Author: noorali

Posted on

Marijuana and Madness

A recent British study reveals that all users of cannabis (marijuana and hashish) are genetically at risk of developing schizophrenia or a related psychotic disorder.

What is psychosis?

According American Heritage Dictionary, psychosis is a severe mental disorder, with or without organic damage, characterized by derangement of personality and loss of contact with reality and causing deterioration of normal social functioning.

What is schizophrenia?

Schizophrenia is any of a group of psychotic disorders usually characterized by withdrawal from reality, illogical patterns of thinking, delusions and hallucinations and accompanied in varying degrees by other emotional, behavioral or intellectual disturbances. Schizophrenia is associated with dopamine imbalances in the brain and may have an underlying genetic cause.

How bad is the problem?

Canada is the industrial world’s leading consumer of cannabis. In 2004, the Canadian Addiction Survey found that 22 per cent of all male and 10 per cent of all female respondents aged 15–24 use cannabis on a weekly or daily basis. In Alberta, the most popular illicit drug is cannabis.

Those who use illicit drugs are usually chronic tobacco and alcohol abusers as well.

Tobacco use continues to be the leading lifestyle-related cause of death in Canada – 45,000 each year. About 30 percent of adult Canadians over 15 smoke regularly. Teenage girls are more likely to smoke (39 percent) than teenage boys (22 percent).

Everybody knows smoking is harmful. But not many people know that smoking may cause infertility in both men and women. In experimental animals, nicotine has been shown to block the production of sperm and decrease the size of a man’s testicles. In women, tobacco changes the cervical mucus, thus affecting the way sperm reach the egg.

Alcohol use takes its toll as well. About 10 percent of adult Canadians have a drinking problem. Impaired driving is a major cause of death. About 45 percent of the dead drivers have some alcohol in their blood and 38 percent are over the legal limit of blood alcohol concentration. In 2005, French researchers found people who drive after using marijuana are nearly twice as likely to be involved in a fatal car crash. Quite often there is a combination of marijuana and alcohol.

Marijuana has been found to cause other problems as well. In 2006, a report in Neurology found smoking marijuana may gradually fade verbal memory and other mental skills. Marijuana has been found to disrupt a woman’s ovulation cycle (release of the egg). Marijuana use affects men by decreasing the sperm count and the quality of the sperm.

The most important message for the youth is smoking cannabis, or marijuana, as a youth significantly increases the risk of developing a psychotic illness later in life by about 40 per cent. Those who use illicit drugs, tobacco and alcohol are danger to themselves, to their families and to society at large. I hope we can all pass this message to our children and grandchildren.

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

Posted on

A man with benign enlarged prostate gland – What are the treatment options?

A man has symptomatic benign enlargement of the prostate gland. What are his treatment options?

“Prostatic disease eventually affects almost all men; benign prostatic hypertrophy or hyperplasia (BPH) is an inevitable part of aging,” says an article in the Canadian Medical Association Journal (CMAJ June 19, 2007).

Do we need to worry about prostatic hypertrophy or hyperplasia which in simple terms means prostatic enlargement? Sure, we have to worry. Who knows, it could be malignant. Although prostatic enlargement eventually affects almost all aging men, not all men suffer from prostatic cancer. The lifetime risk of diagnosis of prostatic cancer is 18 per cent and death from prostatic cancer is three per cent.

Enlarged prostate gland has several effects. These include difficulty with voiding urine and blood PSA levels may go up. Other complications are urinary retention, urinary bleeding, bladder stones, recurrent urinary tract infections and renal failure. These effects become progressively worse requiring frequent medical attention and rising PSA requires multiple tests to rule out prostate cancer.

About 20 years ago, the standard treatment for benign enlargement of prostate gland was surgery. Now, patients with mild symptoms do not need any treatment. Patients with moderate symptoms are treated with medications. These medications have shown to improve the flow of urine and improve the quality of life. Do these medications prevent complications of BPH? Studies have shown that this is possible.

The two major classes of drugs used to treat BPH are: a) alpha-blockers like doxazosin relax smooth muscle fibers of the bladder neck and prostate gland to reduce prostatic obstruction, b) five- – reductase inhibitors like finasteride decrease levels of testosterone in the prostatic gland itself but do not affect the systemic testosterone level. This leads to reduction of the prostate gland by 20-30 per cent.

With -blockers, patients experience relief of symptom within two weeks of starting the medication, compared with several months with finasteride. Researchers have found that doxazosin and finasteride slowed down the growth of BPH compared with placebo; the combination therapy was significantly more effective than either drug alone.

The CMAJ article says that the Medical Therapy of Prostatic Symptoms study showed that:
-BPH is a progressive disease
-progression can be prevented by medical therapy
-patients at risk for progression can be readily identified by PSA level, prostatic volume and symptom severity
-and the combination of finasteride and doxazosin is more effective than either alone in preventing progression, particularly in high-risk groups.

Are there any side-effects to these medications?

The article says that clinically significant side effects, mainly postural hypotension (low blood pressure), were infrequent and they led to cessation of therapy in 18–27 per cent of the men involved in the study. Side effects that occurred were minor and related mainly to sexual function.

Patients treated with finasteride had significant benefit with improvement in urinary symptoms. There was also an added advantage in that the finasteride-treated patients saw reduction in the overall risk of prostate cancer by 25 per cent – a rate almost unheard of in the field of cancer prevention, says the CMAJ article. The authors of the article say, “Because PSA levels are reduced in men with BPH who are taking finasteride, rising PSA findings are more likely to be caused by prostate cancer. Taking this drug may therefore provide a diagnostic advantage as well.”

