Category: Medicine Hat News

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Exercise With Care

Dear Dr. B: My friend and I go to a gym regularly. At the end of a strenuous session my friend feels nauseated. What is the reason?

Answer: Regular exercise has many benefits. Those benefits are achieved if the exercise is done properly. Otherwise, exercise may harm you. Let us try and understand what happens when we exercise.

Exercise considerably increases muscle metabolism (break down of substances to yield energy). To meet this increased metabolic activity, muscles require more nutrition and more oxygen. Blood carries nutrition and oxygen to the muscles. That means more blood is pooled to the muscles at the expense of other vital organs.

The body responds to this need immediately. The body ensures that the metabolic needs of exercising muscles are met, that hyperthermia (overheating) does not occur, and that blood flow to essential organs is protected.

This protective mechanism is achieved by the circulatory system (heart and blood vessels). It involves a complex series of adjustments resulting in a large increase in cardiac output (blood flowing out of the heart) proportional to the increased metabolic demands. The increased metabolic activity rapidly increases the heart rate.

During a tough workout in a hot environment, the body can lose two liters of fluid per hour through sweat. There is also loss of electrolytes. This can result in severe dehydration which can be dangerous.

Hyperthermia can be a problem as well. It causes lightheadedness, nausea, headache, hyperventilation, fatigue, and loss of concentration. Heatstroke is the most dangerous complication of hyperthermia.

Those who use anabolic steroids to stimulate production of muscle tissue are also at an increased risk of complications.

What are the other dangers of strenuous exercise?

Heart attack and sudden death from strenuous exercise has been reported. One American report says that an estimated 1.5 million heart attacks occur every year; of these, 75,000, or about five percent, occur after heavy exertion, leading to 25,000 deaths.

Strenuous exercise or high-impact aerobics can cause injuries to bones and muscles.

High-impact exercise can also damage the inner ear, causing dizziness, ringing in the ear, motion sickness, or loss of high-frequency hearing.

The risk factors which are associated with complications during exercise are age, presence of heart disease and intensity of exercise.

How can you exercise safely?

Most important thing is to listen to warning signs. It is estimated that at least 40 percent of young men who die suddenly during a workout have previously experienced, and ignored, warning signs of heart disease: irregular heartbeat, undue shortness of breath, chest pain and weakness.

Be careful to warm up, cool down, and stretch; flexibility is the key to preventing many muscle strains. Vary training and alternate easy and harder workouts.

Don’t eat two hours before vigorous exercise. Drink plenty of fluids before, during, and after a workout. Adjust activity according to the weather and reduce it when fatigued or ill.

When exercising, listen to the body’s warning symptoms, and consult a physician if exercise induces chest pain, irregular heartbeat, undue fatigue, nausea, unexpected breathlessness, or light-headedness.

My advice to your friend is to review his exercise regime, listen to body’s warning signs and symptoms and consult a physician.

Finally, it is February. It is Heart Month. Today is Valentine’s Day. Let me wish you all a Happy Valentine’s Day. Take care of your own hearts and the hearts of your loved ones! And support Heart and Stroke Foundation.

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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Anal Fissure

Dear Dr. B: I have painful bowel movements. I also bleed rectally. I thought I have hemorrhoids. But I have been told I have a fissure. What is a fissure? How did I get it? How can I get rid of it?

Many of the patients who are evaluated in the office for hemorrhoidal problems have in fact other conditions. It is important to remember that all anal or rectal symptoms are not due to piles or hemorrhoids.

Anal fissure (fissure-in-ano) is a painful condition. It can be confused with hemorrhoids. Uncomplicated hemorrhoids should not be painful. Hemorrhoids can be a nuisance but not painful unless they are thrombosed (have a blood clot) or are strangulated.

What is a fissure?

Chronic anal fissure is a tear in the lower half of the anal canal. There is a disruption of the skin at the entrance of the anus. The condition was first recognized in 1934. Ninety percent of the fissures are at six o’clock position (posteriorly).

Many patients with chronic fissure develop a sentinel skin tag and a little growth of tissue (hypertrophied anal papilla) inside the anal canal.

