noorali

May 31, 2016

Medical Management of Heartburn can be Challenging

An American Robin at Echo Dale Regional Park in Medicine Hat, Alberta. (Dr. Noorali Bharwani)

More than one-third of the population has symptoms of heartburn secondary to gastro-esophageal reflux disease (GERD), with about one-tenth afflicted daily. Infrequent heartburn is usually without serious consequences, but chronic or frequent heartburn (recurring more than twice per week) can have severe consequences.

Here are some points to remember to prevent complications secondary to reflux:

Lifestyle modifications may or may not help. But it is worth trying. That means try and avoid stressful situations and learn to sleep well.
Weight loss has been shown to be beneficial for individuals with recent weight gain or those with a BMI over 25.
Elevation of the head of the bed and avoidance of late evening meals, particularly with high fat content, has shown to be beneficial for individuals with nocturnal symptoms or sleep disturbance.
Avoid food that trigger heartburn such as chocolate, caffeine, citrus foods, spicy foods, carbonated beverages, etc., has been shown to be beneficial only if an individual can identify a specific trigger.

If a person has classical symptoms of GERD not relieved by conservative measures then it is worth trying a trial of medications called proton pump inhibitors (PPIs). There are several medications in this group and they all have very similar effect in terms of symptom relief or healing of erosive esophagitis (inflamed esophagus).

Some examples of PPI are: omeprazole (Losec), lansoprazole (Prevacid), pantoprazole (Tecta), esomeprazole (Nexium).

The PPI should be taken once a day, usually 30-60 minutes before the first meal of the day. The pills should be tried for a month or two to see if there is any relief of symptoms before ordering invasive investigations. If there is symptom relief then the patient can be put on maintenance therapy using the lowest effective dose, which could include on-demand therapy.

Some patients may have side effects from these medications such as headache, rash, diarrhea or constipation, nausea or abdominal pain. Dose reduction or change of pill may help.

If the PPI agents do not help then further investigation should be undertaken to make a diagnosis and check for complications such as acute inflammation or malignancy.

PPI has long-term side effects such as vitamin B12 deficiency, increased risk of infection, such as colitis with Clostridium difficile, warns Health Canada advisory issued in February 2012. They also warn that the high rate of seniors on PPIs raises worries about C. difficile outbreaks in hospitals and nursing homes.

C. difficile is a bacteria capable of causing life-threatening cases of diarrhea (10 bowel movements a day) and conditions like colitis.

By lowering stomach acid levels, PPIs might affect the body’s absorption of calcium, which in turn could lead to osteoporosis and fractures. Researchers found a link between long-term use of PPIs and hip fractures. Their results also suggested that the risk increased the longer people were taking PPIs.

If you suffer from GERD then try conservative measures such as: lifestyle changes, weight loss and eat smart by avoiding foods that bother your stomach. If you need to use PPI then try lower dose and short duration of treatment.

Finally, my British teacher used to advise his patients to avoid hurry, worry and curry!

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

May 17, 2016

“Pink Viagra” for Women Coming Soon to Canada

"Who is the pretty one?" Birds in New Orleans, Louisiana. (Dr. Noorali Bharwani)

Most people know that in a relationship the sexual honeymoon does not last forever. Then came along Viagra for men’s erectile dysfunction. It was soon realized that a man needs a partner who has the same kind of desire. There are many women who have difficulty with libido – also known as hypoactive sexual desire disorder. They need help as well.

Now that help is here. The US Food and Drug Administration recently (August 2015) approved flibanserin (Addyi) for the treatment of reduced sexual desire in pre-menopausal women. This should offer help in the bedrooms of North American couples.

What is hypoactive sexual desire disorder (HSDD)?

HSDD affects up to one in 10 American women. It’s characterized as an unexplained persistent lack of sexual thoughts, fantasies, responsiveness and desire to engage in sex, which causes personal distress.

What you should know about the drug flibanserin (Addyi)?

It is approved for the treatment of pre-menopausal women with reduced sexual desire that causes personal distress or relationship difficulties. The medication increases the number of satisfying sexual events per month by about one half over placebo from a starting point of about two to three.
Most side effects of flibanserin were mild to moderate. The most commonly reported adverse events included dizziness, nausea, feeling tired, sleepiness, and trouble sleeping.
Drinking alcohol while on flibanserin may result in severely low blood pressure.
Flibanserin was originally developed as an antidepressant, before being repurposed for the treatment of low sexual desire.
Flibanserin should not be used to treat low sexual desire caused by co-existing psychiatric or medical problems, problems in the relationship; or low sexual desire due to medication side effects.
In the U.S. physicians and pharmacies dealing with flibanserin have to undergo a certification process, while patients need to submit a written agreement to abstain from alcohol.

How does flibanserin work?

Sexual response depends on several factors and actions. Various nerve transmitters, sexual hormones and other hormones play a significant role in sexual excitation and inhibition. Among nerve transmitters, excitatory activity is driven by dopamine and norepinephrine, while inhibitory activity is driven by serotonin. The balance between these systems is of significance for a normal sexual response.

By changing serotonin and dopamine activity in certain parts of the brain, flibanserin may improve the balance between these neurotransmitter systems in the regulation of sexual response.

Flibanserin (Addyi) has been favourably received by many physicians, women’s organizations and women in general. But there are some who have reservations. People who disapprove of this medication have questioned the relevance of turning a woman into a patient if she has no interest in having sex.

