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.

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

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.

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

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.

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

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!

Maternal Age the Most Significant Risk Factor Associated with Down Syndrome

“Attacking people with disabilities is the lowest display of power I can think of.” -Morgan Freeman

Down syndrome is the most frequently occurring chromosomal congenital abnormality in Canada. It is a lifelong condition. It adversely affects infant’s life and mortality.

An English physician John Langdon Down first described Down syndrome in 1862, and helped to differentiate the condition from mental disability. Prior to that for centuries, people with Down syndrome have been alluded to in art, literature and science. Many individuals were killed, abandoned or ostracized from society. Many of these children died during infancy or early adulthood.

Humans usually have 46 chromosomes in every cell, with 23 inherited from each parent. Due to the extra copy of chromosome 21 (trisomy 21), people with Down’s syndrome have 47 chromosomes in their cells. This additional DNA causes the physical characteristics and developmental problems associated with the syndrome.

The cause of the extra full or partial chromosome is still unknown. Maternal age is the only factor that has been linked to an increased chance of having a child with Down syndrome. There is no definitive scientific research that indicates Down syndrome is caused by environmental factors or the parents’ activities before or during pregnancy.

The additional partial or full copy of the 21st chromosome that causes Down syndrome can originate from either the father or the mother. Approximately five per cent of the cases have been traced to the father.

Children with Down syndrome experience intellectual delays and are at an increased risk for several medical conditions.

Congenital heart defects and respiratory infections are the most frequently reported causes of death in children and young adults with Down syndrome. Childhood leukemia is also associated with Down syndrome.

Due to higher birth rates in younger women, 80 per cent of children with Down syndrome are born to women under 35 years of age. Women aged 35-39 years have the highest percentage of babies born with Down syndrome (29 per cent).

According to a report on the Government of Canada website, the birth prevalence of Down syndrome in Canada from 2005 to 2013 has remained stable. Approximately one in 750 live born babies in Canada has Down syndrome. Advanced maternal age is the most significant risk factor, says the website.

Prenatal screening for Down syndrome has advanced in both accuracy and early detection. The number of children born with Down syndrome has remained stable due to increased use of prenatal diagnostic procedures followed by terminations of pregnancies.

The Society of Obstetricians and Gynecologists of Canada’s clinical care guidelines for prenatal testing advise against using maternal age as the only criterion for invasive prenatal diagnosis. They recommend prenatal screening for clinically significant fetal abnormalities be offered to all pregnant women, irrespective of age.

There are 45,000 Canadians with Down syndrome, with a very active organization, Canadian Down Syndrome Society (CDSS). The CDSS is a non-profit organization that provides Down syndrome advocacy in Canada, says their website.

The organization helps people with Down syndrome. People with Down syndrome can go to school, finish university, find careers, and get married. CDSS goal is to ensure all people with Down syndrome live fulfilled lives. It is Canada’s voice for Down syndrome.

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

Autism Spectrum Disorder (ASD) Encompasses Four Challenging Conditions

"Autism is part of my child. It's not everything he is. My child is so much more than a diagnosis" -S.L. COELHO (Autism Treatment Center of America)
"Autism is part of my child. It's not everything he is. My child is so much more than a diagnosis" -S.L. COELHO (Autism Treatment Center of America)

In 2013, the American Psychiatric Association merged four previously distinct diagnoses into one umbrella diagnosis of autism spectrum disorder (ASD). What causes these conditions? We don’t know. There are different combinations of genetic and environmental influences that cause these illnesses.

The four conditions are:

  1. Autistic disorder
  2. Childhood disintegrative disorder
  3. Pervasive developmental disorder-not otherwise specified (PDD-NOS)
  4. Asperger syndrome

These four conditions are characterized by challenges with social skills, repetitive behaviours, speech and nonverbal communication, as well as by unique strengths and differences.

Autism is a lifelong spectrum disorder. Autism is now the fastest growing and most commonly diagnosed neurological disorder in Canada. Autism occurs in all racial, ethnic and socio-economic groups.

Autism has no single known cause. Given the complexity of the disorder, and the fact that symptoms and severity vary, there are probably many causes. Both genetics and environment may play a role.

There is no link between vaccines and autism. And there’s no way to prevent autism.

In Canada, one in 68 children are currently diagnosed with autism spectrum disorder. The prevalence of autism has increased over 100 per cent in the last 10 years.

The unemployment rate for individuals with ASD is over 80 per cent. With the right support, all individuals with autism can thrive. No two people with autism are the same, not even identical twins.

How do you know your child is autistic?

Because autism varies widely in symptoms and severity, making a diagnosis may be difficult. Mental health concerns such as anxiety and depression are common in individuals with autism. There isn’t a specific medical test to determine the disorder.

Autism’s most obvious signs tend to appear between two and three years of age. Sometimes developmental delays associated with autism can be identified and addressed even earlier.

Autism is characterized by what is clinically described as “deficits in social reciprocity.” Social reciprocity may include a range of back-and-forth actions, such as gestures, sounds, play, attention, and conversation.

Around one third of people with autism have difficulty with communication and have intellectual disability. Many of these individuals have stomach and bowel problems, seizures, sleep disturbances, attention deficit, hyperactivity disorder (ADHD), anxiety and phobias.

The symptoms are varied, but one thing is clear: the earlier a child is diagnosed and begins receiving services, the better the outcome for the child.

Management of a child with autism spectrum disorder

There is no cure for autism but intensive, early treatment can make a big difference in the lives of many children.

Each child with autism spectrum disorder is different with a unique pattern of behavior and level of severity – from low functioning to high functioning, normal to high intelligence. As they mature, some children become more engaged with others and show fewer disturbances in behavior.

Unfortunately, some continue to have difficulty with language or social skills, and the teen years can bring worse behavioral and emotional problems. The goal of treatment is to maximize your child’s ability to function. Early intervention during the preschool years is important. It can help your child learn critical social, communication, functional and behavioral skills.

For more information visit Autism Speaks Canada

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