Did Dinosaurs Existed in Noah’s Great Flood?

 Dinosaurs in Noah’s Great Flood?

Yesterday, I attended a talk in Evangel Bible-Presbyterian Church in Oval Damansara in Kuala Lumpur. The talk was on Creation given by two scientists, Dr Don Batten and Dr Kee Fui Kon.

Dr Don Batten spoke about the evolution of life on earth, and Dr Kee on Noah’s Great Flood in the eyes of the Church against the eyes of science. Their view was that the Creation of Earth took only 7 days as mentioned in Genesis of the Bible, and the Great Flood of Noah together with the existence of dinosaurs according to Dr Kee took place only a few thousand years ago, and not millions of years ago.  

As I am a bit short of hearing I could not catch up with what they spoke. But here’s my independent personal view as a scientist myself.

Before we write, most people ask, during the Great Flood of Noah, how was it possible to accommodate huge terrible lizards like dinosaurs, and in pairs too into his ark?

Before we answer, let’s look at the timeline on the creation of Earth and life on Earth in the eyes of Science.

Mya here stands for “millions of years ago.”  

1. 4,500 – 4,400 million years ago (Mya). Accretion of Earth

2. 4,200 million years ago (Mya) Atmosphere and oceans form

3. 4,000 million years ago (Mya) Prebiotic chemistry became possible

4. 3,800 million years ago RNA world shown by the first chemical fossil

available (viruses)

5. 3,600 million years ago the first DNA protein life came into existence

6. 3,500 million years ago LUCA: Archaea / Bacteria spilt and also

photosynthesis (autotrophy) began.

7. 2,700 – 1,900 million years ago the first eukaryotes / sexual reproduction

became possible.

8. 1,000 Mya?

9. 650 Mya Metazoans

10. 575 Oldest large organisms

11. 555 Mya Oldest sponge fossils

12. 542 – 488 Mya Cambrian Radiation

13. 525 Mya Earliest vertebrates

14. 440 Mya First vascular land plants

15. 425 Mya First jawed vertebrates

16. 420 Mya Earliest terrestrial animals

17. 396 Mya First insects

18. 365 Mya Plants evolves seeds and first tetrapods

19. 354 Mya Insects flight

20. 350 Mya First land-dwelling vertebrates

21. 240 Mya First dinosaurs

22. 210 Mya First mammals

23. 200 Mya Pangea breakup begins

24. 150 Mya Archaeopteryx / birds flight

25. 140 Mya Flowering plants

26. 128 – 124 Dinosaurs flight

27. 125 Mya Mammalian gliding flight

28. 105 – 95 Mya Gondwanaland breakup

29. 90- 80 Mya Formation of Galapagos geological hot spot

30. 57 – 53 Mya Whale ancestor

31. 55 Mya Australia breaks away from Antarctica

32. 51 Mya Mammalian powered flights (bats)

33. 50 Mya First fossil Equidae

34. 45.6 Whale ancestor

35. 40 Mya Primate order diverges

36. 35 Mya First grasses evolve

37. 30 Mya Old-world / new-world monkey spilt

38. 25 Mya Old-world monkey / apes split. Also, Drosophila melanogaster / D. obscura split

39. 15 Mya Apes migrate to Asia

40. 6 -7 Mya Sahelanthropus

41. 5 - 4 Mya: Common ancestors of chimps and humans. Formation of current

Galapagos Islands

42. 3.6 Mya Panama Isthmus rise / Lucy fossil / Australopithecus afarensis

footprints

43. 2.5 Mya Tool use

44. 1.8 Mya Homo habilis out of Africa

45. 1.6 Mya Homo erectus in Asia

46. 600,000 years ago Human / Neanderthal split

47. 500,000 years ago Homo erectus use fire

48. 355,000 Homo heidelbergensis footprints

49. 200,000 years ago Anatomically modern human

50. 250,000 – 160,000 Homo sapiens

51. 120,000 Homo language possible

52. 100,000 years ago Wolf / dog split

53. 79,000 – 15,000 years ago Start of Wisconsin glaciations

54. 50,000 years ago. Humans migrate from Asia to Australia

55. 45,000 years ago. Megafauna extinction in Australia

56. 30,000 years ago. Human migration from Asia to North America

57. 14,000 – 10,000 years ago. Domestication of dog and Megafauna extinction

in North America

58. 12,000 years ago. Early agriculture

59. 8,000 years ago Domestication of cattle

60. 6,000 years ago Domestication of horse

61. 3,000 years ago Iron tools

Major extinctions of life took place during:

62. 445 Mya in the Late Ordovician

63. 375 Mya Late Devonian

64. 251 Mya End Permian

65. 200 Mya Late Triassic

66. 65 Mya Cretaceous-Tertiary

We shall now concentrate on the Cambrian Radiation that happened 542 – 488 million years ago in the eyes of science as I see it.

 555 million years ago when the oldest sponge existed, there was no question of Noah bringing only sponges into his ark. Much after down the timeline of life on Earth were the dinosaurs where people often ask how could Noah bring in all those “terrible lizards” in pairs into his ark?

 Let’s have a look at this problem when non-bird dinosaurs lived between about 245 and 66 million years ago, in a time known as the Mesozoic Era. This was many millions of years before the first modern humans, Homo sapiens, appeared.

But before we discuss further, calculation of the date of the flood based on literal interpretation of the Old Testament has been a scholarly activity for two millennia. The seventeenth century estimate given by the Irish Bishop James Ussher has been acknowledged among many of the devout.

The calculation is undertaken by adding the genealogies beginning in Genesis 11:10. This is the account of Shem: Two years after the flood, when Shem was 100 years old, he became father of Arphaxad. Arphaxad is then designated father to Shelah, Shelah to Eber, Eber to Pelg, and so on until Abram and his successors which eventually brings one to the division of the kingdom at the death of Solomon.

In this way, Bishop Ussher computed that the earth had been created in 4004 BC and that the flood occurred in 2350 BC which was henceforth accepted as the "traditional" biblical date, (though there is rival literal interpretation similarly inspired, setting the date at 2459 BC). These traditional chronologies were acceptable among the learned until the foundations of religion were shaken by Darwin and a succession of natural historians including George Curier, William Buckland, and finally, that " high priest of uniformitarianism" Charles Lyell, who collectively contribute to the modern, predictable, comfortable, uniform, manageable version of the world that we know, that puts the Great Flood of Noah far earlier than believed by the church using evidence-based records. Science showed Earth was created between 4,500 – 4,400 million years ago, and not in a few thousand years?

Now let’s return to the Great Flood of Noah. The timing of Noah's flood, according to biblical chronology, would place it thousands of years before the Cambrian explosion, which occurred around 541 million years ago. Therefore, it happened long before the Cambrian explosion, which marks a significant period in Earth's history characterized by the rapid diversification of life forms.

I asked Dr Kee after his talk if the dinosaurs came before the Cambrian Radiation or after that, he told me it was before the Cambrian Explosion, and that happened only a few thousand, and not a few million years ago as taught by science. 

If the Great Flood occurred before the Cambrian radiation where there was no vast diversity of life on Earth it would mean the absence of very large reptiles like the dinosaurs for which it would be almost for Noah to accommodate even just one into his ark let alone a pair of each.

Before the Cambrian Period there were only small life form and the majority of living organisms on the whole were small, unicellular organisms including worms, stromatolite, trilobites, anomalocaris, Opabinia regalis and halkieriids and simple Ediacaran fauna. There were no other  animals two of its kind as describe in Genesis. 

