Year: 2002

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Oral Contraceptive Pill

There is good news about oral contraceptives, says an editorial in the New England Journal of Medicine (NEJM).

“The development of oral contraceptives stands as a major advance in women’s health in the past century. By virtue of their ability to prevent pregnancy in 99 percent of women who use them properly, oral contraceptives have revolutionized reproductive choices for women,” says the editorial.

How safe is the oral contraceptive, also known as “the pill”?

A study in 1986 did not show any association between oral contraceptive use and breast cancer. But ten years later, studies of oral contraceptive use showed that women had a slightly increased risk of breast cancer while on the pill. But there was no increase in the breast cancer rates 10 years after quitting the pill.

So, what’s the good news now?

A well-conducted, population-based study, published in the recent NEJM, shows no association between past or present use of oral contraceptives and breast cancer.

That indeed is very good news for women who are currently on the pill or who have been on the pill in the past.

And there is more good news in the NEJM!

Use of oral contraceptives reduces the risk of uterine cancer by 40 percent after 12 months of taking the pill. There is also a 40 percent reduction on the risk of ovarian cancer after as short a period as three to six months of use, and 10 or more years of use was associated with an 80 percent reduction in the risk of ovarian cancer.

But nothing is hundred percent safe in life. Use of the pill is associated with some side-effects in a small percentage of women. These are:

-Deep vein thrombosis (blood clot in the legs)
-Pulmonary embolism (blood clot in the lungs)
-Stroke
-Liver cancer
-Heart attack in women over 35 years of age who smoke

But for most women, the advantages of the pill out weigh disadvantages. Besides the benefits mentioned earlier, there are other advantages to using the pill:

-Greater regularity of menstrual cycle
-Reduced menstrual blood loss and hence prevention of anaemia
-Reduced incidence of painful periods

Today, despite the threat of AIDS, users of oral contraceptives outnumber condom users by two to one. There are approximately 100 million women world-wide who use the pill. And these women should be thankful to a nurse named Margaret Sanger. In 1914, Sanger defiantly championed women’s right to have sex without fear of pregnancy in “The Woman Rebel”.

Based in Brooklyn, Sanger spread the gospel of voluntary motherhood relentlessly, says the Life Millennium book on the 100 most important events and people of the past 1000 years. Her birth control clinics were raided by the police and in 1914 she also faced an obscenity charge which was later dropped.

In 1960, six years before Sanger’s death, the U.S. Food and Drug Administration approved the birth control pill. One of the developers of the pill, Dr. Gregory Pincus, dedicated his research to Sanger’s “pioneering resoluteness”. The pill was cheap, convenient and reliable. It instantly became popular with doctors and patients.

So where do we go from here?

Women’s right to have sex without fear of pregnancy has been established. The next challenge for the scientists is to develop a pill which will have no side-effects affecting the heart and the lungs.

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Heat Wave and Heat Stroke

Hot days are here. Some like it hot. Others find it unbearable. But hot days can be dangerous. Especially during a heat wave.

What is a heat wave?

Three or more consecutive days during which the air temperature is more than 32.2 degrees Celsius. Because of the global warming, the intensity of the heat waves is expected to increase over the years to come.

What is a heat stroke?

“Heat stroke is a life-threatening illness characterized by an elevated core body temperature that rises above 40 degrees Celsius and central nervous system dysfunction that results in delirium, convulsions, or coma”, says an article in the New England Journal of Medicine (NEJM).

Extreme heat can cause other minor to moderate ill effects called heat stress and heat exhaustion. If not controlled or prevented then these conditions can lead to heat stoke and eventually death.

Heat strokes can occur due to exposure to high environmental temperature or from strenuous exercise.

The NEJM article says that the most complications of heat stoke are those falling within the category of multiorgan-dysfunction syndrome. That means many systems of the body are affected – brain (encephalopathy), muscles (rhabdomyolysis), kidneys (acute renal failure), lungs (acute respiratory injury), blood (bleeding complications).

Who is prone to heat stroke?

Usually very young or elderly persons and in those who have no access to air conditioning, says the article. It is also common among persons with chronic mental disorders or heart and lung problems.

How can we prevent heat stroke?

Heat stroke can be prevented. Authors of the NEJM article propose the following actions to prevent heat stroke:

-acclimatize yourself to heat
-schedule outdoor activities during cooler times of the day
-reduce your level of physical activity
-drink additional water
-consume salty foods
-increase the amount of time you spend in air-conditioned environments.

We cannot change nature. But we can adapt to our environment and create conditions to protect ourselves.

Prevention is better than cure! Enjoy the summer and stay cool!

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Money, Health, Happiness

“They’ve bought the BMW, and they have the $3 million Mill Valley house. And they still wake up in the morning and say, ‘I don’t feel good about myself’,” says Stephen Goldbart, psychologist and cofounder of the Money, Meaning and Choices Institute, highlighting the perils of Sudden Wealth Syndrome.

So, how about you? How do you feel each morning? Do you feel good about yourself?

