The pleasures and perils of winter.

Marigot (French side), Saint Martin and the Caribbean Sea. (Dr. Noorali Bharwani)
Marigot (French side), Saint Martin and the Caribbean Sea. (Dr. Noorali Bharwani)

Winter is here! Some people have died. Some have exacerbation and/or complication of their pre-existing conditions. Some have broken bones. Some have flu. Some are depressed.

The lucky ones – if that is an appropriate word for them – are in Hawaii or Florida. Some are in Arizona or Palm Springs. Some are on a cruise in Bahamas or South America. Some are on the big mountains, gyrating down the slopes on their ultra super speed skis.

The big chill does create a new dynamics in peoples’ lives. As soon as the leaves start gathering on the ground, we are gripped with fear or joy depending on what we have planned for the snowy days.

But we carry on. Sometimes smiling, sometimes annoyed and sometimes angry. Each morning, we get ready for work in our best winter clothes. At work, the heating is on and the windows are shut. Your comfort level goes down. Your smile fades and your layers start coming off. You look out of the window for some inspiration and comfort. You see a pile of snow. You feel trapped.

Do you find this stressful? Does this affect your health?

About 50 per cent of deaths in winter are related to coronary artery disease and blood clots in the brain.

Studies have shown that most deaths occur 24 hours after cold days. This appears to be due to brief rather than prolonged exposure to cold. Resulting in rapid changes in the blood viscosity, formation of blood clot and increase demand for oxygen by heart muscles.

Those who are already known to have coronary artery disease are prone to spasm of these vessels. This further aggravates the risk of heart attacks. Asthmatics run the risk of aggravating their condition by inhaling cold air especially during exercise.

The precise mechanism of cold-induced changes is being hotly debated by the experts. Engorgement of blood vessels and release of substances which produce spasm of lung vessels are responsible for asthmatic attacks.

Patients with Raynaud’s disease suffer significant spasm of blood vessels of hands and feet when exposed to cold. This occurs mainly in young healthy women. Their blood vessels are extremely sensitive to cold or emotions.

In most of these conditions, the underlying mechanism appears to be the effect of cold on blood vessels.

Asthmatics, who want to enjoy winter sports, should keep inhalers (bronchodilators) handy at all times. People with heart problems should wear a light face mask to maintain a favorable air temperature and humidity during exertion. Warm clothings, mittens, gloves and socks should protect the rest of the body from the big chill.

Remember, better safe than sorry! We still have almost four months of winter to enjoy. Keep smiling!

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

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

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

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!