Author: noorali

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Celebrating Column No.500

Five hundred columns for Medicine Hat News! That is hard to believe.

It was the summer of 1998, when I had a meeting with Gordon Wright, the then Managing Editor of the Medicine Hat News. With his help and encouragement, the first column appeared in the News on August 13, 1998.

People ask me: How do you do it, doctor?

With a busy practice and family life, not to mention all the time I spend on golf courses in summer months and little bit of skiing here and there in winter months, the joy of writing never leaves my mind, body or soul. Sounds poetic? May be. But that is the truth. My mind is always buzzing with ideas. Occasionally, I fire a letter to the editor if something is bugging me too much.

My columns also appear in Oyen Echo, Brooks Bulletin and I believe in the Commentator. Occasionally, I have written for the Medical Post and the Globe and Mail. I have been fortunate enough to have one book published (A Doctor’s Journey). There are many more projects on my list. Let us see how many I can accomplish.

My desire to write (and my ego) is also boosted by all the wonderful comments I get from the readers. They come by emails, letters, verbally on the golf course, ski area lift chairs, restaurants, shopping malls and from the patients in the office. These comments are highly appreciated. I also learn from people who write to me disagreeing with what I write.

My columns and interesting clinical photographs are also posted on my website (nbharwani.com). You can see some columns generate a lot of discussion worldwide. It is amazing how people use Internet to find solutions to their health problems because doctors cannot fix everything. I also admire their desire to share their ideas with others. I find such feedback a learning experience for me as well.

And I would not be able to write and get published if it wasn’t for the wonderful editors I work with at the News. They are always kind and accommodating.

Why do I like to write?

To explain this, I will borrow what Charley Reese of Orlando Sentinel wrote on December 27, 1998.

My purpose in writing a column….. is to stimulate people to think about what I consider fairly important issues. It does not matter to me if people agree or disagree. I don’t pretend to be omniscient, and, in fact, I am no smarter than anybody else.

There are other reasons too. I try to help the reader understand the various aspects of health care spiced with a local touch and some humour.

I try to explain to readers why it is important to take certain proactive preventive measures to live a happy, stress free and healthy life.

I try to explain that medicine is not a perfect science and doctors are like any human beings – from time to time vulnerable and prone to making mistakes.

Writing the column has also been a selfish endeavor. Teaching is the best way to learn. Sharing knowledge is the best way to improve one self. In the process I have learnt a lot about myself, my health and my own deficiencies.

One change at a time has added up to a better and satisfactory lifestyle so far for me. Rome wasn’t built in a day. So there is still hope to achieve nirvana – an ideal condition of rest, harmony, stability, and joy. We can continue our journey together.

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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Inflammation of the Pancreas Should Not be Ignored

In the last column we discussed about pancreatic cancer. Today, we will briefly discuss inflammation of the pancreas which can be serious too.

The pancreas lies in the upper abdomen behind the stomach. Its function is to produce digestive enzymes and hormones such as insulin.

Pancreatitis is a chemical inflammation of the pancreas caused by its own digestive enzymes. Pancreatitis has two forms: acute and chronic.

Most common causes of pancreatitis are gallstones and alcohol abuse. Sometimes no cause can be found. That leaves the patient and the doctor frustrated.

Patients with acute pancreatitis present with abdominal pain, nausea, vomiting, fever and a rapid pulse. The diagnosis is made by a blood test to measure blood level of enzyme lipase. All pancreatitis patients require intravenous fluids, oxygen and pain killers to stabilize their condition. If the condition is due to gallstones then the patient will need surgical removal of the gallbladder.

An abdominal ultrasound is taken to look for gallstones and a CAT (computerized axial tomography) scan to look for inflammation or destruction of the pancreas. CAT scans are also useful in detecting cyst formation in the pancreas.

In about 20 percent of cases, acute pancreatitis can be severe, with many complications. Severe cases may cause dehydration and low blood pressure and the condition may become life threatening. The vital organs such as heart, lungs, or kidneys may fail. If bleeding occurs in the pancreas, shock and sometimes even death follow.

Chronic pancreatitis can present as episodes of acute inflammation in a previously damaged pancreas. There is intermittent or persistent abdominal pain. The chronic destruction of pancreatic tissue causes malabsorption of fat and diabetes.

Chronic pancreatitis is most often caused by alcoholism and alcohol abuse. Sometimes the cause of chronic pancreatitis cannot be determined. But any condition that causes repeated episodes of acute pancreatitis may result in chronic pancreatitis.

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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Steve Jobs – a Victim of Pancreatic Cancer

Pancreatic cancer has taken another life. The prognosis for pancreatic cancer is dismal. The overall five year survival rate is less than two percent, the worst of any cancer. Only 20 percent of the patients will be diagnosed at a stage where surgery may offer hope.

Last time I wrote about pancreatic cancer was in 1996. That was the year my sister, Gulshan, age 60, passed away within three months of diagnosis of pancreatic cancer. Steve Jobs was 56. He lived for four years after having had a diagnosis of pancreatic cancer. He also received a liver transplant.

