Headache

Two boats in Antigua. (Dr. Noorali Bharwani)
Two boats in Antigua. (Dr. Noorali Bharwani)

Headache is not an uncommon symptom. Headache can be on one or both sides of the head. It can radiate across the head.

The type of pain one experiences can vary a lot. A headache may appear as a sharp pain, a throbbing sensation or a dull ache. Headaches can develop gradually or suddenly, and may last from less than an hour to several days.

There are many causes of headache. It can be a sign of stress or emotional distress. It can be due to migraine or high blood pressure, anxiety, or depression. In some cases, there may be evidence of a tumour. Tumour can be benign like meningioma or malignant.

If a person has severe or persistent headache then further investigation is warranted. Urgent medical attention is required if you have weakness, dizziness, sudden loss of balance. Other symptoms requiring urgent attention are numbness or tingling, or you cannot move your body. Majority of the headaches are due to migraine or tension. A headache can be a symptom of a serious condition, such as a stroke, meningitis or encephalitis.

Investigating headache

Radiological investigation of headache is done by having CT scan or MRI. One test usually supplements the other.

The biggest difference is MRIs (magnetic resonance imaging) use radio waves and CT (computed tomography) scans use X-rays. There is some radiation exposure with CT scan. While both are relatively low risk, there are differences that may make each one a better option depending on the circumstances. Usually CT scan is done first and if that does not answer the question then MRI is done next.

Most of the time you do not need these tests. Often these tests are not helpful.

Doctors see many patients for headaches. And most of them have migraines or headaches caused by tension. Both kinds of headaches can be very painful. But a CT scan or an MRI rarely shows why the headache occurs. And they do not help you ease the pain, says Choosing Wisely (2016 Consumer Reports developed in cooperation with the American College of Radiology).

From the individual’s medical history and physical examination, a doctor can diagnose most headaches during an office visit. If your medical history and exam are normal, radiological tests usually will not show a serious problem. The results of your test may also be unclear. This can lead to more tests and even treatment that you do not need.

When should you have CT scan and/or MRI test for headache?

In some cases, a doctor may order a CT scan or an MRI if your physical exam finds something that is not normal.

You may also need a CT scan or an MRI if you have unusual headaches. Go to a hospital emergency room or call 911 if:

  1. you’re experiencing the worst headache of your life, a sudden, severe headache
  2. you have headaches that are sudden or feel like something is bursting inside your head
  3. your headaches are different from other headaches you’ve had, especially if you are age 50 or older
  4. your headaches happen after you have been physically active
  5. you have headaches with other serious symptoms, such as a loss of control, a seizure or fit, or a change in speech or alertness
  6. it occurs more often than usual
  7. they are more severe than usual
  8. it worsens or don’t improve with appropriate use of over-the-counter drugs
  9. it keeps you from working, sleeping or participating in normal activities
  10. it causes you distress, and you would like to find treatment options that enable you to control them better

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Artificial Intelligence in Medicine

Granada, Spain. (Dr. Noorali Bharwani)
Granada, Spain. (Dr. Noorali Bharwani)

Artificial intelligence (AI) in medicine is a problem-solving computerised program. It is like science fiction, something out of Star Trek. AI, robotics and big data are the future of medicine. It is expected to revolutionize patient care.

AI has capacity of a machine or computer to mimic intelligent human thought processes and learn new information. All this without being programmed to do so. This is just a simplified explanation. It is more complicated than that. But we will leave that for the experts to figure it out.

What I am interested to know is how it will affect the practice of medicine and patient care in the future. There is a lot of material out there on this subject. I have tried to make it as simple as I could.

Reviewing some articles in the medical journals indicate AI will impact on physicians’ ability to deliver quality care. Is it going to be good or bad? The view is there are a number of unknowns about AI, both in healthcare and more generally, which creates uncertainty for both physicians and patients.

There is no need to panic. We are still in the early stages for AI to be used in healthcare. Hopefully, there is enough time to ensure legal and regulatory frameworks are in place. By that time, we should know what AI can and cannot do, and not lose sight of the important goal of better patient care.