Only time will tell if in the long run the “female Viagra” will create overall satisfaction and happiness in the bedrooms of the nation. As our former Prime Minister Pierre Elliott Trudeau said, “There’s no place for the state in the bedrooms of the nation.” What about the drug companies? Can they bring satisfaction and happiness in our bedrooms?

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

May 3, 2016April 3, 2017

High-Rise Buildings Present Challenge in Cardiac Arrest

If there is a life-threatening emergency in a high-rise building then it is longer to rescue the people trapped in the building. In case of fire there are problems related to evacuation, accessibility, smoke movement and fire control.

What happens if you have a heart attack (cardiac arrest) in a high-rise building?

A study shows patients residing on higher floors of high-rise buildings in Toronto had lower survival after out-of-hospital cardiac arrest. Most out-of-hospital cardiac arrests occur in residential areas, and these cases are associated with poorer outcomes than nonresidential cardiac arrests, says an article in the Canadian Medical Association Journal (CMAJ).

Studies have shown that the mean time from ambulance arrival on scene to patient contact was 2.8 minutes for people on the first two floors but 3.1 minutes for those on the 3rd to 9th floors and 3.3 minutes for those on the 10th floor or higher.

Cardiac arrests on higher floors had longer rescue times, which contributed to poorer outcomes.

There are a number of issues which affect access in a high-rise building. For example:

Lack of witnesses to provide immediate help, CPR (Cardio Pulmonary Resuscitation) or call to paramedics.
There are barriers to elevator access. Studies have shown additional elevator stops happened in 18.6 per cent of high-rise residential calls. Elevators were not easily accessible in 33.9 per cent of all paramedic calls to apartment buildings.
Requirement for an entry code to a building (67.6 per cent of all access barriers), lack of directional signs (82.6 per cent) and inability to fit the ambulance stretcher into the elevator (67.9 per cent).
CPR in elevators is challenging.

What would help?

Train the family members of those at risk to do CPR.
Place automated external defibrillators strategically in certain residential locations.
Smartphone technology can link residents who are trained first responders to defibrillators in their neighbourhoods and to victims of cardiac arrest in apartments.

Recently another article in CMAJ (January 18, 2016) discussed this subject. During the study period, 7842 cases of out-of-hospital cardiac arrest met the inclusion criteria. Of these 76.5 per cent of patients had cardiac arrest below the third floor and 23.5 per cent of the patients had cardiac arrest on the third floor or higher.

The authors found survival was greater on the lower floors (4.2 per cent v. 2.6 per cent). They also found survival was 0.9 per cent above floor 16, and there were no survivors above the 25th floor. Wow, that can make you nervous!

Their conclusion: “In high-rise buildings, the survival rate after out-of-hospital cardiac arrest was lower for patients residing on higher floors. Interventions aimed at shortening response times to treatment of cardiac arrest in high-rise building may increase survival.” This kind of action can alleviate other disasters like fire.

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

April 30, 2016

Everything you want can be found in New Orleans.

China Lights at New Orleans City Park Botanical Gardens (Dr. Noorali Bharwani)

It has been more than 30 years since we were last in New Orleans. It was time to revisit the city that has to offer everything you ever wanted for fun and food.

“New Orleans is one of the world’s most fascinating cities – it’s home to a truly unique melting pot of culture, food and music,” says New Orleans Official Guide. Everything the guide says is true. We were there in early April and the city was full of tourists.

New Orleans is a major United States port on Mississippi River and the largest metropolitan area in the state of Louisiana. The population of the city is about 400,000. The city is named after the Duke of Orleans. It is well known for its distinct French and Spanish Creole architecture, as well as its cross-cultural and multilingual heritage. It is also famous for Mardi Gras, dating to French colonial times.

Here are few items of interest to note:

China Lights at New Orleans City Park Botanical Gardens

This incredible exhibit from China is open for a limited time from February 23 to May 1, 2016. Best time to visit is at night as display of over 30 extraordinary structures light up. There is food and music and things to see in the Botanical Garden. The exhibits will travel the world and may come to a city near you.

New Orleans Cemeteries (Cities of the Dead)

Normally, a public cemetery would not be a tourist attraction. But in New Orleans it is different. New Orleans is built on a swamp. The deceased have to be buried above ground. Each unit belongs to a family to accommodate multiple bodies. Over time the cemeteries, with elaborate sculptures and other decorative artwork, resemble small villages.

Entertainment

New Orleans, birthplace of jazz, offers all kinds of music. Whether you like jazz, rock, hip-hop, pop, funk, indie, blues, there is live entertainment for everyone. There are street musicians and there are world famous performers come and perform at Jazz Fest.

The nightlife goes on all night. You can drink anywhere you want. You can play music and dance. Nobody stops you as long as you are having fun. Spending a night or two (or more) walking and drinking on the Bourbon Street is a must. It is a famous historic street dating from the time of French Louisiana, along the French Quarter. Bourbon Street is steeped in history, folklore and beauty that date back to the early 18th century.

Riverside Walk

A walk along the Mississippi River in New Orleans, you get to experience riverfront area adjacent to the French Quarter. You get to experience public art, family activities including food outlets offer delicious food. There is also an air-conditioned mall.

Looking for alligators

We used the services of Airboat Tours by Arthur Matherne, Inc. to look for alligators and swamp wild life. This is a high speed adventure that is part tour and part ride.

The adventure takes you through swamp, marsh and lake. You may see anything from a Bald Eagle to a Pelican to Osprey to an Owl and alligators. It is very exciting.

Well, there is a lot to see and do in New Orleans – more than what I can write here.

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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