Category: Medicine Hat News

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The Silent Killer – Hypertension on the Rise

“The number of adults with hypertension more than doubled from 1995 to 2005. The age- and sex-adjusted prevalence increased from 153.1 per 1000 adults in 1995 to 244.8 per 1000 in 2005, which was a relative increase of 60 per cent,” says an article in the Canadian Medical Association Journal (CMAJ).

The article was discussing public health strategies to prevent and manage hypertension and its consequences in Ontario, the most populous province in Canada. I think the problem of hypertension is no different in the rest of Canada and the U.S.

Articles in the CMAJ reported marked improvement in the diagnosis and treatment of high blood pressure. This may explain the increase in the prevalence of hypertension which may represent an increase in the detection of hypertension rather than a true increase in its incidence.

It is estimated that a middle-aged man with normal blood pressure has 90 per cent risk of becoming hypertensive. That is scary.

The consequences of high blood pressure are severe. Nearly two-thirds of all cases of stroke and one-half of all cases of coronary heart disease are directly related to hypertension. What is scarier is that most cases of hypertension either go undiagnosed or untreated. That is why it is called a silent killer. You may have high blood pressure but may not have any symptoms.

For example, in U.S., studies show that only 37 per cent of hypertensive patients were treated and adequate control of blood pressure achieved. Comparative studies from Europe indicate that less than 25 per cent of people with hypertension receive adequate treatment. In Canada, 1985–1992 Canadian Heart Health Survey reported a treatment and control rate of only 13 per cent.

One of the most important findings reported in one of the studies from Ontario is the remarkable improvement in hypertension management. The study reported hypertension awareness rate of 87 per cent, treatment rate of 82 per cent and treatment and control rate of 66 per cent. These numbers are by far the highest from any population-based study, says one of the CMAJ article.

The study also revealed that South Asian and female black Canadians had a disproportionately high prevalence of hypertension. This means intervention programs should be targeted to such groups at community and individual levels. They also found that one in three adults with hypertension did not have blood pressure control.

Diabetic patients with hypertension have a high risk for cardiovascular disease. Unfortunately, two-thirds of these patients did not have blood pressure control and that over one-quarter had received no treatment. If these patients receive intensive treatment for high blood pressure then this actually saves the health care system money as well as prevents death and disability, says one of the articles.

As they say, prevention is better than cure. You can reduce the risk of hypertension by 50 per cent by maintaining healthy weight and exercising daily. Eating a healthy diet with lots of fruits and vegetables also helps. Have your blood pressure checked when you visit your doctor. Common symptoms of hypertension to look out for include recurring headaches, dizziness, confusion, unexplainable nosebleeds, and vision problems.

Bare your arm for blood pressure measurement next time you visit your doctor.

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How Safe Do You Feel As a Patient?

How safe do you feel as a patient?

Some years ago, experts estimated that in U.S. up to 98,000 people die each year from medical errors that could have been avoided. Many others may have been less seriously injured. In Canada and other developed countries the figures are proportionally no different.

There is no doubt that health care professionals work hard to provide safe and high quality medical care. But errors occur and there are many reasons for that. We cannot cover them all here but we can discuss few in terms of how you, as a patient, can stay safe.

Your safety, first of all, depends on your identification. Make sure your name and current address is correctly spelled and written, your date of birth is correct and your health insurance plan number on the card is correctly copied.

If you Google your name on the Internet you will find there are many people in the world who bear the same name as yours. In our office we have several patients with identical names. We have to be very careful that we do not mix their reports or give them wrong treatment. We feel checking the name, address, date of birth and health care insurance card number is very important. In the hospital, make sure your wrist band has correct information.

One thing which bothers me a lot is how dates are written by various people, organizations, departments, hospitals and doctors’ offices. The way I like to write is month in alphabets followed by day and year in numerical (June 10/08). This creates no confusion. Can you imagine people writing the same date in various different ways: 6/10/08 or 10/6/08 or 08/10/6? I think it is ridiculous and dangerous that we allow so many different ways to write dates.

Medication errors are not uncommon. There are many medications which have similar sounding names. You should always carry in your purse or wallet a list of medications you take. When you visit a doctor (who is not your regular doctor) you should take all your medications with you. Each year, during your annual physical, take with you all your pills and review with your doctor the necessity of continuing to take them. Also make sure your allergies are recorded properly.

You run the risk of picking up infection in every health care setting. To minimize the risk take necessary precautions. Wash your hands before and after your visit to a health facility. Just like washing your hands before and after you eat. Shower and wear clean clothes before your visit. With snow and rain, we tend to carry lot of dirt on our shoes. Most health care facilities request patients to remove wet and dirty shoes before they go in the examination rooms. Some facilities provide shoe covers. There is no guaranteed way to prevent infection. But each person, including health care providers, has responsibility to minimize the risk of infection.

What about complications from surgical procedures and invasive investigations? All procedures carry risks. Risks vary from minor to major like death. Before going through a procedure, you should discuss with your health care provider your expectation of the outcome. In return, the health care provider will explain to you the procedure and its likely complications. Make sure the site of surgery is marked with indelible ink so you do not end up getting a wrong foot amputated or a wrong side hernia repaired or a healthy knee replaced. In your follow-up visit make sure you get the results of all your tests and procedures.

Finally, carry a copy of your health history. It should contain your personal and medical information as discussed earlier including your family history. Being safe is being healthy.