Advantages of using AI in health care

  1. AI is expected to improve healthcare and change the way it is delivered. It is expected to increase diagnostic accuracy, improving treatment planning, and forecasting outcomes of care.
  2. AI has shown particular promise for clinical application in image-intensive fields, including radiology, pathology, ophthalmology, dermatology, and image-guided surgery.
  3. AI technologies are currently intended to complement clinical care. It is too early for AI to take over clinical care.
  4. What distinguishes AI technology from traditional technologies in health care is the ability to gain information, process it and give a well-defined output to the end-user.

Challenges of using AI in health care

  1. Suicide prediction models have largely been ineffective to date.
  2. Evidence about the effectiveness and reliability of the practical applications of AI continues to be limited.
  3. AI is unabile to explain its reasoning processes, otherwise known as the “black box” effect.
  4. The use of AI in patient care can be limited in some situations when the AI-assisted diagnosis does not include information to verify its reliability.
  5. The dataset used by some has the potential to introduce bias. For example, a dataset that unintentionally excludes patients with certain backgrounds, conditions, or characteristics may not be reliable for broader segments of the population.
  6. There is no legal and/or regulatory clarity for physicians to use AI. The buck stops with the physician, not the machine.

The future of AI

The future is exciting. In the last half-century, the medical and technological advances have enabled the growth of healthcare-related applications of AI.

Medical institutions such as The Mayo Clinic, Memorial Sloan Kettering Cancer Center, Massachusetts General Hospital, and National Health Service, have developed AI algorithms for their departments. Some hospitals are looking for AI.

Medical community would like to see development of artificial intelligence systems for health care, which have the potential to transform the diagnosis and treatment of diseases, helping to ensure that patients get the right treatment at the right time.

The role of AI can help manage and analyze data, make decisions, and conduct conversations, so it is destined to drastically change clinicians’ roles and everyday practices.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Wasting Money on Fish Oil and Vitamin Supplements

Gaudi's depiction of breasts. (Dr. Noorali Bharwani)
Gaudi's depiction of breasts. (Dr. Noorali Bharwani)

Omega-3 supplements (fish oil supplements) are popular. The global market of these pills is valued at three billion dollars. More billions are spent by consumers on other supplements like vitamins and minerals. Experts say this kind of money can be used for better health by doing what is proven to be good for your heart, brain and rest of the body.

Smart way to meet your omega-3 needs is to eat healthy. There is no need to spend money on the pills.

Omega-3s are a family of essential fatty acids that play important roles in our body and may provide a number of health benefits. It is important to know, omega-3s are not produced in our body. We must get them from our diet because they are essential for our good health.

The three most important types of omega-3 are ALA (alpha-linolenic acid), DHA (docosahexaenoic acid), and EPA (eicosapentaenoic acid). ALA is mainly found in plants, while DHA and EPA occur mostly in animal foods and algae.

Common foods that are high in omega-3 fatty acids include fatty fish, fish oils, flax seeds, chia seeds, flaxseed oil, and walnuts.

People take fish oil to reduce the risk of heart attacks and strokes, to treat high triglycerides and high blood pressure, and to improve symptoms of rheumatoid arthritis.

What is the evidence?

There are about 3,000 scientific clinical trial reports on the benefits of omega-3 fatty acids. When teams of researchers scrutinized the most reliable of these studies, they concluded that the treatment potential of these supplements is minimal to nil. In a few cases, inconclusive.

Health Canada recommends you eat at least five ounces (150 grams) of cooked fish every week. You can also get EPA and DHA omega-3 fatty acids from eggs, fish oil supplements and EPA and DHA-enriched foods.

Evidence in the population generally does not support a beneficial role for omega−3 fatty acid pills in preventing cardiovascular disease (including myocardial infarction and sudden cardiac death) or stroke. If you’re healthy and at low or average risk for heart disease, chances are you don’t need an omega-3 supplement (in the form of pills), provided you eat fish often.

Is it healthy to take vitamins and minerals on a regular basis?

Six years ago (December 17, 2013) an editorial in the Annals of Internal Medicine titled, “Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements” said despite sobering evidence of no benefit or possible harm, use of multivitamin supplements has increased among U.S. adults.

Three articles in this issue of the Annals address the role of vitamin and mineral supplements for preventing the occurrence or progression of chronic diseases.

The article concluded, β-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful.

Other pills like folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing death or sickness due to major chronic diseases.

