Author: noorali

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Sleep Apnea

Dear Dr. B: I snore and my doctor says I have obstructive sleep apnea. Can you please tell me more about this? Yours, Mr. Snorer.

Dear Mr. Snorer: Normally, breathing is regular. Apnea means cessation of breathing. Sleep apnea is a condition that interrupts breathing during sleep.

Sleep apnea may be central – that is due to instability of the feedback system that regulates breathing. Or sleep apnea may be obstructive – due to recurrent obstruction of the upper airway. Or it can be mixed – central followed by obstructive.

Today, we will confine our discussion to obstructive sleep apnea.

Obstructive sleep apnea affects two percent of women and four percent of men. It is a condition of middle-aged adults.

A typical individual with obstructive sleep apnea starts snoring shortly after going to sleep. The snoring proceeds at a regular pace for a period of time, often becoming louder, but is then interrupted by a long silent period during which no breathing is taking place (apnea). The apnea is then interrupted by a loud snort and gasp and the snoring returns to its regular pace. This behaviour may recur repetitively and frequently throughout the night.

Obstructive sleep apnea causes frequent night awakening, feeling of tiredness in the morning, abnormal daytime sleepiness, headaches, memory loss, poor judgement, personality changes and lethargy. It may also raise the blood pressure.

Who suffers from obstructive sleep apnea?

Obstructive sleep apnea occurs most frequently in obese middle-aged men. Contributing factors may include use of alcohol or sedatives before sleep, anatomically narrowed airways, and massively enlarged tonsils and adenoids. Genetic and environmental factors may also adversely affect airway size. The condition may run in some families.

Diagnosis of sleep apnea is made by sleep studies. One article on this subject says that a sleep study should be strongly considered for two groups of patients: those who habitually snore and report daytime sleepiness, and those who habitually snore and have observed apnea (regardless of daytime symptoms).

Are there any medical or physical side effects to obstructive sleep apnea?

Once upon a time, sleep apnea was thought to imply poor prognosis. It was thought to arise from the diseases of the brain and heart. It is now known that periodic breathing generally occurs during sleep. That it may occur in healthy persons.

During periodic breathing, there is change in the partial pressure of carbon dioxide and oxygen in the blood and this results in the fluctuation of heart rate (with irregular rhythm) and blood pressure and in the autonomic nervous system. Heart failure, heart attack and stroke are other likely complications.

Chronic sleep deprivation caused by sleep apnea increases risk for motor vehicle accidents. The accident rate for such patients has been reported to be seven times that of the general driving population.

Does obstructive sleep apnea really damage our health?

In 1997, a review article in the British Medical Journal evaluated all studies published between 1966 and 1995 on the association between obstructive sleep apnoea and mortality and morbidity, and on the efficacy of nasal continuous positive airways pressure. The authors concluded that there was limited evidence of increased mortality or morbidity in patients with obstructive sleep apnea.

They also concluded that the evidence linking the condition to cardiac irregular rhythm, coronary artery disease, heart failure, high blood pressure, pulmonary hypertension, stroke, and automobile accidents was conflicting and inconclusive. They concluded, that there were insufficient data to determine its effect on quality of life, morbidity, or mortality.

So, is there a need to do anything about snoring and obstructive sleep apnea? Well, Mr. Snorer, stay tuned for an answer next time!

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Vitamin C

In the 16th century, the Dutch sailors knew that eating citrus fruits prevented scurvy. But it wasn’t until 1920s when it was recognised that the active ingredient in citrus fruits was vitamin C (ascorbic acid).

The next big development for vitamin C came in 1974. A research paper was published with careful description of the responses of 50 consecutive patients with advanced, untreatable cancer to high-dose intravenous and oral vitamin C.

Most patients in this group of 50 did not respond to high doses of vitamin C. But extraordinary things happened to a significant minority of them. These included several cases of tumour regressions.

This report generated some controversy. In 1991, a panel set by the US National Cancer Institute, reviewed 25 of the 50 patients who had complete remission of the tumour. The panel found that in each and every case, “there were alternative explanations for the observed remissions”.

So, what do we know about vitamin C and its usefulness in cancer prevention and treatment?

Vitamin C is known to play an important role in the synthesis of collagen (fibrous protein of connective tissue), to promote wound healing and to influence many immunological and biochemical reactions in the body.

In laboratory animals, vitamin C has been shown to have a range of effects that could be beneficial to cancer patients, including tumour regression, the inhibition of tumour growth and increased survival on animals with implanted cancer.

There is some evidence that populations whose dietary intake of vitamin C is high have a decreased risk of some types of cancer, cardiovascular disease and cataracts. Vitamin C supplements are generally well tolerated. In adults, a dose of one gram per day is safe with minimal toxicity. Very minimal toxic effects have been reported even at much higher doses.

Vitamin C can interfere with absorption of many other medications: blood thinners, iron, vitamin B12, and vitamin E.

Humans cannot manufacture vitamin C. We have to obtain it from dietary sources. It is found in many fruits such as oranges, grapefruit, strawberries, raspberries and kiwi fruit, and in vegetables such as cabbage, tomatoes and bell peppers.

Canada’s Food Guide, prepared by Health Canada, sets guidelines for the recommended daily intake (RDI) of vitamins and minerals. Most people who eat a balanced diet that is made up of a variety of foods and that is rich in fresh fruits and vegetables will meet the RDI of vitamins and minerals.

Advocates of mega dose vitamins often recommend combining vitamins A, C, and E and claim that these vitamins improve general well being, strengthen the immune system and may delay the development and progression of serious disease.