How does one get a fissure?

The exact cause of anal fissure is hard to define. Injury due to passage of a large or hard stool is thought to be the common initiating factor. But it is not always possible to get this history from patients who have a fissure. Some get a fissure after a bout of diarrhea.

Patients who have a fissure have a high resting pressure in the anal canal – that means the anal sphincter muscle tone is much higher than those who have no fissure. This high pressure causes reduced blood supply to the sphincter muscle at six o’clock position. Passing hard stool through a sphincter with high muscle tone can cause a tear in the lining of the sphincter.

The tear causes pain and further increases the spasm in the sphincter and perpetuates the problem. Patients are afraid to have a bowel movement. The more they delay the bowel movement the worse it gets as the stool gets drier and harder.

Fissures can occur in patients with Crohn’s disease and HIV/AIDS.

What is the treatment?

Treatment can be medical or surgical.

Medical treatment can heal the fissure in about 50 to 60 percent of patients. The treatment involves:

-Hot bath two to three times a day.
-Use of psyllium fiber supplements (Metamucil or Prodiem) to keep the stool soft and bulky.
-Use of ointment to relax the anal sphincter. This reduces the resting anal pressure and improves blood supply to the sphincter and allows the fissure to heal.

Glyceryl trinitrate ointment has been shown to be effective for anal fissures, but it causes headaches in a significant number of patients.

Newer treatments with fewer expected side effects include diltiazem, nifedipine, and injection of botulinum toxin. Others have tried nitric oxide, anal dilatation and hyperbaric oxygen. None of these treatments provide 100 percent cure rate. Each has advantages and disadvantages.

About 30 percent of patients will have recurrence of fissure after medical therapy.

Surgical treatment is offered to those who do not respond to medical treatment or who have frequent recurrences. The surgery of choice is lateral internal sphincterotomy (division of anal sphincter).

The surgical procedure is associated with minor continence alterations in a minority of patients. Rate of recurrence of fissure after surgery is small – three percent in one series.

How can I prevent getting a fissure in the future?

The quality and quantity of stool passing through the anal sphincter is important. It should be soft, bulky and dry. Chew your food well. Eat fruits and vegetables. Use of psyllium helps. And relax when you have a bowel movement.

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How Can I Stop Smoking?


Not what we have, but what we use;
Not what we see, but what we choose;
These are the things that mar or bless
the sum of human happiness.
-Joseph Fort Newton

Recently, I was pleased to read that Premier Ralph Klein is planning to quit smoking. He says his grandchildren want him to give up the bad habit.

As we know, Klein is a determined man. Once he decides do something, he does it. He stopped drinking and he received praise from all over Canada. He set a good example.

Klein may be aware that tomorrow is the first day of National Non-smoking Week. And next Wednesday is Weedless Wednesday. Wouldn’t it be nice, if during the next seven days, Klein goes public with a statement that he has given up smoking?

Klein is a very respected and successful politician. And I know one of these days, when he is ready, we will here the good news. And it will be a good present for his grandchildren.

Why it is so difficult for Klein and millions of others to quit smoking?

Nicotine is an addictive drug. It causes dependence and tolerance. Once you are hooked on it, it takes control of your mind and body. There is craving for more and more nicotine.

If you try to deprive your mind and body of nicotine then you get very unpleasant withdrawal symptoms. These are: irritability, anger, impatience, restlessness, difficulty concentrating, insomnia, increased appetite, anxiety and depression.

Smoking is also habit forming. It becomes part of our routine – cigarette on waking up, cigarette after a meal, cigarette with a drink, cigarette with coffee, cigarette before a bowel movement, cigarette after sex (remember Austin Power joke?), cigarette to relieve stress and so on.

Is there help for people who want to quit smoking?

Sure, there is help. The world does not come to an end the day you stop smoking. In fact, a whole new world opens up.

One can successfully quit smoking:

1. If the person is motivated.
2. If the person seeks counseling.
3. If the person goes on nicotine replacement therapy.

As a caring society, we can only create awareness and support system to help people quit smoking. But in the end, the success or the failure depends on personal motivation.

What motivates people to quit smoking?

