Category: Medicine Hat News

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Points to Ponder

Stroke prevention:

Each year in Canada stroke occurs in 50,000 people and account for seven per cent of all deaths. About five per cent of men and women over the age of 65 have been affected by stroke. Patients with stroke require a lot of care and health care resources. The question is: can we prevent stroke?

Chronic conditions like atherosclerosis (hardening of the arteries), atrial fibrillation (irregular heart rhythm), hypertension, high cholesterol levels and diabetes can lead to stroke if not appropriately managed.

For example, about 26 per cent of Canadian adult men and 18 per cent of women have hypertension. But 40 per cent of such people are unaware they have hypertension. This is not good.

Some risk factors like age, gender and genetic factors cannot be changed. Physical inactivity, smoking and heavy use of alcohol increases the risk of stroke. These risk factors can be changed if a person so desires.

It is important to know the warning signs of stroke: sudden weakness, trouble speaking, sudden loss of vision and severe unusual headache or dizziness. If you do experience these symptoms then call for help. Timely use of aspirin and clot busting drugs can significantly modify the outcome of stroke.

According to an article in the Canadian Medical Association Journal, several agents can be used to manage underlying disease to prevent stroke:

-Antiplatelet agents like aspirin
-Blood thinners like Coumadin
-Control of high blood pressure with thiazides and ACE inhibitors
-Reducing the cholesterol level with statin
-If indicated, surgery for correction of narrowing of carotid artery in the neck

These measures should be combined with increased physical activity, no smoking and reduction in the amount of alcohol consumed. So stroke can be prevented if we take control of our health and modify the risk factors. See your doctor and find out what kind of risk factors you can modify to prevent stroke.

Germs in the work place:

“It turns out the typical office is a fertile breeding ground for germs – especially if you’re a teacher or an accountant,” says a news item in Stitches for Patients. A study conducted at the University of Arizona found that bacteria levels in accountants’ offices were almost seven times higher than in lawyers’ offices.

The study also found that phones, desks and keyboards used by teachers, accountants and bankers had two to 20 times more bacteria per square inch than other occupations. The more time you spend at your desk, the more germs you collect.

The American Dietetic Association has found that 20 per cent of American workers never clean their desks before eating on them and more than 75 per cent do so occasionally even though 57 per cent eat at their desks at least once a day.

What about the health conscious doctors? They were number five on the list of germiest offices, says the Stitches news item. Well, now I know where not to have my lunch! Honey, I am coming home.

Thought for the day from my friend George:

Never put both feet in your mouth at the same time because you won’t have a leg to stand on.

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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Gastroparesis

Dear Dr. B: What is gastroparesis?

Answer: It is a condition in which the muscles in the wall of the stomach do not function normally. This leads to delayed gastric emptying. Patients complain about nausea and vomiting.

Most cases of gastroparesis are mild in nature. They respond to medications. According to an article in Tech-Wise, published by Alberta Heritage Foundation for Medical Research (www.ahfmr.ab.ca), about six to 10 people per 100,000 population have gastroparesis and do not respond to conventional treatment.

In severe cases of gastroparesis, patients have severe nausea, vomiting, pain, loss of appetite and weight loss. Vomiting usually occurs several hours after eating when the stomach is full of undigested food, stomach enzymes and acid. Patient’s nutrition is poor as the food does not reach the small intestine where digestion and absorption of food occurs.

Diagnosis of gastroparesis is difficult to make as nausea and vomiting can be symptoms of many conditions. Two most common investigations used to investigate gastroparesis are barium x-rays and endoscopy of the esophagus, stomach and duodenum. These tests are not always diagnostic but are important to rule out mechanical obstruction (cancer, ulcer, scarring and narrowing of the lumen) in the upper gastro-intestinal tract. Gastro-duodenal manometry is not available in all centers and is not necessary to make a diagnosis of gastroparesis.

What causes gastroparesis?

Most often the cause of gastroparesis is not known. According to Mayo Clinic website (www.mayoclinic.com) there are many precipitating factors like diabetes, surgery to upper gastro-intestinal tract, certain types of medications, cancer chemotherapy and other medical conditions like anorexia, bulimia, scleroderma, Parkinson’s disease, other nervous system illnesses and metabolic disorders such as hypothyroidism can lead to gastroparesis. Quite often it is not possible to find a cause of gastroparesis.

Is there a good treatment?

Currently there is no cure for gastroparesis. The first line of treatment to control symptoms is dietary changes (eat easily digestible food), medications to control vomiting and stimulate gastric emptying. These measures may not be effective in every case.

Researchers are investigating other types of therapies, including a stomach “pacemaker,” that eventually may prove more effective than current treatments for gastroparesis, says the Mayo Clinic website. This is called Enterra Therapy System (ETS). This new treatment is described and reviewed in Tech-Wise (June 2006). Here is the summary:

ETS is a neurostimulator that is implanted under the skin in the abdominal wall. It provides high frequency, low energy stimulation to the stomach wall through a pair of electrodes. The device is licensed in Canada for the treatment of chronic intractable nausea and vomiting.

The article reviewed six studies. Four studies showed at six to 12 months follow up there was significant symptomatic improvement after the device was implanted. Three studies showed improvement in nutritional status and two studies reported a significant improvement of quality of life.

The review article says that these improvements were not associated with improvement in gastric emptying. The device relieves symptoms of gastroparesis but how it does that is not known. Some authors speculate that it may be a placebo effect. The article says that the device is not for routine use in cases of gastroparesis. It should be used only as a last resort when other measures fail to relieve the symptoms.