The International Commission on Stratigraphy lists the Cambrian Period as beginning at 538.8 million years ago and ending at 485.4 million years ago. There were no large animals like dinosaurs and flying reptiles then.
Dinosaurs are a diverse group of reptiles of the clade Dinosauria. They first appeared during the Triassic period, between 243 and 233.23 million years ago (mya), although the exact origin and timing of the evolution of dinosaurs is a subject of active research. They became the dominant terrestrial vertebrates after the Triassic–Jurassic extinction event 201.3 mya and their dominance continued throughout the Jurassic and Cretaceous periods. The fossil record shows that birds are feathered dinosaurs, having evolved from earlier theropods during the Late Jurassic epoch, and are the only dinosaur lineage known to have survived the Cretaceous–Paleogene extinction event approximately 66 mya. Dinosaurs can therefore be divided into avian dinosaurs—birds—and the extinct non-avian dinosaurs, which are all dinosaurs other than birds.

Since dinosaurs are huge reptiles and “terrible lizards” many of them flying, it would almost be impossible for Noah to catch them and put them into his ark along with huge amounts of food they would need for 40 days and 40 nights of continuous rain.

Dinosaurs are not one type of reptile, but many types. How could it be possible to bring all of them into Noah’s ark often people ask, including the various types of food they need.  Some of the dinosaurs are huge and very massive. How could Noah possibly catch them and in pairs too, males and females?  The amount of food to feed all these animals would be beyond any ship or ark. Some of the dinosaurs are flying reptiles.  How could Noah catch flying reptiles and flying birds.

The logistics of fitting all dinosaurs, along with other diverse species, onto Noah's Ark present significant challenges from a practical standpoint. Large dinosaurs would indeed require vast amounts of space and resources, including food, water, and suitable habitats. Additionally, capturing and transporting such massive creatures, along with ensuring the presence of both males and females, would be immensely difficult.
As for flying reptiles and birds, capturing and accommodating them on an Ark would pose additional challenges, especially given their ability to fly. It's worth noting that religious interpretations of the story of Noah's Ark often involve miraculous elements or divine intervention to address these logistical difficulties. Some believers view the story as allegorical rather than a literal historical event, while others may interpret it differently based on their faith tradition.

Ultimately, reconciling religious narratives with scientific understanding often involves a nuanced approach that respects both faith perspectives and empirical evidence. Many religious individuals and communities find ways to integrate their faith beliefs with scientific knowledge, recognizing that both can offer valuable insights into the mysteries of the natural world.

My feeling is, if the Great Flood came before the Cambrian Period where there were only small creatures, or long after the dinosaurs became extinct except the birds that are “glorified reptiles” then it may be a possibly to accommodate the much lesser species of life.

It is clearly said “after forty days Noah opened the window he had made in the ark and sent out a raven, and it kept flying back and forth until the water had dried up from the earth. Then he sent out a dove to see if the water had receded from the surface of the ground.

But the dove could find no place to set its feet because there was water all over the surface of the earth; so, it returned to Noah in the ark. He reached out his hand and took the dove and brought it back to himself in the ark. He waited seven more days and again sent out the dove from the ark. When the dove returned to him in the evening, there in its beak was a freshly plucked olive leaf! Then Noah knew that the water had receded from the earth. He waited seven more days and sent the dove out again, but this time it did not return to him.”

(Genesis 8: 6 – 12)

These verses clearly showed the Great Flood came only after the dinosaurs were no more there and only raven and doves replaced them as “gloried reptiles.” This means to me, there was no question of Noah accommodating huge reptiles of all kinds into his ark. It may have happened long after the Cambrian Period and long after the dinosaurs disappeared.

But there is a problem here. If it was long after the Cambrian Period, let us say, from 63 million years ago when  primates and  split into two groups, known as the haplorrhines (dry-nosed primates) and the strepsirrhines (wet-nosed primates) appeared  till 47 million years ago when early whales that gave birth appeared 47 million years ago,  then Noah would still have to deal with an enormously large species of animals that were already evolved. Currently, scientists estimate there are at least between 8 – 10 million species of life on Earth. If the Great Flood occurred in 2350 BC after earth was created in 4004 BC as claimed by the church, then Noah will still have to deal with at least 6 -8 million species of life, and in pairs too, for him to put them into his ark? This is a sheer impossible task, far more difficult than accommodating huge and small dinosaurs?

The logistics of fitting all species onto Noah's Ark, is indeed a challenge to reconcile the biblical narrative with our understanding of biodiversity. Some religious interpretations suggest that the animals brought onto the Ark were representative pairs, rather than every single species, while others view the story as allegorical rather than literal.

But if the Great Flood occurred before the Cambrian Explosion when much less species of life existed, then according to scientists, Noah must have existed 541 million years ago where no humans was around except Noah and all those generations that came before him?

I don’t think neither the Church nor Science can solve this dilemma?  

Then we also have another problem to answer. Was the flood of Noah localized or worldwide and where did the water go after the flood?

The story of Noah's flood, as described in the Bible, is typically interpreted as a worldwide event. However, interpretations vary among different religious and cultural beliefs. As for where the water went after the flood, some interpretations suggest it receded back into the oceans and other bodies of water, while others propose that it evaporated or was absorbed into the earth.

If it was a worldwide event, then the entire Earth will be covered with water. This means there is no possibility for all the waters to drain into the oceans as the whole earth itself is an ocean.

The concept of a worldwide flood raises questions about the feasibility of such an event given our understanding of Earth's hydrology and the vast diversity of life. It's a topic that has been debated among scholars, scientists, and theologians for centuries, with varying interpretations and explanations offered.

Ultimately, interpretations of religious texts like the story of Noah's flood can vary widely based on individual beliefs, cultural traditions, and scholarly analysis. Integrating these interpretations with scientific understanding often involves nuanced perspectives and ongoing dialogue between faith and reason. See my write up on this here: 

Was The Great Flood of Noah a Global Event? And Where Did the Rains Got Its Waters

https://scientificlogic.blogspot.com/search?q=flood+of+noah

But the church claims the creation of Earth and Noah Flood occurred only a few thousand years, and not millions of years ago as scientists calculated. Who is right? This debate has been going on for centuries.

The Church believes the entire Creation of Earth took only 7 days accordingly to Genesis in the Bible, whereas Science say it took 4,500 – 4,400 million years ago for Earth to be form properly till 200,000 years ago for anatomically modern hominids to exist, 250,000 – 160,000 years for Homo sapiens like Noah to exist, and 120,000 Homo language becoming possible.

I think the difficulty between God and us is, we tend to interpret “one day” given in Genesis as our time of 24 hours a day, and not the Maker and Creator (God) time which to Him “one day” is actually millions of years to us. Mortal humans can only live up to 100 years maximum, but God is eternal. There is no match.

It is clearly stated there “For a thousand years in thy sight are but as yesterday when it is past, and as a watch in the night” (Psalm 90:4).

“You do not know what will happen tomorrow. For what is your life? It is even a vapor that appears for a little time and then vanishes away” (James 4:14).

But if anyone at all, whether from the church or outside thinks that these verses are not correct by equating his time and lifespan against the eternity of God by claiming his "one day" is the same as God "one day" given as "morning and evening" of creation in Genesis, is a highly arrogant, self-conceited person who equates himself with God. Such a person is both scientifically and spiritually blind. He must as well delete both these two verses in the Bible and replace them with his own version to read as: 

"For a thousand years in thy sight is the same as my thousand years here on earth, and thy one day in creation in Genesis is the same as my one day that I see here on earth, and my life is not a vapour that vanishes away" 

See explanation on: 

The Origin of Heavens and Earth: Science vs The Bible

https://scientificlogic.blogspot.com/2024/

But are we willing to accept these verses given in the Bible as gospel truth, or do we wish to delete them to equate our time and our lifespan as the same as that of God? This decision is up to us to decide by using our own arrogance and conceited thinking. To me, time is eternal for God, whereas my lifespan can last at most 100 years. This means for me, when God says He created heavens and earth in 7 days, he uses His eternal time scale to measure, and not my time.

