The importance of getting screened for common cancers.

An owl in the Dubai desert. (Dr. Noorali Bharwani)
An owl in the Dubai desert. (Dr. Noorali Bharwani)

“Facts do not cease to exist because they are ignored,” says Aldous Huxley.
Aldous Leonard Huxley was an English writer. By the end of his life, Huxley was widely acknowledged as one of the pre-eminent intellectuals of his time.

Generally speaking, many people ignore going through screening tests. They believe “no news is good news.” That is not good.

The fact remains early detection of cancer increases the chances for successful treatment and improves cure rate and prognosis. With this in mind the Government of Alberta has set up Alberta Cancer Screening Programs called Screeningforlife.

The Alberta program offers cancer screening to people who have no symptoms to get checked for breast, cervical and colorectal cancer.

Breast Cancer Screening

Just because no one in your family has had breast cancer does not mean you are not at risk. In fact, 80 per cent of women who develop breast cancer have no family history at all.

Having routine mammograms is the best way to find breast cancer early.

If you are between the ages of 50 and 74, you are at an age when it is important to consider having mammograms regularly. This is because the risk of breast cancer increases, as women get older.

Women who are under the age of 50 and over the age of 74 may need a screening mammogram on a regular basis if there are strong indications such as family history of breast cancer. These women should discuss their individual situation with their family doctor.

Cervical Cancer Screening

Screening is recommended for all average-risk females 25 to 69 years.

It is important to know cervical cancer can almost always be avoided with screening and vaccination. In fact, 90 per cent of cervical cancer can be prevented with regular Pap tests (the main screening test for cervical cancer) and following up on any abnormal results.

Georgios Nikolaou Papanikolaou (1883 – 1962) was a Greek pioneer in cytopathology and early cancer detection, and inventor of the “Pap smear”.

The single most important reason to have regular Pap tests is that they can save your life. About 75 per cent of sexually active Albertans will get HPV(human papillomavirus) in their lifetime. It is the main cause of cervical cancer. Good news is nine in 10 cases of cervical cancer can be prevented with regular Pap tests.

Colon and Rectal Cancer Screening

It is possible you may have colon cancer but have no symptoms. Speak to your doctor about colorectal cancer screening after you turn 50. Commonly used tests are:

Fecal Immunochemical Test (FIT) – This is a home stool test for people who have no symptoms and no family history of colon and rectal cancer.It is safe, easy to do and can be done right at home. Should be done once a year.

Colonoscopy – If your FIT is positive then you need a colonoscopy.A colonoscopy can also be recommended as your screening test instead of a FIT if you have any history that puts you at an increased risk.

Do not ignore the facts. Get yourself screened. If Albertans follow these guidelines then we can reduce the risk of cancer in Alberta by about 50 per cent. That would be wonderful!

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STROKE – New Stroke Management Guidelines can Benefit More Patients

Sunset in Hawaii. (Dr. Noorali Bharwani)
Sunset in Hawaii. (Dr. Noorali Bharwani)

Every nine minutes someone in Canada has a stroke. In the U.S., it happens once every minute. Usually the prognosis is not good.

But the odds of survival are getting better because of a new emergency intervention being offered at many hospitals across Canada and USA.

While the majority of strokes strike people over the age of 65, 10 to 15 per cent affect individuals 45 and younger. What is alarming is this number is on the rise.

Stroke is the second-leading cause of death in the world and a leading cause of adult disability.

According to the Heart and Stroke Foundation’s 2014 annual report, strokes in people in their 50s have increased 24 per cent over the last decade.

That is the bad news. The good news is Heart and Stroke Foundation is making changes in its stroke treatment guidelines, extending the window for endovascular thrombectomy from six hours to 24 hours.

Endovascular thrombectomy is the emergency procedure to remove the damaging blood clots from the blood vessel that is blocking the blood flow to the vital parts of the brain.

The change in the management of acute stroke comes after both the Heart and Stroke Foundation and the American Heart Association reviewed research suggesting it’s possible for some patients to benefit from the procedure even after many hours have passed since their first symptoms of stroke.