Is this information good enough to make a strong case for vitamins in the management of cancer patients?

In 1998, the Canadian Medical Association Journal (CMAJ) ran a series on “Unconventional therapies for cancer”. The article on Vitamin A, C and E says: There is some laboratory evidence and some clinical evidence that vitamins A, C and E, given separately or on combination, may have value in the management of cancer. However, there is a lack of solid scientific evidence of the sort required to support a recommendation that cancer patients take vitamin supplements.

In the last few years, rational guidelines fro testing biological agents like vitamin C have been developed, says the CMAJ. And hopefully new information on the benefits of vitamin C should be forthcoming. The good thing about vitamin supplements is that they are readily available, can usually be self-administered and are relatively inexpensive and non-toxic for most adults. And hopefully, there will be more good news in the years to come.

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Well, it is time for New Year’s resolutions. Have you decided what you plan to do or change in 2002?

As for me, I have lots to work on. Some of it will be to continue to improve what I achieved in 2001. Especially not get sucked into a rat race! And apply the KISS principle (Keep It Simple Stupid)!

Let me share with you what my plans are for year 2002. You may have your own ideas. When it comes to New Year’s resolutions, most people think in terms of pursuing healthy life style with a desire to live little longer. I am no different than the majority of the people. So what I say here may be on your list of New Year’s resolutions as well!

For year 2001, my New Year’s resolution was to practice ELMOS (exercise, laughter, meditation, organic healthy food, and stress relief). Since I don’t smoke, I did not add another S that would have been for “stop smoking”. So now we have ELMOS with a single S for non-smokers and ELMOSS with double S for smokers!

There are many barriers to good health and the three most important are:

-failure on one’s part to accept that change is required,
-failure to have a strong will power to work toward that change and
-failure to find time to make the change.

I accept that I need to make some more changes in my life. My will power is getting better as I realise that either I work toward achieving good health or suffer the consequences without complain. Finding time has been little better this year than ever before. And I am determined to find more time for my family and myself in 2002. But at work there is always direct and indirect pressure to do more. And that has to be resisted. Workload has to be shared fairly by all.

Well, here is my list:

1. Find more time for myself to continue practicing ELMOS. If I did smoke then “stop smoking” would be first on my list. If smokers can just do that in 2002, then they would be doing a great service to themselves and their families.

2. Find more time for my family.

3. Be an optimist again. Survival rates seem to be better for optimists. Be calm, prudent, levelheaded, resilient, flexible and creative.

4. Continue to eliminate sweet foods from my diet. Use more fruits and vegetables as substitute.

5. Stop worrying about my weight. If I eat right and exercise at least half-an-hour daily then there is no need to worry. If I spend more calories than I take in then my body fat should melt. It is as simple as that!

There is no short cut to good health. It is hard work. And I am determined to do more than I did in 2001. Hope you would do the same. Eating right, exercising moderately, quitting smoking and staying involved in the community can produce enormous benefits to individual’s health. So together, we can keep trying.

Good luck! Happy New Year! And keep it simple stupid!

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Meaning of Christmas and My Mother In-law

Christmas is here. Unfortunately, it is difficult to look back at 2001 and say anything nice.

Not long ago, we thought that the world was shrinking. “It’s a small world,” was one of the most commonly used phrases. I haven’t heard this sentence recently. Now even the U.S. feels distant! Travel across the border is not taken for granted.

Worldwide, there is news of death and destruction, of fear, terror and revenge.

Human differences have never been so much verbalised or written about. Are my fears different than yours? Is my God different than my neighbour’s? Are these differences important when millions of people are dying from illness, civil wars, starvation, terrorism and other wars? Is their God different than yours or mine?

Closer to home, many families lost their loved ones due to sickness or accident. Medical and nursing staff of Palliser Health Authority lost three of their finest: Dr. Ivan Witt, Dr. Keith Clugston and Nurse Wendy Smith. A big loss not only to their families but also to their colleagues and patients. What is more painful is that they were taken away from us so suddenly. What did their God have in mind?

Then there are people in hospitals or at home who are chronically ill and incapacitated. They are waiting to die because they are in pain. They are suffering. One such person is my 88-year-old mother-in-law who lives in Vancouver. For several weeks now she has been close to death. But continues to live. Her end is near. But we don’t know when. The family waits and flies in and out of Vancouver not knowing what to do.

If there was a case for euthanasia, then here is one. Her body is small and frail. All the body fat has disappeared. The joints are stiff and painful. The bedsores are hard to see. The muscles are wasting away. She is unable to eat or drink. She is literally starving to death.

Morphine helps relieve pain. Her dutiful son, who has looked after her for so many years, waits and watches in helpless despair. “What can I do to make it easy for my mother without prolonging her sufferings?” he keeps asking. The best thing is to keep her pain free and comfortable. But it is painful to watch. He wants to be at the bedside until the end.

I wonder what his God is thinking about?

But we know life isn’t fair. Whether it is your God or mine, He has His game plan. And there isn’t much we can do except learn to be descent human beings. Share and enjoy what we have with those who are struggling in life. I think the God of the Christians, Jews, Muslims, Hindus, Buddhists, and others teach the same thing – be nice and help others.

Time and again we have learnt that life is too short. But greed and exploitation continues. Yesterday’s friends are enemies today. And yesterday’s enemies are friends today. It is no secret that ruthless exploiters (I wonder if their God is different than yours or mine) take full advantage of the majority of the people who are honest, descent, and God-fearing individuals.

The message of Christmas transcends all religions and human beings. It is one religious festival that has no defined boundaries. So let me wish you all a very merry Christmas, Ho! Ho! Ho!

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