The Annals editorial says although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, they believe the case is closed – supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. The editorial says, “Enough is enough.”

If you are a well-nourished healthy adult then you should not waste your money on vitamins and mineral pills.

According to Health Canada, more than half of Canadians use supplements vitamins, natural remedies and homeopathic methods. In Canada, The Natural Health Products Directorate was created in 1997 to regulate the industry. Millions of Canadians are spending millions of dollars on these supplements. Has this made Canadians healthy?

Here is a good example of immense wastage of tax dollars. A study published in the medical journal JAMA Internal Medicine (July 15, 2019) says, “Almost two-thirds of Ontario seniors who received vitamin B12 shots had no evidence of a B12 deficiency.” This needlessly cost the province’s health-care system $45.6 million annually.

Readers are cautioned not to stop using any pills without consulting their physician. If you are regularly taking omega-3 fatty acid pills, vitamin and mineral pills or injection then consult with your doctor to review your meds.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

19 reasons why you have back pain.

Fairmont Banff Springs Hotel and Resort (Dr. Noorali Bharwani)
Fairmont Banff Springs Hotel and Resort (Dr. Noorali Bharwani)

If you look at the spine you wonder how it was created.

Spine is a column of bones (vertebrae) held together by muscles, tendons and ligaments and cushioned by shock-absorbing disks. If you have a backache then the problem can be in any one or more of the elements forming your spine.

Low back pain is one of the most common and costly musculoskeletal problems in modern society. It is experienced by 70 to 80 per cent of adults at some time in their lives.

Your symptoms can vary from simply being an annoyance or it can be excruciating and disabling pain.

Good news is most back pain goes away on its own or with some medical treatment within four weeks. Surgery usually isn’t needed and generally is considered only if other treatments are not effective.

Most common reasons for strains and sprains are improper lifting, poor posture and lack of regular exercise. In one article, I saw a list of 19 causes of back pain. Some common problems are herniated disk, obesity, osteoarthritis, osteoporosis, poor posture, sciatica, spinal fractures, spinal stenosis and sprains.

When do you need tests like X-ray, CT scan, or MRI?

According to the guidelines in Choosing Wisely, most people with low back pain do not need these tests because these tests do not help.

There are three reasons why you should not rush into getting these tests. First, most people with lower-back pain feel better in about a month. Second, people who get these tests do not get better faster compared to people who took over-the-counter pain medicine and followed simple steps, like walking, to help their pain. Lastly, these tests lead to surgery and other treatments that you do not need.

That does not mean imaging test for back pain is a bad idea. In some cases, you may need an imaging test right away.

For example, if your back pain is associated with weight loss that you cannot explain, fever over 39 degrees C, loss of control of your bowel or bladder, loss of feeling or strength in your legs, problems with reflexes, and if you have a history of cancer.

These symptoms may suggest nerve damage or a serious problem such as cancer or an infection in the spine. If you do not have any of these symptoms, Choosing Wisely recommends waiting a few weeks for x-rays.

How much bed rest is too much?

For many years, getting bed rest was the normal advice. However, newer data have shown that there is little to no role for bed rest in the treatment of low back pain.

Research suggests if you find comfortable positions and move around sometimes, you may not need bed rest at all. Research also shows more than 48 hours of bed rest may actually increase pain, by increasing the stiffness of the spine and the muscle.

The sooner you start physical therapy or return to activities such as walking, the faster you are likely to recover.

A study published in 2015 by Furlan AD et al (Massage for low back pain) found massage therapy has the potential to minimize pain in the short term and speed return to normal function. More study is required to see if massage has long-term benefits.

According to Harvard Men’s Health Watch, yoga is a gentle practice that is ideal for maintaining back strength and flexibility. It’s also one of the more effective tools for helping reduce low back pain. It should be done gently and carefully.

The benefits of yoga go beyond muscles. The slow movements and the continuous focus on proper breathing can improve the emotional aspect of back pain by helping to lower stress and alleviate anxiety and depression.

It is important to keep moving to maintain muscle strength and flexibility. With bed rest, you lose about one per cent of your muscle strength each day. And you can lose 20 to 30 per cent in a week. Then it is harder to return to regular activity.

Most people with lower-back pain should apply heat or ice. Some people can get pain relief from an over-the-counter anti-inflammatory medication.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!