This is the same as, for instance, a scientist as a creator, carries out an experiment on rats for 100 days. A scientist would naturally use his human time as a creator of the experiment to measure the length of his experiment on rats and not use rat’s time to measure that can live usually for only between 12 to 18 months. Even if we take the human lifespan of a 100 years (36,525 days) and say, at maximum of 2 years (730 day) for a rat, then the rat’s life span is only 0.02 that of a human. There is just no comparison. How could we be so arrogant as to use rat’s time as our standard of reference. Naturally we will use our human time as a creator of our own experiment for our own creation on rats. We will write down the time we took and record this down as understood without one iota of argument and publish the experiment in a scientific journal because this is understood. No scientist would measure the time taken of his own creation of his own experiment using rat’s time, unless he is insane. Don’t we wish to respect God the Creator for using His time as His standard of reference given in Genesis?  It was His own experiment on Creation, He thinks fit and appropriate than insisting it was our time in days that numbered. 

Let us give ourselves another example. Let us say on average a rat lives up to 15 months (450 days) and the experiment by a scientist as a creator took 100 days. This is already 22 % of the rat’s life span. The rat sees it as a very long time in its life for the experiment (creation) to complete, but for the scientist who created the experiment it is only 450 / 36525 x 100 = 1.2 % of his life span to complete the experimental creation. There is no comparison here, let alone just 4.5 billion years in the creation of Earth in the eyes of a scientist who measured it compared it to time eternal for God, making billions of years tending towards zero in time for Him but a very long time for us. We need to respect this scientific and spiritual truth, and not measure length of time using our own personal yardstick. If we do not agree with this mathematical truth, then just delete all the verses in Genesis and replace them with our own. 

Don’t we think so?  If we do not agree, then we should also delete both verses, Psalm 90:4 and James 4:14 and replace them with your own thinking and your own version. But leave me out because you are more scientific, more educated and more intelligent than anyone else.   

But if we can accept this, and fully respect God, and not use our own human mortal thinking, then both the Church and Science will be aligned perfectly in agreement with each other on the length of Creation, and they will not be antagonists to each other anymore. Respect God to the highest whatever He wrote there in His own words in Genesis, and never insist on using our own human version that causes confusion to others and leads them astray.

To interpret the verses in Genesis literally word-by-word, verse-by-verse on the 7 days God needed to take for creation is no different from Nicodemus, the ruler of the Jews. Nicodemus was a very wise and learned person, but he could not understand the meaning of ‘being born again’ He interpreted what Jesus said to him literally in John 3:1-7 asking how can a person who was already old enter into his mother’s womb to be born again? The same if we believe God took 7 days in the eyes, when scientists the world over through their tens of years of research and hard labour tell us it took thousands of millions of years for Earth and the evolution of life to take place. Science is evidence-based, not literal blind acceptance. This is because when we are blind, we tend to interpret the verses written in Genesis literally and accept them literally using our own interpretation and thinking instead of looking them through the eyes of God who wrote them there.   

In short, it depends how you read and intepret time written in the Bible, and time as measured and seen in in the eyes of man 

Furthermore, when Earth was first formed in Creation, the rotation of Earth was much faster. Scientists have calculated the length of the day was less than 6 hours. The Earth’s rotation currently has slowed it down to 24 hours due to the loss of rotational energy caused by tidal frictions and the braking action of the Moon that causes tides twice a day on both sides of Earth.

So, does the church interpret that each day of creation took only 6 or 24 hours?  Which is which? Then explain to us and give us your answer.  I think it would be more respectful to God as a Creator if we use His time written as “one day” as equivalent to millions of years of our time in creation and evolution. This will instantly solve all our headaches between the Church and the scientific community. 

In due respect to other people's thinking, I don't use my earthly human days and thinking to count heavenly days. It will give me a headache.   

See also: 

Did Noah Bring in All those Billions of Life Forms into his Ark?

https://scientificlogic.blogspot.com/search?q=noah+flood

See also my write up on “headaches and how to cure them here.”

https://scientificlogic.blogspot.com/2024/04/migraine-and-headaches-how-to-deal-with.html

- lim ju boo 

 

 

Migraine and Headaches: How to Deal with Them?

 

Headache is one of the most common complaints that brings a patient to see a doctor. Unfortunately, most doctors would not know how to treat a headache, especially a chronic persistent headache, other than prescribing paracetamol. If paracetamol does not work long term, they will switch to nonsteroidal anti-inflammatory drugs (NSAIDs) such as propionic acids (naproxen, ibuprofen, diclofenac, indomethacin), mefenamic acid (ponstan), COX-2 selective NSAIDs, example, celecoxib and rofecoxib. We shall briefly discuss this later.

Some more qualified and experienced clinicians may prescribe other pharmaceuticals such as ergot alkaloids, isometheptene, or even to the extent of giving intranasal lidocaine, triptans, valproate, magnesium, and even narcotics. In short, clinicians are mostly pharmaceutical-oriented trained, and they have no or little clue in other systems of medicine for which may be even better, resulting in better or more permanent cure especially in chronic diseases.  

If drugs prescribed do not work long-term for headaches, clinicians may investigate by taking medical history asking for frequency, severity, and location of the attack. If a diagnose is uncertain they may refer the case to a neurologist who may proceed with erythrocyte sedimentation rate (ESR), a blood test to detect inflammation, MRI or CT scan of the brain, digital subtraction angiography to produce a picture of blood vessels in the brain, or a spinal tap, to determine bleeding in the brain or the presence of bacterial or fungal infection.  Depending on the medical history of headaches, they may refer the case to other specialists such as to an orthopaedic surgeon if it involves the bones and cartilages, to an ENT surgeon if the headache was due to some sinuses in the nose or head areas, or to an oncologist if the pain was due to a malignancy.

 If a doctor thinks your migraine or tension headache was due to stress, he might refer you to a psychiatrist, and the psychiatrist, instead of prescribing stress management, may prescribe you antidepressants drugs. If you are referred to an orthopaedic surgeon he might suggest surgery for your spine, bones, joints and cartilages, or to a dentist, he would offer the removal of your teeth. If you were to be referred to a neurologist, he might give you neurobion, analgesics and pain killers. They would not go into the root causes of your headaches. Everything a doctor prescribes would either be a drug or involves a scalpel or pilers to pluck it out.  

Unfortunately, most clinicians have no clue how to deal with migraine or tension headache using other therapeutic modalities other than drug-based analgesic approaches. But first, let’s have a look at what actually causes a headache most people suffer from.

Among all the headaches, literally 90 % are either migraine, with or without aura; tension-type headache (TTH); or a mixture of the two. Thirty-six percent of adult women in Malysia and 6 % men suffer from migraine.¹   The causes of the other headaches are secondary to disorders of the tissues of the head and neck, including the cervical spine, sinuses, temporomandibular joints, dental structures and soft tissue trauma and post-trauma syndrome, primary tumours, infection, metastatic cancers constituting a very small fraction of all the possible causes.

“Red flag” symptoms of life-threatening disorders include early morning headaches that awaken the patient; visual dimming or double vision; headaches that are increasing in frequency or severity over weeks or months; headaches made significantly worse by postural changes; explosive onset of new, serve head pain; and headaches associated with mental status change, focal motor or sensory deficit, syncope, seizure, fever or stiff neck.

Headaches in the setting of systemic illness, loss of weight, human immunodeficiency virus (HIV), or known malignancy clearly requires thorough investigations. Findings on examination that prompt further diagnostic workup include focal neurological signs, evidence of head and neck trauma, temporal artery tenderness, papilledema, nuchal rigidity, fever, and physical evidence of, local or systemic infection or malignancy.

Clinical guidelines are available for pharmacological prevention.² However, the emphasis should be on non-drug approaches in prevention of treatment especially for migraine as this constitutes most of the causes of headaches. Non-pharmacological intervention includes behavioural, nutritional, and complementary therapies that are effective in the prevention and treatment of migraine and tension-type headache. Let us first have a look at the pathophysiology of migraine.