It has been 15 years since my sister died. Has anything changed to improve the prognosis of patients diagnosed with pancreatic cancer?

Before we look into that, let us look at some numbers. The Canadian Cancer Society’s document “Canadian Cancer Statistics 2010” says that in 2010, Canada will continue to see an increase in the number of individuals diagnosed with and dying from cancer. Every hour of every day, an average of 20 people will be diagnosed with some type of cancer and eight people will die from cancer.

Fifty per cent of the newly diagnosed cancer patients will be suffering from lung, colorectal, prostate and breast cancers. Cancer of the pancreas is 12th on the list of estimated number of new cases. About 4,000 new cases will be diagnosed – this will be equally divided amongst males and females. Almost the same number of people will die of pancreatic cancer each year. Death from pancreatic cancer is fifth on the list after lung, colorectal, breast and prostate.

An article in the Scientific American (January 2011) says that one of the reasons why the prognosis is so dismal in pancreatic cancer is that the disease is not typically diagnosed until 15 years after the first cancer-causing mutations appear, by which point the cancer has spread and become highly aggressive.

What does that mean? That means there may be plenty of time for doctors to intervene before pancreatic cancer becomes lethal. Then the tumour can be successfully removed and the prognosis can be improved with appropriate chemotherapy and radiotherapy, if indicated.

The article says researchers from John Hopkins found that cancer cells appear 10 years after the first cancer-causing mutation arises and that another five years pass before the cancer cells spread and become deadly. Research like this and many others gives hope for the future. In the last two years scientists have brought screening techniques for pancreatic cancer closer to reality.

The article says that these technologies are not available commercially but progress is expected to increase in the next decade. In the meantime, doctors should consider using CT and MRI scans to screen patients who are at high risk because of family history of the disease. Is that practical or economically feasible? There is no defined protocol for this and there are advantages and disadvantages of using CT or MRI scans as a screening tool in otherwise healthy individuals.

What causes pancreatic cancer? The precise cause is unknown. Smoking and chronic inflammation are suspected in the causation of the disease. An estimated 5-10 percent of pancreatic cancers are inherited and additional 10-20 percent may have other significant genetic influence. Most patients present with jaundice, abdominal pain, weight loss, or no appetite. By that time it is too late.

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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Chlamydia, Gonorrhea and Syphilis on the Rise

Recent memo from Alberta Health Services’ South Zone office warns physicians about the significant rise of sexually transmitted diseases (STD) in Southern Alberta. In 2009, Alberta reported the highest STD rates across the country. Most significant is the increase in syphilis.

In 2008, a report in the Canadian Medical Association Journal (CMAJ August 12, 2008) said that Alberta launched a $2 million campaign to combat the rise of sexually transmitted disease a day after releasing figures indicating skyrocketing rates of gonorrhea and chlamydia among young people in the province. The ads were meant to encourage condom use and regular testing for the disease. But the incidence of STD continues to rise.

STD is also on the rise in other western countries. In the United Kingdom, cases of syphilis among people aged 45 to 64 increased 139 per cent between 2002 and 2006. Cases of chlamydia rose 51 per cent.

In March 2008, U.S. Centers for Disease Control and Prevention reported that one in four teenage girls in the U.S. has a STD. An estimated 3.2 million teenage girls in that country are at risk for health problems such as infertility and cervical cancer because they have chlamydia, trichomoniasis, herpes simplex virus or human papillomavirus (causes genital warts).

Cases of syphilis have particularly increased among men having sex with men. In this group, there is also a high incidence of HIV. If a person has sex with someone who has STD then the risk of contracting the disease is extremely high. It does not matter whether a person is heterosexual or homosexual.

You are at risk of having STD if you ever had sex, if you had many sex partners, if you had sex with someone who has had many sex partners and/or you had sex without using condom.

Long term consequences of STD can be serious and sometime life threatening. Chlamydia and gonorrhea can cause pelvic inflammatory disease in women and infection of testicular area in men. This may render a person sterile. Viral warts can cause cancer of the cervix or penis. Syphilis can cause infection of the nervous system, mental problems, blindness and death. Other illnesses related to STD are hepatitis, genital herpes and AIDS.

You can lower the risk of STD by having sex with someone who is not having sex with anyone else – a monogamous relationship, who does not have STD and by always using a condom until your relationship has been established with your partner.

Primary prevention of STD can be achieved by preventing exposure by identifying at-risk individuals, performing a thorough assessment accompanied by patient-centred counselling and education and immunization when appropriate, says one of the CMAJ articles.

Secondary prevention is aimed at preventing or limiting further spread by decreasing the prevalence of STDs through detection in at-risk populations, counselling, conducting partner notification and treating infected individuals and contacts.

Practicing safe sex is the best way to stay out of trouble. Same rules apply to men and women, whether they are homosexual or heterosexual.

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