Author: noorali

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Breast Cancer

Can we prevent breast cancer? Probably not! Prevention implies complete protection from breast cancer. This is not possible. What is possible is to understand the risk factors and then try risk reduction.

What are the risk factors for breast cancer?

Being a woman is a risk factor. Men do get breast cancer. But of all breast cancers, only one percent is in men.

Age of the woman is another risk factor. Incidence of breast cancer has been rising in the North American women probably due to aging population. Breast cancer is uncommon at younger ages.

An article in the New England Journal of Medicine, written by researchers in Toronto, says that a woman entering her 30s has a 1 in 250 chance of breast cancer in the next 10 years. The risk of breast cancer increases with age, so that a woman entering her 40s has a 1 in 77 chance of the disease in the following decade. The risk of breast cancer in any decade of life never exceeds 1 in 34.

The cause of death among women at any age is always more likely to be something other than breast cancer. But proportionately, middle-aged ladies have more deaths due to breast cancer than older ladies, as tumours in younger women are more aggressive than older women.

Here are some interesting numbers on other factors that increase the risk of breast cancer: alcohol (more than 3 drinks/day) – 63 percent increased risk, lack of exercise – 59 percent increased risk, first birth after age 30 – 48 percent increased risk, weight gain (more than 20 kg) – 40 percent increased risk, late menopause – 28 percent increased risk, early menarche (before age 12) – 24 percent increased risk.

A family history of breast cancer is a well-known risk factor. The risk to a woman with a first-degree relative with breast cancer is generally reported to be two to three times higher than the risk to a woman with a negative family history. This is not something new. Physicians knew the familial occurrence of breast cancer as early as the year 100 A.D.

What about women with lumpy and granular breasts (fibrocystic changes)? Many attempts have been made to evaluate the relation between fibrocystic disease and cancer. There has been no clear cut evidence to suggest that fibrocystic changes in general predisposes to cancer. Once a woman has had a biopsy for benign disease, she is more likely to have a second biopsy, either because there is increased follow-up or there is distortion of tissue due to previous biopsy. Biopsy rate amongst women with fibrocystic changes is five times higher than other women.

When it comes to breast cancer, every woman is a potential target. Breast cancer is the leading cause of premature death in Alberta’s women. So, are there any strategies to reduce the risk of breast cancer?

Yes. In the next column, we will look at the recent research results that suggest that the risk of breast cancer can be reduced. So, stay tuned!

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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Religion and Medicine

“Religion is the opium of the people,” says Karl Marx (1818-1883). But Marxism is almost dead and religion has survived. Does that mean religion is healthy and well and good for the people?

Yes, says one reader of this column. She was responding to my question – should doctors prescribe religious activities for medical ailments as they prescribe antibiotics?

The lady (we will call her Mrs. A) says: I am almost sure that healthy spiritual life is directly connected to good mental health. And mental health is directly connected with physical health. It is proven that mental condition has direct influence on our immune system, hormonal balance, sleeping pattern and not to mention the impact it has on our social life. So yes, religion should be somehow involved in medical treatment.

Mrs. A says that the zealots are exploiting religion. She was brought up in a country where religion was not popular and there were many atheists. Atheism was more attractive because some religious leaders encouraged hate among people of different nationality and religion.

“That was the reason I was always happy not to be a part of it, no to be in all the mess. My opinion now is that religion/spirituality is important if it’s in the healthy dosage,” says Mrs. A.

Another interesting letter came from a lady (Mrs. B): Being a “religious” person myself, I feel that faith and medical practise go hand in hand. I have a great deal of confidence in medical science but believe ultimately that God is “the great physician”.

I think it is quite desirable for physicians to recommend that patients seek spiritual comfort from appropriate pastors and counsellors, but not that doctors have to give it – unless they know the patient well and mutually agree to discuss spiritual matters, says Mrs. B.

Mrs. B sent me an article which says that doctors are conducting major research project at the Duke University Medical Centre and the Durham Veterans Affairs Medical Centre, Durham, NC to study the effects of prayer, imagery, and touch on patients who are about to undergo angioplasty, a procedure that removes blockages from coronary arteries.

The article says that the people in the Duke prayer group experience 50 to 100 percent fewer side effects from cardiac procedures than those who aren’t prayed for.

I also received a Chritian Science view from Mrs. C. She says: Christian Scientists rely exclusively on prayer for healing. A Christian Scientist may ask for help from a Christian Science practitioner, who is one who devotes his or her full time to the practice of healing prayer. Testimonials over many years appearing in the Christian Science weekly and monthly publications prove the efficacy of this healing practice. On a personal note, I had a small proof when, through prayer alone, a severely sprained ankle was healed overnight.

Mrs. C says: Christian Scientists have great respect for dedicated doctors. However, Christian Science treatment is not combined with medical practice because the two methods are inherently icompatible.

These are interesting views. George Bernard Shaw (1856-1950) says: there is only one religion, though there are a hundred versions of it.

Whatever religious version we believe in, the ultimate force that creates an environment of well being is our faith. The faith may be in God, in our pastor, our doctor or any non-physician healer. If we don’t believe in something, then I doubt whether it will help us.

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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Irregular Heart Rhythm

What is atrial fibrillation? Why does one get it? How can it be prevented?

Atrial fibrillation is a condition in which the heart rhythm is irregular. Normally, the heart beats on an average 72 times a minute and has a very regular rhythm.