Pathophysiology:

 

Characteristics typical of migraine include subacute onset of throbbing head pain, either one side (unilateral) or on both sides (bilateral) associated with nausea or vomiting, fear or intolerance to light (photophobia) and sound (sonophobia). Headaches are heralded by visual or other non-pain premonitory symptoms (aura) in about 20 – 30 % of those with migraine. The duration usually last for more than 4 hours and can last for as long as 72 hours with fluctuating intensity. ³ The precipitating factors can include menus, certain foods, stress, or letdown following stress changes in the weather, infection, fatigue and bright sunlight or by flashing lights, loud  speakers and loud music, as well as cigarette  smoke inside a nightclub or similar places.

While the origin of migraine pain is not fully understood, recent evidence points to the role for potential vasodilators, such as substance P and calcitonin gene-related peptide (CGRP), released by peripheral nerve endings of cranial nerve V on the blood vessels in the scalp and meninges. ⁴

This leads to sterile inflammation and oedema of the blood vessels, with increased sensitivity to mechanical stimulation, resulting in pain. Glutamate (MSG – monosodium glutamate: food flavouring agent) nitric oxide and vanilloid receptors are also implicated in migraine. Translation of this information to therapy has been very active. For instance, CGRP receptor antagonists are already in phase clinical trials. ^5,6  In the periphery of the nerve, MSG  release  of serotonin by platelets in the early stages seems to increase pain and prolong the headache. Centrally, the presence of a “headache generator” in the midbrain and pons is supported by findings from positron emission tomography studies obtained during migraine attacks. Genetic influences are evident in a majority of patients with one or more family members experiencing migraine. Although the individual attacks of migraine are often stereotypic, variation is not uncommon and comorbid tension-type headaches (TTH) is frequent. This means, patients with migraine often suffer from TTH and other forms of headache. A careful recorded history of headache symptom characteristics helps establish criteria that lead to diagnosis and helps highlight distinction that guides specific therapies. The management of headaches should be integrative rather than depending on conventional allopathic approaches that relies heavily on pharmaceutical intervention to prevent or abort headache with analgesics, and antiemetics as described above. Although these measures by themselves are generally effective in the management of symptoms, they are often expensive, come with significant side effects, drug toxicities, and they do not address the underlying physical, psychological, and energetic issues that cause headache. Patients with headache currently use a variety of alternative complementary therapies when regular use of drugs have not solved their problems.⁷

We shall not go in chapters writing on the various other therapeutic options available to patients suffering from migraines and TTH as these would be very technical and lengthy. What we can do is highlight some of them in summary form without their technical details of how they work. These include lifestyle modification, sleep hygiene, exercise, stress management among others we will describe shortly.

 

Nutrition and Contraceptive Pills:

 

Nutrition, and nutritional supplements and or botanical medicine have been shown to be very effective in the management of migraines and TTH.  Elimination of food triggers such as red wine, dark beers, aged cheese, some nuts, onions, chocolates, aspartame, processed meat containing nitrates such as in sausages, luncheon meat, corned beef is one of the most powerful preventive strategies. 

So is the use of contraceptive pills that trigger a migraine attack. Surprisingly, caffeine in coffee taken during a migraine attack can reduce migraine in some patients, and its withdrawal can temporarily exacerbate migraine or TTHs possibly due to vasoconstrictive effects on the scalp and meningeal vessels. Caffeine excess with over 5 cups of coffee a day can cause chronic daily headaches especially taken with certain medication.  

Diets containing large amounts of proinflammatory omega-6 fatty acids are also likely to aggravate migraine and TTH. In a study of 65 adults with chronic daily headache of which 85 % had chronic migraine, there was a significant improvement in headache severity and frequency in those on high omega-3 and low omega-6 fatty acid diet compared to baseline and compared to those on low omega-6 fatty acids diet alone. ⁸ The dietary intervention lasted 12 weeks. Food was provided in a standardized and controlled intake, and all subjects received regular dietary counselling throughout the intervention. Fatty acid supplements were not given. Clinical benefits were most pronounced in the last 4 weeks of the intervention.  Most striking were the correlation between clinical improvement and levels of omega-3-derived anti-inflammatory lipid mediators. Biochemical endpoints correlated closely with clinical improvement in pain and psychological distress. ⁹

Obesity and metabolic syndrome have also been found to be associated with migraine and chronic headaches, perhaps related to the proinflammatory state associated with these conditions. ^{10 – 12} Inflammatory bowel disorders also have a higher incidence of migraine. ¹³ Treatment implications for migraine in these conditions, while not fully defined, favour integration of dietary choice with other forms of treatment.

Very, very briefly without going into very lengthy details, their dosages, and citations of studies done, it was found that magnesium, riboflavin (vitamin B2), coenzyme Q10, omega-3 fish oil significantly reduces the frequency and severity of migraine and TTH. ¹⁴

 

Lifestyle:

 

Effective management of migraine requires a careful assessment of lifestyle issues related to sleep, nutrition, exercise, stress management, and social relationship. Regular mealtimes, developing an exercise routine and correcting poor sleep can significantly reduce the frequency of migraine. ¹⁵ Adequate sleep and sleep hygiene are easy to follow, and this often leads to a decrease in the severity and frequency of migraine attacks.

 

Botanical Medicines:

Feverfew (Tanacetum parthenium leaf) has been found to be very effective in treating migraines. Johnson et al. reported a significant increase in migraine severity and frequency when feverfew was stopped in small group of migraine sufferers taking it for prevention.¹⁵ In one well-designed study, a 70 % reduction in in headache frequency and severity was shown in 270 patients with migraine. ¹⁶ Variations in the standardization of the dried leaves constituents cofound replication studies of this herb. A reproducibly manufactured extract of feverfew has shown preventive efficacy in a double-blind randomized controlled trial. ¹⁷ There are no head-to-head trials with other preventive medications. The mechanism of action using feverfew in migraine may be related to its inhibiting effects on platelet aggregation and inflammatory promoters, such as serotonin and prostaglandins, or possibly its effect in dampening vascular reactivity to amine regulators of blood flow. The oral administration of feverfew up to 125 mg / day of the dried leave standardized to a minimum of 0.2 % parthenolide. Beneficial effects may take weeks to develop.  Aphthous ulcers and gastrointestinal irritation develop in 5 % - 15 % of feverfew users. Abrupt cessation of feverfew sometimes results in agitation and increased headache, else feverfew is an effective alternative to drug-based treatment. It is not recommended during pregnancy due to prolongation of bleeding times.

 

Butterbur (Petasites hybridus Root)

 

In a large, three-arm, dose-finding RCT of a standardised extract of the root of this perennial shrub, it was found that migraine attack frequency was reduced by almost 50 %. Among those on the highest dose, 68 % had a 50 % or greater reduction in headache frequency. ¹⁸ This effect continued for at least 4 months. One smaller study showed similar results.¹⁹ and in another study in 108 children and adolescence with migraine also showed the same therapeutic results ²⁰ One study that compared butterbur root extract to both music therapy and placebo in the prevention of migraine in children had mixed findings with butterbur demonstrating efficacy compared to placebo in the long-term follow-up. ²¹ A systematic review of the published literature on the effectiveness of P. bybridus revealed that higher dose extracts (150 mg) were associated with a lower frequency of migraine attacks after 3 – 4 months compared to a lower dose and placebo .²² The extract is commonly standardized to 15 % of the marker molecule (petasins) and known carcinogen are removed. Drug-herb interactions have not been studied. The dose for butterbur is 50 mg three times a day for 1 month, 50 mg twice a day.

