Author: noorali

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Melanoma

How ironic that Chuck Cadman, 57, independent Member of Parliament from British Columbia, should die from melanoma during the summer month of July. His death reminds us again that we have to protect our skin from the damaging effect of the sunrays.

Artificial tanning machines are also dangerous. Recently, the World Health Organization (WHO) said the increased popularity of artificial tanning machines is one of the main reasons for a rapid increase in incidence of skin cancer, particularly among young women in Europe and North America.

WHO suggested Governments should pass laws on the responsible use of sun beds, banning their use for all people under 18.

For Canadian males, the rate for melanoma has tripled since the late 1960s. For Canadian females, the rates have varied over the years but still show a gradual increase.

Melanoma is the most serious form of skin cancer. If diagnosed and removed early then the cure rate can be excellent. Once the cancer advances and spreads to other parts of the body, it is hard to treat and can be deadly. The death rate from melanoma continues to rise about two percent annually.

Skin is the largest organ of our body and has many important functions to protect us from environment. Skin is constantly exposed to sun, wind, industrial elements and other causes of external and internal injury.

Melanoma arises from cells called melanocytes. These cells contain melanin (melas = black) – a principal pigment responsible for the color of human skin, hair, and eyes. Melanin also acts as a filter to decrease the harmful effects of ultraviolet rays to the dermis.

When the skin is exposed to ultraviolet radiation, there is immediate increase in the number of melanocytes and production of melanin pigment. This results in tanning. The amount of melanin produced is genetically determined. That is why some people burn easily without tanning.

The risk of skin cancer is increased in individuals who spend too much time out doors, children who have had episodic sunburn, and if there is a family or personal history of skin cancer (especially melanoma). Males are affected more than females.

Can we prevent skin cancer?

There are two important things to remember about prevention of skin cancer: cover up and stay out of the sun.

We need to remember that skin tanned by ultraviolet radiation is damaged skin which predisposes to cancer. We need to avoid sunburn and generally reduce exposure to ultraviolet radiation by staying out of the midday sun, wearing protective clothing, seeking shade, and applying sunscreen.

We should have moles or sun burnt skin surgically removed if they show signs of change or non-healing. Bleeding, chronic irritation, change in color or size should warn us to have these moles removed.

Despite having a good understanding of the relation between overexposure to the sun and skin cancer, 81per cent of North Americans still think they look good after being in the sun. Just like the smokers. They know smoking kills but they still smoke.

Does melanoma occur in children? Yes, approximately two per cent of melanomas occur in patients under the age of 20 years, and about 0.4 per cent of melanomas occur in pre-pubertal children.

Prevention of skin cancer is very important. This should start in childhood. More than 90 percent of skin cancers occur on sun-exposed areas of the body. So, protect yourselves from the damaging effects of sun and tanning beds.

This column will take a summer break and return in September. Have a safe summer!

Thought for the week:

“Genius is the ability to put into effect what is in your mind”.

– F. Scott Fitzgerald

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Lactose Intolerance

Dear Dr. B: I have chronic diarrhea. Is it possible that I may have lactose intolerance?

Answer: Many conditions can cause diarrhea. It can be acute or chronic in nature.

Acute diarrhea is more likely to be the result of a viral illness such as infection with rotavirus, adenovirus, or astrovirus. Bacterial or parasitic infection can also cause acute diarrhea. These may be contracted from exposure to contaminated water and food.

Chronic diarrhea can result from malabsorption, food allergy, celiac disease, bacterial overgrowth, lactose intolerance, chronic Giardia infection, short-bowel syndrome, inflammatory bowel disease, malignancy and irritable bowel syndrome.

Lactose intolerance is a condition where a person has inability to digest lactose, the natural sugar found in milk. Normally, the enzyme lactase breaks down lactose in the intestines to form the sugars glucose and galactose, which are easily absorbed through the intestinal wall.

Persons with lactose intolerance are unable to digest significant amounts of lactose because of a genetically inadequate amount of the enzyme lactase. As a result, the lactose remains undigested in the intestines and causes abdominal pain, diarrhea, bloating and excessive flatus.

The condition most commonly develops in adolescence and adulthood. It is more common in non-Caucasians than in Caucasians. It is present in up to 15 percent of persons of northern European descent, up to 80 percent of blacks and Latinos, and up to 100 percent of American Indians and Asians.

A diagnosis of lactose intolerance is usually not too difficult. It can usually be made with a careful history supported by dietary changes. If necessary, diagnosis can be confirmed by using a breath hydrogen or lactose tolerance test.

Individuals with chronic diarrhea believe they are lactose intolerant but do not actually have impaired lactose digestion, and some persons with lactase deficiency can tolerate moderate amounts of lactose, up to 250 mls. of milk daily without symptoms.

Lactose intolerance is usually a permanent condition. Treatment consists primarily of avoiding lactose-containing foods. Lactase enzyme supplements can be helpful. If one has to go off milk and milk products completely then one must maintain adequate body calcium balance by taking oral calcium supplements.

Question of the week:
What is the difference between a nice guy and a good guy?

According to 83 years-old Jack Fleck (1955 U.S. Open golf champion), nice guys are pleasant outwardly, but they’re looking for how situations can benefit them. Good guys give of themselves, no questions asked.

A thought for the week for the new graduates:
“Having an education is no excuse for not using your head”.
-from Musings by Dennis van Westerborg, a local artist and writer.

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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West Nile Virus

These days it is a rare event to find an ideal day when the wind is not howling, the rain is not falling, the sun is shining, the temperature is just right and the bugs are not getting into your ears, nose and throat.

