Year: 2001

Posted on

Laughter is Good Medicine

“Only three things in life are real: God, human stupidity, and laughter. But the first two pass our comprehension; we must do what we can with the third,” says Aubrey Menen in The Ramayana.

We must do what we can but are we doing enough?

We are lucky. We are blessed with the greatest gift of all – capacity to laugh. But quite often we are trapped in the cycle of fear, depression, and panic. We forget our best weapon against pain and misery is laughter.

Mark Twain said: “The human race has only one really effective weapon and that is laughter.” But the weapons we use against our fellow humans are weapons of terror, destruction, greed, treachery, and hypocrisy.

But, of course, there are exceptions. In his bestseller, Anatomy of an Illness, Norman Cousins writes about his battle against painful condition of joints and muscles. He says, “I made the joyous discovery that ten minutes of genuine belly laughter had an anaesthetic effect and would give me at least two hours of pain free sleep.”

Laughter has been known to be therapeutic for many centuries. But laughter is becoming a rare event in most of our lives as the world becomes faster, smaller, and complicated. We live in a world of instant gratification and band-aid solutions. This does not allow us any time to explore the beauty of the gift of laughter.

Ashley Montagu, who has written about laughter, says that only those animals capable of speech are capable of laughter and the humans being the only animal that speaks, is the only animal that laughs.

So, why do humans laugh? We laugh for many reasons. And for centuries biologists, philosophers, psychologists, and medical doctors have sought a definitive explanation of laughter.

Like anything else, there are positive and negative aspects of laughter. In a negative way, people use laughter to intimidate others, and gain stature over them by humiliating them. We laugh when we compare ourselves with others and find ourselves superior and in fact we laugh at the infirmities of others.

In a positive way, we laugh in order not to cry, we use laughter as a remedy for painful experiences, and we laugh to show our happiness.

The average six years old laughs 300 times a day, the average adult laughs about 170 times a day. Can adults do better?

Sure, we can do better if we have the determination do something about it. First, we need to have a strong desire to live a pain free, stress free, happy, and healthy life. Then we need to assign certain amount of time everyday or every other day to be creative so that laughter is fun rather than a chore to be accomplished.

Here are some helpful hints from www.laughter.com:

-Think funny – find humour in different situations
-Personalize material – adapt humour to personal situations
-Be the target – poke fun at yourself
-Share your humour with others
-Play with children
-Watch comedy shows and movies
-Read funny books, comics, cartoons
-Sing and dance to music
-Seek company of people who are happy and funny

Let me end by telling you couple of doctor jokes taken from laughter.com:

How many psychiatrists does it take to change a bulb?
One, but the light bulb has to want to change!

“Doctor, I can’t stop behaving like a dog.”
“How long have you been acting this way?”
“Since I was a puppy!”

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

Posted on

Doctors and Dieing Patients

“A physician’s responsibility for the care of a patient does not end when the patient dies. There is one final responsibility – to help the bereaved family members. A letter of condolence can contribute to the healing of bereaved family and help achieve closure in the relationship between the physician and the patient’s family”, says an article in the New England Journal of Medicine (NEJM).

How often do we, the physicians, do this? Hardly ever. Well, I shouldn’t say that! There is always some body somewhere who does special things for people he cares about. Let me tell you about my own practice and how things have evolved over the years. This is not only about bereavement. It is also about caring and making patients feel good.

Let me start with a recent example. A patient who I had known for many years was hospitalised with complications from a long-standing illness. I was not directly involved in her care, but I knew she was in the hospital. From time to time, I dropped in to say hello, held her hand and spent few minutes talking about things in general.

Few days later, she died. I received a “thank you” card from the family for having taken care of her in the past and how much my visits and services were appreciated by the patient and the family. I asked my receptionist to give me her file so I could call the family and give my condolence. The file lay on my desk for two weeks and I never got around to phoning.

This is in complete contrast to what I used to do when I started practice 16 years ago. I had no children, my practice was not that busy and I had plenty of time to spend with my patients and their families.