“Plan for a better you in 2002” was the title given to my column on December 27, 2001. This was about New Year’s resolutions. Many of us promised to make changes in our lives so we can feel good about ourselves. Six months have gone by. What have we achieved? Are we better off today than six months ago?

There are many barriers to making a positive change in life. Some of these are:

-Failure on our part to accept that change is required.
-Failure on our part to have a strong will power to work toward that change.
-Failure on our part to find time to make the required change.

But if you have set certain goals in your mind then such barriers are only there to test your determination. Henry Ford says, “Obstacles are those frightful things you see when you take your eyes off your goal.”

The goal should be a reasonable one knowing your own strength and limitations. Rome was not built in a day. And you cannot make all the changes overnight. But six months is a good time to review the progress.

Review involves asking two questions:

-What is important in my life?
-What stops me from living my life on the basis of those important things?

“The aim of a life review is to step back and look at it as a whole, identify any problems, and consider what changes are needed to make it more fulfilling and pleasurable”, says an article in the New England Journal of Medicine (NEJM).

The article says that we play many roles in our lives. To balance these different roles is a real challenge. Lack of balance is one of the most frequent problems people face in their lives.

How can we find balance in life?

By simplifying life!

It’s all about choice and making sacrifices. We just have to learn to choose how we live our lives instead of letting life make all the choices for us. If we don’t, then we’ll have to face the grim reality – in trying to have everything all the time, it may just end up killing us!

So where do you stand with your New Year’s resolutions? Do you feel good about yourself each morning – with or without a BMW? Have you made the right choices? Have you found a right balance in your life? Have you begun to simplify your life? Is greed dominating your agenda?

A Chinese proverb says, “Love is blind and greed insatiable”. So make the right choices. Don’t worry and be happy! And if you want to know – that’s exactly what I plan to do – without a BMW!

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

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My Father, Hussein

Next Sunday is Father’s Day. It’s a day to appreciate our fathers. A father is appreciated for many things. For his sacrifices. For teaching his children the right stuff. For preparing them to survive the constant danger they face everyday. And for being there when he is needed.

With close to 50 percent divorce rate, with wars, uprisings and terrorism, with famine and floods, through illness and accident, there are so many children in the world who have been deprived of their fathers. For them this day becomes even more special – to ask why life is unfair and what can we do to make this world a better place to live.

My father, Hussein, died on February 4th; 1991 in Calgary. He was 79 years old. He died the way he wanted to go – suddenly. He had a heart attack.

Hussein had a fair share of ups and downs in his life. Let me share with you Hussein’s journey through four continents in search of safety, security, prosperity and happiness for his family.

Hussein was born in Gujarat, India. He joined the work force at an early age of 13 when, in 1924, he came to Tanzania (then Tanganyika) from India with his older brother. His father’s business in India had failed, the local economy was bad, and the family needed financial help. So Hussein (after finishing grade four) embarked on a voyage of adventure to find work in Africa.

It took him almost a month by boat (across the Indian Ocean) and by rail (across East Africa) to arrive in Bukoba, on the shores of Lake Victoria, Tanzania. For eight years, Hussein and his brother ran a business in Bukoba and sent money to their father so he could support the rest of the family.

At the age of 21, Hussein went back to India to look for a bride. He married Sikina. Hussein stayed two years in Gujarat and their first child, Gulshan, was born. Sikina stayed back to look after Gulshan and the in-laws, and Hussein went back to Tanzania. This time he went to Musoma, another small town on the shores of Lake Victoria. He found a job, and Sikina and Gulshan joined him two years later when Hussein had saved enough money to get them over.

He was becoming restless again and wanted to start his own business. He did this in Kinesi, another small town across the river from Musoma. After five years in Kinesi, Hussein moved back to Musoma to continue expanding his business. Hussein’s family was growing in number (four girls and four boys). With the family manpower he had, at one time Hussein was running three shops in a fairly small town.

Life as a businessman was not always rosy. There were ups and downs. After 25 years in Musoma, he made another move to a bigger town (Mwanza) on Lake Victoria. Mwanza had a high school and it was good for his children. Perhaps Hussein’s best legacy was to encourage and support his children to seek more knowledge and strive for university education. For a man who had only grade four education, Hussein knew the value of higher learning – security.

Then came the era of Idi Amin and his terror in Uganda. In 1972, after 15 years in Mwanza, Hussein had to move again. First to England (three years) and then to Canada. Hussein and Sikina settled in Calgary.

As Hussein got older, he suffered from several health problems. He had heart disease for 20 years and was in pain with Rheumatoid arthritis. But he was a very strong, handsome, tall man. His appearance defied his internal sufferings.

He feared no one but God, and lived a very clean, sensible life. He believed in caring, loving and giving. He was a tower of strength to his family. He had no unfinished business left when he was summoned to his last journey on February 4th; 1991. He knew he had fulfilled all his obligations as a father. At the end he was a satisfied man. At peace with himself. A job well done!

May his soul rest in eternal peace! Amen!

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