All patients may not be eligible for treatment if they are seen after six hours. But it is expected some patients may be eligible for treatment within six to 24-hour window.

Patients living in remote areas or who suffer a stroke in their sleep expected to benefit most from the new 24-hour guidelines.

Removing blood clots:

Mechanical thrombectomy (endovascular thrombectomy) is a procedure where doctors remove blood clots using a device passed through a blood vessel. New research shows some carefully selected patients may benefit having this procedure even after the six-hour window has passed (up to 24-hours). Up to 20 per cent of all ischemic stroke patients are currently eligible for clot removal. This number is expected to increase.

Dissolving blood clots:

In the second method doctors use clot-dissolving intravenous medication called alteplase (tPA). Alteplase was approved to treat ischemic stroke about 20 years ago and remains the only medication approved by the FDA to dissolve clots. It has been proven to decrease disability when given promptly (within six hours of onset of symptoms).

These two procedures can only be used for ischemic strokes (strokes caused by a blood clot), as opposed to those caused by a bleed in the brain.

Recognizing signs of stroke:

Studies have shown one in seven young patients were given a misdiagnosis of vertigo, migraine, alcohol intoxication, seizure, inner ear disorder or other problems – and sent home without proper treatment.

Age of the patient does not matter. If they have the FAST signs, whether they resolved or not, it was probably a stroke. Call 911 right away. Remember the acronym FAST:

Face: Is it drooping?

Arms: Can they raise both?

Speech: Is it slurred or jumbled?

Time: To call 911 right away.

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Carbon monoxide in your home is a silent killer.

Olympic Flame from the 1988 Winter Games at the University of Calgary. (Dr. Noorali Bharwani)
Olympic Flame from the 1988 Winter Games at the University of Calgary. (Dr. Noorali Bharwani)

A 12-year-old boy has died after high levels of carbon monoxide were detected at an Airdrie, Alberta apartment complex earlier this month.

Sometime ago provincial politicians in Ontario passed a bill named after a family of four who died in 2008 from carbon monoxide (CO) poisoning in their Woodstock, Ontario home.

These are just two examples.

According to Statistics Canada, there were 380 accidental deaths caused by CO in Canada between 2000 and 2009. Approximately 600 accidental deaths due to CO poisoning are reported annually in the United States. Intentional carbon monoxide-related deaths is five to 10 times higher.

CO has no smell, no taste and no colour, but its effects can be deadly if it goes undetected through your house.

CO is produced when fuels such as natural gas, gasoline, oil, propane, wood or coal are burned. The situation gets worse when that combustion is not properly ventilated, or when the CO can not get out of the house because of a blocked or dirty chimney.

It is dangerous to use appliances indoor that are meant to be used outdoors. CO can build up to dangerous levels when fuel-burning generators, space heaters, barbecues, grills or other appliances are used indoors in the garage.

CO is invisible. There are no obvious signs it may be building up around you. When you inhale CO it gets into your body and competes with oxygen. Oxygen is very essential for our survival. The brain is extremely vulnerable to oxygen deprivation. Without oxygen, body tissue and cells cannot function. CO deprives you of oxygen and literally suffocates you.

It is essential to have CO detectors in your vicinity. The most important place to install a CO alarm is in hallways, outside of sleeping areas.

At low levels of CO exposure, Health Canada says, you might have a headache, feel tired or short of breath, or find your motor functions impaired.

At higher levels of exposure, or at lower levels for a long time, symptoms might include chest pain, feeling tired or dizzy, and having trouble thinking.

Convulsions, coma and death are possible with high levels of exposure.

If the levels are very high, death can occur within minutes.

Prevention is better than cure. Fire and public safety officials recommend having CO detectors in the house, ideally located outside every sleeping area. Make sure your appliances are well maintained.

Fuel-burning appliances such as furnaces, water heaters, fireplaces and wood stoves should also have regular maintenance, and ventilation should be checked, ensuring it is not blocked by snow or leaves.