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Colorectal Cancer Screening Program

Last week, every physician in Alberta received an envelope from Alberta Cancer Board containing Alberta’s first clinical practice guidelines for colorectal cancer screening. There isn’t much new in the protocol they advocate. This protocol has been used before and followed by many physicians in Alberta and around the world. What is new is that the protocol has now been formally accepted and promoted by various health organizations in Alberta.

Number one cancer killer in Alberta is lung cancer. What is the second leading cause of cancer death in Alberta? Of course, colon and rectal cancer. In 2004, 650 Albertans died of this disease. In Canada, 8,700 people died of colorectal cancer in 2007.

How many people over the age of 50 get screened for colorectal cancer each year? Less than 15 per cent. That is not good. Alberta Cancer Board hopes that this number will improve in the next few years.

Asymptomatic men and women who are 50 years or older, with no family history of colorectal cancer, are considered to have average risk for colorectal cancer and one of the following options is available for screening:
-Stool tests, also known as fecal occult blood tests (FOBT), yearly or bi-annually or
-Flexible sigmoidoscopy (60 cm. scope) every five years – checks rectum and left side of the colon. This is an office procedure. It picks up 50 to 70 per cent of advanced polyps and cancer or
-Combine fecal occult blood tests with flexible sigmoidoscopy every five years or
-Barium enema every five years (not used very often for screening) or
-Colonoscopy every 10 years

It is quite reasonable to choose any one of the above methods. This is better than no screening. Each method has advantages and disadvantages which your doctor will discuss with you.

It is of interest to note that Alberta Medical Association’s TOP (Toward Optimized Practice) program has launched Health Screen in Act10n (meaning 10 screening maneuvers) program to enhance screening practices among Alberta doctors.

The TOP pamphlet says that the campaign asks physicians to use a checklist of health markers when seeing patients for periodic health examinations to make sure that they have covered areas of importance which would improve the quality of their practice and enhance patient’s health in preventing disease.

Ten markers or maneuvers were selected were on the basis of best practice evidence available from various sources. These are: patient’s smoking behavior, blood pressure, tetanus/diphtheria vaccination status, PAP test, clinical breast examination, fasting glucose, lipids, mammography, colorectal cancer screening and bone density.

It would not be a bad idea for you to make a list of these markers and see where you stand. Even better would be to take the list with you when you see your doctor next time and see how you are doing. Human memory can be short or deceptive when it comes to remembering dates. Your doctor should be able to help you update your checklist.

It is not easy to stay healthy. It requires time, perseverance and sacrifice. Good luck.

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Testicular Cancer In a Nutshell

Two things happened recently: a local celebrity went public about his recent encounter with testicular cancer and a pamphlet, published by the Canadian Testicular Cancer Association (TCTCA), arrived in my mail box. I thought it was a good topic to discuss and put the subject in a nutshell (no pun intended).

Testicular cancer is rare but it is the most common cancer in young men between the ages of 15-35, says the TCTCA pamphlet. A young man has a one-in-300 chance of developing it sometime in his life. In the last 30 years, rates in Ontario have increased by 60 per cent. The incidence of this disease has been increasing in developed countries throughout the world for several decades. We should not forget that testicular cancer can occur in older men as well.

According to a document released by Alberta Cancer Board (Cancer in Alberta: A Regional Picture 2007) the incidence of cancer of male genital organs (testicles, scrotum and penis) in 2004, excluding prostate cancer, was 8.2 per 100,000 population. Total number of cases was 124 for all three male genital organs compared to prostate cancer the total number was 1986 (138.8 per 100,000 population). The document does not give a separate figure for testicular cancer. But these statistics give you an idea that the number of testicular cancer is not very high.

Who gets testicular cancer?

There are several risk factors. These are: delayed drop of the testicles into the scrotum at birth, a family history of testicular cancer, abnormal testicular development, some rare genetic condition or one testicle is significantly smaller than the other. But some men get the disease with none of these risk factors.

Early detection of cancer is important. And this can be done by self-examination after a hot shower when the scrotum is completely relaxed. Check for any swelling on the scrotum. Examination of the testicles should not be painful. You should feel the size and weight of each testicle. It is common for one testicle to be slightly bigger than the other and one may hang lower than the other. Examine yourself at least once a month.

What are the signs and symptoms of testicular cancer?

If you notice any change in size, shape or consistency of the testicle then you should talk to your doctor. Quite often (but not always) there is a painless hard lump. You should be concerned if there is any swelling or pain in the scrotum, if you notice any heaviness or dragging in the lower abdomen or scrotum or a dull ache in the lower abdomen and groin, unusual backache that doesn’t go away or you have unexplained weight loss. Any soreness or sudden unexplained enlargement of the breast should be checked out. It could be secondary to testicular cancer. TCTCA warns that some males get testicular cancer without any of these signs or symptoms.

First line of investigation for a suspected lump in the scrotum is an ultrasound. If cancer is suspected then additional blood tests are done to look for tumour markers. The tumour markers for testicular cancer are AFP (alpha-fetoprotein), beta-HCG (beta-human chorionic gonadotropin) and LDH (lactate dehydrogenase).

A definitive diagnosis of testicular cancer is made by removing the testicle and sending it for biopsy. Then the cancer is checked for any spread to lymph glands or other organs. Treatment may include surgery, radiation therapy or chemotherapy. The cure rate for testicular cancer is greater than 90 per cent for all stages. In men, whose cancer is diagnosed in an early stage, the cure rate is nearly 100 per cent. Even those with advanced disease have a cure rate of greater than 80 per cent.

For more information visit: www.tctca.org.

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