Published: 2:00 AM – 12/14/11

Q. What is “white coat syndrome?”

A. if you suffer from “white coat syndrome,” your blood pressure jumps as soon as a doctor or nurse approaches you. if your doctor knows this, he or she may recommend a home blood-pressure monitor or ambulatory monitor that is worn around the clock and takes your pressure every half-hour.

Blood pressure tends to spike when you are excited by an emotion such as anger or fear. But high blood pressure — known as hypertension — is very sneaky. It’s called the silent killer, because it usually has no symptoms.

Doctors say you have high blood pressure if you have a reading of 140/90 or higher. A blood pressure reading of 120/80 or lower is considered normal. Pre-hypertension is blood pressure between 120 and 139 for the top number, or between 80 and 89 for the bottom number.

The first number represents your systolic pressure when the heart beats. The second number represents the diastolic pressure when the heart rests. if only one number is elevated, you still have high blood pressure with all its dangers.

When you go to your doctor to have your blood pressure taken, there are a few things you can do to get an accurate reading. first, don’t drink coffee or smoke cigarettes for a half-hour before your pressure is taken. (What are you doing smoking, anyway?). empty your bladder, because a full tank can affect the reading. Sit quietly for five minutes before the test.

Q. How can I eat healthier?

A. To maintain a plan for healthy eating, follow these tips from the National Institutes of Health:

Q. What is the difference between Type 1 diabetes and Type 2 diabetes?

A. if you have diabetes, your body can’t produce insulin or use it properly. Insulin is a hormone that helps control the sugar in your blood. Insulin is made by the pancreas, a large organ behind the stomach.

A small percentage of diabetics have Type 1 diabetes, which usually occurs in people under age 30. Diabetics with this form of the disease cannot produce insulin.

About 90 percent of Americans with diabetes have Type 2 diabetes. It is most common in adults over age 40, and the risk of getting it increases with age. with this form of diabetes, the body does not always produce enough insulin or does not use insulin efficiently. Being overweight and inactive increases the chances of developing Type 2 diabetes.

Type 2 diabetes can be prevented in people who are at an increased risk or have pre-diabetes, a condition in which glucose levels are higher than normal but not yet high enough for a diagnosis of diabetes. People with pre-diabetes are more likely to develop diabetes within 10 years and are also more likely to have a heart attack or stroke.

Email questions to freelance health-care writer Fred Cicetti at . Cicetti’s book, “How to be a Healthy Geezer,” is available for purchase at healthygeezer.com.

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The Bay Area is the epicenter of a liver cancer epidemic. there are more cases of liver cancer in Santa Clara and San Francisco counties than anywhere in the United States.

Largely caused by hepatitis B viral infection (HBV), liver cancer is lethal. According to the World Health Organization, it kills nearly 750,000 people each year. The five-year survival rate after diagnosis is just 15 percent.

The good news is that most cases of liver cancer can be prevented. there is an effective and safe vaccine for HBV that the Centers for Disease Control and Prevention and WHO call the first “anti-cancer” vaccine. HBV is also easily diagnosed with a simple blood test. The challenge is to educate, test and vaccinate as many people as possible, especially those at greatest risk.

HBV, which can appear in either chronic or acute form, is responsible for 80 percent of liver cancers. HBV is called a “silent killer” because most people with chronic infection often have no symptoms. By the time they realize they have the disease, it is too late for effective treatment. sometimes people only find out about the disease when they are diagnosed with liver cancer. Untreated, HBV can also lead to cirrhosis and liver failure.

HBV is transmitted much the same way as HIV/AIDS. it is only transmitted through blood or semen, but it is 100 times more infectious than HIV. it cannot be transmitted through casual contact.

No one is immune, but liver cancer is especially prevalent in people from Asia and the Pacific Islands. The statistics are staggering. Asians and Pacific Islanders make up 4.5 percent of the U.S. population but account for more than 50 percent of chronic hepatitis B cases. recent immigrants are at greater risk. Two-thirds of those infected are unaware that they have HBV. Many acquired the virus at birth from mothers who were unaware they were carriers.