I used to do my ward rounds twice a day. Morning rounds are usually “quickies”, as we are rushing to the office, or to the operating room. Evening rounds allowed me to sit with my patients and learn more about their illness and family. Occasionally, I sent flowers to patients who I had known who had major surgery. Some times my wife visited them in the hospital.

On weekends, I used to take my 5-year-old son to meet my patients. We had a white coat made for him and he would carry his plastic stethoscope in his pocket. Many of my patients still remember this. Even now they ask me how is my little boy doing (he is 14 now!). Few years later I started taking my daughter as well. Some time it was hard to control both and I heard a nurse say, “I didn’t know doctor’s children can be naughty!” That put an end to my family ward rounds on weekends!

As I got busy with my practice and my family, the evening rounds occurred only if a patient was sick and needed another visit to check his progress. The desire to rush home and play with my kids was irresistible after a long day in the hospital and office.

In the last 16 years, I don’t remember having written a letter of condolences to bereaving family members. Occasionally, I have phoned. Contact with the patients in hospital is now to a minimum. Most patients are discharged the same day or day after surgery. Due to long waiting lists, the pressure to see more patients in the office does not allow too much time to talk about other things. As a specialist, it is hard to know my patients more than what they come to see me for. That old style “family physician” type of relationship is hard to establish.

The NEJM article says that in the 19th century America, the process of grieving was detailed and elaborate. The doctor’s letter of condolence was an accepted responsibility and an important part of the support offered to the bereaved. But today, the pattern of mourning has changed and has become much abbreviated.

But the article makes a strong point to encourage physicians to find time and write a letter to bereaved family. It says, “Unlike expressions of condolence made by telephone or in person, a letter of condolence is a concrete gift that the recipient can and will review over and over”. I agree. But will I be able to do it? Only time will tell.

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

Posted on

Alcohol Use

Dear Dr. B: Some time ago, there was a discussion in this newspaper about the health benefits of alcohol. The letters to the editor has left me confused. Can you help? What does the medical literature say? Yours: A Heart Patient

Dear Heart Patient: Mankind has known the use and abuse of alcohol for many centuries. In fact, the term alcoholism first appeared in 1849 in an assay written by a Swedish physician, Magnus Huss, titled “Alcoholism Chronicus”.

Alcoholism is considered a disease. It is a compulsive addictive behaviour. Alcoholism means excessive and repeated use of alcoholic beverages. Ten percent of the population is dependent on alcohol. It costs the health care system millions of dollars.

Raymond Chandler (1888-1959) said, “Alcohol is like love: the first kiss is magic, the second is intimate, the third is routine. After that you just take the girl’s clothes off.” Where does the benefit stop and the harm start?

For many years, there has been scientific evidence to suggest that moderate amount of alcohol is good for our health. But physicians have been reluctant to publicize or promote this advantage. They are worried that some people will use this as an excuse to justify excessive drinking. The alcohol industry will use this to promote their products. And the promotion of the benefits will raise moral, religious and ethical issues and confuse and divide the people who otherwise would benefit the most.

But Dr. B, what are the benefits?

-There is overwhelming evidence that moderate alcohol drinking reduces sickness and death from coronary artery disease.
-Alcohol also favourably changes the blood lipid levels and makes the blood thinner.
-There is 24 to 53 percent decline in the risk of duodenal ulcer.
-It reduces death from stroke, reduces the incidence of blood vessel disease in the legs and arms, and reduces adult onset diabetes.
-Up to three drinks a day, alcohol reduces blood pressure in females but heavy drinking will have the reverse effect.
-Moderate drinking of wine, beer, and spirits can reduce the incidence of Alzheimer’s disease, and dementia.
-Alcohol alleviates the effects of stress.

Dr. B, what are the dangers of abusing alcohol?