Treatment of CO exposure consists of removing the person from the site, administrating 100 per cent oxygen and transporting to the nearest hospital for further management.

Finally, make sure your house has CO detectors and smoke alarms. Smoke alarms alert you to fires. Install a CO alarm certified by a certification body that is accredited by the Standards Council of Canada.

Test your CO alarms regularly. Replace batteries and the alarm itself as recommended by the manufacturer.

Contact your municipal or provincial government office for more information on the use and installation of carbon monoxide alarms. Your local fire department may also be able to assist you.

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Follow This Simple Principal for a Long and Healthy Life

Whats up, deer? (Dr. Noorali Bharwani)
Whats up, deer? (Dr. Noorali Bharwani)

“Diet-related risks combined with physical inactivity are estimated to cause nearly one in five deaths worldwide,” says an article in the Canadian Medical Association Journal (CMAJ December 13, 2017 – New ammunition in the fight to label unhealthy foods).

Since 20 per cent of the deaths are related to what we eat, there is an urgent need to put warning labels on the packages containing foods high in sugar, salt and fat.

Unhealthy eating causes chronic diseases. This impacts on mortality and morbidity. It also has a large bearing on the economy in terms of direct health care costs and indirect costs, such as those related to loss of productivity.

When you think about eating sugar, salt and fat you should think about chronic non-communicable diseases, such as obesity, type 2 diabetes, heart disease, and cancer.

The incidence of type 2 diabetes continues to rise and heart disease is one of the leading causes of death in Canada. With high rates of obesity and hypertension, as well as an aging Canadian population, the impact of chronic diseases is likely to continue to increase unless action is taken to reduce modifiable risk factors.

Consuming poor unhealthy diet costs taxpayers $26.7 billion annually. That is lot of money. We can use that kind of money to improve the quality of our health and other social needs of the population.

If you are obese then eat healthy and try to lose one pound a week or a month. As they say slow and steady wins the race. If you lose your weight slowly then you can maintain the loss.

There are hundreds of diet plans in the market. You just have to find one and stick to it. I looked at the Mayo Clinic diet. That makes sense to me. The Mayo Clinic Diet is the official diet developed by the Mayo Clinic in Minnesota. It focuses not just on what you eat and how much you weigh but also on your overall health and lifestyle.

If you follow Mayo Clinic diet then you can drop one to two pounds a week until you reach your goal. Then you follow a program to maintain your weight.

The Mayo Clinic diet gives you lots of food choices within six food groups:

  1. Fruits
  2. Vegetables
  3. Whole grains
  4. Lean proteins such as beans and fish
  5. Unsaturated fats such as olive oil and nuts
  6. Sweets, in small amounts

The global plan is to begin work on global standards for front-of-package nutrition labeling, with new guidelines expected in the next three to five years. The labels on the package will warn consumers about unhealthy foods and ingredients.

The global talks come at a crucial time for Canada, which is poised to announce draft-warning labels for foods that contain more than 15 per cent of the daily value for sugar, sodium or saturated fat.

Do warning labels work? Surveys show that the warnings influenced more than 91 per cent of consumers, and food companies reformulated 18 per cent of products to avoid the labels.

Some have raised concerns about the government’s narrow focus on sugar, sodium and saturated fat. Four times as many nutrition-related deaths are linked to diets low in fruits, vegetables, whole grains and other ingredients, says the CMAJ article.

Just follow a simple principal – eat right and eat less.

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Five Things to Know About Take-Home Naloxone

Antigua (Dr. Noorali Bharwani)
Antigua (Dr. Noorali Bharwani)

“Nothing is impossible; the word itself says, ‘I’m possible!'” -Audrey Hepburn

Naloxone is a life saving medication when used after opioid overdose. In March 2016, the Canadian government made the antidote available without prescription.

There are three kinds of opioid drugs. These are synthetic opioids (example fentanyl), semi-synthetic opioids (oxycodone, heroin), and natural opioids (opium, morphine, codeine). Natural opioids are from a natural source – opium poppy.