In Santa Clara County, where an estimated one-third of the population is of Asian descent, approximately 35,000 live with chronic HBV. A quarter of those with chronic HBV will die from liver cancer.

The Stanford Asian Liver Center and Stanford Health Library have scheduled “Understanding Hepatitis B and Liver Cancer,” a program featuring Stanford physician Stephanie Chao, M.D., 10 a.m. Nov. 5 at the Clark Center auditorium on the Stanford Medical School campus. Admission is free and open to the public. to register, call 498-7826.

Interested in learning more? Visit Stanford Health Library for books and additional resources, in both English and Chinese.

A good place to begin is “The Liver Disorders and Hepatitis Sourcebook” (McGraw Hill, 2006). Author Howard J. Worman, M.D., professor at Columbia University, covers the broad topic of liver disorders, so there is much more in the book than the focused discussion of HBV and liver cancer.

The value of this book is in Worman’s clear, reader-friendly explanation of liver function and things that can go wrong with the liver. An excellent chapter on viral hepatitis begins with an explanation of viruses in general before he delves into the specific types of hepatitis, including hepatitis B. A similar book is the “Cleveland Clinic Guide to Liver Disorders” (Cleveland Clinic, 2009).

A new book, “Hepatitis Essentials” (Jones & Bartlett, 2011), provides a concise overview of viral hepatitis. it is written for clinicians but is of interest to many consumers. with contributions from some of the world’s leading hepatitis experts, this book covers all aspects of prevention and management of the disease.

An action plan that both describes the problem and prescribes a solution, the National Academy of Sciences Institute of Medicine published a report in 2010, “Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C” (Institute of Medicine for the National Academies of Science). The report makes a strong case for stepped-up vaccination efforts, a public education campaign and increased resources for prevention and treatment, as HBV infection is increasing nationwide. it explains that few among the populations most at risk seek testing or information on how to protect themselves from infection. it is valuable reading for those who want to understand the issues better.

Stanford Health Library has a large collection of books on HBV and liver cancer written in simplified Chinese. The library also carries DVDs.

Stanford Health Library is free and open to the public in five locations: Stanford Shopping Center, Stanford Hospital, Stanford’s Cancer Center, the Taube Koret Center for Jewish Life and the Ravenswood Family Health Center. For more information, call 725-8400, email This e-mail address is being protected from spam bots, you need JavaScript enabled to view it or visit healthlibrary.stanford.edu.

Nancy Dickenson is head librarian at Stanford Health Library.

 1 Comment 1Commentat Thursday, 20 October 2011 09:12by JP where did you get the statistics for the liver cancer? How do you know it is caused by the virus? What about the radiation coming from Fukushima? Please substantiate. Post Comment

I am just curious because I am currently being monitored for HBP and I asked my doctor about symptoms because every where I look it is called the "silent killer", yet some ppl say nosebleeds, floaters, dizziness, lightedness etc can be symptoms. What has anyone else experienced as symptoms of HBP.

BECAUSE the Philippines has a young population, most of whom are under 30 years old, the bone disease osteoporosis has not been given much attention.

But in many countries with aging populations, osteoporosis has been dubbed the “silent killer”, especially for women—although recent medical research have shown that men can also be afflicted by the disease.

I read up a lot about osteoporosis primarily because I live with my still-active 82-year-old mother. Also because, well, being 45, I must admit I do sometimes feel the wind whistling through my bones. There have also been a few times when getting up from a stationary position after a while can sometimes be, ahem, a bit taxing.

While Mama is still up and about, and can manage our stairs, albeit slowly, I make sure she holds on tightly to me whenever we negotiate certain areas in the mall or in dimly lit places. She has to take deliberate steps when she walks around so as not to slip.

I have nightmares about what happened to my grandmother happening to my mother. my lola, who was in her 70s, slipped and fell while going about the house, breaking her leg. She spent quite some time at the National Orthopedic Hospital, with her leg in traction, before we were able to bring her home. while she was always full of energy and fiercely went about her business in and out of the house, I was so surprised how quickly she deteriorated even though her leg was technically repaired. She never walked quite well again after that. Suddenly she was just bedridden, and then she was gone.

