Author: noorali

Posted on

Teenage Smoking

Why do teenagers smoke?

Is it because it is “cool” to smoke? Is it because the idols of many teenagers – movie actors and actresses – smoke on screen? These are the questions asked in an editorial in the Annals of the Royal College of Surgeons of Canada.

But we do not know the answer. What we know is that if you are not addicted to tobacco by the age of 20, then it is less likely that addiction will start later. Hence, teens and pre-teens should be key groups for whom anti-smoking programs should be designed.

Do you think movies and television may have a significant role to play in this public-health problem? Well, next time you go to a movie or sit down to watch TV, think about it!

Do you think smoking protects against dementia?

Well, that is what some people think. But the British Medical Journal writes that Richard Doll, who has been studying the smoking habits of doctors since 1951, says that contrary to previous suggestions, persistent smoking does not substantially reduce the rate of Alzheimer’s disease or of dementia in general. If anything, it might increase rather than decrease the rate, but any net effect on severe dementia cannot be large in either direction.

Which Canadian province spends the most money on health care?

It’s not Alberta. Alberta has the 5th lowest expenditure at $2832 per person. Quebec has the lowest expenditure per capita among the provinces – $2453 per person in 1999. According to the Canadian Institute for Health Information, Albertans continued to spend a lower proportion of their provincial gross domestic product on health in 1999 (7.6 percent) than citizens of any other jurisdiction on Canada.

Among the provinces, spending per person was highest in Ontario and British Columbia in 1997, at $2,746 and $2,728, respectively. The three Prairie provinces occupied third to fifth positions. The Atlantic provinces and Quebec occupied the lower half of the distribution.

Now that Bill 11 has gone through the Alberta legislature, does the government think that for-profit health delivery is cheaper than publicly funded health care?

An article in New England Journal of Medicine says that US healthcare spending in 1995 in for-profit markets resulted in $5.9billion in excess costs when compared with spending in not-for-profit markets. So private health is not cheap!

In the last column we discussed six important risk factors for cardio-vascular disease. Somebody was kind enough to remind me that I missed the seventh risk factor – diabetes.

Diabetes causes hardening of the blood vessels. When diabetes develops, the blood sugar level goes up because insulin (the substance which keeps blood sugar level under control) is in short supply.

Insulin is produced by pancreas. In diabetics, pancreas either does not produce enough insulin or our body does not respond to insulin as it should.

Warning signs of diabetes are many – drowsiness, excessive weight, easy fatigue, constant urination, family history of diabetes etc. Discuss these symptoms with your family doctor.

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

Posted on

Heart Disease

Recent newspaper headline says that heart and blood vessel disease kills more women than breast cancer. Are you surprised? Well, you shouldn’t be!

We know that heart and blood vessel (cardio-vascular) disease is a number one killer of all adults, irrespective of gender. Over the years, and from time to time, our doctors and our media, remind us about the known risk factors associated with cardio-vascular disease. But how many of us have the ability to remember and recall these risk factors?

Now, if you are one of those Canadians who can remember and recite these risk factors before each meal then you run the risk of being left alone to eat your own breakfast, lunch and dinner. You will be a social outcast!

And if you are a physician, sitting with non-physicians who enjoy extra salt, a blood soaked 20-oz steak cooked in butter, and double size cheesecake with extra whipping cream then you better keep your mouth shut! And you better keep your mouth shut, if you are a non-physician sitting with physicians who smoke and eat just like “normal” human beings!

In any case, how can we change our eating habits if we are to stay healthy? Is it by keeping our mouth shut or by being a social outcast? Before you start your meal, would rather say “grace” or recite the innumerable commandments of healthy eating?

While you are struggling to make up your mind, lets look at recent articles in Canadian Medical Association Journal that say that in order for a person to change his behaviour, he has to rely on his knowledge or have access to information to make sound judgement on what is good for his health. They also believe that monitoring the population’s knowledge of risk factors can help guide public health programs.

Here is a test for you! In the next 60 seconds, name the six risk factors for cardiovascular disease. Now compare yourself with how 23,000 Canadians aged 17 to 74 did in a survey conducted by Canadian Heart Health Research Group between 1986 and 1992.

Overall, the percentage of Canadians who identified the six important risk factors for cardio-vascular disease is: fat in food (60 percent), smoking (52 percent), lack of exercise (41 percent), excess weight (32 percent), elevated cholesterol (27 percent), and high blood pressure (22 percent). So, how did you do? Never mind, must be that mental block!

The researchers found that the behaviour related risk factors – fat consumption, smoking and exercise – were mentioned more often than physiologic ones – high blood pressure and raised cholesterol level. They also found that all segments of the Canadian population are missing some information about the different cardio-vascular risk factors.

Their findings suggest that health promotion campaigns should consider individual differences and include distinct messages for subgroups of the population, at least those defined by age and education level. And not to forget the disadvantaged segments of our population.

Now, can you recall the six important risk factors for cardio-vascular disease?

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

Posted on

Pilonidal Cyst

Dear Dr. B: My son is 18. About a year ago he had surgery for pilonidal disease in the tailbone area. The wound got infected and has not healed. The wound continues to drain bloody discharge. My son finds it very frustrating as it soils his clothes. Can you please tell me about pilonidal disease? Yours, Mrs. Z.