Fentanyl is a fully synthetic opioid, originally developed as a powerful anaesthetic for surgery. It is also administered to alleviate severe pain associated with terminal illness like cancer.

Fentanyl is a powerful drug. It is up to 100 times more powerful than morphine. Just a small dose can be deadly. Illicitly produced fentanyl has been responsible in the number of overdose deaths in recent years. It plays a role in the deaths of more than four people on average every day in B.C. and Alberta alone.

Fentanyl poisoning results in respiratory depression, miosis (excessive constriction of the pupils) and altered level of consciousness. These three features should alert physicians to the possibility of fentanyl poisoning.

An article in the Canadian Medical Association Journal (CMAJ September 18, 2017) titled “Five things you should know about take-home naloxone” emphasis the following points:

1. Naloxone is available without prescription in Canada

In 2016, naloxone was removed from the federal Prescription Drug List. Now pharmacists can dispense it without prescription. It is available in commercial formulations, including intranasal preparations, as well as in locally prepared take-home naloxone kits, available from some pharmacies, clinics, emergency departments and community health centres.

2. Most take-home naloxone kits contain similar equipment

Most take-home naloxone kits will contain two ampules of naloxone (0.4 mg per vial), two safety-engineered syringes, two ampule-opening devices, alcohol swabs, nonlatex gloves and a rescue-breathing barrier. The average cost for a take-home naloxone kit is $35. However, many sites offer them free of charge.

3. Multiple doses of naloxone may be required for overdoses related to high-potency opioids

In overdoses related to fentanyl and other synthetic opioids, multiple doses may be required to restore breathing. Most take-home naloxone kits include two doses, and additional doses can safely be administered every two to five minutes if there is no response. Naloxone should be used in conjunction with basic life support principles, such as rescue breathing, cardiopulmonary resuscitation and calling 911.

4. Take-home naloxone kits may reduce overdose-related mortality

Observational studies in North America, Europe and Australia, has found that take-home naloxone programs led to improved survival rates among program participants.

5. Take-home naloxone kits are not only for patients with current opioid abuse

The kit can be used for other at-risk populations include individuals who are on methadone or on high doses of prescription opioids, or who frequently use recreational drugs.

Naloxone can be delivered to the patients in different forms: intravenously, intramuscularly, subcutaneously, through the trachea and nose. The drug is effective in one to eight minutes after administration.

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Understanding Factors that Determine Our Health

A teepee in North Battleford, Saskatchewan, in 1984. (Dr. Noorali Bharwani)
A teepee in North Battleford, Saskatchewan, in 1984. (Dr. Noorali Bharwani)

“The perception that health comes from the health care system is widespread. Yet the health care system accounts only for a small – albeit important – part of the overall health of the population, mainly through treatment. It’s really an illness care system,” says Dr. Trevor Hancock in the Canadian Medical Association Journal (CMAJ December 18, 2017). The title of the article – “Beyond health care: the other determinants of health.”

Hancock is an internationally recognized public health physician. The Canadian Public Health Association recently recognized his outstanding contributions in the broad field of public health with the R.D. Defries Award.

Our health care system is geared towards providing acute care. Most major determinants of health lie outside the acute care system. Health care system should provide major care towards factors that really make us sick, says Hancock.

Hancock says a 2014 policy brief found the health care system to be responsible for just 10 to 20 per cent of broadly defined health outcomes. It does not take into account other factors that affect our health. For example: our behaviour, our social circumstances, physical environment that includes pollution, and genetic factors.

This is hardly a new understanding. The Canadian government’s 1974 landmark Lalonde Report suggested four health fields:

  1. Human biology
  2. Lifestyle
  3. Environment
  4. Health care

Public health care service should attempt to reduce the overall burden of disease, ensuring clean water and air, clean and reliable energy, and quality early child development experiences.

Clearly most of these factors do not lie within the jurisdiction of the Minister of Health or the health authorities, says Hancock.

