.

It would take the loss of their home and a business bankruptcy for the Lehmanns to demand answers to what was going on. In 2009, they moved from Sacramento to Edina, Minn., to live with a daughter. And there, at last, they found a neurologist who, despite initial skepticism (“but he presents so well!” the doctor proclaimed), diagnosed dementia.

For the Lehmanns and many patients and families like them — as well as for neurologists — that diagnosis is often just the beginning of a deeper mystery.

Alzheimer’s disease is the most feared and most common form of dementia, accounting for between 60% and 80% of all dementia cases diagnosed. But at least seven other forms of dementia, and dementia linked to the movement disorder Parkinson’s disease, can cause loss of memory, reasoning, judgment and the ability to speak, comprehend and care for oneself.

To the estimated 16 million Americans living with some form of cognitive impairment, telling the difference could make a significant difference. Dementia forms with different origins progress differently (or sometimes not at all). They respond best to different medications, and will come to require different levels of care and treatment. Some (though not Alzheimer’s) can even be reversed with treatment.

Being able to distinguish which form of dementia a patient has should help doctors and caregivers to make better choices.

But it’s a question that until recently could be answered only after death. At that point, a postmortem examination of the brain could be done to look for the built-up clumps and tangles of beta-amyloid proteins, the overall shrinkage, and the loss of neurons in the brain’s hippocampus that are, collectively, the hallmarks of Alzheimer’s.

No more. Improved medical imaging technologies developed over the last decade have made it possible to peer inside the brain of a living patient, detect and measure thIn 2012, the Food and Drug Administration took a first step in making such imaging possible, giving its blessing to the imaging agent florbetapir F18, which binds to amyloid aggregates in the brain and allows a PET scan to be used to make the diagnosis. In 2013, two new imaging agents won FDA approval, and new imaging agents and techniques promise ever more precise means to visualize and diagnose Alzheimer’s in the brain.

On Wednesday, research published in the journal Neurology suggested that transcranial magnetic stimulation, a technique that can selectively turn up or down activity in different parts of the brain, could prove useful in distinguishing between Alzheimer’s disease from frontotemporal dementia.

In many ways, Ken Lehmann’s symptoms fit neatly into a diagnosis of frontotemporal dementia. A form of cognitive impairment that typically becomes evident earlier than most cases of Alzheimer’s, FTD often affects judgment, personality and verbal communication. This form of dementia progresses as inexorably as does Alzheimer’s. But its typical course differs slightly.

As an enrollee in the IDEAS trial, Lehmann was prepared to learn what it was he had.

“I had come to the conclusion they just don’t know,” said Lehmann, now 80, from his home in Minnesota. “In seven years, my journey of decline has been very miniscule, and they don’t know why.”

It turns out, he added, “I have all the biomarkers of Alzheimer’s disease.”

Once he and his wife learned that, they stepped up their preparations for further decline. And they redoubled their efforts to do things that bring joy, and that may slow Ken’s decline as well.

They follow a diet rich in fatty fish, healthful fats and fruits and vegetables, and Ken does woodworking. He also sings in a Minneapolis chorus, Giving Voice, with other dementia patients. He has regained a long-lost ability to read music.

“Just not knowing is very disconcerting,” says Mary Margaret, who is her husband’s principal caregiver. “I don’t know what the timeline is, but I now know what the needs are, in terms of financial and legal needs and end-of-life issues. Those all need to be planned for ahead of time, and now we have all of that in place. To me, that’s a safety net.”e accumulation of beta-amyloid, and make a definitive diagnosis.

In 2012, the Food and Drug Administration took a first step in making such imaging possible, giving its blessing to the imaging agent florbetapir F18, which binds to amyloid aggregates in the brain and allows a PET scan to be used to make the diagnosis. In 2013, two new imaging agents won FDA approval, and new imaging agents and techniques promise ever more precise means to visualize and diagnose Alzheimer’s in the brain.

On Wednesday, research published in the journal Neurology suggested that transcranial magnetic stimulation, a technique that can selectively turn up or down activity in different parts of the brain, could prove useful in distinguishing between Alzheimer’s disease from frontotemporal dementia.

In many ways, Ken Lehmann’s symptoms fit neatly into a diagnosis of frontotemporal dementia. A form of cognitive impairment that typically becomes evident earlier than most cases of Alzheimer’s, FTD often affects judgment, personality and verbal communication. This form of dementia progresses as inexorably as does Alzheimer’s. But its typical course differs slightly.

As an enrollee in the IDEAS trial, Lehmann was prepared to learn what it was he had.

“I had come to the conclusion they just don’t know,” said Lehmann, now 80, from his home in Minnesota. “In seven years, my journey of decline has been very miniscule, and they don’t know why.”

It turns out, he added, “I have all the biomarkers of Alzheimer’s disease.”

Once he and his wife learned that, they stepped up their preparations for further decline. And they redoubled their efforts to do things that bring joy, and that may slow Ken’s decline as well.

They follow a diet rich in fatty fish, healthful fats and fruits and vegetables, and Ken does woodworking. He also sings in a Minneapolis chorus, Giving Voice, with other dementia patients. He has regained a long-lost ability to read music.