According to the International Osteoporosis Foundation (IOF), a nonprofit, nongovernment organization in Switzerland, osteoporosis, which literally means “porous bone”, is a disease “in which the density and quality of bone are reduced. As the bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone occurs ‘silently’ and progressively. Often there are no symptoms until the first fracture occurs.”

It has long been considered an old person’s disease, but what few people realize is that bone breakdown can begin as early as the age of 25.

While human bones are living tissues that naturally undergo a constant breakdown and renewal process, this changes during the mid-20s, when the deterioration of our bones begins. 

I wouldn’t have believed this until my gal pal Miggy, who is nowhere near senior citizenship, broke her little toe two years ago after someone accidentally stepped on her bare foot at the beach. As soon as we got back to Manila, she had her foot checked and mended, but was told she already had osteoporosis. (Which, of course, made her feel much older than her real age. I tell you, these doctors are depressing!)

Studies also show that smokers, those who ingest alcohol liberally, and people with low-calcium diets and generally sedentary lifestyles are susceptible to osteoporosis. (Miggy, lay off Facebook!) Owing to our hormones and petite frames, women are more prone to this disease than men.

Monthly periods and pregnancy also drain the body of calcium—the nutrient which builds and strengthens bones—while menopause accelerates bone loss even more, as the body produces less and less estrogen, which helps protect bones, according to experts.

While there are no exact figures on how many are afflicted with osteoporosis in the Philippines, population figures from the National Statistics Office show there are close to 4.8 million women aged 50 and older, and most, if not all, at risk for the bone disease. Deadly sa kababaihan, indeed. 

Some of the tell-tale signs of this “silent killer” are the following: the stooped back, loss of height, and the easy breakage of bones in the back, hips, wrists and ankles. Fractured bones, however, are not the end of it: according to the IOF, 30 percent of those who develop a hip fracture never walk again, while 20 percent die in a year’s time. Just like my lola.

To ensure optimum bone health, most doctors recommend calcium-laden products such as milk. A glass of Anlene, for instance, contains 500 mg of calcium, while Anlene Gold has 600 mg per glass. Anlene is not just ordinary milk, by the way; it is especially formulated for adults—enriched with the essential bone nutrients like calcium, vitamin D, magnesium, zinc and protein.

Anlene also recently published a breakthrough clinical study that showed women who drank two glasses of Anlene daily reduced their bone breakdown within four weeks (based on evidence from a 16-week bone-marker trial and additional Anlene research). Imagine that!

Of course, drinking milk alone won’t save your bones. It’s important for women to also engage in regular exercise such as running, walking, strength training, and yoga or Pilates. A diet rich in calcium is also recommended, and this can be found in soy-based foods like tofu, as well as dark, leafy green vegetables.

Another way to improve bone density is to increase one’s intake of vitamin D, which makes it easier for bones to absorb calcium. Vitamin D can be found in fatty fish like salmon and mackerel, fish liver oil and egg yolks. Recommended calcium intake for women between the ages of 25 and 50 years is 750 mg a day; and more for those who are older, pregnant or lactating. As for vitamin D, the Recommended Daily Allowance for women aged 19 to 50 is 600 IU (international units). 

With Anlene, a proper diet and regular exercise, we girls may lick this silent killer yet.

For more information about osteoporosis, visit the IOF web site at iofbonehealth.org, or Anlene at anlene.com.au/default.asp?menuid=34 for more tips on how to help our bones.

Silent virus can lay dormant for 15 years

ISLAMABAD: Jade Goody. Does the name ring a bell? She was paired up with Indian actress Shilpa Shetty on the UK reality TV show ‘Big Brother’ back in 2008. Most of us would recall the bit of news that Shetty had more or less walked out of the show after a spat with Goody.

Then came the bombshell in March 2009: Jade had succumbed to cervical cancer at the age of 27 years. Like so many others, she had simply not known of the cancer until it was in its advanced stage, and that was just too late.

Cervical cancer symptoms are usually benign and there are little to no initial symptoms and signs. It is a disease that can strike women of any age, ethnic background, or social and economic class.