Each heartbeat normally starts in the upper right chamber of the heart from where an electric impulse travels to the lower chambers to complete the heartbeat. When there is disturbance in the initiation and/or transmission of the electrical impulse, the heartbeat goes haywire and irregular. This is called arrhythmia.

There are many types of arrhythmias affecting the upper and lower chambers of the heart. Atrial fibrillation is one of the common ones requiring treatment. It affects five percent of people older than 65 years. It accounts for up to 36 percent of all strokes in elderly people. The symptoms of atrial fibrillation are palpitation, shortness of breath, and fatigue.

Atrial fibrillation can be paroxysmal (episodic) or persistent. Some times the paroxysmal form occurs in healthy persons for no reason. It can also occur in individuals who develop acute infections, or in patients who have rheumatic heart disease, heart attack or have some other medical conditions.

Usually, paroxysmal attacks occur few times before permanent atrial fibrillation gets established. The episodic attacks may last from few seconds to few days. The onset and offset of atrial fibrillation can sometimes be quite abrupt. Permanent atrial fibrillation is almost always (with few exceptions) associated with some heart problem or other medical conditions like overactive thyroid gland.

The human heart beats 100,000 times each day. About 2000 gallons of blood is pumped out of the heart each day into the blood vessels. Irregular rhythm can impair this function. As a result, a person can go into heart failure, get a heart attack or stroke.

The most effective way to minimise the increased risk of stroke is to return the heart rhythm to sinus (regular) by electrical or chemical (medications) cardioversion. Cardioversion is a process by which the heart is returned to sinus rhythm. Cardioversion is safe, says an editorial in the British Medical Journal, with an estimated risk of stroke of less than one percent even among those at highest risk. If the atrial fibrillation has been present for more than 48 hours then the patient should receive blood thinners before and after the cardioversion to minimise the risk of stroke.

The editorial says that large series have shown initial success rates for cardioversion of around 75 to 91 percent of patients of all ages. It says that restoration and maintenance of sinus rhythm after successful cardioversion maybe enhanced by the use of medications, though optimal drug therapy has yet to be determined.

If it is difficult to sustain sinus rhythm, then the patient should receive blood thinners (like warfarin) on regular basis to reduce the risk of stroke by 70 percent. The editorial says that many physicians are reluctant to use blood thinners in the elderly due to associated risk of internal bleeding and prefer to keep them on aspirin. Aspirin does not do the job.

The editorial concludes by saying: In practice, even though the ideal may be unachievable, many elderly patents with atrial fibrillation remain suboptimally treated.

If you have irregular heart rhythm then get yourself checked out. If you think your condition is suboptimally treated then get a second opinion. It may save your life!

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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Gambling

Sometime ago, video lottery terminals (VLT) were in the news. People in general expected VLTs and all types of gambling to disappear.

Did this happen? No.

In fact, Canada experienced a dramatic increase in legalized gambling in the 1990s, primarily because of governments’ need to increase revenue without additional taxation, says Dr. David Korn, health and addiction consultant at the University of Toronto. His article appears in the Canadian Medical Association Journal.

Gambling is as old as human history. Casinos have existed at least since the 17th century. In the 20th century, they became commonplace and assumed almost a uniform character throughout the world. In the late 20th century, the governments started to get involved, generating revenue for programs that we would otherwise not be able to afford.

Dr. Korn says that there are now more than 50 permanent casinos (in 7 provinces), 21,000 slot machines, 38,000 VLTs, 20,000 annual bingo events and 44 permanent horse race tracks in Canada.

By 1997, Canadians were wagering $6.8 billion annually on some form of government –run gambling activity, 2.5 times that amount in 1992, with casinos and video lottery terminal accounting for almost 60 percent of government revenue from gambling. In 1997, gambling accounted for at least three percent of total government revenue in all provinces.

Public health problems associated with gambling were brought to the forefront in 1972, when Dr. Robert Custer, a psychiatrist in Ohio, described a medical syndrome called “compulsive gambling”. In 1980, the American Psychiatric Association included “pathological gambling” in its Diagnostic and Statistical Manual of Mental Disorders, categorizing it as an impulse disorder.

A pathological gambler is one who disrupts his personal, family and work related pursuits. There is development of tolerance – need to gamble with increasing amounts of money to achieve the desired excitement – and withdrawal.

About 5.5 percent of general adult population has problems with pathological gambling. The impact of gambling is significant on our vulnerable population such as youth (13.3 percent), women, older adults and aboriginal people, says Dr. Korn. Lower income households spend proportionately more than higher income households on gambling.

Is there help for compulsive gamblers?

Yes. Locally we have Gamblers Anonymous. For help and more information call Lynn (526-7792) or Shirley (527-7673). Gamblers Anonymous runs a 12-step program that has helped many people. If you are or have a tendency to be a compulsive gambler then a phone call is worthwhile.

There is Calgary based Gambling Help Line (1-800-665-9626) which can find you help with Legal Aid, credit counselling, and refer you to one of the rehab centres. These centres run 21-day rehab programs. You can also try AADAC (Alberta Alcohol and Drug Abuse Commission) at 529-3582.

Gambling continues to increase in Alberta and Canada. Dr. Korn says, “ The cost to families in terms of dysfunctional relationships, violence and abuse, financial pressure, and disruption of growth and development of children can be great.”

If you think you or your loved one have gambling problem then help is only a phone call away. Ask for it!

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