The article poses the question: Should selected patients now be offered finasteride to lower their risk of developing prostate cancer and BPH progression?

“The answer, based on these trials, is unequivocally yes,” conclude the authors of the CMAJ article.

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

Posted on

The Power of Sleep

Are we sleep deprived?

When I was at the peak of my career, I used to brag that I did not need more than five hours of sleep each night. I take power naps at least couple of times a day to keep me fresh and alert. I also brag about my capacity to dose off anywhere at any time in any position – even standing!

If you are a workaholic then your sleep habit is no better. It is estimated that one in six adults report getting less than six hours of sleep nightly. Work related stress is one reason. But there are several other reasons as well. Too much caffeine, nicotine and alcohol does not help. And 24-hour cable TV, the Internet and email also take a toll on our sleep.

A report in the Globe and Mail says that nearly eight in 10 married couples say their partner has a sleep problem, like snoring, insomnia, or incessant tossing and turning. A quarter say sleep difficulties force their mate into separate sleeping quarters. More than 20 per cent say they’re too sleepy for sex.

What happens if you don’t get enough sleep?
According to a large British study released few days ago, people who do not get enough sleep are more than twice as likely to die of heart disease. Researchers said lack of sleep appeared to be linked to increased blood pressure. We know that increased blood pressure raises the risk of heart attacks and stroke.

Previous reports have linked too little sleep to impaired memory and thought processes, depression and decreased immune response. Sleep deficits result in poor work performance, driving accidents, relationship problems, and mood problems like anger and depression. Diabetes and obesity have also been linked with chronic sleep loss.

How much sleep do we need?

Infants usually require about 16-18 hours of sleep per day, while teenagers need about 9 hours per day on average. Most adults need about seven to eight hours of sleep per day. The British researchers say that consistently sleeping around seven hours per night is optimal for health. When we sleep, the body rests and restores its energy levels. Good sleep is essential for our physical and mental well-being. A good night’s sleep will help us cope with stress, solve problems, or recover from illness.

Also be aware that the quality of sleep we get is as important as the quantity. Each morning, after seven to eight hours of sleep we feel tired and not fresh then it is a sign of poor quality sleep. If this is a chronic problem then you may be suffering from a sleep disorder which requires investigation and treatment. Your doctor can help you by referring you to a sleep clinic.

Remember, good sleep is just as important for overall health as diet and exercise. So Dr. B, stop bragging and start sleeping. The magic number is – seven hours.

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

Posted on

The Power of Vitamin D

Summer is almost over. Kids are back to school. I am back to writing my columns.

A friend wants to know: What should I make of all the news about vitamin D?

I said to him: If you haven’t started taking vitamin D everyday then you better talk to your doctor and start taking one. Talking to your doctor is important to make sure vitamin D is compatible with other medications you take.

We have always known vitamin D is needed for good health and strong bones and teeth. Your doctor will prescribe vitamin D supplements if you don’t get enough in your diet. Vitamin D is also used to treat rickets, low phosphate levels, and parathyroid problems.

In the last few months several reports have appeared which advance the case for universal intake of vitamin D on a daily basis.

A report published in the Journal of the American Geriatrics Society says vitamin D, taken in a high dose, may help prevent falls in the elderly. The study shows that nursing home residents who took a daily dose of 800 international units (IU) of vitamin D for five months were less likely to fall than those who took either lower doses or no vitamin D.

Another report appeared in the journal Nutrition Reviews suggests that adults should daily take 2,000 IU of vitamin D to help prevent some cancers.

The authors reviewed 29 observational studies and concluded that in North America, a projected 50 per cent reduction in colon and breast cancer incidence would require a universal intake of 2,000 to 3,500 IU per day of vitamin D.

A third report came out in the Archives of Internal Medicine. This review paper analyzed the results of 18 vitamin D studies says that taking vitamin D supplements may help people live longer. But it’s not yet clear exactly how vitamin D does that. But it appears to be a life extender.

So how much vitamin D should you take?

It has been previously determined that “adequate intake” of vitamin D is 200 IU per day for the first 50 years of life, 400 IU per day from 51-70, and 600 IU per day after age 71. Researchers now say that 2,000-IU daily dose of vitamin D is currently considered the “tolerable upper limit” for vitamin D. Most commercially available multivitamins contain between 400 and 600 IU.

The Canadian Cancer Society is now recommended taking 1,000 IU of vitamin D daily as a cancer prevention step. Experts suggest taking supplements of no more than 2,000 IU per day.

Some foods – for example, oily fish like salmon and sardines – are a natural source of the vitamin. Milk is commonly fortified with 100 IU per cup. The sun is the most potent source. When the sun’s ultraviolet rays hit the skin, the skin makes the vitamin, which is rapidly absorbed in the blood and can be stored for several months, mostly in the blood and fat tissue. However, excessive sun exposure is not recommended because of the well-known risk of skin cancer.

Are there any side effects if you take too much vitamin D?

Likely side effects are: Constipation, diarrhea, dry mouth, constant headache, thirst, metallic taste, irregular heartbeat, weakness, fatigue, loss of appetite, dry mouth, muscle pain, bone pain, irritability, nausea, and vomiting.

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