Author: noorali

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A Golfer’s World

The golf season has started in earnest. But the fairways and the greens are dry. We need more rain. Rain for the golfers, rain for the farmers, rain for the forests.

We know golf courses drink too much water. TIME magazine says that 9.5 billion liters of water is used a day to irrigate the world’s golf courses. Same amount water supports 4.7 billion people in the world. Everybody needs water.

Golf is one of the most difficult and unpredictable games. Most golfers are very enthusiastic about their sport. Almost nothing can stop a golfer from playing unless there is thunder and lightning. It is the challenge and the love of the outdoor (not the ball!) which gets the best and the worst out of a golfer.

A recent Golf Digest survey asked, “Would you give up sex with your spouse to become a member at Augusta National? Thirty percent said “yes” and 70 percent said “no”. I don’t know the marital status of those who said “yes”. But it is good to know that the majority of golfers have their priorities in the right place!

Each golfing season starts with the golfer’s desire to cut his handicap by a reasonable number. Unfortunately, this fails. It has been shown that even among the most dedicated players; only 25 percent will improve their handicap index by at least one stroke during a 12-month period.

At the request of the Golf Digest, the U.S. Golf Association studied the handicap indexes of more than 1.1 million golfers from 2002 to 2003 and found that only two percent of players improved by five strokes or more during that 12-month span. The biggest shocker: 50 percent of players got worse!

It is said that golf mimics life. During a round of golf, a golfer faces so many challenges that after the 18th hole if he comes out smiling then he deserves to go to heaven.

A good golfer needs a good swing. The mechanics of a good swing have been thoroughly studied. But very few can duplicate it.

The ball, with multiple dimples, is supposed to fly like a bird and provide good distance. They are expensive to buy. Most golfers end up buying cheap “experienced” balls because who wants throw away money in the multiple ponds and creeks they call hazards!

Golfers are like farmers. Accurate weather forecast is important for them. Playing in the wind and rain is no fun. Sometime golfers do get lucky with sunny days and no wind. Then come the mosquitoes. It is worth remembering that Health Canada recommends insect repellents containing DEET as the best defense against West Nile for now. Hopefully, we will have a vaccine soon.

Sunny days also increase the risk of skin cancer. The Canadian Dermatology Association recommends using a sunscreen with a sun protection factor (SPF) of between 30 and 60.

Dehydration and fatigue can be dangerous. Golfers have to drink plenty of water. In 2002, a 15-year-old boy in Phoenix contracted Norwalk virus (he subsequently died) from a golf course water cooler. Eighty other golfers were taken ill. The Canadian National Golf Course Owners Association had recommended that its 2,300 member courses remove all coolers.

Golfers do get hungry. It is good to pack snacks which do not contain refined flour, sugar or tans fats (they can clog arteries). Try nuts, seeds, fruits, and low carbohydrate bars.

There are good things about golf. Golf is good exercise. You can burn 250 to 500 calories an hour. Golf is not good for building stamina. But it is good for flexibility and has a small effect on building strength.

Golf is fun if you like it and have reasonable expectations. As somebody has said, the world of golf has loads of weird terms, wild rules, and wacky practices. Either you love it or hate it. There is no fun if you are sitting on the fence. Then you might as well be a politician!

Well, when is my next tee time?

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My Easter Vacation

Every now and then go away,
Have little relaxation,
For when you come back to your work
Your judgement will be surer;
Since to remain constantly at work
Will cause you to lose power of judgement…

–Leonardo da Vinci (1452-1519)

I like this quote. I have used it before in my column. I may use it again. I like it because it is so true. It was written about 500 years ago and it is more valid now than ever.

But planning and getting ready for a stress free holiday is stressful in itself. That is one reason why many refuse to take a holiday.

Holidays are expensive. There are many hidden costs. And there are many fears. If you are in a wrong place at a wrong time then your time is up.

Workaholics feel they are indispensable. Or they are subconsciously afraid to accept that life will go on whether they are there or not.

Every time I book a family vacation, I have mixed feelings. My anxiety level settles down when I am back home with my family and am able to sleep in my own bed. I like the security and comfort of my home.

That is how I felt last Sunday when I got home after spending Easter week cruising some Caribbean and Mexican islands.

We had left on Easter Friday. The day started around 4.30 a.m. The flight from Medicine Hat was at 6.30 a.m. with a tight connection (I worry about tight connections!) in Calgary to fly to Toronto.

In Toronto we had to change planes and terminals and go through U.S. Customs and Immigration at the new big beautiful Pearson Airport to catch a flight for Fort Lauderdale.

We were in our Fort Lauderdale hotel at about 10.30 p.m. local time – 17 hours after we left our home in Medicine Hat. Long enough to get a blood clot in the leg which can be fatal.

After a good night’s sleep, we boarded Caribbean Princess the next day. There were long lines everywhere but the organization was great and the lines moved pretty fast.

Caribbean Princess is a brand new ship. This was her second voyage. It is beautiful inside. As we boarded the ship and entered our stateroom (cabin), we were handed a precautionary health advisory on Norwalk virus. Also known as “24 hour stomach bug”. We were advised to call the Medical Centre if we had diarrhea or vomiting.

