Author: noorali

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My New Year’s Resolution: Get enough sleep!

A woman sleeping in bed with an eye mask. (Brand X Pictures)
A woman sleeping in bed with an eye mask. (Brand X Pictures)

Sleeping well is important to our health. Sleeping enough is even more important. As we continue to live a faster and more competitive lifestyle, it is becoming difficult to get enough rest and sleep.

It is estimated that one in six adults report getting less than six hours of sleep nightly. This is related to too much work, stress, caffeine, nicotine, alcohol, 24-hour cable TV, the Internet and email.

A report in the Globe and Mail says that nearly eight in 10 married couples say their partner has a sleep problem, like snoring, insomnia, or incessant tossing and turning. A quarter say sleep difficulties force their mate into separate sleeping quarters. More than 20 per cent say they’re too sleepy for sex.

According to a large British study released some time ago, people who do not get enough sleep are more than twice as likely to die of heart disease. Researchers said lack of sleep appeared to be linked to increased blood pressure which raises the risk of heart attacks and stroke. Diabetes and obesity have also been linked with chronic sleep loss.

Not getting enough sleep can lead to impaired memory and thought processes, depression and decreased immune response, poor work performance, driving accidents, relationship problems, and mood problems like anger and depression. People who are tired and sleepy tend to eat more to stay awake and hence put on weight. They smoke more, drink more coffee and alcohol.

That is a long list of problems. We can avoid all that by sleeping well and sleeping enough.

Infants usually require about 16-18 hours of sleep per day, while teenagers need about 9 hours per day on average. Most adults need about seven to eight hours of sleep per day. The British researchers say that consistently sleeping around seven hours per night is optimal for health. When we sleep, the body rests and restores its energy levels. A good night’s sleep will help us cope with stress, solve problems and recover from illness.

The quality of sleep we get is as important as the quantity. Each morning, after seven to eight hours of sleep we feel tired then it is a sign of poor quality sleep. If this is a chronic problem then you may be suffering from a sleep disorder which requires investigation and treatment. Your doctor can help you by referring you to a sleep clinic.

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Be Safe, Do Not Drink and Drive

Alcoholic drink and car keys. (iStockphoto)
Alcoholic drink and car keys. (iStockphoto)

Drivers, here is a recipe for disaster: drugs, alcohol, not wearing a seat belt and speeding.

The highest rate of impaired driving is amongst young drivers aged 19 to 24. This accounts for 56 per cent of all reported criminal incidents.

The rate of impaired driving is at its worse at age 21 and relatively constant for 25 to 44 year olds. Seniors aged 65 years and older have the lowest rates. Statistics show impaired driving was a factor in almost 50 per cent of all incidents causing death.

Here are some other statistics:

-Every 22 minutes someone dies in an alcohol-related motor vehicle accident.

-There is a 200 per cent chance that you or someone in your family will either cause, or be an innocent victim to, a drunk driving accident.

-A lot of young people (15 to 24 ages) are dying before they get old. These are tragic, meaningless deaths.

-In a single year, 522 children under the age of 14 were arrested for driving while intoxicated, (113 of them were under 10 years old).

Driving under the influence of alcohol is the single risk factor for motor-vehicle-related incidents and injury. It is about time we crack down on irresponsible teenagers and adults who drink and drive. Alberta is now in tune with B.C., Ontario and six other provinces in passing laws which will lower the legal limit for blood-alcohol concentration from 0.08 to 0.05 per cent.

If you are caught drunk driving then you may pay a steep fine, lose your license and have your car impounded – all before you set foot in court. So, be warned.

The new legislation in Alberta soon after four teens were killed by an alleged drunk driver just south of Grande Prairie. A 21-year-old Grande Prairie, Alta., man was to face a slew of alcohol-related charges in a devastating crash that left four teens dead and one in serious condition. Matthew Deller, 16, Vincent Stover, 16, Walter Borden-Wilkens, 15, and Tanner Hildebrand, 15, all of Grande Prairie, were killed.
Speeding and not wearing a seat belt are other causes of fatalities on our roads. Again the majority of culprits are kids in their 20s or younger. Six months ago, citing a lack of evidence, cops in Calgary released a 21-year-old driver involved in a high-speed rollover that killed his younger brother and girlfriend.

The original charge included impaired driving. The crash happened shortly before midnight on a Sunday on Stoney Trail at McKnight Blvd. N.E. Two of the five people on board, the driver’s 16-year-old girlfriend and his 20-year-old brother, were not wearing seatbelts and were thrown from the car. They were taken to hospital where both later died.

Few months ago, the town of Magrath, Alta. was in mourning after four teens were killed in a horrific crash on a Sunday. The four – Clay Card, 16, Renzo Dainard, 16, Danae Gough, 14, and Jorden Miller 14 – were in a vehicle that left the road east of Magrath, about 240 km southwest of Calgary, landing upside down and partially submerged in a creek. According to the local Mounties, speed and driver inexperience probably caused the crash.

The holiday season is here. Drinking and partying is part of the Christmas and New Year celebrations. If you drink then don’t drive. If the party is in a hotel then book a room and stay there. Otherwise, take a cab or have somebody (who is not drinking) to drive you home. Wear a seat belt and do not speed.

Have a wonderful, safe Christmas and holiday season and Happy New Year. This column will return in January, 2012.