Dear Mrs. Z: The pilonidal disease most commonly occurs between the buttocks, close to the tailbone. This condition has been described since 1847. The term pilonidal means “hair-nest”. It can also occur in other areas such as beard, the armpit, the belly button and the web spaces of the hands (in barbers) and feet.

Pilonidal disease is a spectrum of three conditions: acute pilonidal abscess, chronic pilonidal abscess or sinus, and the unhealed pilonidal surgical wound.

For many years, experts believed that this was a congenital condition. In 1946, Patty and Scarff challenged this theory and drew attention to the role of hair in the origin of this problem. Current evidence strongly indicates an acquired origin for pilonidal disease, with most infections being related to penetration of the skin by hair through small midline pits.

Where do these pits come from? Some people believe they are congenital while others believe them to be enlargement of hair follicles. These pits have sinus openings through which the hairs penetrate. Hirsutism in the buttock and perineal area appears to be associated with the development of pilonidal disease.

Management of the condition depends on the type of presentation. Acute pilonidal abscess needs to be drained immediately once the diagnosis is made. The area should be kept shaved. Daily bath or shower will keep the area clean. Once healed, it may become necessary to excise the midline pits under local anaesthesia to prevent recurrence.

Treatment of chronic pilonidal abscess or sinus remains controversial as no one treatment has proved superior. The choices are: non-operative treatment with repeated phenol injections; conservative excision of the sinus openings and midline pits; laying open the sinus tract and stitch the skin margins to fibrous tissue (marsupialization); or wide excision with or without different types of closures of the skin.

The unhealed pilonidal surgical wound and recurrence of pilonidal disease after initial treatment is very common. Management of this problem can be very difficult. To start with, the unhealed wound should be curettaged to control the excessive granulation tissue (healing tissue which fills the wound), and the surrounding skin should be shaved weekly. The wound should be kept clean and dry with gauze. Strapping the buttocks apart may help prevent the continuous shearing movement during walking.

The wound may take six to eight weeks to heal. Quite often healing does not occur. Then a skin graft or some form of plastic flap may help the healing process. Overall, treating pilonidal disease should not be taken lightly as the results are quite often disappointing. If it ain’t broken then don’t fix it!

Finally, on a personal note, I would like to thank all those who phoned, e-mailed or sent messages through my family about last week’s column on my mother. The reaction from the readers was overwhelming. Many people reminded me that it is Mother’s Day this Sunday!

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

Posted on

My Mother, Sikina

Allow me to tell you a story of a very special, tough and courageous 84-year-old lady. Her name is Sikina. She recently spent five weeks in Foothills Hospital for removal of a 6-cm. benign brain tumour. The tumour had left her partially paralysed.

Sikina was born in India. At a very tender age of 15 she married a young handsome fellow named Hussein who was 21. At the age of 13, Hussein had gone to East Africa with his older brother to look for work. After eight years of work and making some money, he had returned to India to look for a bride. That is when he was introduced to Sikina and got married.

Hussein and Sikina lived in East Africa for many years. They had eight children. One day, in 1965, Sikina was travelling from Tanzania to Uganda when her car was involved in a head on collision with a drunk driver. She sustained life-threatening injuries to head, face, right thigh and both upper limbs. There were many broken bones.

Sikina never gave up. With Hussein at his bedside, she fought back and survived. She spent four months in a hospital in Kampala, Uganda. She came home to Tanzania walking with crutches. Another two months of physiotherapy and she was back taking care of her family.

With Idi Amin (does anybody remember him?) in Uganda, the political atmosphere in East Africa became very uncertain. So, 25 years ago, Hussein, Sikina and their children moved to Calgary.

Five years later, Sikina developed right-sided weakness. She was found to have a brain tumour close to a large blood vessel. Two neurosurgeons in Calgary felt that nothing should be done, as there was a significant risk of damaging the blood vessel during surgery.

Hussein wasn’t a man to give up easily. As Sikina’s condition worsened, Hussein insisted on another opinion. The third neurosurgeon, after considerable deliberation and consultation with his colleagues at the General Hospital, elected to do the surgery. This was in 1980. Sikina and her family were warned of the likely complications. But Sikina was ready for it, as she could not live the way she felt.

Sikina survived the six-hour surgery. She had a full recovery. Eighty percent of the tumour was removed. Luckily it was benign. Tumour close to the blood vessel was left behind.

After many years of good health, Sikina’s troubles started again. Her right leg was getting weaker. Then six weeks ago, she momentarily lost her speech and function on the right side of her body. She was thought to have a stroke and rushed to Foothills Hospital. Investigations revealed recurrence of a large tumour at the site of previous excision.

Within a week, she was back in the operating room undergoing another six hours of brain surgery. This time the recovery was slow. She was in the hospital for five weeks. But she did not give up!

Now she is home looking better and walking with a walker. Another courageous fight and a miraculous recovery! This time Hussein wasn’t there. He passed away nine years ago. But all her children and their families were there. So were the neurosurgeons, anaesthetist, geriatrician, nursing staff and physiotherapists. It was an excellent teamwork.

Sikina believes in God and miracles. But one thing stands out – Sikina’s courage. I am proud of her. She is a special lady. And she is my mother!

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