Then there are ants. Many houses are swamped by the ants but not many people talk about that. Then there are many other kinds of worms and insects taking over the trees, backyards, parks and barbeque areas.

Do you get a feeling that you are under siege?

I have been worried about the West Nile virus (WNV). But my fears were partially alleviated by the recent announcement by Palliser Health Region’s medical officer of health who said the WNV hasn’t showed up in mosquitoes, birds, horses or humans in southern Alberta yet.

The Corvidae family of birds, which includes crows, blue and grey jays, ravens and magpies, are particularly susceptible to illness and death from WNV. Public health units have relied on dead crow sightings, the testing of standing water for the presence of mosquito larvae and the trapping of adult mosquitoes for WNV testing to monitor control efforts.

When I lived in Africa, I was not threatened by the lions or the elephants. I felt threatened by malaria carrying mosquitoes. Malaria is a life-threatening parasitic disease transmitted by mosquitoes. Today, approximately 40 per cent of the world’s population, mostly those living in the world’s poorest countries, is at risk of malaria. It causes more than 300 million acute illnesses and at least one million deaths a year.

Africa is also the source WNV. It was first isolated in 1937 from the blood of a patient on the West Nile province of Uganda. The man had fever. Initially, the outbreaks of the disease were few. But in the last 10 years the numbers have increased. In North America, the virus was first detected in New York 1999. From there it was exported to Ontario and rest of Canada.

Statistically, a person’s risk of contracting West Nile is low. Less than one per cent of those infected develop serious illness from the virus. Those at highest risk for serious illness are the elderly and those with lowered immune systems. However, people of all ages can develop serious illness. Most cases of WNV are mild and self-resolving. But one per cent of cases the virus infects the nervous system and this can be serious. It may result in long term disability, coma and death.

Humans can be infected with WNV by a mosquito bite, through blood and organ donation, pregnancy, lactation, needle-stick injury and exposure to infected laboratory specimens.

WNV incubates for three to 14 days in humans. Only 20 per cent of infected people have fever. Fever is accompanied by malaise, headache, muscle pain, rash, enlarged lymph glands, eye pain, loss of appetite and vomiting lasting for three to six days.

Currently, prevention is the best way to keep the virus away from our body. How do we do that?
-By elimination of mosquito breeding sites (standing water). Many mosquitoes will breed in containers that hold water, such as flowerpots or discarded tires.
-By the use of personal protection. One survey showed that only less than eight per cent of the public consistently used an insect repellent containing DEET during outdoor activities.

Once again, it boils down to prevention. Enjoy the summer safely!

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Toenail Problems

There are many people with toenail problems. I wonder if toenails are the most neglected part of our anatomy. I have written about ingrown toenails and fungus infection in the nails. I feel it is time to revisit the subject.

The nails are appendages of our most versatile organ – skin. Besides nails, the skin has three other appendages – hairs, sweat glands, and sebaceous glands.

Nails protect the tips of our fingers and toes. Hairs protect and provide warmth to the skin. Sweat glands help regulate body temperature and fluid and electrolyte balance. Sebaceous glands provide oil and odour to the skin.

The nail has a free end which we trim on regular basis. The two sides of the nail are under the skin folds. The root is at the base where the growth occurs. The average rate of growth of the nail is 0.1 mm a day or 3 mm per month. About 3.6 cm a year.

Fingernails grow faster than toenails. Both grow faster in the summer than in the winter. The nails grow rapidly in “nail biters” and slowly in people confined to bed. The growth is faster in males than females. Certain illnesses can arrest the growth.

The nail can be a window for physicians to suspect other illnesses. Normally, nails are flat and light pink. They are pale in anaemia. Nails in general and big toenail in particular can be sites of many problems. Ingrown big toenail with infection and pain is a very common condition. It can lead to gangrene and amputation in patients with diabetes and circulatory problems.

Ingrown toenail of the big toe usually occurs when sweaty feet are encased in tight shoes. The situation gets worse when the nail is trimmed short and the corners are curved down. The side of the nail curls inwards and grows to form outer spikes. This causes painful infection of the overhanging nail fold.

Ingrown toenails can be prevented by keeping feet nice and clean. Wear roomy shoes and clean cotton socks. Allow the outer corners of the nail to grow over the skin margins placing small piece of cotton soaked in an antiseptic just under the outer corners of the nail. Cut the nails straight. Antibiotics will help relieve acute infection but will not cure the primary problem.

If all this fails then surgical treatment becomes necessary. Simple whole nail avulsion or wedge removal of the nail can result in more than 50 percent recurrence rate. The best results are obtained by removing the root at the same time. This is done under local anaesthetic in a doctor’s office. About 10 days of tender loving care of the big toe after the surgery usually results in satisfactory outcome. There is about 10 percent or less recurrence rate.

Fungal infection of the nails is common as well. It affects toenails more than finger nails. The nail is thickened and discolored. It is usually yellowish. The nail may grow in a twisted manner. The infection is picked up in a public place where it is transmitted from person to person. Poor feet hygiene does not help.

Fungus infection is best treated with anti-fungal therapy orally and locally for three months. Cure rate is around 80 percent. Ongoing meticulous foot care is very important to prevent recurrence.

In my view, walking bare feet is the worst thing you can do for your feet. Wash your feet at least once a day (twice if your feet sweat a lot) with soap and water. Dry them well with a soft towel. Wear good quality clean socks and proper fitting comfortable shoes.

If you love your feet then take good care of them.

Thought for the week:

“War is the unfolding of miscalculations.” – Barbara Tuchman (1912-1989)

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