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Four Most Dangerous Groups of Drugs for Seniors

Pharmacist and a senior. (Jupiterimages)
Pharmacist and a senior. (Jupiterimages)

As we get older, our health tends to deteriorate. We need medications to control these adverse changes. Also there is a price to pay in old age if we did not take care of ourselves when we were younger.

A recent study published in the New England Journal of Medicine says that 40 percent of people over 65 take five to nine medications every day. What this means is that hospitalizations for accidental overdoses and adverse side effects are likely to increase among this group.

The study found that every year, about 100,000 people in the United States over age 65 are taken to hospitals for adverse reactions to medications. Most of the patients are there because of accidental overdoses. Sometimes the amount of medication prescribed for them had a more powerful effect than intended.

The four most common groups of medications putting seniors in hospitals are: warfarin, insulin injections, antiplatelet drugs to thin the blood and oral diabetes drugs.

Warfarin accounts for the most visits due to adverse drug reaction. It accounted for 33 percent of emergency hospital visits. Warfarin (Coumadin) is an anticoagulant – popularly referred to as a “blood thinner.” In reality, it does not make the viscosity of the blood thin. What it does is that it acts on the liver to decrease the quantity of a few key proteins in blood that allow blood to clot.

It was initially marketed as a pesticide against rats and mice. Later it was found to be effective and relatively safe for preventing blood clots in humans. It was approved for use as a medication in the early 1950s and now it is the most widely prescribed oral “blood thinner” drug in North America.

Insulin injections were next on the list, accounting for 14 percent of emergency visits. Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body.

Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle. When control of insulin levels fails, diabetes mellitus will result. Patients with type 1 diabetes depend on insulin injections.

Antiplatelet drugs like aspirin, clopidogrel (Plavix) and others that help prevent blood clotting were involved in 13 percent of emergency visits. An antiplatelet drug is a member of a class of pharmaceuticals that decrease platelet aggregations and inhibit clot formation. They are effective in the arterial circulation, where “blood thinners” have little effect.

Lastly, diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations. Anti-diabetic medications treat diabetes mellitus by lowering glucose levels in the blood. There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors.

Why do these four groups of medications cause problems?
-the line between an effective dose and a hazardous one is thin.
-they can be difficult to use.
-some require blood testing to adjust their doses.
-blood sugar can be notoriously hard to control.
-warfarin can interact with many other drugs and foods.

The authors of the article say that in order to reduce the number of emergency hospitalizations in older adults we should focus on improving the safety of this small group of blood thinners and diabetes medications, rather than by trying to stop the use of drugs typically thought of as risky for this group. And patients should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.

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Does ibuprofen help if taken before and during exercise?

Ibuprofen (also marketed as Advil and Motrin) is a non-steroidal anti-inflammatory drug (NSAID). That means it is an anti-inflammatory without cortison. It is one of the most common and widely used over-the-counter anti-inflammatory pain killers.

For adults, the dosage is 400-800 mg/dose three to four times a day (maximum: 3.2 g/day) to be taken by mouth. It should be taken with food or milk to avoid stomach irritation and development of a stomach ulcer. Bleeding from a stomach ulcer can be catastrophic, especially in elderly patients who are on blood thinners and/or Aspirin.

Ibuprofen should not be given to patients who have kidney or liver failure as it is metabolized in the liver and excreted by the kidneys. It reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors. It has antipyretic (reduces fever), analgesic (pain killer), and anti-inflammatory properties.

You can feel the effect of the medication within 30-60 minutes. The effect lasts four to six hours.

The effect peaks in one to two hours and half of the drug is eliminated from the body in two to four hours. Preoperative use of ibuprofen at a dose of 400-600 mg every six hours 24 hours before the appointment decreases postoperative swelling and hastens healing time.

Ibuprofen can interfere with the anti-platelet effect of low-dose aspirin (81 mg/day), potentially rendering aspirin less effective when used for cardio-protection and stroke protection. Safer choice in these cases would be to use acetaminophen or prescription diclofenac in place of ibuprofen.

Athletes and people who exercise regularly put lot of stress on their bodies. It affects athlete’s immune system and muscles. Research has shown marathoners who take ibuprofen pills before and during the race displayed significantly more inflammation and other markers of high immune system response afterward than the runners who hadn’t taken anti-inflammatories.

The ibuprofen users also showed signs of mild kidney impairment and, both before and after the race, of low-level endotoxemia, a condition in which bacteria leak from the colon into the bloodstream, says an article in the New York Times.

Athletes take these anti-inflammatory pills before the event to prevent pain during and after exercise. But it does not work that way. In fact, there is no difference in the pain felt by runners who had taken anti-inflammatory and those who did not take it. Laboratory experiments on animal tissues, NSAIDs actually slowed the healing of injured muscles, tendons, ligament, and bones. Your bones don’t thicken and your tissues don’t strengthen as they should.

So, there is no indication to use anti-inflammatory painkillers before and during exercise. Ibuprofen can be used after the event to reduce inflammation from and acute injury. In this situation it is very effective.

There are other ways to reduce pain and stiffness after exercise. You can try stretching, do yoga, sit in a hot tub or go for a massage therapy. Ibuprofen is a good drug but has side effects and the pain relief with just one dose does not last too long. It is very useful for acute pain to get some immediate relief. Taken every six hours after surgery or sprained ankle (just one example) for two to three days does help relieve pain but you have to make sure you don’t take it on an empty stomach.

For chronic pain, you should talk to your doctor for better options. Take pain killers which last longer in pain relief and have fewer side effects.

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