There is fear of disability and death due to cancer or heart disease. There is desire to be healthy. There is a desire to have better old age, desire to be a role model for one’s family, desire to save money and use it for healthier activities, and desire to prevent damage to the environment and one’s family from second hand smoke.

What really works?

Studies have shown that self-motivation, counseling and nicotine replacement therapy achieves the highest rate of success, 40-60 percent in the initial phase and about 30 percent at the end of one year.

Nicotine replacement therapy is available in different preparations – gum, skin patch, nasal spray and vapor inhaler.

We also need to create a good support system – at home, at school and in the community.

We know that smoking is harmful. But people do start smoking and continue to smoke. Most smokers start before the age of 20, out of curiosity and from peer pressure (to look cool!).

Unfortunately, 50 percent of smokers will die prematurely due to smoke related disease. They will certainly be missed by their friends and families.

But it is never too late. You can quit smoking and reverse the damage. Help is only a phone call away.

You can see your family physician. He can help. You can also contact Rita at Freedom from Smoking (phone: 502-8224). She has plenty of tricks to share with you. But first, you should have the motivation and desire to quit smoking! Then make the phone call.

National non-smoking Week (January 18-24) is a good week to call. Good luck!

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Looking Ahead To 2004

The best years of your life are the ones in which you
decide your problems are your own.
You do not blame them on your mother,
the ecology or the president.
You realize that you control your own destiny.
– Albert Ellis

Well, 2004 is here. And it is going to be here for the next 365 days. So, what are you going to do to stay healthy and happy and perhaps control your own destiny in areas of mental and physical health?

It’s a simple question. Can we find a good and a simple answer for you? Let us give it a try!

First, you need to take stock of your current situation. Then you need to have some idea of what you expect to achieve in the next 363 days (two days have already gone by!).

Do you have any risk factors – genetic, environmental, or lifestyle habits – which make you prone to mental and physical ill health? If yes, then you need to take actions to reduce these risks factors and if possible to eliminate them.

If you do not have any risk factors then you need to take actions which will keep you healthy and happy for many years to come.

As we know, our health is determined by many things. Our genes play an important role. So do our environment and the lifestyle we choose to pursue.

About hundred years ago, many lives were lost in infancy and childhood or before the age of 50. This was due to malnutrition and infection.

Since then we have made progress. Now a child born in Canada can expect to live to about 80 years. Many factors have contributed to our longevity – improvement in nutrition, public hygiene, discovery of antibiotics, introduction of immunization programs, newer and better methods of understanding, diagnosing and treating many illnesses.

Now we seem to take life for granted – especially in the industrialized and affluent countries we live in. Very few people die of infection or malnutrition. Instead we have an epidemic of obesity – which leads to diabetes, heart disease and other illnesses and disabilities.

The prevalence of diabetes in Canada is increasing. The proportion of Canadians with diabetes rose from 3.4 percent in 1994/95 to an estimated 4.5 percent in 2000/01.

Heart disease, stroke, cancer and lung diseases (most of them related to smoking) take its own toll. Use and abuse of alcohol costs our health care system billions of dollars. A British government sponsored report found that “average drinkers” today are consuming 150 percent more alcohol than their counterparts did 50 years ago.

Motor vehicle accidents and other types of accidents kill and disable many of our young people.

So, is this how life is going to be? Or can we change it? Or can we be selfish enough to keep ourselves and our families out of trouble?

We cannot change our genes. But we can make a contribution to improve our environment. We can try and reduce stress and make better lifestyle choices. Yes, lifestyle choices! Healthy lifestyle choices.

Here are few suggestions – eat right, exercise regularly, get enough sleep, quit smoking, wear a seatbelt, drive carefully, and watch your alcohol intake. Make time for laughter, meditation and family.

Making changes is not always easy. But one has to make a commitment and go for it. You may have to make some sacrifices but in the long run it will be a good investment.

It is estimated that if you live up to 80, then the last 10 years of your life will be spent fighting some sort of disease or disability. This burden may be reduced if we take care of our health during our better days.

So, 2004 is here. And you have to make some choices – yes, choices. Make sure they are healthy ones!

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