The cancer is caused by the human papillomavirus (HPV) and is simply a silent killer that nests in the host’s body for up to 15 to 20 years, so the woman finds out when it is already too late.

Cervical cancer is the second most common cancer among women and the third leading cause of cancer deaths among women globally. The global burden of cervical cancer is 500,000 cases every year, with 270,000 women dying of it globally — that is one death every two minutes.

According to a report in the Times of India, cervical cancer is “the commonest cancer in India”.

“If detected at a pre-cancerous stage (when the cells are not normal, but are not yet cancerous), this cancer is 100 per cent curable,” says oncologist Dr Gauravi Mishra of the Tata Memorial Hospital, Mumbai.

Approximately 80 per cent of deaths related to cervical cancer occur in developing countries such as ours. Typically in Pakistan, a woman would be susceptible to this cancer from marriage onwards, with commencement of sexual relations.

But unfortunately studies have shown that a lack of awareness — of both the disease as well as availability of the preventive vaccine — is steadily increasing the incidence of cervical cancer in Pakistan.

A 2008 study by GLOBOCAN, a WHO project for cancer-related research, reveals Pakistan’s cervical cancer incidence is 19.5 per 100,000 in 2008 as compared to less than nine per 100,000 in 2002 — a clearly rising trend. The same study shows deaths from the cancer at 12.9 per 100,000.

Risk levels for young girls are much higher today than before. Pakistan has in fact moved from a low risk to a moderate risk country for cervical cancer and the increasing incidence is seen especially in younger women with the disease at an advanced stage when they go to the doctor for diagnosis.

The onset of cervical cancer would not only create deep trauma to both the woman and her family, but also be unbearable in terms of the cost of treatment. Young women should therefore be vaccinated before marriage, as this is the most effective option for prevention from the disease.

In fact, this should really be a part of the protection that parents provide to their daughters. An easy and practical action is simply a visit to the gynaecologist, who would advise the best course of action for the bride-to-be. Such a prior visit could be the parents’ most precious gift of all — timely vaccination would provide a future free from the trauma of this cancer. Among other things, the gynaecologist would clarify that cervical cancer is not a hereditary disease and that any woman can acquire it.

[Ed’s note: About a month or so ago, a new vaccine Cervarix became available in the Pakistani market. It costs Rs4,700 and a woman will need three doses.]

As cervical cancer is caused by a virus, it can be prevented if an effective vaccine is available. And such vaccines are indeed available, and all women, whether young or not, deserve such protection. I strongly suggest no delay in this matter; parents must do what’s best for their daughters and get that appointment sooner rather than later.

Dr. Hashmi is a healthcare services manager with the Health Awareness Society

Published in The Express Tribune, November 6th, 2010.

I've been having headaches the last few days and tylenol isnt helping. I also have been getting light headed and dizzy which is not normal. I have been feeling tired when I've done little or nothing and dont really feel like doing anything either. Someone also commented that I was very red faced. I am 32 and I otherwise good health. Does this sound like high blood pressure or something else?

headaches,dizziness,irritability and yes it sounds like high blood get it checked. you can get it checked free at most drug stores or at wal-mart

To me it sounds like high blood pressure cuz i had some of the same symptoms. go to the doctor and have them check your blood pressure. They will be able to better tell you what you need to know.

Talk to a doctor.

High Blood Pressure is called the silent killer because you can have it with no symptoms at all. But with the symptoms you described I would suggest getting to a Doctor soon. there could be many things including high blood pressure or a heart problem. Heart problems can happen at any age so don't dismiss that idea too fast. go to the doctor better safe than sorry.

Headaches and fainting.

there's no substitute for NOT getting a blood pressure test.

There are free blood pressure testing at some drug stores. Please get it checked.

High blood pressure will tear your arteries and possibly give you a grave risk for kidney damage, stroke, or an aneurism.

Unfortuately, there are NO clear risk signs of high blood pressure….hence it's called the silent killer. Blood pressure will creep up until it's too late.

It can also be low blood pressure and/or hormonal disbalance. See a doctor!