Author: noorali

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Christmas

This is the last column of the year. I am writing it on Christmas day. By the time you read this, the Christmas will be over. And like me, you will be sitting and wondering where did the year go.

It wasn’t too long ago that we were spending millions of dollars to prepare for the impending disaster in year 2000. We are grateful that no disasters wrecked our lives. Now December is here and almost gone. But the month of December is probably the most exciting month of the year.

Month of December is a month to take stock of our lives and our deeds

Month of December is a month to be generous. Generous to our family, our friends, our co-workers, and ourselves. Generous to people who are not known to us but are not as better off as we are.

Month of December is also a month of happiness and celebrations. Millions of people all over the world celebrate the birth of Jesus Christ. We also celebrate the end of the year and beginning of the New Year.

Month of December is also a month of physical stress. The weather – especially this year – has not helped. Some people have suffered broken bones due to slippery conditions. Some have been maimed or killed on the roads. Some have suffered ill health due to flu or pneumonia or other ailment.

Month of December is also a month of financial stress. Shopping for presents, travelling to meet family and friends, finding money to go on holidays. Cooking for friends and families. And thinking of January as a month to pay all the bills.

Month of December is also a month of “fighting the battle of the bulge” stress. The parties. All that food and alcohol. The guilt and anger that all that hard work to lose few pounds has gone down the drain.

Month of December is also a month of “time management” stress. At work, the month is pretty short. You have to finish a month’s work in two to three weeks. Then there are people who want things done before the holiday starts. Parents have to find time to attend children’s year-end activities – besides attending all those parties. It is a stressful time!

As a non-Christian, I do not have all the stresses mentioned here. But it is hard to escape the spirit and celebration of Christmas. We take part in many of the activities taking place around us. You don’t have to be a Christian to enjoy good parties and good food! Or take time off and have a good holiday with our family

This Christmas day, I am spending a day in Calgary in a hotel room with my family and writing this column. We are going to visit my mother and take her to my sister’s house for a Christmas dinner (turkey and all that!).

In couple of days, we will back in Medicine Hat. Then I will start thinking about the New Year and the New Year’s resolutions. The rat race will begin. Hopefully, I will be fresh again to fight the same old battles with renewed energy and enthusiasm although my body and mind will be one year older. And that sucks!

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Prostate Cancer

Dear Dr. B: Pierre Trudeau died of prostate cancer. At the age of 58, Preston Manning is diagnosed to have prostate cancer. Can you please tell me something about prostate cancer – especially prevention and early detection? Yours: Mr. Worried.

Dear Mr. Worried: Let us start with bad news first. Every man, who lives long enough, will develop prostate cancer. The risk of getting prostate cancer increases rapidly after the age of 50. In fact, by age 75, the risk of getting prostate cancer is 30 times higher than age 50. But the good news is: if the prostate cancer is detected early then it can be cured.

How common is prostate cancer? If you take 100 men age 50 or older, 30 will have prostate cancer, 10 will be diagnosed with and treated for prostate cancer, and three will die from it. According to the National Cancer Institute of Canada (1996), prostate cancer is the most frequent cancer and the second leading cause of death from cancer in men, exceeded only by lung cancer.

According to Alberta Clinical Practice Guidelines, there are four major risk factors for prostate cancer: age, race, diet and family history.

Age: this has been discussed earlier. Race: African-American men have a 30 percent greater incidence of prostate cancer compared with white men. Diet: a high intake of dietary fat also seems to be associated with a higher risk for developing prostate cancer. Family history: there is an increased risk for the development of prostate cancer in men who have first-degree relatives with the disease.

How do I know I have prostate problems?

If the prostate is large enough to partially block the flow of urine, then there is diminished urine flow (Doc, I cannot hit the wall!); delay in onset of urine flow (honey, don’t rush me!); and frequent urination (sir, when is the next bus stop!) especially at night (oh boy, a man has to go when he has to go!). The enlarged prostate can be due to benign prostatic hypertrophy (BPH) or prostate cancer.

Does it mean that if I don’t have any symptoms then I do not have prostate cancer?

No, that is not true. You may be harbouring cancer in the prostate gland without any symptoms. That is why there is a big drive to screen asymptomatic men over 50 with digital rectal examination (DRE) and prostate specific antigen (PSA) blood test.

Although digital rectal examination has a cancer detection rate of only 0.8 to 7.2 percent, it remains an important test that can be done easily in a doctor’s office. It also checks for anal and rectal tumours. So it has a double advantage. PSA blood test has a false positive rate of 20 to 50 percent and false negative rate of 25 to 45 percent. That is means 30 to 50 percent of the time the test is wrong! So, why do them? The reason is simple – this is the best shot we have to get an early diagnosis!

What about prevention? Preventive strategies for prostate cancer are same as any other cancers. The Canadian Cancer Society recommends the following: stop smoking, eat low-fat, high fibre foods, and exercise regularly, limit salts, alcohol, and caffeine intake.

DRE and PSA is the best we have to make early diagnoses. So, Mr. Worried, talk to your doctor and get yourself checked out!

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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Exercise and Health

Dear Dr. B: Physical activity clearly benefits cardiovascular health. But people do die suddenly during or immediately after vigorous exertion like jogging or snow shovelling. What can one do to reduce the risk of sudden death during or after vigorous exertion? Yours: Born to Exercise!