“Just not knowing is very disconcerting,” says Mary Margaret, who is her husband’s principal caregiver. “I don’t know what the timeline is, but I now know what the needs are, in terms of financial and legal needs and end-of-life issues. Those all need to be planned for ahead of time, and now we have all of that in place. To me, that’s a safety net.”

http://www.latimes.com/science/sciencenow/la-sci-sn-alzheimers-transcranial-magnetic-stimulation-20170726-story.html

Breakthrough: How to Detect Cancer Super Early!

This is the first of two reports about the 2015 Cancer Control Convention and Doctors’ Symposium, held over Labor Day weekend at the Sheraton Universal Hotel, Universal City, California

One of the most compelling speakers at the 2015 Cancer Control Society’s Convention and Doctors’ Symposium was Jenny Hrbacek, R.N., who worked as a neonatal nurse. She made a bold promise: “I’m going to tell you how to detect cancer the size of a pin point.”

Here’s what she had to say. . .

October 2015
Newsletter #545
Lee Euler, Editor

By Andrew Scholberg 

Jenny’s own story of cancer survival led to her quest to find ways to detect cancer years before the cancer shows up on conventional tests. When she was diagnosed with breast cancer, she was shocked to learn that it had been developing in her body for about seven or eight years. She had always had an annual medical exam, and each year the doctor had told her everything was “fine.”

She wondered how her health could be “fine” year after year, according to a doctor’s assessment of her annual exams, and then suddenly she’s diagnosed with a wicked case of cancer.

Her experience is typical. Even when conventional doctors diagnose early stage cancer, the reality is that the disease has been present for years. Before that, it’s simply too small to find – for them.

How this cancer patient “got smart”

After undergoing surgery Jenny submitted to four rounds of chemo. Her doctor also recommended the standard radiation treatments, but she decided to take a pass on radiation. Instead, she told the CCS audience that she got smart and decided to boost her immune system.

At one point, her doctor declared, “You’re cancer free. You have clean margins. Have a cupcake. Take multivitamins. Enjoy your life.” The hospital vending machine was jam-packed with cancer-feeding junk food.

A PET/CT scan did show she was clear of cancer. But she found out from a blood test that both the PET/CT scan and the doctor were wrong.

Jenny also found out later that it’s a mistake for cancer patients to submit to a PET/CT scan, because these scans zap the body with a huge amount of cancer-causing radiation. One PET/CT scan emits as much as 500 to 600 times the radiation dose of a simple chest X-ray. This excessive radiation beats down the patient’s immune cells, which are radio-sensitive, according to James Forsythe, M.D., one of America’s best cancer doctors.

Contradicting the results of the PET scan, the blood test showed that Jenny still had plenty of circulating tumor cells. In fact, she had the most circulating tumor cells the lab had ever seen!

Her doctors never specifically told her that chemo cures cancer, but they certainly led her to believe it would. They also never told her that chemo doesn’t do anything to kill circulating tumor cells, which can cause cancer to reappear just about anywhere in the body – after you’ve been told you’re “cancer free”. No wonder cancer so often comes back after patients submit to the standard cut-burn-poison treatments.

Jenny’s new book is groundbreaking. The title is Cancer Free! Are You Sure? In this book she describes ten tests that will detect cancer early — years before conventional doctors can find it. Jenny says that such super-early detection is crucial because it gives you an opportunity to make certain lifestyle changes, such as diet, stress management, and detoxification that will prevent you from ever getting an official cancer diagnosis from a conventional doctor.

Here’s a list of the tests she recommends for super early detection:

• Cancer Profile Plus
• Colon Health Screening for Occult Blood in Stool — Home Test Kit.
• EarlyCDT — Lung Test
• Human Chorionic Gonadotropin (hCG) test
• Nagalase Test
• ONCOblot Labs: ENOX2 Protein Test
• Papanicolaou (PAP) and Human Papillomavirus (HPV) Tests for Cervical Cancer
• Red Drop: Thymidine Kinase Test
• Tests from the Research Genetic Cancer Center: Circulating Tumor Count (CTC) Test, Chemo Sensitivity and Resistance Test, Natural Substance Sensitivity Test, Immunity Test Panels, Megastasis Marker Tests

 The costs of these tests vary widely. For example, the Cancer Profile Plus test by the American Metabolic Laboratories in Hollywood, Florida, costs $576.    

In sharp contrast, the Human Chorionic Gonadotropin (hCG) test costs $55 plus the cost of U.S. Post Office first class international mail. You also need about $10 worth of household items for this test. The accuracy of this test is high, and the cost is dirt cheap. That’s why Bill Henderson and I recommend it in our book How to Cure Almost Any Cancer at Home for $5.15 a Day.

No one wants to know they have cancer, right? Wrong!

Had Jenny detected the start of her cancer seven or eight years before she got the official diagnosis of full-blown cancer, she’s confident she could have avoided a mastectomy and six reconstructive surgeries, not to mention four miserable rounds of chemo. She would have had the chance to make a few adjustments in her lifestyle, and the tumor would never have grown large enough to be detectable by mainstream tests.