 

 

 Sleep Medicine:

 

Sleep management is the major therapeutic strategy in helping patients gain control over their headaches. Melatonin and valerian root can be used on a temporary basis to improve sleep. Melatonin is used in the management of migraine to improve sleep and circadian rhythms. Melatonin is recommended every night for 4 -6 weeks and then tapered off. During that period, a sleep hygiene program can be put in place to reduce the need for melatonin supplement. Melatonin has very few side effects such as fatigue, drowsiness, dizziness, abdominal cramps and irritability, but these are rare.  Leone and coworkers demonstrated that a daily intake of 10 mg of melatonin for 14 days significantly reduced cluster headache frequency. ¹⁶ Others have shown beneficial effects of melatonin in migraine and other types of headaches including migraine prevention in children. ^{23, 24, 25}

However, a crossover study comparing extended-release melatonin at a dose of 2 mg 1 hour before bedtime did not demonstrate improvement in migraine frequency compared to placebo. ²⁶ The dosage for melatonin is 2 - 12 mg, start at 2 mg and titrate up to 4 days as needed for sleep. Lower doses are needed if taken each evening for several weeks. Higher doses > 15 mg are needed to acutely sleep over several days such as in jet lag.  

Another natural botanical medicine for sleep is valerian (Valeriana officinalis Root). When taken at night for sleep, valerian rarely result in residue drowsiness on awakening. It is non-addictive and useful as an anxiolytic when given in the daytime up to 250 mg three times a day.  It does not impair psychomotor or cognitive performance. ²¹ The mechanism of action includes stimulation of the central nervous system gamma-aminobutyric acid (GABA) receptors along with enhanced release and inhibition of reuptake of GABA.

In clinical trials, including the use of for sleep and anxiety, it has been shown to be safe. ^{27, 28, 29, 30, 31, 32}  Gastrointestinal irritation is the most common side effect at 15 %.  The dosage for valerian is 100 -300 mg of the extract standardized to 0.8 % valerenate at bedtime or 250 mg every 6 hour for anxiety. The precaution is, it may aggravate nausea during migraine due to its unpleasant smell if not encapsulated. It may worsen TTH if taken for more than 3 months. It is contraindicated during pregnancy.

 

Pharmaceutical Approaches:

 

There is no inherent difficulty in integrating conventional drug -based with complementary approaches in the management of migraines and headaches.

We shall not go into the pharmacology of drug-based interventions as this makes this brief article far too lengthy. We shall drastically cut this down by mentioning preventive pharmaceutical therapies into categories, namely, preventive pharmaceutical therapies that includes the use of tricyclic antidepressants such as amitriptyline in doses up to 150 mg at bedtime, starting as low as 10 mg for prevention. Beta-blockers such as propranolol, nadolol, timolol, atenolol and metoprolol, and also calcium channel blockers along with anti-convulsant such as sodium valproate, gabapentin, topiramate, zonisamide and levetiracetam has also been prescribed. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirins, naproxen, ketoprofen and tolfenamic acid and ketoprofen including even botulinum toxins in conventional medical treatment of migraines.

 

In abortive pharmaceutical therapies other drugs such as ergot alkaloids, isometheptene , intra nasal lidocaine and the triptans (5-hydroxytryptamine receptors 1B / ID agonists ) have also been used. We shall not go into all these drugs and their pharmacodynamics as this article on migraine and headaches is not on pharmacology.

 

We have not even touch on other non-drug therapies such as mind-body techniques, biofeedback, relaxation techniques, cognitive-behavioural therapy, hypnosis, mindfulness meditation, biomechanical and physical techniques, spinal manipulation in chiropractic and osteopathic manipulation approaches, bioenergetics such as acupuncture and homeopathic and Traditional Chinese Medicine in the effective management of migraines and tension headaches. To discuss and explain their dynamics and clinical efficacies will take an estimated another 30 - 40 pages to type. That attempt itself will give me an acute tension headache I wish to prevent and will not be able to solve unless I stop writing here to allow me to rest. 

I hope I have not given you a headache reading my blog articles. 

If not, thank you for reading and kindly write a comment in the comment column below each article. I will appreciate this very, very much.  

 

Liver Diseases, Epidemiology, Presentations, Diagnosis, and Integrated Treatment

Liver Diseases, Epidemiology, Presentations, Diagnosis, and Integrated Treatment  

A paper “Chronic Viral Hepatitis in Malaysia: "Where are we now?" was published online by Ruksana Raihan, Rosmawati Mohamed, Muhammad Radzi Abu Hassan, and Rosaida Md Said here:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663777/

We shall discuss this further and separately with different other views:

Pathophysiology:

Chronic hepatitis is not confined only to Malaysia but is a worldwide problem. This disease is characterized by hepatic-necrosis and inflammatory cell infiltration which is most commonly caused by viral and toxic agents. Deemed chronic when persisting for longer than 6 months. Hepatitis triggers an ongoing inflammation that oftens leads to fibrosis and eventually cirrhosis, with a concomitant increased risk of hepatocellular carcinoma. 

Chronic hepatitis may develop due to a variety of aetiology, either in isolation or in combination such as: 

hepatitis viruses causing hepatitis B (+ / - hepatitis D), and hepatitis C. It can also be caused by toxins and medications such as ethanol, methyldopa, isoniazid, nitrofurantoin, amiodaron, or even by aflatoxins especially from mouldy peanuts where aflatoxins are produced by the micro fungi Aspergillus flavus especially in hot humid countries like Malaysia, Africa, and other tropical countries. Constant ingestion of contaminated peanuts or peanut sauce or their products can lead to cancer of the liver.   The majority of individuals develop chronic hepatitis without a recent recognizable acute clinical illness or obvious symptoms. The condition is typically insidious and slowly progressive, declaring itself clinically only after cirrhosis develops with accompanying signs and symptoms. 

Hepatitis C is the most common cause of chronic viral hepatitis in Malaysia and elsewhere in the world accounting to approximately 3/4 of all cases.^1,2 Given its high prevalence and clinical implications, chronic hepatitis C (CHC) is the focus of this article. Integrative treatment aimed at controlling hepatitis inflammation and its sequelae underlying the pathogenesis of CHC are applicable to other liver disorders that share a similar pathophysiology. 

The hepatitis C virus (HCV) is hepatotropic but minimally cytopathic. The detrimental effects of chronic infection arise predominantly from the ongoing inflammation, which causes marked oxidative stress. In the presence of ongoing hepatic necrosis, connective tissues are laid down as the body attempts repair. Accumulation of extracellular connective tissues lead to fibrosis which progresses predictably, in stage 0 where there is no fibrosis, stage 1, confines to enlarged portal zone, stage 2, periportal or portal-portal septa with intact architecture, stage 3, architectural distortion (septal fibrosis bridging) without obvious cirrhosis, and lastly, stage 4 with probable or definite cirrhosis. 

Cirrhosis is the final stage of the fibrotic process, characterized by diffused hepatocyte damage, nodular regeneration, and aberrant architecture accompanied by impaired hepatocyte function and impeded portal blood flow. The histopathological hallmarks of chronic hepatitis are hepatic necrosis, mononuclear infiltration, and fibrosis, which serves as the primary indicator of hepatic injury. Fibrosis and cirrhosis are assessed directly with liver biopsy or indirectly with non-invasive testing, including transient elastography and blood markers, such as platelet count, hyaluronic acid, procollagen type 3 N-terminal peptide, and tissue inhibitor of matrix metalloproteinase. ^1,3

 Chronic inflammation due to hepatic infection results in free radical production, fibrosis, cirrhosis, and hepatocellular carcinoma. Advanced fibrosis and cirrhosis are associated with increased risk of hepatocellular carcinoma (HCC). CHC is the leading cause of HCC worldwide with approximately 5 % to 12 % incidence per year among individuals with HCV-related cirrhosis. ⁴   Liver cancer incidence in developed countries like in the United States tripled between 1975 and 2005 and doubled that in 2023. We have no statistics for Malaysia.  Although the 1-year-cause-specific for HCC has increased from 25 % in 1992 to 47 % in 2004.^3, overall, 3-year survival remains approximately 17 %.⁷

With the recent introduction of direct-acting antivirals (DAAs), curative-intent treatment is recommended for all adults with CHC.⁸ Fibrotic stage, however, is a primary consideration in determining the relative urgency of antiviral treatment.  Approximately 5 % to 20 % of individuals with CHC develop cirrhosis over 20 - 30 years.^{9 - 11} The result s of prospective observational studies and outcome modelling projection indicates the risk of CHC disease progression to severe fibrosis or cirrhosis is minimal at 10 to 15 years in individuals with persistently normal alanine aminotransferase (ALT) levels, but greater than 30 % to 40 % in those with elevated serum ALT levels and portal fibrosis.^{9 ,12} Because clinical findings and liver enzymes levels do not predictably correlate with hepatic histological features, cirrhosis cannot be ruled out based on clinical and laboratory assessment alone. ^13,14 Non-histological factors associated with accelerated CHC progression in genotype males are: age > 40 years at the time of the time of initial infection, heavy alcoholism, daily marijuana use, obesity, and or insulin resistance, genotype 3 infection, coinfection with HIV and or, HBV, organ transplant.  Viral load is notably absent as it has not been found to correlate with disease progression. 

