Author: noorali

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Problems of Hands and Feet

There are numerous minor but common conditions of the hands and feet which bother people. Most people do not understand why they get them. The conditions are not life threatening but they are a nuisance. I will describe few conditions here and briefly discuss their cause and treatment.

Ganglion: A ganglion occurs mainly in the hand and foot and joint areas. It is a cyst containing jelly like substance. It may be soft or tense. It is usually smooth. It arises from the bursa within the substance of a joint capsule or the sheath covering a tendon. Some times this occurs after an injury. Sometimes it may cause pain.

Treatment: There are non-surgical methods to treat ganglion. But surgery usually provides satisfactory results. Occasionally it may recur at the same site.

Plantar warts: These are same as common warts. They grow on the soles of the feet. They grow into the skin because we walk on them. They can be painful on walking. The virus causing the wart is picked up from walking bare foot in locker rooms and swimming pools.

Treatment: They may spontaneously disappear if you wait long enough – months to years. They can be managed by freezing, scrapping or burning. They can recur.

Plantar fasciitis: Also known as “policeman’s heel”. It is common in men aged 40-60years. Exact cause of the condition is not known. There is pain beneath the heel. It is tender when pressure is applied.

Treatment: Pain can be minimized by padding and/or by cortisone injection. This may or may not work. Pain usually gets better in six to twelve months.

Callus and corns: These are thickened areas on the hands or feet caused by pressure or friction. This is usually related to work or sporting activities. Uneven pressure of body weight during walking or ill fitting shoes can cause calluses and corns on the feet.

Treatment: Wear proper fitting shoes and use corn pads to relieve pressure on the corns. Thick calluses can be sliced down to normal skin over a period of time. If the source of friction and pressure is removed then corns and calluses should not recur.

Toenail problems: Mainly involves the big toe. It may be ingrown or overgrown. Ingrown toe nails are commonly due to ill-fitting shoes pressing on an incorrectly cut nail. Poor foot hygiene encourages infection.

Treatment: In an acute stage antibiotic, painkillers and bathing the foot in warm salt water are necessary. Surgery is required in most cases. The problem can be prevented from recurring by keeping the feet clean and wear correctly fitting shoes. Cut the nail straight.

Fungus infection of the nails: Usually affects toenails. 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.

Treatment: Anti-fungal therapy is required – orally and locally for three months. Cure rate is around 80 percent. Ongoing meticulous foot care is very important to prevent recurrence.

Our feet are subjected to more wear and tear and hence they get more problems than our hands. Our natural tendency is to take care of our hands more than our feet. Many of these problems are preventable.

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.

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Outbreak of Diarrhea in Calgary and Montreal

Dear Dr. B: I am concerned about the recent reports of outbreak of diarrhea in Calgary and Montreal hospitals. Can you please explain the cause and effect of this kind of colitis?

“More people have died after contracting a virulent infection that has broken out in hospitals in Montreal and Calgary than were killed by SARS – yet neither public health nor hospital officials warned the public until CMAJ broke the news,” says an article in the recent issue of the Canadian Medical Association Journal (CMAJ).

The bacterium responsible for the outbreak of diarrhea is called Clostridium difficile (C. difficile). The condition is known as Clostridium difficile-associated diarrhea (CDAD).

In the last 18 months, at least 12 hospitals in Montreal have been fighting CDAD. More than 1400 patients have tested positive to this organism in that city. At least 79 people have died in Montreal and four in Calgary from C. difficile infection.

The organism was first described in 1935. In the last 25 years, it has been recognized that C. difficile can cause mild to life threatening diarrhea – also called psuedomembranous colitis.

The C. difficile infection is most commonly associated with antibiotic use. The antibiotics cause disruption of normal bacterial flora in the gut and allow C. difficile to thrive and produce toxins which causes diarrhea. C. difficile is resistant to most common antibiotics. Hence, the difficulty of controlling the infection.

July 16th issue of the CMAJ has several articles on the subject. One of the articles written by Dr. Thomas Louie from Foothills Medical Centre, Calgary says, “The root cause of outbreaks of C. difficile diarrhea in our hospitals relates to the difficulty of practicing and maintaining good infection control measures in hospitals.” This is because of high occupancy rate in hospitals, intensive antibiotic use and increasingly complex care of patients.

Many hospitals are old, there are few single or isolation rooms, many patients have to share toilet facilities and there is rapid turn over of patients. All these factors make it difficult to control or contain infection.

What’s the situation in Medicine Hat? I spoke with Dr. Wai Chow, Regional Medical Director of Laboratory Services in the Palliser Health Region. He said that there is no evidence of any outbreak of CDAD in our region. The laboratory continues to get sporadic cases of CDAD which is not unusual. Most cases are due to antibiotic use.

Hospitals in Canada are acutely aware of the situation and continue to implement infection control measures. But there is no guarantee that there won’t be another outbreak of CDAD. Changing behavior of bacteria and viruses will continue to challenge our survival, our resources and our skills. SARS and avian flu are good examples.

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Holiday in British Columbia

This summer, we decided to go to Victoria and Vancouver for a holiday. We have been there before but it has been few years since we went as a family. Both places have a sentimental value for my wife and I. We were married in Vancouver and had our honeymoon in Victoria.

I remember those days quite well. We were both working hard to finish our studies and training. That was the time when we could not afford much.

