Author: noorali

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Irritable Bowel Syndrome a Significant Problem for Some

Irritable bowel syndrome (IBS) is the most common chronic intestinal disorder. The symptoms are due to disturbance in the movement and sensation of the bowel. The person is otherwise well but presents with chronic or recurrent abdominal pain, change in bowel habit (constipation and/or diarrhea) and bloating.

Literature suggests at least 15 percent of the population has this condition. I feel that almost everybody has some element of irritable bowel syndrome.

IBS affects twice as many women as men and usually begins in early adult life. Although IBS can cause much distress, it does not lead to life-threatening illness. It is also called spastic colon. IBS is not like other conditions. There are no definite abnormalities to find in a patient with IBS and there are no tests to confirm the diagnoses.

IBS is a complex condition that affects a person’s psychology (emotional and behavioural characteristics). A physician treating this condition must have a good understanding of the problem. He should be able to dedicate time and energy to help his IBS patients.

IBS is considered to be a functional disorder of the gastrointestinal tract. But there is high incidence of psychiatric disorders in patients with IBS – panic disorder, major depressive disorders, and phobias.

Patients have to realise that they may need psychological treatment for a physical condition. And having irritable bowel does not mean a person is mentally ill. Antidepressants and medications that inhibit anxiety have been shown to be effective in IBS. But these drugs have to be used with care.

Stress-induced anxiety can make symptoms of IBS worse. The source of stress can be internal (from within your own body) or external (from your environment). IBS patients experience higher levels of anxiety and fatigue than do healthy people.

Management of IBS can vary from simple to complex. First, you have to see a doctor and get some basic investigations done to rule out any other illness like infection in the bowel, cancer, ulcerative colitis, Crohn’s disease and celiac disease. Anemia, rectal bleeding and loss of weight are not symptoms of IBS. This may suggest inflammatory bowel disease (IBD) or cancer of the bowel.

There is no cure for IBS. However, controlling the diet and emotional stress usually relieves the symptoms. Sometimes symptoms come and go. Some medicines may also help.

In more severe cases, like treatment-resistant IBS, psychotherapy has been proven to be useful. But there is no evidence to suggest that psychotherapy is beneficial in patients with mild IBS.

Management of IBS poses a big challenge to a physician. Many drugs are available in the market for use in IBS. But none of them have proven benefits. Some of them may act as placebo. Smooth muscle relaxants tend to help relieve abdominal pain with or without relief of other symptoms. Loperamide (Imodium) is beneficial in patients who have diarrhoea as a predominant symptom. Psyllium and other higher fibre diets are useful for patients with constipation.

Current treatment of IBS includes advice on high fibre low fat diet, smooth muscle relaxant, agents to stop diarrhoea or bloating and psychotherapy or psychoactive drugs to take care of depression or anxiety.

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A New Blood Thinner for Patients with Irregular Heart Rhythm

About 250,000 Canadians suffer from irregular heart rhythm called atrial fibrillation (AF). In the U.S. there are approximately 2.3 million adults with AF. Older you are, higher the risk of developing this condition. Some heart problems and medical conditions can put you at a higher risk.

Most dangerous complication of AF is stroke. It accounts for up to 36 percent of all strokes in elderly people. The cost of looking after patients with stroke runs into millions of dollars.

To prevent this, patients with AF are converted to regular (sinus) rhythm by applying direct-current electrical shock (cardioversion), by medications or by ablation therapy. If it is difficult to sustain regular rhythm, then the patients receive blood thinners (like warfarin) on a regular basis to reduce the risk of stroke by 70 percent. Warfarin, as you may know, is a rat poison.

Main advantage of warfarin is that it is cheap and is covered by provincial drug plan. Major disadvantages are that you need frequent blood tests to make sure that the blood concentration of the drug is at a safe level to keep the blood thin but not dangerous enough to make you bleed in the brain or some other place. It is quite difficult to achieve the safe level and maintain it. The blood levels fluctuate when you eat certain kinds of foods or take other medications. So there is always some level of anxiety and uncertainly when you are on warfarin.

Now, here is the good news. In the last few weeks, the Canadian Cardiovascular Society issued new guidelines for prevention of stroke in patients with AF by recommending that patients at high risk of stroke be prescribed the new blood thinner dabigastran (Pradax) instead of warfarin. The new drug has fewer side effects and requires no blood tests. But it is not covered by provincial drug plans.

In a study published in the New England Journal of Medicine (September 17, 2009), the authors report that the rate of major bleeding was 3.36 per cent per year in the warfarin group, as compared with 2.71 per cent per year in the group receiving 110 mg of dabigastran twice a day and 3.11 per cent if you are on 150 mg dabigastran twice a day.