We shall discuss this further along with free radicals, liver detoxification enhancing therapy,  the use of pharmaceuticals, direct-acting HCV antivirals, clinical factors that increase priority for antiviral hepatitis C treatment, ribavirin, treatment response, hepatitis A and B vaccination, nutritional supplements such as glutathione, vitamins C, E, selenium, and S-Adenosylmethionine, herbal medicines such as Schizandra (Schisandra chinensis) that has long been used in Traditional Chinese Medicine, and other traditional Chinese botanical medicines, together with mind-body therapy, lifestyle interventions such as reducing dietary toxin exposures.

However, may take an estimated of another 60,000 words to complete this article. This would amount to almost writing out an MSc dissertation in nutritional and medical toxicology, and may not be worthwhile my efforts, unless readers request for this. 

I have also left typing out all the cited references as this is not a research paper, but meant only for clinicians, scientifically oriented readers and other interested readers.  

 

 

 

 

Colorectal Cancer: Prevention, Screening, Diagnosis, Conventional Treatment and Integrated Therapeutic Modalities

 

In Malaysia there were 48,639 cases of cancers recorded in 2020 of which breast cancer is leading with 8,418 (17.3 %), colon and rectum (CRC) at 6,597 cases (13.6 %), lung cancer with 5,139 cases (10. 6 %), nasopharyngeal cancer, 2,222 cases (4.6 %) liver cancer, 2,149 cases (4.4 %) and other cancers with 24,114 cases (49.6 %). We can clearly see colorectal cancer or CRC for short, is the second most common cancer after breast cancer in this country as shown in this 2020 epidemiological statistics. 

 Most colorectal cancers begin as a noncancerous polyp, which can be detected during a routine screening by colonoscopy. From the time the first abnormal cells start to grow into polyps, it takes about 10 - 15 years for them to develop into colorectal cancer (CRC). Adenomatous polyps have a higher chance of turning into cancer, while hyperplastic and inflammatory polyps are not precancerous ². Dysplasia is a type of precancerous condition that is usually seen in people with long-standing ulcerative colitis or Crohn's disease as these conditions cause chronic inflammation of the colon. If cancer forms in the polyp or dysplastic area, it can invade the wall of the colon or rectum locally and progress via lymphatic or hematogenous spread. Patients with oligometastatic disease, where only one or two lesions are present in an organ such as the lungs (already written on this in this blog of mine), or liver (shall write on this later), can still experience long-term disease-free survival after treatment. 

 

Incidence and Prevalence:

 

The lifetime risk for developing CRC is about 1 in 20 (5 %), and it is 60 % more common in developed countries especially among meat-eaters. For instance, the incidence of colorectal cancer is 5 times higher among the Scots than among the South Indians in India whose diet is predominantly curry where salicylates (aspirin) are present and are plant-based, especially among vegetarians and vegans. In the UK, the same observations were seen among the Pakistanis living there compared to the local British whose diet is almost absent in curries and mainly meat based.  

 

In Malaysia, the incidence of CRC is highest among the  Chinese who eat a lot of the more expensive  meat, virtually no curry, followed by the Malays with a significant amount of curries in the diet, and lowest among and Southern Indians in the  country but higher than those in south India, the reason probably is because the Indians in Malaysia especially the richer Indian families in the cities often go to Chinese restaurants to eat Chinese food? However, this needs to be investigated further. Elsewhere outside Malaysia, for example, in the United States it is the leading cause of cancer-related cause of death. The risk of CRC is lower in women than in men. Survival rates have been improving possibly due to public awareness for higher rates of screening, improvement in therapeutic regimens, and the adoption of healthier dietary lifestyles and nutritional habits.

 

Screening: 

Regular screening can detect CRC early which gives it the best chance of curable and survival. In most people, screening can prevent CRC altogether because polyps can be seen and surgically removed before they become cancerous. CRC screening includes the presence of occult blood in the stool, especially the more sensitive guaiac-based faecal occult blood test (gFOBT) and the faecal immunochemical test (FIT), both of which are used to detect blood in the stool; together with a stool DNA test to check for polyps and cancer; together with sigmoidoscopy, colonoscopy, and computed tomography (CT) colonography, which directly visualize the polyp or cancer. The frequencies of screening are as follows: gFOBT / FIT annually, stool DNA test every 3 years, sigmoidoscopy every 5 years with gFOBT / FIT every 3 years, or colonoscopy every 10 years. One in three adults aged 50 - 75 has not been screened for CRC as recommended in the United States Preventive Services Task Force, and possibly none of these are done in Malaysia or in less developed countries.

Symptoms of CRC are vague and non-specific, to include blood in the stool during defecation which is often mistaken as internal piles. Sometimes it is presented as persistent abdominal pains, unexplained weight loss which are already late into the disease. It is imperative that clinicians should encourage their patients to go for routine screening for CRC. The number needed to screen (NNS) to detect one case of colon cancer is 154 for colonoscopy, 166 for stool DNA panel, and 208 for faecal immunochemical testing. ³

 

Risk Factors:

 

Regular screening and removal of polyps with colonoscopy reduces the risk of developing CRC by at least as high as 90 -95 % People with a first degree relative who has CRC have a two to three chance of developing the disease compared with those with no family history. Approximately 20 % of all CRC patients have a close relative who was diagnosed with the disease. About 5 % of individuals with CRC have a genetic syndrome that triggers this disease. These individuals should have more screening frequencies based on their risk.⁴

 

Primary and Secondary Prevention:

 

The modifiable risk factors such as nutrition and dietary lifestyles greatly reduces the chance of individuals developing CRC even though changes of dietary lifestyle from a constant meat-eater into a vegetarian or a vegan diet is not easy to follow for most people. Clinicians and nutritionists can use motivational interviewing methods to guide people on how to achieve sustainable health practices It has been shown that up to 70 % of CRC has been prevented by nutritional and lifestyle changes. ⁵

Integrative Therapeutic Modalities:

We shall go into integrative therapy and dietary intervention later. We shall stop here for the moment as I have at least 80 % more to write here to include conventional treatment, nutritional intevention, exercise, mind-body therapy supplements with calcium citrate, retinol, vitamins D3, B6, curcumin folic acid, the use of aspirin or salicylates, accupuncture support, and other therapeutic inteventions, such as the use  of ginger root, L-glutamine 10 g three times a day during the first 7 days of chemotherapy, and acetyl-L-catnitine 1 gram tds to reduce fatgiue and neuropathy.  

As this article has still another about 80 % more to go for the above integrative therapeutic modalities in the above last paragrah, it would be very time and effort consuming to continue, unless readers request personally, and I shall write the remaining part personally only for him or for her. 

 

Lung Cancer: Conventional Treatment and Other Integrated Therapeutic Modalities

 

Lung cancer is one of the major causes of death.  It is the 2nd most common cancer worldwide, more common in men and the 2nd most common cancer in women.

There were more than 2.5 million new cases of lung cancer in 2020.