-Alcohol is addictive – it’s a drug with complex behavioural effects that can be pleasurable or unpleasant, stimulating or depressing.
-Drinking during pregnancy causes fetal alcohol syndrome in the new born – a very serious condition.
-It can cause cirrhosis of liver, liver failure and pancreatitis.
-It can cause gastritis and bleeding .
-It can cause traffic or work related accidents – resulting in disability or death.
-Alcohol is implicated in more than 20 causes of death.
-It can cause cancer of the oesophagus, breast and other cancers.
-Alcohol abuse can destroy a person’s personal life, family life and capacity to earn a decent living.
-What is moderate drinking? Is it one, two, three drinks a day? Moderation for a non-drinker is different than for a habitual drinker.

Critics of alcohol use say that much of the protective effect gained from alcohol use in coronary artery disease can be achieved by other means – exercise, diet, avoiding smoking, and control of cholesterol level.

The question remains: Should the Canadian medical organizations and physicians publicize the benefits and the risks of moderate alcohol consumption to the Canadian public?

The best thing for you, as a heart patient, is to discuss your individual case with your family doctor or your specialist. I hope the information provided here will be of help.

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

Posted on

M.R.I.

If you listen carefully, then you can almost hear Dr. Ken Blair, Palliser Health Authority’s Director of Diagnostic Imaging, say with pride: “Heeeeere’s is MRI!”

Besides Blair, there are numerous people who are proud of successfully bringing the MRI service to Palliser Health Authority (PHA). We tend to criticize our health care system a lot. Perhaps with good intentions. We want more of everything. The human desire for more is some time insatiable. Some times that is good and some times not so good.

In case of MRI, it was good! Certainly the Government of Alberta and our local MLAs deserve a big “Thank you”. So do the public, the health authority, the health care providers and Dr. Ken Blair and his team of tireless people in the x-ray department (oops! it is called the Department of Diagnostic Imaging).

What is MRI?

MRI stands for Magnetic Resonance Imaging. In 1946, Bloch and Purcell demonstrated that some atomic nuclei respond to the application of particular magnetic fields by emitting or absorbing electromagnetic field. This was then used for analytic chemistry.

A Swedish physicist, Erik Odeblad, pioneered the medical application of this technique in the 1950s. In the next 30 years, much work was done on the MRI images showing human pathology. Initial emphasis was placed on imaging of the brain. But since 1980, studies of other organs have also been performed.

All MRI machines are constructed around a large magnet that provides a uniform, static magnetic field. There are no adverse effects reported from this and there are guidelines designed to prevent possible hazards. The only adverse effect reported is three to four percent incidence of claustrophobia.

Dr. Jay Daniels, PHA’s Director of MRI Services, says the technology uses a super conducting magnet which is kept to a temperature approximately four degrees above absolute zero, with a resulting magnetic field over 50,000 times stronger than the earth’s. No ferrous metal is allowed in the examination room as it could become a very dangerous missile in the presence of the magnetic field!

Within a week or so, the first MRI images will roll out of the new addition to the Medicine Hat Regional Hospital. Daniels predicts excellent availability for the patients of our Region with lower waiting lists than has traditionally been the case in Alberta. The examination time will vary from few minutes to 40 minutes depending on the body part being imaged.

Common indications for the tests are: chronic headaches, family history of brain aneurysms, possible spinal disc diseases, and arthritis of the back, knees and shoulders. Other indications depend on the clinical situations. Daniels says the MRI is safer than using ionizing radiation as in the case with x-rays. Patients with metal in the eyes, pacemakers, and cardiac leads however cannot be imaged. Orthopaedic hardware like metals in the knees and hips can distort the pictures if they are too close to the organ being imaged

Blair is very proud of “the first class state of the art physical facility, which includes not only the room for the scanner, but also an excellent patient reception and waiting area”. There is a great lack of trained MRI technologists in Canada. PHA was fortunate to recruit an experienced technologist for the position of supervisor and have trained two of the local staff as MRI technologists.

Blair is worried that public’s perception and expectation on what an MRI can do may be too high. MRI is not indicated for all undiagnosed conditions and is not a “magic answer” to people’s anxiety about their health. Each request for MRI will be carefully screened, says Blair.

And he is serious. He will not accept my request for a total body MRI to see why my golf swing is so bad! For that I may have to go to a private clinic! But seriously, MRI will make a difference to the health of PHA residents. So be proud and make judicious use of the new service!

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