Dear Born to Exercise: This is an interesting question. There are so many benefits to regular physical activity that we tend to forget exercise or any type of physical exertion can kill.

“Approximately 6 to 17 percent of all sudden deaths occur in association with exertion and there is evidence to suggest that vigorous exertion simultaneously triggers and protects against sudden death,” says an article in the New England Journal of Medicine (NEJM).

The authors of the article looked at the role of vigorous exertion in precipitating or preventing sudden death. It was part of the Physicians’ Health Study to determine whether vigorous exertion triggers sudden death and whether habitual vigorous exercise diminishes the risk.

About 22,000 male physicians between the ages of 40 to 84 years were studied over a period of 12 years. These physicians were otherwise well and had no obvious cancer or cardiac problems.

The majority of the participants in the study reported exercising vigorously two to four times per week. During the 12-year follow-up, 122 deaths occurred from cardiac causes (in apparently healthy male physicians). Fourteen percent of the deaths occurred during vigorous exertion and five percent of deaths occurred within 30 minutes after vigorous exertion.

These individuals were involved in different types of activities: 68 per cent jogging or racquet sports; 25 per cent other sports; 7 per cent were doing heavy yard work or home repairs.

It was found that the relative risk of sudden death associated with an episode of vigorous exertion was lower among those who exercised more frequently compared to men who rarely engaged in vigorous exercise (less than once a week). Men who exercised at least five times a week had a much lower risk of dying suddenly during or after vigorous exertion.

How can one avoid sudden death from vigorous activity?

There is no good answer to that. The article says that habitually active men have a much lower risk of sudden death in association with vigorous activity. But most active men’s risk remained significantly elevated during and after vigorous exertion.

This is scary because is no 100 per cent protection against sudden death. The benefits and risks of vigorous exercise are paradoxical. It is a double-edged sword. The important thing is to know ones limit as regular moderate exercise or physical activity has tremendous benefits. It is an important strategy in the prevention of the cardiovascular diseases and other chronic ailments.

So, if you are Born to Exercise then carry on exercising and stay within your limits. Talk to your family doctor to define these limits. “The balance of evidence supports the value and importance of participation in regular exercise regimens,” says the NEJM. A good workout is always better than no workout!

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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Impotence (Erectile Dysfunction)

Dear Dr. B: I have erectile dysfunction (impotence) and have been on Viagra (sildenafil) for sometime. Can you tell me more about this drug and is it safe to take Viagra if a person has heart disease? Yours Anxious.

Dear Mr. Anxious: About 100 million people worldwide are estimated to be affected by erectile dysfunction. Since the introduction of Viagra (sildenafil), the treatment of erectile dysfunction has significantly improved. It is a medication easy to take by mouth and is effective in 84 percent of the people with erectile dysfunction. Viagra (sildenafil) is quite specific in improving penile circulation and thus effective in producing penile erection.

A recent review article in the Canadian Medical Association Journal (CMAJ) says that there are several risk factors common to both, erectile dysfunction and cardiovascular diseases. These are: age, high blood pressure, hardening of the arteries, smoking, and diabetes. Therefore, cardiovascular disease and erectile dysfunction frequently occur together.

Sildenafil was first tested on patients with angina to relax coronary arteries to improve blood supply to the heart. One of the side effects was penile erection. This is how the researchers discovered that sildenafil might be beneficial to patients with erectile dysfunction. But the erection occurs only after sexual stimulation. Sildenafil does not cause spontaneous erection.

Sildenafil dosage can be anywhere from 25mg to 100mg. The drug is metabolized in the liver and excreted in the feces and urine. So sildenafil should be used with caution in patients with liver failure and kidney failure. Under normal conditions, the drug disappears from the body within four hours.

The most common side effects are from the drug’s property to relax the blood vessels – this leads to headache, flushing and runny nose. Some people get heartburn due to relaxation of the muscle at the junction of oesophagus and stomach. In about three percent of sildenafil users, there is visual abnormality related to blue-green colour vision.

Sildenafil’s effect on blood pressure is small and lasts for approximately four hours. Heart rate is not significantly affected. The article says, “The increase in sexual activity that can be expected after a patient receives a prescription for sildenafil should not be of concern for men with stable coronary artery disease (and negative results on exercise stress testing).”

But the situation is different for patients who are taking nitrates in any form (pill under the tongue, spray, patch) for the treatment of angina. There is a potential for the interaction between sildenafil and nitrates resulting in significant prolonged drop in blood pressure and heart attack. This may lead to death. Sildenafil is absolutely contraindicated in patients who take nitrate in any form.

Sildenafil should be used with caution in patients who have recent positive result on cardiac stress test, who have congestive heart failure, who are on multidrug therapy for high blood pressure and patients who are on any drug that could prolong the disappearance of sildenafil from the body.

The article says that overall, sildenafil does not appear to increase the incidence of heart attack or death in men with erectile dysfunction. So, if you are on sildenafil and have heart problems then you must discuss this with your family doctor. Although your heart may not be your most favourite organ, it is necessary to have good heart to enjoy the good effects of sildenafil!

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