In Malaysia lung cancer accounts for approximately 10.6 % out of a total of 48,639 of all malignancies in 2020. The most common cancers in Malaysia in 2020 are: breast (17.3 %) colorectal (13.6 %), lung (10.6 %), nasopharyngeal (4.6 %), liver (4.4 %) and others (48.6 %)

 The lifetime risk is approximately 1 in 55 for Malaysian males. The risk is highest in Chinese males (1 in 43), followed by Malays (1 in 62) and Indians (1 in 103). For women, the risk is approximately 1 in 135, although in recent years the incidence of lung cancer has shown an increase in women even though females are less likely to smoke compared to males. The age-standardized incidence rate of lung cancer increases rapidly from age 45 years and is highest in the 60- to 74-year-old age group. Nearly 90% of lung cancer patients in Malaysia are diagnosed with stage III or IV disease. 

 

Pathophysiology:

 

The classical bifurcation of lung cancer is non-small cell lung cancer (NSCLC), the more common type, and small cell lung cancer (SCLC). SCLC is typically less amenable to surgical resection, whereas NSCLC can more often be treated with surgery. NSCLC can be divided into three major histological subtypes, namely, squamous cell carcinoma, adenocarcinoma, and large cell lung cancer. It is also possible for lung cancers that have mixed features to be identified as mixed small cell and large cell cancer.

 

Signs and Symptoms:

 

Symptoms do not normally occur until the cancer is advanced and can include persistent cough, haemoptysis, chest pain, voice change, example hoarseness, worsening shortness of breath, recurrent pneumonia, or bronchitis. 

 

Risk Factors:

 

Smoking and Tobacco Use:

 

Cigarette smoking is by far the most important risk factor for lung cancer, wherein risk increases with both the quantity and duration of smoking^.1 Approximately 90 % of lung cancers are the result of tobacco use, and the risk of a smoker developing lung cancer is 25 times greater than that of a non-smoker. Smoking is strongly linked with SCLC and squamous cell carcinoma, and adenocarcinoma is the most common type in patients who have never smoked^.3 

 

Environmental Carcinogen:

 

Environmental risk factors that have been implicated in lung cancer includes exposure to radon as the second most common cause, second-hand smoke, asbestos, metals like chromium and cadmium, tar exposure, arsenic, certain organic chemicals such as bis(chloromethyl) ether, silica, radiation exposure, air pollution, and diesel exhaust. Certain occupations may increase exposure to lung carcinogens, including rubber manufacturing, paving, painting, and chimney sweeping in cold countries. In addition to asbestos exposure, cigarette smoking greatly increases the chances of an asbestos-related lung cancer. 

 

Genetic and Biomarkers:

 

Lung cancer is a complex and heterogeneous disease, not only at the biochemical level involving genes, protein, metabolites, but also at the tissue, organism, and population level.⁴ There are many early detection biomarkers for lung cancer, including both tissue and biofluid-based biomarkers such as airway epithelium, sputum, blood, and exhaled breath. Mutation in p53 has been seen in chronic smokers before there is evidence of neoplasia, making it a potentially useful predictor of lung cancer. Due to the heterogeneity of lung cancer, detection by one single biomarker remains difficult. Panels of biomarkers can be useful, but these frequently have overlap with other diseases, especially other cancers and inflammatory conditions. ⁵

 

Screening and Detection: 

 

Compared with standard chest X-ray (CXR), screening with spiral computed tomography (CT) has been shown to reduce lung cancer-related deaths by 16-20 % among adults with a 30 pack-year history who were current smokers or who had quit within the past 15 years. Current American Cancer Society guidelines suggest discussing utilization of low dose helical CT (LDCT) in current or former smokers aged 55 - 74 years in good health with at least a 30 pack-year history of smoking. A "pack-year " is the packs of cigarettes smoked a day (1 pack = 20 cigarettes) multiplied by the number of years smoked. "Clinicians with access to high-volume, high -quality lung cancer screening and treatment centres should initiate a discussion about lung cancer screening with apparently healthy patients ages 55-74 who have at least a 30 pack-year smoking history and who currently smoke or have quit within the past 15 years. A process of informed and shared decision making with a clinician related to the potential benefit, limitations, and harms associated with screening for lung cancer with LDCT should occur before any decision is made to initiate lung cancer screening. Smoking cessation counselling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk for lung cancer. Screening should be viewed as an alternative to smoking cessation.

 

Low-dose helical CT (LDCT) is recommended annually starting at age of 55 till 79 in those with a 30 pack-year smoking history. This recommendation continues if a nodule measuring </- 4 mm is found. For nodules that measure 4-6 mm repeat LDCT in 6 months. If the nodule grows to 6 -8 mm or greater, radiology may recommend positron emission tomography (PET) / CT or bronchoscopy based on nodule characteristics.

 

Chest Radiography: 

 

CXR is no longer recommended as the screening technique for lung cancer and is less useful than newer technologies such as LDCT. According to the large Prostate, Lung, Colorectal, and Ovarian cancer screening trial published in 2011, annual screening with chest radiography did not reduce lung cancer mortality when compared with a "usual care" group who did not receive an annual chest radiography.⁷

 

Sputum Cytology:

 

This technique is more likely to be helpful in the detection of cancer that start in the major airways, such as squamous cell lung cancer.⁸ According to four prospective randomized controlled studies of lung cancer screening using a combination of CXR and sputum cytology there is no significant reduction in lung cancer mortality associated with an invitation to undergo sputum cytology screening. 

 

Positron Emission Tomography (PET):

 

Not all patients with lung cancer will require a PET scan; however, it can be a useful tool for determining cancer staging.⁹ It can be effective for determining the level of tissue activity and is more effective than CT in distinguishing between benign and malignant lesion. ¹⁰ Glucose uptake alone is nonspecific because it can be increased with inflammatory conditions.

 

Laser Bronchoscopy:

 

Conventional white-light bronchoscopy (WLB) alone identifies the lesion in only 29 % of cases. ¹¹

 

Conventional Treatment: 

 

Conventional treatment includes surgery, radiofrequency ablation (RFA), radiation therapy, chemotherapies, targeted therapies, and immunotherapy. Palliative therapies may also be used to help with symptoms. 

 

Surgery:

 

Surgery to remove lung cancer may be an option for early-stage NSCLC. More advanced lung cancer, especially with metastasis, may not be helpful by surgery. If surgery can be done early, it provides the best chance to cure NSCLC. The risk for serious consequences is high ⁸ Types of lung surgery includes pneumonectomy, lobectomy, and segmentectomy (wedge resection). 

 

Radiofrequency Ablation:

 

RFA may be useful for some small cell NSCLC tumours that are near the edge of the lungs, especially in people who cannot tolerate surgery. In RFA, a thin probe is used to heat the tumour to destroy the cancer cells. This is typically done as an outpatient procedure. Major complications are uncommon but can include a partial collapse of the lungs or bleeding into the lungs. ⁸        

 

Chemotherapy:

 

Patients with SCLC are frequently treated with chemotherapy. If the disease is in a limited stage, radiation therapy and rarely surgery may be used for SCLC. ²⁰ The side effects of treatment with chemotherapy for SCLC include hair loss, mouth scores, loss of appetite, nausea, vomiting, diarrhoea, constipation, immunodeficiency such as myelosuppression (decreased blood cell counts).

   easy bruising, and fatigue 

 

The list of chemo drugs used are:  

 

1. Platinum-Based Chemotherapy:
• Cisplatin
• Carboplatin
2. Paclitaxel and Docetaxel:
• Paclitaxel
• Docetaxel
3. Vinorelbine
4. Gemcitabine
5. Epidermal Growth Factor Receptor (EGFR) Inhibitors:
• Erlotinib
• Gefitinib
• Afatinib
• Osimertinib (for patients with EGFR mutations)
6. Anaplastic Lymphoma Kinase (ALK) Inhibitors:
• Crizotinib
• Ceritinib
• Alectinib
• Lorlatinib
7. Programmed Death-Ligand 1 (PD-L1) Inhibitors:
• Pembrolizumab
• Atezolizumab
• Durvalumab
• Nivolumab
8. Tyrosine Kinase Inhibitors (TKIs):
• Bevacizumab (targets vascular endothelial growth factor, VEGF)

Side effects of these drugs can vary, and not everyone will experience the same side effects. Common side effects may include fatigue, nausea and vomiting (antiemetic) diarrhoea, hair loss, and myelosuppression (decreased blood cell counts).