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Asthma and Reflux

Dear Dr. B: I have asthma and my doctor thinks it is caused by gastro-esophageal reflux disease although I have no history of heartburn. Can you please explain this to me?

Answer: Heartburn and regurgitation are classical symptoms of gastro-esophageal reflux disease (GERD). But GERD may present in atypical ways. Atypical presentation may be in the form of diseases of the lungs, ear, nose and throat or in some other ways. In atypical presentation, majority of the patients do not have classical heartburn or acid regurgitation.

Asthma, chronic bronchitis, aspiration pneumonia, bronchiectasis and pulmonary fibrosis may be some of the lung problems a person may have with atypical GERD.

Atypical GERD may affect ear, nose and throat in the form of chronic cough, laryngitis, hoarseness, pharyngitis and sinusitis.

Non-cardiac chest pain, dental erosions and sleep apnea are other conditions related to atypical presentation of GERD.

These patients are suspected to have atypical presentation of GERD when they fail to respond to conventional therapy for their medical condition. For example, all patients with non-allergic asthma in which wheezing is poorly controlled should be evaluated for GERD.

Studies have shown that 30 per cent or more patients undergoing cardiac angiogram for chest pain will have normal findings. Of these 40 to 50 per cent will have abnormal findings in the esophagus on endoscopy and pH monitoring.

Finding a cause for various conditions mentioned here can be frustrating. Heartburn is often absent. Endoscopy is often negative. It may be worth trying gastric acid suppression therapy using proton pump inhibitors (PPI) to see if the symptoms affecting the lungs, ear, nose and throat and other conditions are relieved by these medications. Trial of medications twice a day for two to three months may be effective.

If the patient does not respond to this therapy then the next line of investigation would be 24-hour pH study while on PPI.

So, it is not easy to come to a diagnostic conclusion when investigating patients who are suspected to have atypical presentation of gastro-esophageal reflux disease. I presume you have had thorough investigation and your doctor has made a diagnosis after taking into consideration all the results.

*****

Are you worried about getting old? Here is a joke I received from a friend:

“Sixty is the worst age to be,” said a 60-year-old man. “You always feel like you have to pee and most of the time you stand there and nothing comes out.”

“Ah, that’s nothing,” said a 70-year-old. “When you’re 70, you don’t have a bowel movement any more. You take laxatives, eat bran and sit on the toilet all day and nothing comes out.”

“Actually,” said the 80-year -old, “Eighty is the worst age of all.”

“Do you have trouble peeing, too?” asked the 60-year old.

“No, I pee every morning at 6:00. I pee like a racehorse on a flat rock, no problem at all.”

“So, do you have a problem with your bowel movement?”

“No, I have one every morning at 6:30.”

Exasperated, the 60-year-old said, “You pee every morning at 6:00 and have a bowel movement every morning at 6:30. So what’s so bad about being 80?”

“I don’t wake up until 7:00,” said the 80-year-old.

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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All About Skin

Dear Dr. B: My mother tells me that I have a very beautiful skin and I should take care of it. She says skin has many important functions to keep us healthy. Is that true? What does skin really do?

Answer: Yes, your mother is right. Skin is not only the largest organ of our body but has many important functions to protect us from environment. Skin is constantly exposed to sun, wind, industrial elements and injuries.

Summer is officially here and it is a good time to remind ourselves what a good job our skin does to protect us and keep us healthy. It is an organ we take for granted. But we should know better than that.

Skin is thick and waterproof. Skin is a protector, a temperature regulator and has a very sharp sensitive device. Skin has a capacity to excrete fluid and electrolytes. It stores fat and synthesizes vitamin D when our skin is exposed to sunlight or ultraviolet rays. Skin has great absorbing capacity and it can absorb many chemicals and drugs.

It plays an important role in maintaining body temperature. When a person feels hot the blood vessels in the skin dilate and sweat secretion increases. The body loses heat by radiation from the large amount of blood circulating through the dilated blood vessels in the skin and by evaporation of sweat.

Our skin has millions of sensitive nerve endings. These nerve endings act as antennas to give us pleasure or protect us from heat, cold, pressure and pain.

Our skin is full of hair except the palms of the hands and the soles of the feet. Hair on the head grows faster, 12 mm (half-an-inch) per month or five inches a year. Hair on the rest of the body grows more slowly. Hair keeps us warm and protects us from dust and sand.
Hair is sensitive to touch.

What about nails? We have fingernails and toenails. Nails are small in size but they play an important role, serving to help protect our fingers and toes and improve dexterity. They also may reveal clues to our general health.

Sweat glands are found in almost every part of the skin. They normally release a little fluid all the time, and as this fluid evaporates, our body cools off. If we need to cool off then these glands can get stimulated to be more active. They secrete even more fluid and help us cool off more thanks to skin temperature nerve endings.

Oil glands (sebaceous glands) produce oil secretion known as sebum. The sebum spreads on the skin. It prevents excess water loss, lubricates and softens the skin and hair. It keeps the skin flexible and waterproof. Hormones control the production of sebum. Sebum is mildly toxic to some bacteria.

So, you can see how much skin can do to protect us. It is indeed an important organ. Look after it. Protect it against the damaging effects of sun, wind and harmful chemicals. If your mother thinks your skin is beautiful then she is right. You owe it to her and to yourself to look after it.

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