We stopped for a day at Princess Cays island in Bahamas. Next port of call was Montego Bay. Then we sailed to Grand Cayman Island. Unfortunately, we could not land because of inclement weather. So we headed towards Cozumel, Mexico and then to Fort Lauderdale.

We disembarked at Fort Lauderdale at 8.30 a.m. on Saturday. Rushed to Miami airport to catch a flight at 12 noon. After over six hours in the plane we arrived in Vancouver. We cleared the customs and immigration and waited about three hours at the airport before catching a flight to Calgary. We arrived in Calgary at 9.30 p.m. with no connecting flight to Medicine Hat as it was Saturday. So we stayed overnight.

Four days from Medicine Hat to Fort Lauderdale and back. Three days at sea and three days at different islands. Quite a journey. Was it all worth it?

Yes, there was plenty of food – healthy and unhealthy. The service was good. Nightly entertainment in Princess Theatre could have been better. Recreational activities were plentiful. And the sun was shining most of the time (yes, I did use my sunscreen!).

I feel holidays are always worth taking – in spite of all the hassles. But wherever I go, I am glad to be back in Medicine Hat, sleeping on my own bed and getting back to my daily routine – until it is time for another holiday!

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We’re Clinicians, Not Mere Technicians

Dr. Ronald Witzke’s letter (“Colonoscopy should be top colon CA screening test,” the Medical Post, March 9) is interesting. He implies my earlier letter (“Flexible sigmoidoscopy should be encouraged,” Feb. 3) recommends flexible sigmoid-oscopy as a screening tool for colorectal cancer for all age groups and all kinds of patients. That is not true.

Let me simplify my point. Colonoscopy is an excellent screening, diagnostic and therapeutic tool in the right hands, for the right patients and for the right indications. For others (as described in my letter), flexible sigmoidoscopy should be considered. There is nothing new in what I said.

Good patient care requires a good history and physical, good clinical judgment, responsible use of resources, good indications for the use of highly expensive and invasive tests, and appropriate followup of patients.

Those who are interested in the subject should read “The tyranny of the scope,” an editorial written by Dr. Noel Hershfield in the Canadian Journal of Gastroenterology (August 2002). Dr. Hershfield is a highly respected senior gastroenterologist at the University of Calgary. He laments the current culture of “endoscopy on demand” and expresses concern “about this wholesale epidemic of unnecessary endoscopic mayhem.”

I agree with him that we should not become mere technicians. We should remember we are clinicians first.

—Dr. Noorali Bharwani, Medicine Hat, Alta.

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Lactose Intolerance

Dear Dr. B: I have been told I am lactose intolerant. What does that mean? How did I get the problem? What can I do about it? What is my prognosis?

Answer: Lactose is a natural sugar found in milk and dairy products. Lactose intolerance means inability to digest lactose. This inability results from a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine.

Function of lactase is to break down milk sugar into simpler forms that can then be absorbed into the bloodstream. Lactose is broken down in the intestine by lactase to glucose and galactose. These simple sugars are easily absorbed through the intestinal wall and enter the blood stream to be transported to the liver. Galactose is further broken down in the liver into glucose.

Lactose intolerance commonly develops after adolescence. It is more common in certain ethnic groups. Information obtained from the internet suggests that between 30 and 50 million Americans are lactose intolerant.

Certain ethnic and racial populations are more widely affected than others. As many as 75 percent of all African Americans and American Indians and 90 percent of Asian Americans are lactose intolerant. The condition is least common among persons of northern European descent.

Medical literature says that at birth large amount of lactase may be present in the intestine. But as the child grows the level of lactase may fall and by adolescence the level may be low enough that the milk can no longer be digested.

Lactase deficiency may be congenital. Or the deficiency may be acquired. It may occur temporarily after a bout of gastroenteritis. Certain digestive diseases and injuries to the small intestine can reduce the amount of enzymes produced. But for most people, lactase deficiency is a condition that develops naturally over time.

Absence of lactase will make lactose ferment in the intestine and cause symptoms.
Common symptoms include nausea, cramps, bloating, gas, and diarrhea. The severity of symptoms varies depending on the amount of lactose each individual can tolerate.

Most individuals will be diagnosed by the typical symptoms they experience. You may be asked to keep a diary for few days of what you eat and the symptoms you get. You may be advised to completely quit dairy products and see if the symptoms disappear. Then you will be asked to go back on the dairy products. If the symptoms reappear then the diagnosis is confirmed

The most common tests used to measure the absorption of lactose in the digestive system are the lactose tolerance test, the hydrogen breath test, and the stool acidity test.

Lactose intolerance is usually permanent in adults. The symptoms can be completely relieved by eliminating lactose from the diet by avoiding milk and milk products. Others can use lactase liquid or tablets to help digest the lactose. Other option would be to drink lactose-reduced milk available at supermarkets. This milk contains all the nutrients found in regular milk.

Milk is an important source of calcium in our diet. We need calcium for growth and repair of bones. If milk and milk products are avoided then consult your dietitian or physician to suggest other sources of calcium for your body.

Although lactose intolerance is widespread, it does not pose serious threat to our health.

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