 

Radiation Therapy: 

 

The two major types of radiation therapy include external beam radiation therapy (EBRT) and brachytherapy, a type of internal radiation therapy. The use of EBRT is less common than in the past because there are newer treatments that allow for greater accuracy. ⁸ When radiation is given with chemotherapy, the side effects are often worse. 

 

Fever therapy or pyrotherapy (artificial fever):

Induced fever is another method of treatment by raising the body temperature or sustaining an elevated body temperature using a fever. In general, the body temperature was maintained at 41 ° C (105 ° F). Many diseases were treated by this method in the first half of the 20th century. In general, it was done by exposing the patient to hot baths, warm air, or (electric) blankets. The technique reached its peak of sophistication in the early 20^th century with malariotherapy, in which Plasmodium vivax, a causative agent of malaria, was allowed to infect already ill patients in order to produce intense fever for therapeutic ends. The sophistication of this approach lay in using effective anti-malarial drugs to control the P. vivax infection, while maintaining the fever it causes to the detriment of other, ongoing, and then-incurable infections present in the patient, such as late-stage syphilis. This type of pyrotherapy was most famously used by psychiatrist Julius Wagner-Jauregg, who won the Nobel Prize for Medicine in 1927 for his elaboration of the procedure in treating neurosyphilis. However, this method of using malarial parasite to induce a fever is no longer used but is replaced by the term ‘hyperthermia therapy’ today which is essentially the same thing serving the same purpose of elevating the body temperature to levels higher than normal (typically around 41-45° C) using external methods such as heat blankets, warm water immersion, or focused microwave or radiofrequency energy. Today fever therapy is used as a treatment for cancer because high temperatures can damage and kill cancer cells.

It's commonly used in cancer treatment as a complementary therapy alongside other treatments like chemotherapy or radiation therapy. The elevated temperature can help in several ways:

1. Direct Cell Damage: High temperatures can directly damage and kill cancer cells.
2. Sensitizing Effect: Hyperthermia can make cancer cells more sensitive to radiation or chemotherapy, enhancing the effectiveness of these treatments.
3. Immune System Stimulation: It may also stimulate the body's immune response, aiding in the destruction of cancer cells.

Overall, hyperthermia treatment can be effective in certain cases of cancer treatment, especially when combined with other therapies. However, its effectiveness varies depending on factors such as the type and stage of cancer, as well as individual patient factors. It's often used as part of a comprehensive treatment plan tailored to each patient's specific needs.

Alternative Therapies to Consider:

Research is ongoing at various stages with herbal and natural preparations with astragalus, ginseng, pomegranate, rosemary, sage, parsley, oregano, and various combinations of Chinese herbs, although conclusive evidence may not be apparent yet. Another potential anti-cancer herb is Sabah snake grass (Clinacanthus nutans) and lemon grass or serai, in the Malay language. See some of the many scientific papers published on the use of lemon grass for the treatment of cancers here: 

   https://www.scielo.br/j/cta/a/YwZrtspBFZZMFxrPrMK9Lvs/?format=pdf&lang=en#:~:text=Lemongrass%20extract%20possesses%20potent%20anticancer,Cancer%20Therapies%2C%2018%2C%201534735419889150.

https://www.thenaturalhealthmarket.co.uk/blog/lemongrass-tea-kills-cancer-cells-fact-or-fantastical-thinking/

https://www.researchgate.net/publication/265842609_Anticancer_effect_of_lemongrass_oil_and_citral_on_cervical_cancer_cell_lines

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918039/

https://www.nature.com/articles/nindia.2014.45

https://www.sciencedirect.com/science/article/abs/pii/S1773224723000357

Here is just one research paper among several dozen published on the use of Clinacanthus nutans (Sabah snake grass) for treating cancers. https://www.hindawi.com/journals/ecam/2021/5560502/

Patients with lung cancer and other poor-outlook cancers are particularly vulnerable to heavily promoted claims for unproven or disproven "alternatives". Inquiring about the patients' uses of these therapies should be routine because these practices may be harmful and can delay or impair treatment. However, physician-guided mind-body modalities and massage therapy can reduce anxiety, mood disturbances, and chronic pain. Acupuncture can assist in the control of pain and other side effects and help reduce quantities of pain medication that may be required. 

Yoga:

Some controlled trials suggest yoga is beneficial for chemotherapy-induced nausea, anticipatory nausea, pain, invigoration, acceptance, fatigue, and appetite loss, and can decrease salivary cortisol levels. Investigators also report a positive dose-response relationship. 

Massage:

Massage therapy, an effective adjunct to cancer supportive care, can reduce anxiety, depression, and pain. The evidence that supports its effect on anxiety is stronger than that on depression. 

Exercise-Based Pulmonary Rehabilitation:

Overall, the studies published to date suggest that short-term (6 - 8 weeks), low-intensity, multidisciplinary, exercise-based rehabilitation is potentially feasible and safe for select patients with inoperable NSCLC. The preliminary data further suggest that low-intensity, multidisciplinary, exercise-based rehabilitation is associated with modest improvements in exercise tolerance and functional capacity endpoints in select patients who are able to tolerate and achieve reasonable adherence.

Acupuncture:

Acupuncture is a relatively safe and minimally invasive modality that may be useful for treating symptoms of lung cancer and side effects of anticancer treatment. A small case series showed some improvement in both an analogue pain scale and well-being score for patients with lung cancer. Overall, there is a lack of data on whether acupuncture could be useful in the treatment of chemotherapy-induced peripheral neuropathy. 

 

Nutrition: 

Nausea and vomiting are common side effects of chemotherapy treatments. There are numerous methods for treating chemotherapy-related nausea, including corticosteroids, dopamine antagonists, serotonin antagonists, benzodiazepines, aprepitant, and cannabinoids. One of the best natural medicines for nausea is ginger. Ginger can also be recommended for both its anti-nausea and anti-cancer benefits ¹⁵ Generally a diet rich in non-starchy vegetables and fruits and low in red meat is recommended B-complex vitamins, tea, and cruciferous vegetables can also be recommended. For patients with weight loss, nutritional supplements may be recommended along with a diet rich in protein while still limiting red meat consumption. In patients with sarcopenia, supplementation with n-3 fatty acids may be beneficial.¹³ Oral supplementation of eicosapentaenoic acid (EPA) in patients with NSCLC significantly improves energy, protein intake, and body composition, while decreasing fatigue, neuropathy, loss of appetite, according to a randomized trial. ¹⁶

Curcumin is a food and herbal medicine, scientifically called diferuloylmethane. It is a hydrophobic polyphenol that is the main curcuminoid of turmeric. "The mechanism implicated as a good natural anticancer medicine in the inhibition of tumour genesis by curcumin are diverse and appear to involve a combination of anti-inflammatory, antioxidant, immunomodulatory, proapoptotic, and anti-angiogenic properties via pleiotropic effects on genes and signalling pathways at multiple levels. ¹⁷ Gene inhibition of cyclooxygenase (COX)-2 is thought to be the main anti-inflammatory activity of curcumin. Curcumin tends to be well tolerated, however, its systemic bioavailability after dosing is poor, which may limit its effectiveness outside the gastrointestinal tract. However, pipevine, a major component of black pepper, has been shown to increase the bioavailability of curcumin.¹⁸ 

Prevention:

Smoking cessation continues to be the most important factor in reducing the risk for lung cancer. People who discontinue smoking, even well into middle age, avoid most of the subsequent risk for lung cancer, and discontinue smoking before middle age avoids more than 90 % of the risk attributable toobacco^.19

However, in recent years women who hardly smoke unlike men are also found to develop lung cancer for reasons unknown to medical scientists.