We need to broaden our concept of health policy and ask ourselves, in what way is current food, housing, transport, or economic policy bad for health, and, conversely, what would a healthy housing and transport policy look like, asks Hancock.

In another article, (CMAJ November 20, 2017) titled “No quality health care without strong public health,” Hancock says public health is in the same business as the rest of the health care system: saving lives and reducing suffering. But it does so by intervening before – rather than after – the onset of disease or injury.

Hancock says the objectives of public health are three:

  1. To focus on improving health in the population as a whole rather than through one-on-one care. It has been found that local and national public health interventions were highly cost-saving.
  2. To improve the patient’s experience of care. Prevention should be seen as the first step in disease management and a key marker for quality health care.
  3. The final aim is to reduce the per-capita cost of health care. This can be approached in four main ways: reduce the burden of disease, improve self-care so fewer people seek care, improve the efficiency and effectiveness of care services, or reduce services.

We have to strike a better balance between prevention and treatment. Let us intervene before the onset of disease or injury. That will save lives and reduce suffering. I will finish with the following words of wisdom:

“Nothing that has value, real value, has no cost. Not freedom, not food, not shelter, not healthcare,” says Dean Kamen, an American inventor and businessman.

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

New Year’s Resolution: Drive Safely and Prevent Motor Vehicle Collisions

Sunrise at Haleakala Volcano Summit in Maui. (Dr. Noorali Bharwani)
Sunrise at Haleakala Volcano Summit in Maui. (Dr. Noorali Bharwani)

“Only I can change my life. No one can do it for me.” -Carol Burnett

Most people are good and responsible drivers. They care about their own safety and they care about others. But some drivers are serious threat to safety.

A recent survey done by the Alberta Motor Association and published in their magazine (AMA Insider – Winter 2017) identified the following five actions to be serious threat to safety while on the road:

  1. Drivers texting or emailing
  2. Drivers talking on the phones
  3. People driving after drinking alcohol
  4. Aggressive driving
  5. Speeding on residential streets

It is estimated that traffic collisions would soon become the third major cause of death worldwide. The major victims of these traffic collisions are people between five and 44 years of age. That is tragic.

Let us briefly look at what Transport Canada has to say about road safety.

Although drivers aged 15 to 34 represent only about 30 per cent of the driving population, they accounted for 40 per cent of the fatalities and 45 per cent of the serious injuries, indicating that younger drivers are at greater risk.

The annual social costs of the motor vehicle collisions in terms of loss of life, medical treatment, rehabilitation, lost productivity, and property damage are measured in tens of billions of dollars. We can certainly use that kind of money treating other health issues.

Here are few examples where we can do better:

  1. Seat belts worn correctly can reduce the chances of death and disability. It is estimated about 300 lives could be saved every year if everyone wore seat belts.
  2. Aggressive driving includes speeding, running red lights, tailgating, weaving in and out of traffic, and failing to yield right of way, among other behaviours should be avoided. Forty per cent of speeding drivers involved in fatal crashes were 16 to 24 years of age.
  3. Young drivers, 16 to 24 years of age, continue to be at higher risk of being killed in motor vehicle collisions. One of the reasons being the use of cell phones or other similar devices while driving.
  4. In 2008, coroners’ testing showed almost 40 per cent of fatally injured drivers had been drinking some amount of alcohol prior to the collision.
  5. Drugs, other than alcohol, are also being found in about one-third of tested fatally injured drivers, similar to the prevalence of alcohol.

There are many other reasons why a driver can be distracted: using electronic devices, reading maps, eating, drinking, talking, or impaired by fatigue.

It is estimated about 20 per cent of fatal collisions involve driver fatigue. Everyone is subject to their body’s circadian rhythms such that they are less alert during certain times of the day, usually 2:00-4:00 a.m. and 2:00-4:00 p.m. Therefore, taking breaks from driving during these times could lower the risk of fatigue related collisions.

Let’s make a New Year’s resolution to drive safely and prevent death and disability.

Have a happy and healthy 2018.

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