My wife and I had several family members in Vancouver. But much has happened since our wedding. We have had two children. They are now teenagers and close to finishing high school. And we have had some losses. My father, brother and sister have passed away. And my wife’s parents have left this world.

But still there are number of other relatives who are there. For them Medicine Hat is not an exciting place to visit. So we thought it is time for us to visit them. It is good for family bonding, especially for children. Besides that we wanted to visit universities in B.C. in case our children decide to go there.

Victoria, of course, is a very beautiful city. It has 150-year history. It is British Columbia’s oldest city and provincial capital. In 1908, it had a population of 25,000. Now the population is 326,000. The horse-shoe shaped Inner Harbour is the hub of activity during the day as well as at night. Besides the marine activity there are street musicians and artists who entertain and draw crowds of onlookers. It is a very lively and busy place.

The downtown has excellent walking and shopping areas and multitudes of restaurants to cater to almost everybody’s needs. The city boasts of several beautiful golf courses whose green fees run into three figures. And there are lots of recreational activities of all kinds.

We spent fair amount of time in and around the Inner Harbour and downtown area. We also visited the Butchart Gardens which was celebrating 100 Years in Bloom (1904-2004). We spent a day at the University of Victoria and took a campus tour.

The University was founded in 1963. It is located on 160 hectares in residential Greater Victoria. It is a 15-minute drive from downtown Victoria. It has 12,014 full-time students and 6,022 part-time students. Tuition: $4,271.

Vancouver is a cosmopolitan city where you can hike, ski, or golf by day, and enjoy lavish accommodations, live theater and fine dining by night, says a tourist brochure. And that is the truth.

Vancouver is Canada’s third largest city. The city of Vancouver has a population of 571,708. But Vancouver and its 18 surrounding municipalities (Greater Vancouver) have a population of 2,028,996. Besides doing some sight seeing we did lot of walking and eating. We also took campus tours at the Simon Fraser University (SFU) and University of British Columbia (UBC).

SFU is situated at the summit of 400-metre-high Burnaby Mountain. It is 25 minutes from downtown Vancouver. It opened its doors in 1965. It has 12,104 full-time students and 9,580 part-time students. Tuition: $4,174. Every high school student with a 90 percent or higher admission average automatically receives a $3,500 entrance scholarship.

UBC is like a city in itself with 40,000 students (full-time 28,091, part-time 11,141) on a 402 hectares land and 412 buildings. It is 20 minutes drive from downtown Vancouver. UBC has students from 114 countries. Tuition: $4,036. It is one of the most beautiful campuses I have seen. UBC was established in 1908.

It was an interesting holiday. Weather was perfect until the last couple of days. The experience was diverse. Visiting institutions of higher learning was quite an experience for our children. We hope it will be a positive factor in their future planning. We had lots to eat. And I put on five pounds! Time to get on my treadmill!

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Do We Complain too Much About our Health?

How has the summer weather been in your area so far?

This question appeared on the Globe and Mail website recently. Many readers responded to the question. Of the 11,287 people who registered their opinion, 71 percent thought the weather was unusually cold. Twenty percent said the weather was average and nine percent felt it was hotter than normal.

My response to the question would have been – the weather is weird. But there were only three choices to pick from. So what do you do? Whine and suffer in silence. You can curse nature but you cannot fight it. In any case, my opinion would not have changed the course of the next hailstorm or lightning.

Unpredictable weather brings with it unpredictable dangers.

During the summer months there is immense heat, drought, rain, wind, thunder, lightning, hail, floods, tornados and forest fires. This causes damage to life and property.

Then there is danger of West Nile virus. In 2002, Canada had 426 cases of West Nile virus. In 2003, there were 1335 cases. Unfortunately there is no specific treatment yet. The movement of the virus is unpredictable. All blood products are screened for the virus, so are the donor organs for transplant. The only way to prevent the disease is to protect against mosquito bites.

Summer is not the only time when we face danger. A recent AIDS conference reminded us that many millions of people continue to die from this illness through out the year.

The Canadian Journal of Infectious Disease and Medical Microbiology has an editorial on this subject. It reminds us that it has been 25 years since the first case of AIDS was recognized in gay men in Los Angeles. Since then the disease has spread around the world in a relentless fashion. The editorial says, “The virus is now a permanent fixture in our human landscape.”

In couple of months winter will be here and we will be worried about flu and SARS. The cycle of worrying, whining and complaining goes on.

I was looking at some newspaper clippings on my desk. I found one from the Globe and Mail dated May 23rd, 2003. It is an article written by their columnist, Marcus Gee. Its title, “Stop your snivelling, you bunch of pathetic hypochondriacs”.

Gee starts by saying, “People living in Canada and other rich countries today enjoy a healthier, safer life than any other generation in the whole of human history. Yet if you picked up the newspaper this week, you wouldn’t know it.”

One year later, we have the same sort of headlines. He was talking about SARS. Now we are talking about the weather and the West Nile virus. And our whining and complaining goes on through out the year. He says we have become a nation of pathetic hypochondriacs, snivelling over little hurts while people in poor countries drop dead like flies from real killers like malaria, AIDS and tuberculosis.

Has he got a point? Are we a nation of pathetic hypochondriacs? Do we spend too many precious health care dollars worrying about too many little things? Well you have whole summer to think about this. In the meantime this column takes a little break and will be back in a month.

Have good summer and don’t let the bugs bite you!

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