The rate of stroke due to bleeding in the brain was 0.38 per cent per year in the warfarin group, 0.12 per cent in the 110 mg dabigastran group and 0.10 per cent in the 150 mg dabigastran group.

The death rate was 4.13 per cent in the warfarin group, 3.75 per cent in 110 mg dabigastran group and 3.64 per cent per year in 150 mg dabigastran group.

The authors conclude by saying that if you switch over to 110 mg dabigastran twice a day from warfarin then the risk of stroke would be similar to warfarin but lower rate of major bleed.

If you switch over to 150 mg dabigastran twice a day then compared to warfarin, you will have lower risk of stroke but similar risk of major bleed as warfarin.

Dabigastran (Pradax) is made by Boehringer Ingelheim and more information is available on their website: www.boehringer-ingelheim.ca.

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Case 2 – Neurofibromatosis

Ten things you should know about this condition: (photos at bottom)

1. Neurofibromatosis (von Recklinghausen disease) was first described in 1882 by the German pathologist, Friedrich Daniel von Recklinghausen (December 2, 1833-August 26, 1910).

2. Neurofibromatosis (also known as von Reklinghausen disease) is a genetically-inherited disorder in which the nerve tissue grows tumours (neurofibromas) that may be benign or may cause serious damage by compressing nerves and other tissues.

3. They develop disordered skin pigmentation and “cafe-au-lait” spots.

4. The tumours may cause bumps under the skin, coloured spots, skeletal problems, pressure on spinal nerve roots, and other neurological problems.

5. Neurofibromatosis is an autosomal dominant disorder, which means that it affects males and females equally and is dominant (only one copy of the affected gene is needed to get the disorder). If only one parent has neurofibromatosis, his or her children have a 50 per cent chance of developing the condition. In about 50 per cent of cases there is no other affected family member because a new mutation has occurred.

6. There are two types of neurofibromatosis: type 1 (90 per cent) and type 2 (10 per cent). Neurofibromatosis-1 is found in approximately 1 in 2,500-3,000 live births.

7. Major symptoms are often due to involvement of optic (blindness) or acoustic (deafness) nerves or the spinal cord. Less than 3 per cent of the tumours can turn into cancer – such as neurofibrosarcomas.

8. There is a high incidence of learning disabilities or cognitive deficit.

9. There is no cure for the condition itself. Surgery may be needed when the tumours compress organs or other structures.

10. Joseph Merrick, the Elephant Man, was once considered to have been affected with neurofibromatosis type I. However, it is possible that Merrick suffered from the very rare Proteus syndrome. This however has given rise to the common misconception that Neurofibromatosis and “Elephant Man Disease” is one and the same (Wikipedia).

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Mr. Heart, Who’s Your Daddy?

February is meant to be a fun month. We have Valentine’s Day and Family Day. Children have reading week. Many families make use of this time to take a holiday. Put real meaning to what family means. This is the month when many people find their life partner and make life-long commitment.

Then there are people who are born on February 29. You wonder whether it would have been better to be born on February 28 or Mar 1. February is also Heart Month. Every day you hear and read about heart disease and how it is going to kill you or paralyze you. You say, “Enough of this. Life is too short. Let me have my fun. Leave me and my heart alone.”

Your heart belongs to you. It has only one daddy. That is you. Same thing applies to me. I am responsible for my heart’s well being. We should all take as much responsibility as we are able for our own health. An editorial in the Canadian Medical Association Journal (CMAJ Jan 31, 2006) says, “…we know that people who are likely to live longer eat less, exercise more and are unlikely to smoke tobacco…” I call this simple and basic personal responsibility for taking care of our health.

The WHO research has shown that high proportion of the world’s illness can be attributed to relatively small number (20 or so) modifiable risk factors. In affluent countries like Canada, we talk about lifestyle factors in diseases like obesity, hypertension, cardiovascular disease, diabetes and cancer. Remember, we are talking about modifiable risks factors.

Lifestyle changes mean any activity of an individual, family or community, with the intention of improving or restoring health, or treating or preventing disease. Lifestyle changes can result in large reductions in premature death and increase national productivity, says the CMAJ editorial. These changes can be made slowly in incremental fashion to achieve your goal. When it comes to eating, replace bad fats with good fats. Eat more fruits and vegetables. Do not forget little bit of red wine, almonds, garlic and dark chocolate. Who said making lifestyle changes was dull and uninspiring?

You can go dancing, swimming, make love, pray, meditate, laugh and go for a walk. Be involved in your community. There are lots of fun things you can do to stay healthy. You are only limited by your imagination.

In the last three columns, we have covered most of the areas you need to work on and be heart smart. Heart Month is almost over. Weather is still lousy. Snow is still on the ground. But don’t get depressed. Go out and have some fun.

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