She believes people would rather know they have cancer so they can do something about it, instead of burying their heads in the sand and pretending everything’s “fine.”

Cancer can only become a problem in a body with an environment that welcomes, fosters, and feeds cancer. Dietary changes, detox, and immune-boosting strategies can change the environment inside the body (the bio-terrain), making it hostile to cancer cells.

The problem is this: If you don’t know you have cancer, you have no motivation to change your lifestyle.

Thanks to the tests Jenny recommends in her book, you no longer have to wait for a lump or bump. You can now find out about a potential cancer problem when the cancer is the size of a needle point — years before conventional doctors would detect it.

I do believe Jenny’s book will save lives. Those who believe they may be at risk of cancer should definitely get her book, which she wrote for the general public.

In another presentation at the conference, Dr. Emil Schandl, Ph.D. spoke on “Pre-Visual Detection by the Cancer Profile Test” (one of the tests Jenny describes in her book). It’s available from his organization, the American Metabolic Testing Laboratories in Hollywood, Florida.

The Cancer Profile Test can detect the presence of just a few dozen cancer cells. Another test, ONCOblock (also on Jenny’s list) purports to identify where the cancer is, but Dr. Schandl says ONCOblock needs a few million cancer cells in order to identify the location.

Turning up the heat on cancer

Dr. Oscar Streeter, M.D., gave a presentation on hyperthermia, a heat therapy he provides at the Center for Thermal Oncology in Santa Monica, California. He established his credibility right away by showing “before” and “after” photos of a patient with a gigantic tumor on one of his eyes. Hyperthermia and radiation made the cancerous bulge over his eyelid disappear.

Long-time readers of this newsletter know hyperthermia is one of the most effective cancer treatments on earth. The therapy involves raising the part of the body affected by cancer – or, in some cases, the whole body – to temperatures similar to those you experience if you have a high fever. Just as a natural fever is your immune system’s response to infection, so the “artificial fever” of hyperthermia is an effective response to cancer.

It’s hard to understand why it isn’t used as a standard treatment. Heat treatments are not only safe but also remarkably effective.

Dr. Streeter’s clinic can give hyperthermia with chemo at the same time. The hyperthermia weakens cancer cells, and a low dose of the right chemotherapy drug can finish them off – instead of resorting to the high doses used in conventional treatment that cause miserable side effects.

Another speaker, Dr. Sean Devlin, D.O., seconded what Dr. Streeter said about the benefits of hyperthermia. Dr. Devlin treats patients at the Institute of Integrated Oncology in Santa Monica, California. He declared that hyperthermia is “probably the safest and most innocuous therapy we use.”

Another speaker, Dr. Kazuko Tatsumura, Ph.D., O.M.D., spoke on “Far Infrared Onnetsu Therapy” — another form of hyperthermia. Instead of heating up the whole body with an artificial fever, the Onnetsu device is an inexpensive way to heat up the part of the body where the cancer is located. She said that when the device finds the cancer, the patient can actually feel the tumor heating up.

According to Dr. Tatsumura, the Onnetsu, a hand-held device, improves blood circulation, flushes the lymphatic system (which is important for detox), and promotes the free circulation of qi (which she describes as electro-magnetic energy) along the acupuncture meridians.

The device uses far infrared heat to achieve deep penetration. The benefits for cancer patients are obvious, if you understand the concept of using fever to kill cancer cells. She said the Onnetsu also works on rheumatoid arthritis and benefits a wide variety of other health problems as well.

The Onnetsu isn’t just for health practitioners. It’s inexpensive enough that many patients purchase one for home use. But some instruction is necessary in order to get the full benefit from this remarkable device. Dr. Kazuko offers classes in Onnetsu therapy.

How to pay for alternative treatment if you’re broke

It’s ironic that health insurance companies willingly pay hundreds of thousands of dollars for toxic, dangerous – and usually ineffective — cancer treatments like chemo and radiation, but they won’t pay for inexpensive treatments that safely kill millions of cancer cells.

Although holistic treatment is cheap in comparison to conventional treatment, the cost can still be steep if you have to pay for it yourself. Holistic clinics typically charge $5,000 to $10,000 per week, and the course of treatment usually lasts about three weeks.

The question is: how can you pay for $30,000 worth of alternative cancer treatment if you don’t have that much in your savings account? Alex Barba of the Life Credit Company has come up with a solution. In his presentation he pointed out these pertinent facts:

• Six out of ten bankruptcies are the result of medical bills.
• Seven out of ten adults have life insurance.
• Eight out of ten life insurance policies lapse without a payout.

 Barba’s company offers cancer patients a cash advance of up to half the value of their life insurance policy (whole or term) to pay for alternative cancer treatment, collateralized by the life insurance. This is a brilliant solution to enable financially stressed cancer patients to pay for the kind of treatments that are most likely to be successful

http://www.cancerdefeated.com/breakthrough-how-to-detect-cancer-super-early/3358/